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Nassar A, Vérité F, Pechereau F, Vitrani MA. Assistance by adaptative damping on a complex bimanual task in laparoscopic surgery. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03082-6. [PMID: 38453723 DOI: 10.1007/s11548-024-03082-6] [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: 10/21/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Laparoscopic surgery has improved outcomes in abdominal surgery, but presents kinematic restrictions for surgeons. Robotic comanipulation with adaptative damping has been investigated in simple laparoscopic tasks. The present protocol aimed to determine the contribution of adaptive damping in complex bimanual tasks approaching clinical setting. METHODS Fourteen residents in general surgery performed three exercises, and for each three repetitions without (classic repetitions) and three with robotic assistance (robotic repetitions) in a randomised order. The exercises chosen were trajectory, modified Pea on a Peg and intracorporeal suture. Task performance, gesture performance, workload and impression were measured. Also, a semi-directed interview was performed to collect the participants' feeling about companipulated robots and their potential application in clinical practice. RESULTS Adaptative damping assistance did not impact task performance, but allowed an economy of movement in the non-dominant hand during suture exercise (distance 916 ± 500 mm in classic vs. 563 ± 261 mm in robotic, p < 0.001). Perceived workload (p = 0.12) and user's impression were not different between classic and robotic repetitions, except novelty (p < 0.001). Participants' interviews revealed their interest for the robotic devices, particularly the gravity compensation, and were ready to use the adaptative damping provided an intermittent use, for example to dissect dangerous areas. CONCLUSION Adaptative damping applied by comanipulated robots does not influence the performance of the task, but improves the performance of the gesture itself, particularly for the non-dominant hand, and during the realisation of a complex task like suturing. For residents in digestive surgery, this assistance does increase workload, and they would use this help in the operating room under certain conditions.
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Affiliation(s)
- A Nassar
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France.
| | - F Vérité
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - F Pechereau
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - M A Vitrani
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
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Levin G, Siedhoff M, Wright KN, Truong MD, Hamilton K, Brezinov Y, Gotlieb W, Meyer R. Robotic surgery in obstetrics and gynecology: a bibliometric study. J Robot Surg 2023; 17:2387-2397. [PMID: 37429970 PMCID: PMC10492767 DOI: 10.1007/s11701-023-01672-1] [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: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
We aimed to identify the trends and patterns of robotic surgery research in obstetrics and gynecology since its implementation. We used data from Clarivate's Web of Science platform to identify all articles published on robotic surgery in obstetrics and gynecology. A total of 838 publications were included in the analysis. Of these, 485 (57.9%) were from North America and 281 (26.0%) from Europe. 788 (94.0%) articles originated in high-income countries and none from low-income countries. The number of publications per year reached a peak of 69 articles in 2014. The subject of 344 (41.1%) of articles was gynecologic oncology, followed by benign gynecology (n = 176, 21.0%) and urogynecology (n = 156, 18.6%). Articles discussing gynecologic oncology had lower representation in low- and middle-income countries (LMIC) (32.0% vs. 41.6%, p < 0.001) compared with high income countries. After 2015 there has been a higher representation of publications from Asia (19.7% vs. 7.7%) and from LMIC (8.4% vs. 2.6%), compared to the preceding years. In a multivariable regression analysis, journal's impact factor [aOR 95% CI 1.30 (1.16-1.41)], gynecologic oncology subject [aOR 95% CI 1.73 (1.06-2.81)] and randomized controlled trials [aOR 95% CI 3.67 (1.47-9.16)] were associated with higher number of citations per year. In conclusion, robotic surgery research in obstetrics & gynecology is dominated by research in gynecologic oncology and reached a peak nearly a decade ago. The disparity in the quantity and quality of robotic research between high income countries and LMIC raises concerns regarding the access of the latter to high quality healthcare resources such as robotic surgery.
