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Furukawa S, Wakiyama K, Okamura K, Noshiro H. Usefulness of laparoscopic inguinal hernia repair using the Endoscope Manipulator Robot (EMARO). Hernia 2024:10.1007/s10029-024-03090-0. [PMID: 38907879 DOI: 10.1007/s10029-024-03090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/09/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO). METHODS This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups. RESULTS Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77-87) and 70 min (range, 60-94), respectively, and the median blood loss was 5 mL (range, 1-5) and 2 mL (range, 1-5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5-12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042). CONCLUSION Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed.
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Affiliation(s)
- Shunsuke Furukawa
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan
| | - Kota Wakiyama
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan.
| | - Keiji Okamura
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan
- Department of Surgery, Yamaguchi University Faculty of Medicine, Saga, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
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Cepolina F, Razzoli R. Review of robotic surgery platforms and end effectors. J Robot Surg 2024; 18:74. [PMID: 38349595 PMCID: PMC10864559 DOI: 10.1007/s11701-023-01781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/10/2023] [Indexed: 02/15/2024]
Abstract
In the last 50 years, the number of companies producing automated devices for surgical operations has grown extensively. The population started to be more confident about the technology capabilities. The first patents related to surgical robotics are expiring and this knowledge is becoming a common base for the development of future surgical robotics. The review describes some of the most popular companies manufacturing surgical robots. The list of the company does not pretend to be exhaustive but wishes to give an overview of the sector. Due to space constraints, only a limited selction of companies is reported. Most of the companies described are born in America or Europe. Advantages and limitations of each product firm are described. A special focus is given to the end effectors; their shape and dexterity are crucial for the positive outcome of the surgical operations. New robots are developed every year, and existing robots are allowed to perform a wider range of procedures. Robotic technologies improve the abilities of surgeons in the domains of urology, gynecology, neurology, spine surgery, orthopedic reconstruction (knee, shoulder), hair restoration, oral surgery, thoracic surgery, laparoscopic surgery, and endoscopy.
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Affiliation(s)
- Francesco Cepolina
- DIMEC-PMAR Lab, Instrumental Robot Design Research Group, Department of Machines Mechanics and Design, University of Genova, Via All'Opera Pia 15A, 16145, Genoa, Italy.
| | - Roberto Razzoli
- DIMEC-PMAR Lab, Instrumental Robot Design Research Group, Department of Machines Mechanics and Design, University of Genova, Via All'Opera Pia 15A, 16145, Genoa, Italy
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Vukelić M, Bui M, Vorreuther A, Lingelbach K. Combining brain-computer interfaces with deep reinforcement learning for robot training: a feasibility study in a simulation environment. FRONTIERS IN NEUROERGONOMICS 2023; 4:1274730. [PMID: 38234482 PMCID: PMC10790930 DOI: 10.3389/fnrgo.2023.1274730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/31/2023] [Indexed: 01/19/2024]
Abstract
Deep reinforcement learning (RL) is used as a strategy to teach robot agents how to autonomously learn complex tasks. While sparsity is a natural way to define a reward in realistic robot scenarios, it provides poor learning signals for the agent, thus making the design of good reward functions challenging. To overcome this challenge learning from human feedback through an implicit brain-computer interface (BCI) is used. We combined a BCI with deep RL for robot training in a 3-D physical realistic simulation environment. In a first study, we compared the feasibility of different electroencephalography (EEG) systems (wet- vs. dry-based electrodes) and its application for automatic classification of perceived errors during a robot task with different machine learning models. In a second study, we compared the performance of the BCI-based deep RL training to feedback explicitly given by participants. Our findings from the first study indicate the use of a high-quality dry-based EEG-system can provide a robust and fast method for automatically assessing robot behavior using a sophisticated convolutional neural network machine learning model. The results of our second study prove that the implicit BCI-based deep RL version in combination with the dry EEG-system can significantly accelerate the learning process in a realistic 3-D robot simulation environment. Performance of the BCI-based trained deep RL model was even comparable to that achieved by the approach with explicit human feedback. Our findings emphasize the usage of BCI-based deep RL methods as a valid alternative in those human-robot applications where no access to cognitive demanding explicit human feedback is available.
