[Robotic surgery: history and teaching impact]

Studying Brain Activation during Skill Acquisition via Robot-Assisted Surgery Training

Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05).

Robotic video-assisted thoracoscopic surgery using multiport triangular trocar configuration: initial experience at a single center

Background

Recent developments in robotic technology have brought significant changes in robotic video-assisted thoracoscopic surgery (r-VATS) worldwide, particularly including the treatment in the thorax for the mediastinal, esophagus, and pulmonary lesions. Currently, there are only a few reports describing the procedural experience and outcomes with r-VATS. The objective of this study is to provide our initial experience using r-VATS at a single center, with specific attention to safety, efficacy, and procedural details.

Methods

We retrospectively reviewed patients who underwent a newly modified r-VATS procedure for various surgical operations at the thoracic department of our hospital, from July 2018 to January 2020. Multiport trocars were placed in the classic triangular arrangement as in conventional VATS (c-VATS) but with modifications based on the type of surgery. The peri- and postoperative outcomes such as duration of surgery, complications, and duration of hospital stay for these patients were reported.

Results

Overall, 142 patients underwent r-VATS for lobectomy (66), wedge resection (15), thymectomy (22), mediastinal tumor resection (30), pneumonectomy (4), transthoracic esophagectomy (1), esophageal tumor resection or esophageal diverticulum repair (2), diaphragm plication (1), and mediastinal tumor resection plus thymectomy (1). For the entire cohort, the median operative time was 110 min, and the median length of hospital stay was 5 days. Conversion to open thoracic surgery was reported only in a total of 3 (2.1%) patients of pneumonectomy (1.4%) and mediastinal tumor resection (0.70%). All our patients were managed successfully with no postoperative complications and mortality.

Conclusion

Our method of r-VATS was found to be safe and effective and may be applied to different surgical operations. Adequate and proper training of thoracic surgeons is immediately needed for the transition from c-VATS to r-VATS. The utility and advantages of triangular trocar configuration for r-VATS require further refinement and research before it can be routinely adopted in clinical practice.

Trial registration

Retrospectively registered.

The evolution of robotic thoracic surgery

Robotic surgery has the features to represent the future of surgery, considering the rapid evolution of its technology and the resulting in the surgical field. In the last years, the robotic technique in thoracic surgery has progressively become widespread in the word, particularly for the treatment of the mediastinal and pulmonary lesions. The development of technology in the robotic system has been associated with the improvement of intraoperative and postoperative results. Due to the satisfying results and increasing experience and confidence with the robotic technique, surgeons are consequently enlarging the surgical indication, moving to increasingly challenging cases. Thoracic robotic surgery is being affirmed as a safe technique also for those complex cases, which in the past were considered a matter solely for open surgery. In fact, robotic surgery is increasingly associated with positive surgical results and guarantees less traumatism and a fast recovery to the patients. These positive results have resulted from the evolution of the technique, which has developed in parallel with the evolution of the technology, exploiting to its best the latest features of the robotic system. These features, such as the fluorescence-detection tool or the robotic stapler, have been aiding the surgeon to maximise the safety and feasibility of the application of the robotic technique to thoracic surgery.

Analysis of historical articles published in Actas Urológicas Españolas

OBJECTIVE

On the 40th anniversary of the edition of Actas Urológicas Españolas, we assess the articles on history to determine the proportion represented, analysing the study subjects and their relevance, getting to know the authors, the main study centres and the interest that the studies offer for understanding the specialty.

MATERIAL AND METHODS

We extracted as many subjects of historic content from the journal as were published between January 1976 and December 2016.

RESULT

There were 103 historical studies representing 3% of the total number of articles, with a mean of 2.57 articles published annually, written by 127 separate urologists. As first author, there were 59 articles, and as coauthors, there were 68. The main activity came from 21 of the main university hospitals in Spain, and 43 of the articles were personal articles signed by a single individual. Their content mainly covers the facts of Spanish urology from the Renaissance to the 20th century, with special emphasis on the profile of Spanish specialists. Data on 22 of these specialists are provided in 37 articles. The evolution of diagnostic and treatment procedures, both medical and surgical, are well reflected, as are a number of diseases.

CONCLUSION

Most of the studies are personal works of historical research and represent 3% of the total number of articles. As a whole, the quality is high, and the articles provide data with interesting details and useful reviews, giving them considerable value, as well as forming a precious compendium for the understanding of the history of Spanish urology. These articles are highly recommended reading.

A new forecasting kinematic algorithm of automatic navigation for a laparoscopic minimally invasive surgical robotic system

This paper presents a novel forecasting kinematic algorithm for autonomously navigating the 3D visual window of laparoscopic minimally invasive surgical robotic system (LMISRS). By the application of the proposed technique, a constant distribution area ratio of the micro devices can be guaranteed in the visual window; real-time concurrency motion of the visual window of the laparoscope and the mark points of the instruments is realized, i.e. the visual window can keep tracking the movement of the marks automatically, so that the user does not have to switch between the master-slave controlling targets. The implementation of the new technique is summarized as follows: the robotic kinematics and space analytic geometry are thoroughly analyzed and modeled, and a “following kinematic algorithm” is proposed for the visual window of the laparoscope, which tracks the mark points of the instrument arms; a “forecasting kinematic algorithm” is established by using a combination of the “following kinematic algorithm”, the basic visual parameters of 3D visual field, the Verhulst Grey Model and the filtered amendment method. The proposed technique is verified by a series of simulations by using two groups of marks' motion trails with different sampling times, indicating that the technique is accurate, feasible and robust.

New technologies in robotic surgery: the Korean experience

PURPOSE OF REVIEW

The development of the robotic systems has made surgery an increasingly technology-driven field. Since the introduction of the first robotic platform in 2005, surgical practice in South Korea has also been caught up in the global robotic revolution. Consequently, a market focused on improving the robotic systems was created and Korea has emerged as one of its frontrunners. This article reviews the Korean experience in developing various robotic technologies and then Korea's most recent contributions to the development of new technologies in robotic surgery.

RECENT FINDINGS

The goal of new technologies in the field of robotic surgery has been to improve on the current platforms by eliminating their disadvantages. The pressing goal is to develop a platform that is less bulky, more ergonomic, and capable of providing force feedback to the surgeon. In Korea, the Lapabot and two new robotic systems for single-port laparoscopic surgery are the most recent advances that have been reported.

SUMMARY

Robotic surgery is rapidly evolving and Korea has stayed in the forefront of its development. These new advancements in technology will eventually produce better robotic platforms that will greatly improve the manner in which surgical care is delivered.

A new kinematics method based on a dynamic visual window for a surgical robot

This paper proposes a new effective kinematics method based on the dynamic visual window (DVW) for a surgical robot that is equipped with two instrument arms and one laparoscope arm, to enable doctors to achieve operations with their visual habits under the laparoscopic visual environment. The problem of the consistency principle between the doctor's operations under the visual window's feedback and the master–slave operations of the surgical robot is solved. The kinematics models of the surgical robotic arms are established, and the new kinematics methods based on the DVW of the laparoscope and instrument arms are proposed according to their inverse kinematics with respect to the visual coordinate system. Finally, the proposed kinematics method is verified by simulation experiments based on the theoretical algorithm and the mechanism model; the multiple sets of the simulation data are presented to illustrate the correctness and feasibility of the new method in this research.