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Affiliation(s)
- Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Matthew Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kacey Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yoav Brezinov
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Walter Gotlieb
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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Nassar A, Vérité F, Pechereau F, Morel G, Vitrani MA. Adaptative damping assistance in bimanual laparoscopic surgery. Int J Comput Assist Radiol Surg 2023; 18:741-751. [PMID: 36477584 PMCID: PMC9735186 DOI: 10.1007/s11548-022-02796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Laparoscopic surgery has demonstrated various advantages for the patients' care, but also presents some difficulties for the surgeons, such as kinematic restrictions. Robotic comanipulation, in which control of instruments is shared between the robot and the surgeon, can provide adaptative damping assistance which allows stabilisation of movements. The objective of the present study was to determine the contribution of this assistance on a bimanual laparoscopic task. METHODS Adaptative damping was studied on Peg Transfer task, performed by eighteen surgery-naive subjects. This exercise was repeated seven times without (Classic repetitions) and seven times with comanipulated robots (Robot repetitions), in a randomised order. We measured task performance, using Peg Transfer score; gesture performance, using hand oscillations and travelled distance; eye-tracking movements as an indicator of emergence of expertise. Participants' perceived workload was assessed by NASA TLX questionnaire, and difference in impression between the two conditions by UEQ questionnaire. RESULTS Adaptative damping improved gesture performance (oscillations F(1,17) = 23.473, p < 0.001, η2 = 0.580), with a statistically significant simple effect on the tool oscillation for both non-dominant (p < 0.001) and dominant hands (p = 0.005), without influencing task performance (mean Peg Transfer score t(17) = 0.920, p = 0.382, d = 0.29), but deteriorating eye-tracking movements associated with emergence of expertise (mean fixation rate per second F(1,17) = 6.318, p = 0.022, η2 = 0.271), at the cost of a high perceived workload (NASA TLX score 59.78/100). CONCLUSION Assistance by adaptative damping applied by comanipulated robots improved gesture performance during a laparoscopic bimanual task, without impacting task's performance without allowing the emergence of comportments associated with an expertise, and at the cost of a high perceived workload. Further research should investigate this assistance on more precise and clinical tasks performed by professionals.
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Affiliation(s)
- Alexandra Nassar
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France.
| | - Fabien Vérité
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Félix Pechereau
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Guillaume Morel
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Marie-Aude Vitrani
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
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Ferrier-Barbut E, Gauthier P, Luengo V, Canlorbe G, Vitrani MA. Measuring the Quality of Learning in a Human–Robot Collaboration: A Study of Laparoscopic Surgery. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2022. [DOI: 10.1145/3476414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Robot-Assisted Laparoscopic Surgery (RALS) is now prevalent in operating rooms. This situation requires future surgeons to learn Classic Laparoscopic Surgery (CLS) and RALS simultaneously. Therefore, along with the investigation of the differences in performance between the two techniques, it is essential to study the impact of training in RALS on the skills mastered in CLS. In this article, we study comanipulated RALS (Co-RALS), one of the two designs for RALS, where the human and the robot share the execution of the task. We use a rarely used in Human–Robot Interaction measuring tool: gaze tracking and time recording to measure for the acquisition of skills in CLS when training in Co-RALS or in CLS and time recording to compare the learning curves between Co-RALS and CLS. These metrics allow us to observe differences in Co-RALS and CLS. Training in Co-RALS develops slightly better but not significantly better hand–eye coordination skills and significantly better timewise performance compared with training in CLS alone. Co-RALS enhances timewise performance in laparoscopic surgery on specific types of tasks that require precision rather than depth perception skills compared with CLS. The results obtained enable us to further define the Human–Robot Interaction quality in Co-RALS.