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Affiliation(s)
- Mathias Vukelić
- Applied Neurocognitive Systems, Fraunhofer Institute for Industrial Engineering (IAO), Stuttgart, Germany
| | - Michael Bui
- Applied Neurocognitive Systems, Fraunhofer Institute for Industrial Engineering (IAO), Stuttgart, Germany
| | - Anna Vorreuther
- Applied Neurocognitive Systems, Institute of Human Factors and Technology Management (IAT), University of Stuttgart, Stuttgart, Germany
| | - Katharina Lingelbach
- Applied Neurocognitive Systems, Fraunhofer Institute for Industrial Engineering (IAO), Stuttgart, Germany
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Kudo T, Kanaji S, Harada H, Ohmura Y, Sawada R, Urakawa N, Goto H, Hasegawa H, Yamashita K, Matsuda T, Oshikiri T, Kakeji Y. Evaluation of the Efficiency of a Joystick-Guided Robotic Scope Holder Compared to That of Human Scopists: A Prospective Trial. Surg Innov 2023; 30:564-570. [PMID: 36788211 DOI: 10.1177/15533506231157039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE This study aimed to compare motions of the laparoscope tip during a laparoscopic task in a training box using a recent joystick-guided robotic scope holder to those manipulated by human scopists. We hypothesized that laparoscopic manipulation could be positively affected by robotic scope holders due to the elimination of unintentional movement. METHODS Twelve surgeons participated as operators, and eight medical doctors participated in this study. Among the human scopists, five were trained surgeons and three were novices who had no experience with laparoscopic surgery. A validated laparoscopic task was used to evaluate the path length of the laparoscope tip using an optical position tracker and operative time. The operators performed the designated camera task under three different laparoscopic manipulations: using a joystick-guided robotic scope holder, expert human scopists, and novice scopists. RESULTS The median path lengths (cm) of the laparoscopic tip were 94.0, 110.0, and 122.2 in the robotic scope holder, expert, and novice groups, respectively. The path lengths in the robotic scope holder group were significantly shorter than those in the other groups (P < .01). The median operative times (seconds) were 136.6, 66.4, and 62.3 in the robotic scope holder, expert, and novice groups, respectively. The operative time of the robotic scope holder group was significantly longer than that of the other groups (P < .001). CONCLUSION A robotic scope holder can provide shorter camera movement owing to the stable holding and intentional scope manipulation by the operator, although it requires a longer operative time than a human assistant.
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Affiliation(s)
- Takuya Kudo
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Harada
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Ryuichiro Sawada
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironobu Goto
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeru Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Wan GY, Zhou XY, Duan HX, Zou ZY, Zhang MM, Mao JB. Comparison of robotic camera holders with human assistants in endoscopic surgery: a systematic review and meta-analysis. MINIM INVASIV THER 2023; 32:153-162. [PMID: 37051809 DOI: 10.1080/13645706.2023.2199332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Robotic camera holders can overcome the shortcomings of human assistants, such as shaking and accidental rotation in endoscopic surgery. Robotic camera holder is not affected by the operation time and surgical position and reduces the size of the team. However, there is still controversy over the practicality of robotic camera holders. MATERIAL AND METHODS We searched PubMed, Web of Science, Embase, Cochrane Library PubMed, Embase, Cochrane Library and Web of Science. The last database search was performed on 30 April 2022. Two reviewers independently reviewed the studies. RESULTS A total of eight studies (n = 698, 354 controls and 344 robotic camera holders) were included in our analysis. The results showed that the robotic camera holder significantly outperformed human assistants on the frequency of lens cleaning (SMD, -0.48; 95% CI, -0.90 to -0.05) and inappropriate movements (MD, -3.57; 95% CI, -4.93 to -2.21). There was no difference in total operation time (MD, 6.99; 95% CI, -2.47 to 16.72), preparation time (MD, 2.43; 95% CI, -0.32 to 5.18) or blood loss (MD, 34.47; 95% CI, -8.05 to 76.98) between the robotic camera holder and human assistant. However, the robotic camera holder was significantly slower in the core operation (MD, 5.06; 95% CI, 1.18 to 8.94), and surgeons had mixed reviews of robotic systems. CONCLUSIONS The robotic camera holder provided the surgeon with a highly stable environment. Although the robotic camera holder will not increase the total time, it still needs to improve the core operation time. There is much room for improvement in robotic camera holders. Further development of devices with intuitive control systems and a greater range of motion will be required to accommodate more complex surgeries.
