Closed chest totally endoscopic coronary artery bypass surgery: fantasy or reality?

Robotics and surgery: A sustainable relationship?

Robotic surgery is increasingly being employed to overcome the disadvantages associated with use of conventional techniques such as laparoscopy. However, despite significant promise, there are some clear disadvantages and robust evidence base supporting the use of robotic assistance remains lacking. In this paper, the advantages and drivers for robotics will be discussed, its drawbacks and its future role in surgery.

Short-phase training on a virtual reality simulator improves technical performance in tele-robotic surgery

BACKGROUND

The da Vinci tele-robot necessitates the acquisition of new skills and surgical educators must develop standardized training programmes. It is possible that virtual reality (VR) computer simulation maybe used and it is necessary to define whether a simulator is an appropriate tool.

METHODS

Ten surgical novices performed a series of five tasks, ten times on a commercially available VR robotic simulator. Two experts repeated the series of tasks twice in an attempt to validate the simulator.

RESULTS

Each of the five tasks displayed statistically significant learning curves. Error scores did not improve significantly over successive repetitions except in one task. The experts completed two of the tasks in a significantly faster time.

CONCLUSIONS

Practice sessions on a VR simulator improve technical performance. The simulator enables surgeons to mount the early part of the learning curve within a laboratory environment, which may lead to a more effective training programme.

Flexible robotics: a new paradigm

PURPOSE OF REVIEW

The use of robotics in urologic surgery has seen exponential growth over the last 5 years. Existing surgical robots operate rigid instruments on the master/slave principle and currently allow extraluminal manipulations and surgical procedures. Flexible robotics is an entirely novel paradigm. This article explores the potential of flexible robotic platforms that could permit endoluminal and transluminal surgery in the future.

RECENT FINDINGS

Computerized catheter-control systems are being developed primarily for cardiac applications. This development is driven by the need for precise positioning and manipulation of the catheter tip in the three-dimensional cardiovascular space. Such systems employ either remote navigation in a magnetic field or a computer-controlled electromechanical flexible robotic system. We have adapted this robotic system for flexible ureteropyeloscopy and have to date completed the initial porcine studies.

SUMMARY

Flexible robotics is on the horizon. It has potential for improved scope-tip precision, superior operative ergonomics, and reduced occupational radiation exposure. In the near future, in urology, we believe that it holds promise for endoluminal therapeutic ureterorenoscopy. Looking further ahead, within the next 3-5 years, it could enable transluminal surgery.

Robotics technology: a journey into the future

Some major technologic improvements are needed for robotic technology to reach its ultimate potential, which includes better visualization, tactile sensing, diagnostic sensing, and miniaturization. This article gives a vision of the future of robotic technology with respect to these improvements.

Robotics in laparoscopic surgery: current status and future perspectives

BACKGROUND

Laparoscopic surgery has been introduced to limit the burden of surgical damage to the abdominal wall and peritoneum.

METHODS

Description of procedure and results of robotic laparoscopic surgery.

RESULTS

Laparoscopic surgery has resulted in reduction of postoperative pain, surgery-related complications and scarring. Laparoscopic techniques, however, are challenging for the surgeon owing to the disadvantages of inverted and restricted manipulation and the indirect two-dimensional view. In order to solve these problems, robotic telemanipulation systems were developed and introduced to the market at the end of the past decade. This article describes and discusses the current status and future perspectives of robotic systems in endoscopic surgery.

CONCLUSION

Robotic laparoscopic surgery overcomes some of the disadvantages of conventional laparoscopic surgery.

Anesthesia for robotic repair of the mitral valve: a report of two cases

IMPLICATIONS

We describe the anesthetic management of two patients who underwent successful mitral valve repair with use of a robot-assisted cardiac surgical technique. We describe the robot used, as well as the surgical procedure, and highlight aspects of the anesthetic management, in particular the need for one-lung ventilation and the utility of transesophageal echocardiography.

Robotics and coronary artery surgery

Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology. With a combined experience of 125 patients, several groups have independently demonstrated the clinical feasibility of totally endoscopic coronary artery bypass with two commercially available robotic telemanipulation systems. Additional enabling technology is needed to overcome the challenges currently limiting development and widespread application of totally endoscopic off-pump multivessel coronary artery bypass surgery.

Totally robotic technique in multivessel coronary disease--is it possible?

Robotic techniques in coronary surgery have been established for a few years. The preparation of the internal mammary arteries is now a well-described procedure, as is anastomosis to the anterior wall vessels under cardiopulmonary bypass. To achieve totally robotic complete revascularization of the heart, there are still some problems to be solved. Potential solutions are discussed. Current techniques using telemanipulation systems in cardiac surgery are described and explained. Totally endoscopic off-pump complete revascularization of the heart might be achieved by a combination of techniques already developed by different teams around the world.