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Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes. J Minim Invasive Gynecol 2019; 27:1095-1102. [PMID: 31421250 DOI: 10.1016/j.jmig.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/17/2019] [Accepted: 08/10/2019] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches. DESIGN Retrospective cohort study. SETTING An academic medical center. PATIENTS Sixty-nine women with acquired or congenital cervical insufficiency. INTERVENTIONS All women underwent TAC either by laparotomy or robotic-assisted approaches by 2 primary surgeons between January 2003 and July 2018. Women with a preconceptional TAC without a subsequent pregnancy were excluded. MEASUREMENTS AND MAIN RESULTS A total of 69 women met inclusion criteria in the 15-year study period with 40 in the historical TAC-LAP group and 29 in the TAC-RA group. Gestational age at delivery was similar in the 2 groups (36 weeks 3 days vs 37 weeks; median difference -1 day, 95% confidence interval [CI] -6 to 2, p = .36). There were no differences in birth weight, Apgar scores, neonatal intensive care unit admission, or neonatal survival. Estimated blood loss and length of stay were significantly greater in the TAC-LAP group (50 mL vs 20 mL; median difference 25, 95% CI 5-40, p = .007 and 76 hours vs 3 hours; median difference 71, 95% CI 65-75, p <.001, respectively). Operative time was significantly shorter in the TAC-LAP group (65 minutes vs 132 minutes; median difference -64.7, 95% CI -79 to -49, p <.001). There was one intra-operative complication and 4 minor postoperative complications in the TAC-LAP group and none observed in the TAC-RA group. All outcomes were similar when comparing postconceptional TAC alone, except there was no longer a difference in blood loss. When comparing pre- versus postconceptional robotic TAC, there were no differences in surgical outcomes. CONCLUSION Robotic TAC has similar favorable obstetric outcomes to traditional laparotomy and is associated with reduced blood loss and shorter hospital stays. Despite longer operative times, the robotic group did not experience any intra-operative or postoperative complications, which speaks to the benefits of this minimally invasive approach to TAC.
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Iavazzo C, Minis EE, Gkegkes ID. Robotic assisted laparoscopic cerclage: A systematic review. Int J Med Robot 2018; 15:e1966. [PMID: 30315678 DOI: 10.1002/rcs.1966] [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: 09/06/2017] [Revised: 09/11/2018] [Accepted: 10/09/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The gold standard in the management of cervical incompetence is cerclage via vaginal approach. Minimally invasive techniques, such as robotic, have been also described. MATERIALS AND METHODS A systematic search was performed in PubMed and Scopus, searching evidence on robotic assisted laparoscopic cerclage in both pregnant and non pregnant women. RESULTS Sixty-four patients were included in this study. Cervical insufficiency, failure of transvaginal cerclage, and short cervix were the most frequent indications for robotic assisted cerclage. Mean operative time was 107.3 minutes. Mean estimated blood loss was 62.8 mL. Four patients converted to laparotomy. No postoperative complications were reported. Pregnancy after robotic cerclage was reported in 59 patients with mean gestational age at delivery of 36.4 weeks. The majority of pregnant women who underwent robotic assisted cerclage gave birth to live neonates. CONCLUSION Till now, evidence does not show a clear advantage of robotic over laparoscopic approach, under the evaluation of the current literature. However, further comparative studies might be essential to clarify the possible role of da Vinci robot in this field; this might be quite difficult even in the near future based on the fact that only five cases per year are described in the current literature.