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Affiliation(s)
- Guang-Ying Wan
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiao-Yang Zhou
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hong-Xiang Duan
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhen-Ya Zou
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Man-Man Zhang
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jin-Bao Mao
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
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Hamza H, Baez VM, Al-Ansari A, Becker AT, Navkar NV. User interfaces for actuated scope maneuvering in surgical systems: a scoping review. Surg Endosc 2023:10.1007/s00464-023-09981-0. [DOI: 10.1007/s00464-023-09981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
A variety of human computer interfaces are used by robotic surgical systems to control and actuate camera scopes during minimally invasive surgery. The purpose of this review is to examine the different user interfaces used in both commercial systems and research prototypes.
Methods
A comprehensive scoping review of scientific literature was conducted using PubMed and IEEE Xplore databases to identify user interfaces used in commercial products and research prototypes of robotic surgical systems and robotic scope holders. Papers related to actuated scopes with human–computer interfaces were included. Several aspects of user interfaces for scope manipulation in commercial and research systems were reviewed.
Results
Scope assistance was classified into robotic surgical systems (for multiple port, single port, and natural orifice) and robotic scope holders (for rigid, articulated, and flexible endoscopes). Benefits and drawbacks of control by different user interfaces such as foot, hand, voice, head, eye, and tool tracking were outlined. In the review, it was observed that hand control, with its familiarity and intuitiveness, is the most used interface in commercially available systems. Control by foot, head tracking, and tool tracking are increasingly used to address limitations, such as interruptions to surgical workflow, caused by using a hand interface.
Conclusion
Integrating a combination of different user interfaces for scope manipulation may provide maximum benefit for the surgeons. However, smooth transition between interfaces might pose a challenge while combining controls.
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Abdurahiman N, Khorasani M, Padhan J, Baez VM, Al-Ansari A, Tsiamyrtzis P, Becker AT, Navkar NV. Scope actuation system for articulated laparoscopes. Surg Endosc 2023; 37:2404-2413. [PMID: 36750488 PMCID: PMC10017632 DOI: 10.1007/s00464-023-09904-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND An articulated laparoscope comprises a rigid shaft with an articulated distal end to change the viewing direction. The articulation provides improved navigation of the operating field in confined spaces. Furthermore, incorporation of an actuation system tends to enhance the control of an articulated laparoscope. METHODS A preliminary prototype of a scope actuation system to maneuver an off-the-shelf articulated laparoscope (EndoCAMaleon by Karl Storz, Germany) was developed. A user study was conducted to evaluate this prototype for the surgical paradigm of video-assisted thoracic surgery. In the study, the subjects maneuvered an articulated scope under two modes of operation: (a) actuated mode where an operating surgeon maneuvers the scope using the developed prototype and (b) manual mode where a surgical assistant directly maneuvers the scope. The actuated mode was further assessed for multiple configurations based on the orientation of the articulated scope at the incision. RESULTS The data show the actuated mode scored better than the manual mode on all the measured performance parameters including (a) total duration to visualize a marked region, (a) duration for which scope focus shifts outside a predefined visualization region, and (c) number of times for which scope focus shifts outside a predefined visualization region. Among the different configurations tested using the actuated mode, no significant difference was observed. CONCLUSIONS The proposed articulated scope actuation system facilitates better navigation of an operative field as compared to a human assistant. Secondly, irrespective of the orientation in which an articulated scope's shaft is inserted through an incision, the proposed actuation system can navigate and visualize the operative field.
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Affiliation(s)
| | | | | | - Victor M Baez
- Department of Electrical Engineering, University of Houston, Houston, TX, USA
| | | | | | - Aaron T Becker
- Department of Electrical Engineering, University of Houston, Houston, TX, USA
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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Abstract
Abstract
Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.
