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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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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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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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Yip HM, Wang Z, Navarro-Alarcon D, Li P, Cheung TH, Greiffenhagen C, Liu YH. A collaborative robotic uterine positioning system for laparoscopic hysterectomy: Design and experiments. Int J Med Robot 2020; 16:e2103. [PMID: 32163664 DOI: 10.1002/rcs.2103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uterus manipulation is a lengthy and tedious task that is usually performed by a human assistant during laparoscopic hysterectomy. Note that the performance of the assistant may decrease with time. Moreover, under this approach, the primary surgeon does not have direct control over the uterus position. He/she can only verbally request the assistant to place it on a particular configuration. METHODS A robotic system composed of a 3 degrees-of-freedom uterine positioner is developed to assist in changing configuration of the uterus during laparoscopic hysterectomy. The developed system has a remote centre of motion structure; independently controlling the uterus motion with one joint at the time is allowed. RESULTS From the lab experiments, it is found that the robot shows better performance in retaining the uterus position and shows quicker response to the surgeon's instruction. Cadaver studies have been conducted to evaluate the feasibility of the robot. The robot was also applied to real patients in a clinical study. CONCLUSIONS The robot is capable of assisting in uterus manipulation during laparoscopic hysterectomy. However, its user friendliness can be improved by simplifying the docking procedure. Furthermore, a more ergonomic user interface is desired.
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Affiliation(s)
- Hiu Man Yip
- The Chinese University of Hong Kong, Shatin, Hong Kong
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Zerui Wang
- The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Peng Li
- Harbin Institute of Technology, Shenzhen, China
| | | | | | - Yun-Hui Liu
- The Chinese University of Hong Kong, Shatin, Hong Kong
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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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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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Chen PD, Hu RH, Liang JT, Huang CS, Wu YM. Toward a fully robotic surgery: Performing robotic major liver resection with no table-side surgeon. Int J Med Robot 2019; 15:e1985. [PMID: 30659758 DOI: 10.1002/rcs.1985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence has suggested that robotic system helps perform more major liver resections. However, the required table-side surgeon has remained a concern because of the uncertain performance and the incomplete control of console surgeon. METHODS Data were reviewed for consecutive 333 robotic liver resections, of which 56 patients underwent left liver resection with the usual setting, and 35 with no table-side surgeon. RESULTS No conversion was required in the setting with no table-side surgeon. The group without the table-side surgeon had similar complication rates, blood loss, and operative time compared with that of the normal settings, as well as focused analysis on major left hemihepatectomy. CONCLUSION Our data suggest that performing robotic major liver resection without the presence of the table-side surgeon is safe and feasible. The concise performance of robotic platforms might accelerate the machine learning process along with the ability to predict patterns of future autonomous surgery.
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Affiliation(s)
- Po-Da Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Ali JM, Lam K, Coonar AS. Robotic Camera Assistance: The Future of Laparoscopic and Thoracoscopic Surgery? Surg Innov 2018; 25:485-491. [PMID: 29938603 DOI: 10.1177/1553350618784224] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Minimally invasive techniques have become the standard for a variety of procedures across all surgical specialties. There has been a recent move to integrate robotic technology into standard laparoscopic and thoracoscopic surgery with the aim of improving stability of the visual field with the use of robotic camera assistance. The aim of this study was to report on and examine the use of a headset-controlled robotic camera holder, FreeHand. METHODS Between May 2013 and Dec 2016, 105 procedures were observed where the FreeHand robotic camera assistant was used. Observations were made of 43 consultant surgeons in 30 hospitals performing 21 different surgical procedures. During the surgery, the number of scope cleans and collisions were quantified, and surgeons were asked to score from 0 to 5 the setup, ergonomics, usability, and overall experience in a questionnaire. RESULTS Overall surgeon satisfaction was rated as "good" for setup (4.29), ergonomics of the system (4.12), usability (4.39), and overall experience of the system (4.34). In 8 operations (7.6%), there was a conversion from robotic camera assistant to manual assistant. There were no reported adverse events attributable to the use of the system. CONCLUSION This study demonstrates the breadth of surgical procedures that can be performed with a robotic camera assistant. The robotic camera assistant was found to be safe and simple to use and was positively perceived on assessment in multiple procedures spanning several surgical specialties. This work suggests that robotic camera assistants may offer significant benefits to laparoscopic and thoracoscopic surgeons.