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Evelyn Eleni Minis
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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Li LL, Wang D, Ge CY, Yu L, Zhao JL, Ma HT. Dehydroepiandrosterone reduced lipid droplet accumulation via inhibiting cell proliferation and improving mitochondrial function in primary chicken hepatocytes. Physiol Res 2018. [PMID: 29527919 DOI: 10.33549/physiolres.933769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) possesses fat-reducing effect, while little information is available on whether DHEA regulates cell proliferation and mitochondrial function, which would, in turn, affect lipid droplet accumulation in the broiler. In the present study, the lipid droplet accumulation, cell proliferation, cell cycle and mitochondrial membrane potential were analysis in primary chicken hepatocytes after DHEA treated. The results showed that total area and counts of lipid droplets were significantly decreased in hepatocytes treated with DHEA. The cell viability was significantly increased, while cell proliferation was significantly inhibited in a dose dependent manner in primary chicken hepatocytes after DHEA treated. DHEA treatment significantly increased the cell population in S phase and decreased the population in G2/M in primary chicken hepatocytes. Meanwhile, the cyclin A and cyclin-dependent kinases 2 (CDK2) mRNA abundance were significantly decreased in hepatocytes after DHEA treated. No significant differences were observed in the number of mitochondria, while the mitochondrial membrane permeability and succinate dehydrogenase (SDH) activity were significantly increased in hepatocytes after DHEA treated. In conclusion, our results demonstrated that DHEA reduced lipid droplet accumulation by inhibiting hepatocytes proliferation and enhancing mitochondrial function in primary chicken hepatocytes.
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Affiliation(s)
- L L Li
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, People's Republic of China; College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, Jiangsu, People's Republic of China.
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Li L, Zhao J, Ge C, Yu L, Ma H. Dehydroepiandrosterone rehabilitate BRL‐3A cells oxidative stress damage induced by hydrogen peroxide. J Cell Physiol 2018. [DOI: 10.1002/jcp.26458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Longlong Li
- College of Veterinary MedicineNanjing Agricultural UniversityNanjingPeople's Republic of China
- Key Laboratory of Animal Physiology and BiochemistryMinistry of AgricultureNanjingPeople's Republic of China
| | - Jinlong Zhao
- College of Veterinary MedicineNanjing Agricultural UniversityNanjingPeople's Republic of China
- Key Laboratory of Animal Physiology and BiochemistryMinistry of AgricultureNanjingPeople's Republic of China
| | - Chongyang Ge
- College of Veterinary MedicineNanjing Agricultural UniversityNanjingPeople's Republic of China
- Key Laboratory of Animal Physiology and BiochemistryMinistry of AgricultureNanjingPeople's Republic of China
| | - Lei Yu
- College of Veterinary MedicineNanjing Agricultural UniversityNanjingPeople's Republic of China
- Key Laboratory of Animal Physiology and BiochemistryMinistry of AgricultureNanjingPeople's Republic of China
| | - Haitian Ma
- College of Veterinary MedicineNanjing Agricultural UniversityNanjingPeople's Republic of China
- Key Laboratory of Animal Physiology and BiochemistryMinistry of AgricultureNanjingPeople's Republic of China
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Afshari E, Rostami M, Farahmand F. Review on different experimental techniques developed for recording force-deformation behaviour of soft tissues; with a view to surgery simulation applications. J Med Eng Technol 2017; 41:257-274. [DOI: 10.1080/03091902.2016.1264492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Elnaz Afshari
- Biomechanics Department, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mostafa Rostami
- Biomechanics Department, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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Najarian S, Afshari E. Evolutions and Future Directions of Surgical Robotics: A Review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.32017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cannone F, Ladaique A, Lambaudie E, Collinet P, Houvenaeghel G. Robot-assisted laparoscopy in gynecologic surgery. J Visc Surg 2011; 148:e30-9. [PMID: 21963906 DOI: 10.1016/j.jviscsurg.2011.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F Cannone
- Département de chirurgie oncologique, resident Institut Paoli Calmettes, 232, boulevard Sainte-Marguerite, BP 156, 13273 Marseille cedex 9, France.
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Oh HC, Phua TB, Tong SC, Lim JFY. Assessing the Performance of Operating Rooms: What to Measure and Why? PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There are multiple indicators that measure different aspects of operating room (OR) performance such as OR productivity, satisfaction of patients and staff involved. The choice of these indicator(s) used for monitoring the performance of ORs often impacts how the processes of ORs are organised and managed. However, there is still no consensus in literature on which indicator(s) should be used for monitoring OR performance. In an effort to promote consensus within the healthcare community, this paper discusses potential performance metrics which may be employed for evaluation of ORs, their rationale and their limitations, and explains why a multidimensional approach is critical in assessment of OR performance.