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10
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Ito H, Yanagida S, Toyonaga Y, Yamashita H, Ohori M, Isaka K. Single assistant versus dual assistant robotic surgery for robot-assisted laparoscopic hysterectomy using da Vinci Xi or X. Int J Med Robot 2021; 17:e2315. [PMID: 34312964 DOI: 10.1002/rcs.2315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND To verify the usefulness of single assistant robotic surgery (SA-RS) using da Vinci Xi or X performed for total hysterectomy. METHODS The SA-RS group (S-group) includes surgeries in which the surgeon performed all surgical operations other than that of the uterine manipulator, while the dual assistant robotic surgery group (D-group) includes surgeries performed by the surgeon with two assistants. In S-group, the forceps and camera were replaced during surgery in cases of a large uterus with limited range of motion of the instrument. A comparative study of patient background, intraoperative and postoperative results and surgery-related cost was performed between the two groups. RESULTS No significant differences were observed between the two groups. On the contrary, S-group showed a significant reduction in preparation time and wound closure time, and a savings of $768. CONCLUSION SA-RS for total hysterectomy was possible, which is excellent in terms of cost, esthetics, and manpower.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Satoshi Yanagida
- Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan
| | - Yoichiro Toyonaga
- Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan
| | - Hideyuki Yamashita
- Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan
| | - Makoto Ohori
- Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan
| | - Keiichi Isaka
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan.,Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan
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Wijsman PJM, Voskens FJ, Molenaar L, van 't Hullenaar CDP, Consten ECJ, Draaisma WA, Broeders IAMJ. Efficiency in image-guided robotic and conventional camera steering: a prospective randomized controlled trial. Surg Endosc 2021; 36:2334-2340. [PMID: 33977377 DOI: 10.1007/s00464-021-08508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robotic camera steering systems have been developed to facilitate endoscopic surgery. In this study, a randomized controlled trial was conducted to compare conventional human camera control with the AutoLap™ robotic camera holder in terms of efficiency and user experience when performing routine laparoscopic procedures. Novelty of this system relates to the steering method, which is image based. METHODS Patients undergoing an elective laparoscopic hemicolectomy, sigmoid resection, fundoplication and cholecystectomy between September 2016 and January 2018 were included. Stratified block randomization was used for group allocation. The primary aim of this study was to compare the efficiency of robotic and human camera control, measured with surgical team size and total operating time. Secondary outcome parameters were number of cleaning moments of the laparoscope and the post-study system usability questionnaire. RESULTS A total of 100 patients were randomized to have robotic (50) versus human (50) camera control. Baseline characteristics did not differ significantly between groups. In the robotic group, 49/50 (98%) of procedures were carried out without human camera control, reducing the surgical team size from four to three individuals. The median total operative time (60.0 versus 53.0 min, robotic vs. control) was not significantly different, p = 0.122. The questionnaire showed a positive user satisfaction and easy control of the robotic camera holder. CONCLUSION Image-based robotic camera control can reduce surgical team size and does not result in significant difference in operative time compared to human camera control. Moreover, robotic image-guided camera control was associated with positive user experience.
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Affiliation(s)
- P J M Wijsman
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - L Molenaar
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
- Magnetic Detection & Imaging, University of Twente, Enschede, The Netherlands
| | | | - E C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.
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Trafeli M, Foppa C, Montanelli P, Nelli T, Staderini F, Badii B, Skalamera I, Cianchi F, Coratti F. Robotic colorectal surgery checkpoint: a review of cited articles during the last year. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.19.04963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Use of a ring retractor to facilitate specimen removal in laparoscopic surgery. Obstet Gynecol Sci 2020; 63:548-549. [PMID: 32689781 PMCID: PMC7393762 DOI: 10.5468/ogs.20025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a new surgical technique for specimen removal during laparoscopic surgery. Methods The surgical technique was described, pictured, and recorded. The surgery was performed in a tertiary hospital. Results During laparoscopic surgery, the specimen is resected from the surrounding tissues and contained in a specimen bag to prevent spillage. The edges of the bag are then pulled through the trocar site, and the specimen—protected by the bag—is removed. To facilitate the removal process and to prevent spillage, assistants will normally hold the edges of the bag during the process. To mitigate the need for assistants to hold the edges of the bag, we wrapped the pulled edges of the bag around a ring retractor, which is a plastic ring, to straighten the bag. This technique enabled the operator to remove the specimen without needing an assistant. Conclusion The technique we describe here, using a ring retractor for specimen removal, is useful when assistants are unavailable to help during laparoscopic surgery.