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Affiliation(s)
- Jason M Ali
- 1 Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Kyle Lam
- 1 Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Aman S Coonar
- 1 Royal Papworth Hospital, Papworth Everard, Cambridge, UK
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Boztosun A, Atılgan R, Pala Ş, Olgan Ş. A new method used in laparoscopic hysterectomy for uterine manipulation: uterine rein technique. J OBSTET GYNAECOL 2018; 38:864-868. [DOI: 10.1080/01443615.2018.1441273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Abdullah Boztosun
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Remzi Atılgan
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Şehmus Pala
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Şafak Olgan
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya, Turkey
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Wijsman PJM, Broeders IAMJ, Brenkman HJ, Szold A, Forgione A, Schreuder HWR, Consten ECJ, Draaisma WA, Verheijen PM, Ruurda JP, Kaufman Y. First experience with THE AUTOLAP™ SYSTEM: an image-based robotic camera steering device. Surg Endosc 2017; 32:2560-2566. [PMID: 29101564 DOI: 10.1007/s00464-017-5957-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robotic camera holders for endoscopic surgery have been available for 20 years but market penetration is low. The current camera holders are controlled by voice, joystick, eyeball tracking, or head movements, and this type of steering has proven to be successful but excessive disturbance of surgical workflow has blocked widespread introduction. The Autolap™ system (MST, Israel) uses a radically different steering concept based on image analysis. This may improve acceptance by smooth, interactive, and fast steering. These two studies were conducted to prove safe and efficient performance of the core technology. METHODS A total of 66 various laparoscopic procedures were performed with the AutoLap™ by nine experienced surgeons, in two multi-center studies; 41 cholecystectomies, 13 fundoplications including hiatal hernia repair, 4 endometriosis surgeries, 2 inguinal hernia repairs, and 6 (bilateral) salpingo-oophorectomies. The use of the AutoLap™ system was evaluated in terms of safety, image stability, setup and procedural time, accuracy of imaged-based movements, and user satisfaction. RESULTS Surgical procedures were completed with the AutoLap™ system in 64 cases (97%). The mean overall setup time of the AutoLap™ system was 4 min (04:08 ± 0.10). Procedure times were not prolonged due to the use of the system when compared to literature average. The reported user satisfaction was 3.85 and 3.96 on a scale of 1 to 5 in two studies. More than 90% of the image-based movements were accurate. No system-related adverse events were recorded while using the system. CONCLUSION Safe and efficient use of the core technology of the AutoLap™ system was demonstrated with high image stability and good surgeon satisfaction. The results support further clinical studies that will focus on usability, improved ergonomics and additional image-based features.
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Affiliation(s)
- Paul J M Wijsman
- Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.
| | - Ivo A M J Broeders
- Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - Hylke J Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | | | - Henk W R Schreuder
- Department of Gynecologic Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Esther C J Consten
- Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - Werner A Draaisma
- Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - Paul M Verheijen
- Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuval Kaufman
- Department of Surgery, Assuta Medical Center, Haifa, Israel
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Iavazzo C, Iavazzo PE, Gkegkes ID. Solo gynaecologic laparoscopic surgery: a future one-man show for the experienced surgeon and a cost-effective approach for the National Health Systems? J Robot Surg 2016; 10:283-4. [PMID: 27160675 DOI: 10.1007/s11701-016-0592-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, UK. .,, 38, Seizani Str., Nea Ionia, 14231, Athens, Greece.
| | | | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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