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Affiliation(s)
- Hong Choon Oh
- Centre for Health Services Research, Singapore Health Services, Singapore
| | - Tien Beng Phua
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Shao Chuen Tong
- Health Services Research and Evaluation Division, Ministry of Health, Singapore
| | - Jeremy Fung Yen Lim
- Lien Centre for Palliative Care, Duke-NUS Graduate Medical School, Singapore
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Najarian S, Fallahnezhad M, Afshari E. Advances in medical robotic systems with specific applications in surgery--a review. J Med Eng Technol 2011; 35:19-33. [PMID: 21142589 DOI: 10.3109/03091902.2010.535593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although robotics was started as a form of entertainment, it gradually became used in different branches of science. Medicine, particularly in the operating room, has been influenced significantly by this field. Robotic technologies have offered valuable enhancements to medical or surgical processes through improved precision, stability and dexterity. In this paper we review different robotics and computer-assisted systems developed with medical and surgical applications. We cover early and recently developed systems in different branches of surgery. In addition to the united operational systems, we provide a review of miniature robotic, diagnostic and sensory systems developed to assist or collaborate with a main operator system. At the end of the paper, a discussion is given with the aim of summarizing the proposed points and predicting the future of robotics in medicine.
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Affiliation(s)
- S Najarian
- Biomechanics Department, Laboratory of Artificial Tactile Sensing and Robotic Surgery, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, Tehran, Iran.
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Shah K, Abaza R. Comparison of intraoperative outcomes using the new and old generation da Vinci® robot for robot-assisted laparoscopic prostatectomy. BJU Int 2011; 108:1642-5. [DOI: 10.1111/j.1464-410x.2011.10081.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Najarian S, Afshari E. Applications of Robots in Surgery. ADVANCES IN BIOINFORMATICS AND BIOMEDICAL ENGINEERING 2010. [DOI: 10.4018/978-1-61520-977-4.ch012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this chapter authors explain an application robotics in the field of medical diagnosis as well as in different medical fields such as rehabilitation, surgery, various diagnostic stages, medical and surgical training, etc. They discuss simply omnipresent surgery or MIS and robotic surgery and introduce different robotic surgery systems and technologies in the world. They talk about surgery and different methods of it using a chronological approach.
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Lee PS, Bland A, Valea FA, Havrilesky LJ, Berchuck A, Secord AA. Robotic-assisted laparoscopic gynecologic procedures in a fellowship training program. JSLS 2010; 13:467-72. [PMID: 20202385 PMCID: PMC3030777 DOI: 10.4293/108680809x12589998403921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
An early evaluation of the feasibility of training fellows in robotic surgery suggests that it is feasible to incorporate a systematic approach to robotic-assisted laparoscopic training at the onset of incorporating this technology into current practice. Background and Objective: The robotic surgical platform is an alternative technique to traditional laparoscopy and requires the development of new surgical skills for both the experienced surgeon and trainee. Our goal was to perform an early evaluation of the feasibility of training fellows in robotic-assisted gynecologic procedures at the outset of our incorporation of this technology into clinical practice. Methods: A systematic approach to fellow training included (1) didactic and hands-on training with the robotic system, (2) instructional videos, (3) assistance at the operating table, and (4) performance of segments of gynecologic procedures in tandem with the attending physician. Time to complete the entire procedure, individual segments, rate of conversion to laparotomy, and complications were recorded. Results: Twenty-one robotic-assisted gynecologic procedures were performed from April 2006 to January 2007. Fellows participated as the console surgeon in 14/21 cases. Thirteen patients (62%) had prior abdominal surgery. Median values with ranges were age 51 years (range, 33 to 90); BMI 28 (range, 19.4 to 43.8); EBL 25 mL (range, 25 to 250); and hospital stay 1 day (range, 1 to 4). No significant difference existed between fellow and attending mean total operative and individual segment times. One conversion to laparotomy was necessary. No major surgical complications occurred. Conclusion: These data suggest that it is feasible to incorporate a systematic approach to robotic-assisted laparoscopic training for trainees at the outset of incorporation of this technology into current practice.