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Yoshida D, Maruyama S, Takahashi I, Matsukuma A, Kohnoe S. Surgical experience of using the endoscope manipulator robot EMARO in totally extraperitoneal inguinal hernia repair: A case report. Asian J Endosc Surg 2020; 13:448-452. [PMID: 31692277 DOI: 10.1111/ases.12760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022]
Abstract
Robot-assisted surgery has advanced rapidly since the 1980s. However, new equipment is still needed to overcome problems in conventional endoscopic surgery, including unique risks, such as camera shake and communication difficulties between the operator and the scopist. EMARO, an endoscope manipulator robot, is the world's first pneumatically driven endoscope-holder robot that can operate flexibly and smoothly with the use of air pressure. We herein report the surgical experience of using EMARO in totally extraperitoneal inguinal hernia repair. A 77-year-old Japanese man presented with bulging in the right groin area. After we diagnosed a right inguinal hernia, endoscopic inguinal hernia repair was performed. We selected the totally extraperitoneal approach with EMARO. The endoscopic procedure time was 100 minutes, and no intraoperative complications occurred. EMARO brings together features of smooth motion and good manipulation performance. This operation was performed safely and was comparable to a conventional operation completed with human assistants. Solo surgery with EMARO was beneficial in this inguinal hernia patient.
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Affiliation(s)
- Daisuke Yoshida
- Department of Surgery, Tagawa Municipal Hospital, Fukuoka, Japan
| | - Seiji Maruyama
- Department of Surgery, Tagawa Municipal Hospital, Fukuoka, Japan
| | - Ikuo Takahashi
- Department of Surgery, Tagawa Municipal Hospital, Fukuoka, Japan
| | - Akito Matsukuma
- Department of Surgery, Tagawa Municipal Hospital, Fukuoka, Japan
| | - Shunji Kohnoe
- Department of Surgery, Tagawa Municipal Hospital, Fukuoka, Japan
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De Pauw T, Kalmar A, Van De Putte D, Mabilde C, Blanckaert B, Maene L, Lievens M, Van Haver AS, Bauwens K, Van Nieuwenhove Y, Dewaele F. A novel hybrid 3D endoscope zooming and repositioning system: Design and feasibility study. Int J Med Robot 2019; 16:e2050. [PMID: 31677219 DOI: 10.1002/rcs.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation. METHODS AND MATERIALS Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials. RESULTS Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported. CONCLUSIONS The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon.
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Affiliation(s)
- Tim De Pauw
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Alain Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium
| | - Dirk Van De Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Cyriel Mabilde
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Bart Blanckaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Lieven Maene
- Department of Thoracic and Vascular Surgery, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Mauranne Lievens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Kevin Bauwens
- Division of Robotic Surgery and Training, ORSI Academy, Melle, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
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16
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Kim JS, Park WC, Lee JH. Comparison of Short-term Outcomes of Laparoscopic-Assisted Colon Cancer Surgery Using a Joystick-Guided Endoscope Holder (Soloassist II) or a Human Assistant. Ann Coloproctol 2019; 35:181-186. [PMID: 31487765 PMCID: PMC6732332 DOI: 10.3393/ac.2018.10.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose This study aimed to compare the short-term outcomes of laparoscopic-assisted colon cancer surgery in the Soloassist II-assisted (SA) group and in the human-assisted (HA) group. Methods A total of 76 patients with colon cancer who underwent laparoscopic-assisted right hemicolectomy and anterior resection performed by a single surgeon between January 2017 and May 2018 were recruited from the consecutively enrolled registry and retrospectively analyzed. Results Of 76 patients, 43 underwent surgery with human assistance and 33 underwent surgery using the Soloassist II system. The clinicopathologic characteristics were not statistically different between the 2 groups. In both HA and SA groups, no statistical difference was observed between operation time (220.23 ± 47.83 minutes vs. 218.03 ± 38.22 minutes, P = 0.829), total number of harvested lymph nodes (20.42 ± 10.86 vs. 20.24 ± 8.21, P = 0.938), and other parameters of short-term outcomes (length of hospital stay, blood loss, open conversion, time to flatus, time to soft diet, and complication events). Subgroup analyses did not show statistical differences. Conclusion Soloassist II can reduce the participation of a human assistant during surgery and is not inferior to human assistance in laparoscopic-assisted colon cancer surgery. Thus, it is a feasible instrument in laparoscopic-assisted colon cancer surgery that can provide positive short-term outcomes.
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Affiliation(s)
- Jun Sung Kim
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Joo Hyun Lee
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Ohmura Y, Suzuki H, Kotani K, Teramoto A. Laparoscopic inguinal hernia repair with a joystick-guided robotic scope holder (Soloassist II®): retrospective comparative study with human assistant. Langenbecks Arch Surg 2019; 404:495-503. [PMID: 31129765 DOI: 10.1007/s00423-019-01793-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical usefulness of a joystick-guided robotic scope holder (Soloassist II®) in laparoscopic inguinal hernia repair. METHODS Among 182 inguinal hernia patients treated by laparoscopic transabdominal preperitoneal repair, 82 cases were completed with a human scope assistant, while Soloassist was used in 100 cases. We retrospectively compared perioperative results of Soloassist group and human scope assistant group. In 139 unilateral cases, we also used logistic regression of perioperative factors for the propensity score calculation to balance the bias. RESULTS All operations with Soloassist were carried out laparoscopically as solo-surgery without any system-specific complications. A statistically significant decrease in operation time was observed in Soloassist group compared with human assistant group (93.6 vs 85.9 min, p = 0.05). There was no prolongation of preoperative time or difference in the amount of intraoperative blood loss. Operation time was also significantly shorter in Soloassist group, when analyzing unilateral cases (85.5 vs 76.3 min, p = 0.02) and bilateral cases (126.9 vs 111.8 min, p = 0.01), independently. However, after propensity score matching in unilateral cases, there was no statistically significant difference between the two groups (83.8 vs 77.2 min, p = 0.23). CONCLUSIONS The feasibility of Soloassist in laparoscopic inguinal hernia repair was demonstrated with no adverse device-related events. All surgeries could be completed as solo-surgery, while no additional time for preoperative setting was required. The mean operation time tends to be shorter in Soloassist group compared with human assistant group. Soloassist could be an effective device in laparoscopic inguinal hernia repair.
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Affiliation(s)
- Yasushi Ohmura
- Department of Cancer Treatment Support Center, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan. .,Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.
| | - Hiromitsu Suzuki
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.,Department of Surgery, Yakage Hospital, 2695 Yakage, Yakage-chou, Oda, Okayama, 714-1201, Japan
| | - Kazutoshi Kotani
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.,Department of Surgery, Kasaoka Daiichi Hospital, 1945 Yokoshima, Kasaoka, Okayama, 714-0043, Japan
| | - Atsushi Teramoto
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan
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18
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Mittal R, Sbaih M, Motson RW, Arulampalam T. Use of a robotic camera holder (FreeHand ®) for laparoscopic appendicectomy. MINIM INVASIV THER 2019; 29:56-60. [PMID: 30789101 DOI: 10.1080/13645706.2019.1576052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Use of a mechanical arm to hold the laparoscopic camera has many advantages. FreeHand® (FreeHand Ltd, Guildford, United Kingdom) is a robotic camera holder which uses head movement and infrared technology. This trial assessed the usefulness of FreeHand® in laparoscopic appendicectomy.Material and methods: This was a single center prospective cohort study on patients undergoing emergency laparoscopic appendicectomy using FreeHand®. Patient demographics, operative details, conversion to human camera holder and surgeon discomfort were recorded. Utilization of assistant time while not assisting was also recorded.Results: Twenty-two participants were included, with a mean age of 32 years and a mean BMI of 25.3. The mean set up time was nine minutes. There were five conversions to a manual camera holder (22.7%). There were 22 lens cleaning episodes with nine (40.9%) not requiring any lens cleaning and six (27.3%) requiring one clean. There were no peri-operative complications. Most surgeons reported minimal or no discomfort. Assistant's time was used for ward work (57%), clerking patients (36%) and for a break (7%).Conclusions: FreeHand® can be safely used in laparoscopic appendicectomy. It provides a stable image, puts the surgeon in control of the surgical field, causes minimal user discomfort, and frees up personnel.