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Affiliation(s)
- Paula S Lee
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Affiliation(s)
- Catherine A. Matthews
- Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Abstract
OBJECTIVES Minimally invasive surgery is beneficial for complex operations; robotics may improve performance in these procedures; however, robotic pancreaticoduodenectomy (PD) has been plagued by long operative times. We describe a small series (n = 5) of patients who underwent a hybrid PD for treatment of obstructive jaundice and pancreatic mass. METHODS After diagnostic laparoscopy, the gallbladder was retracted cephalad and the porta hepatis was dissected. The lesser sac was opened to expose the superior mesenteric vein below the pancreas. Once the vein was cleared, the bile duct, stomach, pancreas, and jejunum were transected. After the uncinate process was cleared, the specimen was removed. The da Vinci S Surgical Robotic System was docked to perform a mucosa-to-mucosa pancreaticojejunostomy and an end-to-side choledochojejunostomy. A stapled gastrojejunostomy and drain placement completed the operation. RESULTS Five patients underwent hybrid PD between May 2006 and June 2007. All patients had a history of pancreatitis and presented with obstructive jaundice and a pancreatic mass. The operations were completed with 5 ports. The mean operative time was 7 hours. The mean hospital stay was 9.6 days. At 6 months after the operation, all patients were disease-free. CONCLUSIONS Complex procedures such as PD can be accomplished with minimally invasive surgical techniques using robotic instrumentation.
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Jeong W, Sung ER, Choi JJ, Park SY, Hur H, Baik SH, Kim SW, Rha KH, Cho NH. Robot-assisted laparoscopic removal of extraluminal leiomyoma confused with urachal cyst. J Robot Surg 2010; 3:245-7. [PMID: 27628638 DOI: 10.1007/s11701-009-0166-2] [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: 09/10/2009] [Accepted: 12/08/2009] [Indexed: 11/24/2022]
Abstract
Pedunculated extra-luminal leiomyoma is a rare solid tumor. We present a case of a 20-year-old Caucasian woman with a painful pedunculated extraluminal mass located on the bladder dome and associated with dysuria. She underwent robot-assisted laparoscopic resection, and the histological findings confirmed a leiomyoma.
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Affiliation(s)
- Wooju Jeong
- Department of Urology, Yonsei University Health System, Seoul, Korea
| | - Ee-Rah Sung
- Department of Urology, Yonsei University Health System, Seoul, Korea
| | - Jun Jeong Choi
- Department of Pathology, Yonsei University Health System, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Department of General Surgery, Yonsei University Health System, Seoul, Korea
| | - Seung Hyuk Baik
- Department of General Surgery, Yonsei University Health System, Seoul, Korea
| | - Sang Woon Kim
- Department of Gynecology, Yonsei University Health System, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University Health System, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University Health System, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
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Advincula AP, Wang K. Evolving role and current state of robotics in minimally invasive gynecologic surgery. J Minim Invasive Gynecol 2009; 16:291-301. [PMID: 19423061 DOI: 10.1016/j.jmig.2009.03.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/24/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Abstract
Advancements in conventional laparoscopy afford gynecologists the ability to treat disease with minimally invasive interventions. Procedures such as hysterectomy are still performed predominantly via laparotomy. Instrumentation, complex disease, and steep learning curves are often cited as obstacles to minimally invasive surgery. The advent of robotic technology may provide a means to overcome the limitations of conventional laparoscopy through the use of 3-dimensional imaging and more dextrous and precise instruments. Current studies clearly demonstrate the feasibility and safety of applying robotics to the entire spectrum of gynecologic procedures. Rigorous scientific studies and long-term data are needed to determine the appropriate applications of robotics in gynecology. Numerous questions still exist pertaining to costs, credentialing and privileging, and training.