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Affiliation(s)
- Rohin Mittal
- Colchester Hospital University Foundation Trust, Colchester, United Kingdom
| | - Mohammed Sbaih
- ICENI Centre for Surgical Education, Colchester General Hospital, Colchester, United Kingdom
| | - Roger W Motson
- ICENI Centre for Surgical Education, Colchester General Hospital, Colchester, United Kingdom
| | - Tan Arulampalam
- Colchester Hospital University Foundation Trust, Colchester, United Kingdom
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Ohmura Y, Suzuki H, Kotani K, Teramoto A. Comparative effectiveness of human scope assistant versus robotic scope holder in laparoscopic resection for colorectal cancer. Surg Endosc 2018; 33:2206-2216. [PMID: 30334160 DOI: 10.1007/s00464-018-6506-4] [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: 03/31/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several types of robotic scope holders have been developed to date, but there are only some experimental reports or the results of small clinical cases. The Soloassist® system is a unique robotic scope holder with which the surgeon can control the field of view by a joystick. We evaluated the efficacy of Soloassist in laparoscopic resection for colorectal cancer. MATERIALS AND METHODS We investigated operative time, blood loss, setup time, length of hospital stay, and the number of participating surgeons in 273 laparoscopic colorectal resections, including 130 cases with human assistant (HA group) and 143 cases with Soloassist (SA group). Additionally, we also used logistic regression of the perioperative factors for the propensity score calculation to balance the bias. RESULTS The number of participating surgeons was apparently less in the SA group (HA group: 3.3 vs. SA group: 2.5, p < 0.01). The average operative time was shorter in the SA group, but there was no statistical difference (HA group: 287.0 min vs. SA group: 268.5 min, p = 0.07). No significant difference was found in setup time, conversion rate, perioperative complications, and length of hospital stay. There was no conversion case to human scope assistant and no system-specific adverse event. Similar results were observed between two groups after propensity score matching. CONCLUSION Laparoscopic colorectal resection with Soloassist is safe and feasible. The present study demonstrated that Soloassist system provided the possibilities of saving human resources in laparoscopic colorectal resection without prolonged operative time or system-specific morbidity. Soloassist is an effective robot-assisted surgical instrument for colorectal surgery.
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Affiliation(s)
- Yasushi Ohmura
- Department of Cancer Treatment Support Center, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan. .,Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.
| | - Hiromitsu Suzuki
- Department of Surgery, Yakage Hospital, 2695 Yakage, Yakage-chou, Oda, Okayama, 714-1201, Japan
| | - Kazutoshi Kotani
- Department of Surgery, Kasaoka Daiichi Hospital, 1945 Yokoshima, Kasaoka, Okayama, 714-0043, Japan
| | - Atsushi Teramoto
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan
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Ohmura Y, Nakagawa M, Suzuki H, Kotani K, Teramoto A. Feasibility and Usefulness of a Joystick-Guided Robotic Scope Holder (Soloassist) in Laparoscopic Surgery. Visc Med 2018; 34:37-44. [PMID: 29594168 DOI: 10.1159/000485524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction The Soloassist® system is a joystick-guided robotic scope holder. We evaluated the efficacy of Soloassist in laparoscopic surgery. Methods We investigated operative time, blood loss, set-up time, length of hospital stay, and the number of participating surgeons in laparoscopic cholecystectomy cases before and after the introduction of Soloassist. Furthermore, we evaluated these factors in each group of 20 elective and emergency cholecystectomy cases by single surgeon after matching their background. To evaluate the performance level of operating Soloassist, we divided the operative field into three areas. Then we counted the frequency of energy device activation in initially 10 cases by a single surgical resident and observed its change. Results The number of participating surgeons was significantly less and postoperative hospital days were fewer in the Soloassist group. There was no significant difference between set-up time and blood loss both in elective and emergency cases. The total number of energy device activations and that in the dangerous area decreased in accordance with the experience. Conclusion Considering our results and previous reports, the combination use of an ideal active scope holder and a commercially available 3D scope is currently considered the best approach in laparoscopic surgery. In the near future, development of active scope holders might play an important role in laparoscopic surgery.
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Affiliation(s)
- Yasushi Ohmura
- Department of Cancer Treatment Support Center, Okayama City Hospital, Okayama City, Okayama, Japan.,Department of Surgery, Okayama City Hospital, Okayama City, Okayama, Japan
| | - Mari Nakagawa
- Department of Surgery, Okayama City Hospital, Okayama City, Okayama, Japan
| | - Hiromitsu Suzuki
- Department of Surgery, Okayama City Hospital, Okayama City, Okayama, Japan
| | - Kazutoshi Kotani
- Department of Surgery, Okayama City Hospital, Okayama City, Okayama, Japan
| | - Atsushi Teramoto
- Department of Surgery, Okayama City Hospital, Okayama City, Okayama, Japan
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