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Affiliation(s)
- Arnold P Advincula
- Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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21
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Reyftmann L, Dechanet C, Amar-Hoffet A, Flandrin A, Hédon B, Dechaud H. [Surgery for infertility]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38 Spec No 1-2:F35-F42. [PMID: 19268223 DOI: 10.1016/s0368-2315(09)70230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- L Reyftmann
- Service de gynécologie obstétrique et département de médecine et biologie de la reproduction, CHU A.-de-Villeneuve, Montpellier.
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Woo RK, Peterson DA, Le D, Gertner ME, Krummel T. Robot-Assisted Surgery: Technology and Current Clinical Status. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Da Vinci-assisted abdominal cerclage. Fertil Steril 2007; 88:1437.e1-3. [PMID: 17991516 DOI: 10.1016/j.fertnstert.2007.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 09/14/2007] [Accepted: 09/14/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report the first placement of an abdominal cervicoisthmic cerclage using the da Vinci robot. DESIGN Case report. SETTING Tertiary-care hospital. PATIENT(S) A 39-year-old female with a history of cervical insufficiency who required a cerclage and was not a candidate for transvaginal cerclage placement. INTERVENTION(S) Abdominal cervicoisthmic cerclage placement using the da Vinci robot. MAIN OUTCOME MEASURE(S) Ability to safely and successfully place an abdominal cerclage using the da Vinci robot. RESULT(S) Abdominal cerclage was successfully placed using the da Vinci robot. The patient had minimal blood loss and was discharged to home on the same day as surgery. CONCLUSION(S) Da Vinci robot-assisted abdominal cerclage placement is an innovative application of robotic surgery and may alter the standard of care for women who require this surgery.
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Rodgers AK, Goldberg JM, Hammel JP, Falcone T. Tubal anastomosis by robotic compared with outpatient minilaparotomy. Obstet Gynecol 2007; 109:1375-80. [PMID: 17540810 DOI: 10.1097/01.aog.0000264591.43544.0f] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare tubal anastomosis by robotic system compared with outpatient minilaparotomy. METHODS In this retrospective case-control study, women were identified by current procedural terminology code for tubal anastomosis. We included all cases of tubal anastomosis for reversal of a prior tubal ligation by either outpatient minilaparotomy or robotic system technique. Cases performed by laparoscopy without aid of the robot were excluded. Comparisons were based on Fisher's exact, chi(2), and Wilcoxon rank sum tests. RESULTS There were 26 cases of tubal anastomosis performed with the robot and 41 cases performed by outpatient minilaparotomy. The two groups were comparable in age, body mass index, and parity. Anesthesia time for the robotic technique (median with interquartile range) was 283 (267-290) minutes compared with 205 (170-230) minutes with outpatient minilaparotomy (P<.001). Surgical times for the robot and minilaparotomy were 229 (205-252) minutes and 181 (154-202) minutes respectively (P=.001). Hospitalization times, pregnancy, and ectopic pregnancy rates were not significantly different. The robotic technique was more costly. The median difference in costs of the procedures was $1,446 (95% confidence interval $1,112-1,812) (P<.001). The time to return to work was significantly shorter in the robotic system group by approximately 1 week (P=.013). CONCLUSION Robotic surgery for tubal anastomosis was successfully accomplished without conversion to laparotomy. The robotic technique for tubal anastomosis required significantly prolonged surgical and anesthesia times over outpatient minilaparotomy (P<or=.001). Costs were higher with the robotic technique. Return to normal activity was shorter with the robotic technique.
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Affiliation(s)
- Allison K Rodgers
- Departments of Obstetrics and Gynecology, the Cleveland Clinic, Cleveland, Ohio 44159, USA
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Vlahos NF, Bankowski BJ, King JA, Shiller DA. Laparoscopic tubal reanastomosis using robotics: experience from a teaching institution. J Laparoendosc Adv Surg Tech A 2007; 17:180-5. [PMID: 17484644 DOI: 10.1089/lap.2006.0035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Tubal reanastomosis typically requires a laparotomy and in the past few years has been performed much less frequently due to the development and success of in vitro fertilization. Laparoscopic tubal anastomosis eliminates the need for laparotomy and can be performed in an out-patient setting. MATERIALS AND METHODS From October 2003 to September 2004, five patients who had previous tubal sterilization and requested tubal reanastomosis underwent laparoscopic tubal reanastomosis with the use of the da Vinci surgical system (Intuitive Surgical, Mountain View, CA). RESULTS Ten fallopian tubes were successfully reconstructed, as confirmed by chromopertubation at the end of the procedure. Patency was confirmed by hysterosalpingogram in seven out of eight tubes. The mean (+/- standard deviation) time of the procedure was 172 +/- 53 min. The mean time for docking the robotic arms to the patient was 62 +/- 16.8 min and the mean robotic time was 97 +/- 36 min. There were two live births, one ectopic pregnancy, and one biochemical pregnancy. The mean time to conception was 5.5 +/- 2 months. CONCLUSION Laparoscopic microsurgical tubal reanastomosis after tubal sterilization can be performed using a remote-controlled robotic system. Systematization of the operative steps allowed for operative times that compare favorably with the time needed for open microsurgical techniques. Larger series are needed to standardize the procedure and confirm postoperative fecundity rates.
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Patel VR, Chammas MF, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract 2007; 61:309-14. [PMID: 17263718 DOI: 10.1111/j.1742-1241.2006.01235.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Open retropubic radical prostatectomy is the gold standard treatment for localised prostate cancer. However, the procedure has inherent morbidity associated to it. Therefore, less invasive surgical techniques have been sought, one such alternative is robotic-assisted laparoscopic radical prostatectomy. The advantages provided by robotic technology have the potential to minimise patient morbidity while improving both functional and oncological outcomes. Although it is a recent technological advancement, robotic surgery has shown an increasing rate of adoption worldwide. Currently more than 30,000 patients have undergone this procedure worldwide. We present a review of the available literature on robotic-assisted laparoscopic radical prostatectomy.
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Affiliation(s)
- V R Patel
- Centre for Robotic Urologic Surgery, Ohio State University, Columbus, OH, USA.
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Patel VR. Essential elements to the establishment and design of a successful robotic surgery programme. Int J Med Robot 2006; 2:28-35. [PMID: 17520611 DOI: 10.1002/rcs.77] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The application of robotic assisted technology has created a new era in surgery, by addressing some of the limitations of conventional open and laparoscopic surgery. To optimize success the incorporation of robotics into a surgical program must be performed with a structured approach. We discuss the key factors for building a successful robotic surgery program. MATERIALS AND METHODS Prior to implementing a robotics program certain essential elements must be examined. One must assess the overall goals of the program, the initial applications of the technology and the time line for success. In addition a financial analysis of the potential impact of the technology must also be performed. Essential personnel should also be identified in order to form a cohesive robotic surgery team. These preparatory sets help coordinate the establishment of the program and help to prevent unrealistic expectations; while generating the best environment for success. RESULTS Once the purchase of the robotic system has been approved a robotic surgery team is created with certain essential components. This staff includes: the surgeons, nursing staff, physician assistants, resident/fellows, program coordinator, marketing and a financial analysis team. This team will work together to achieve the common goals for the program. CONCLUSION Robotic assisted surgery has grown tremendously over the last half decade in certain surgical fields such as urology. The success of programs has been variable and often related to the infrastructure of the program. The key factors appear to be creation of a sound financial plan, early identification of applicable specialties and a motivated surgical team.
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Affiliation(s)
- Vipul R Patel
- Department of Robotic and Minimally Invasive Urologic Surgery, The Ohio State University Medical Center, Columbus, OH 43210, USA.
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