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Şenol Çelik S, Tunçbilek Z, Sarıköse S, Topaktaş G, Canda AE. Roles, experience and views of nurses working in robotic surgery settings: A mixed-methods study. J Perioper Pract 2024; 34:248-256. [PMID: 38606911 DOI: 10.1177/17504589241231100] [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: 04/13/2024]
Abstract
Robotic-assisted surgery has benefits for patients, but there are challenges to working in this field. In Turkey, training is not provided for nurses working in robotic-assisted surgery, and national legislation on nurses' roles in these settings has not been implemented. This study aimed to demonstrate the roles and experiences of nurses in robotic-assisted surgery in Turkey. This study was conducted as a mixed-methods research. The qualitative data were analysed by content analysis. More than half of the nurses had received basic training in robotic-assisted surgery. Qualitative data consisted of five themes, including the effects of robotic surgery, feelings and thoughts on robotic surgery, working as a nurse in robotic surgery settings, responsibilities of nurses and competence of nurses working in robotic surgery settings. Determining the working conditions and roles of nurses working in robotic-assisted surgery settings by policymakers in regulations is crucial for improving the quality of nursing care and the outcomes of patients.
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Affiliation(s)
| | | | | | - Gülsen Topaktaş
- Department of Education and Certification, Ministry of Health, Ankara, Turkey
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2
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Presl J, Ehgartner M, Schabl L, Singhartinger F, Gantschnigg A, Wallner E, Jäger T, Emmanuel K, Kessler H, Koch OO. Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis. Langenbecks Arch Surg 2024; 409:200. [PMID: 38935194 PMCID: PMC11211106 DOI: 10.1007/s00423-024-03382-0] [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: 03/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Robotic assisted surgery is an alternative, fast evolving technique for performing colorectal surgery. The primary aim of this single center analysis is to compare elective laparoscopic and robotic sigmoid colectomies for diverticular disease on the extent of operative trauma and the costs. METHODS Retrospective analysis from our prospective clinical database to identify all consecutive patients aged ≥ 18 years who underwent elective minimally invasive left sided colectomy for diverticular disease from January 2016 until December 2020 at our tertiary referral institution. RESULTS In total, 83 patients (31 female and 52 male) with sigmoid diverticulitis underwent elective minimally invasive sigmoid colectomy, of which 42 underwent conventional laparoscopic surgery (LS) and 41 robotic assisted surgery (RS). The mean C-reactive protein difference between the preoperative and postoperative value was significantly lower in the robotic assisted group (4,03 mg/dL) than in the laparoscopic group (7.32 mg/dL) (p = 0.030). Similarly, the robotic´s hemoglobin difference was significantly lower (p = 0.039). The first postoperative bowel movement in the LS group occurred after a mean of 2.19 days, later than after a mean of 1.63 days in the RS group (p = 0.011). An overview of overall charge revealed significantly lower total costs per operation and postoperative hospital stay for the robotic approach, 6058 € vs. 6142 € (p = 0,014) not including the acquisition and maintenance costs for both systems. CONCLUSION Robotic colon resection for diverticular disease is cost-effective and delivers reduced intraoperative trauma with significantly lower postoperative C-reactive protein and hemoglobin drift compared to conventional laparoscopy.
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Affiliation(s)
- Jaroslav Presl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - M Ehgartner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - L Schabl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - F Singhartinger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - A Gantschnigg
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Wallner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - T Jäger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - H Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - O O Koch
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
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Handa A, Gaidhane A, Choudhari SG. Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges. Cureus 2024; 16:e62958. [PMID: 39050344 PMCID: PMC11265954 DOI: 10.7759/cureus.62958] [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: 04/16/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.
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Affiliation(s)
- Alisha Handa
- Community Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sonali G Choudhari
- School of Epidemiology and Public Health, Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Takács K, Lukács E, Levendovics R, Pekli D, Szijártó A, Haidegger T. Assessment of Surgeons' Stress Levels with Digital Sensors during Robot-Assisted Surgery: An Experimental Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2915. [PMID: 38733021 PMCID: PMC11086209 DOI: 10.3390/s24092915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Robot-Assisted Minimally Invasive Surgery (RAMIS) marks a paradigm shift in surgical procedures, enhancing precision and ergonomics. Concurrently it introduces complex stress dynamics and ergonomic challenges regarding the human-robot interface and interaction. This study explores the stress-related aspects of RAMIS, using the da Vinci XI Surgical System and the Sea Spikes model as a standard skill training phantom to establish a link between technological advancement and human factors in RAMIS environments. By employing different physiological and kinematic sensors for heart rate variability, hand movement tracking, and posture analysis, this research aims to develop a framework for quantifying the stress and ergonomic loads applied to surgeons. Preliminary findings reveal significant correlations between stress levels and several of the skill-related metrics measured by external sensors or the SURG-TLX questionnaire. Furthermore, early analysis of this preliminary dataset suggests the potential benefits of applying machine learning for surgeon skill classification and stress analysis. This paper presents the initial findings, identified correlations, and the lessons learned from the clinical setup, aiming to lay down the cornerstones for wider studies in the fields of clinical situation awareness and attention computing.
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Affiliation(s)
- Kristóf Takács
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
| | - Eszter Lukács
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
| | - Renáta Levendovics
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
- John von Neumann Faculty of Informatics (NIK), Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology (ACMIT), 2700 Wiener Neustadt, Austria
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary; (D.P.); (A.S.)
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary; (D.P.); (A.S.)
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
- Austrian Center for Medical Innovation and Technology (ACMIT), 2700 Wiener Neustadt, Austria
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Devine M, Morris M, Kavanagh D. Transferability of Technical Skills Across Robotic Surgery Platforms: A Scoping Review. Cureus 2024; 16:e56429. [PMID: 38638798 PMCID: PMC11024662 DOI: 10.7759/cureus.56429] [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] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
As the application of robotic approaches to surgery continues to broaden, new consoles have been introduced to the market. Due to the global utilization of a single platform, previously validated curricula have not been assessed on new robotic systems. Surgery by its nature occurs in a high-stakes environment, potentially exacerbated by non-standardized robotic systems. The aim of this review is to critique the evidence available regarding the transferability of technical skills across robotic platforms. A scoping review utilizing the Medline (Pubmed) and Cochrane Databases was conducted. Full texts were reviewed and appraised. Selected articles were eligible for inclusion if they investigated the ability or implications of the transfer of skill across robotic platforms. Data was extracted, coded inductively, and themes synthesized. NVIVO software was used as an adjunct for this qualitative analysis. Following the removal of duplicates a total of 278 papers were screened according to the eligibility criteria. Fifty full-text articles were reviewed and four met the criterion for inclusion. Novices' performance across platforms was comparable. Increasing levels of prior robotic experience revealed an improvement in technical performance on a novel robotic platform. Safety metrics appear comparable across systems. Quantifying learning curves across robotic platforms and their implications for the robotic surgeon in training remains to be determined. Future research needs to address the gaps in the literature by clearly defining the extent of technical skills transfer between robotic platforms. These factors will guide the next iteration of surgical training curriculums and regulations for robotic surgery.
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Affiliation(s)
- Michael Devine
- Department of Surgical Affairs, Royal College of Surgeons in Ireland/Hermitage Medical Clinic, Dublin, IRL
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Dara Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, IRL
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Stalder A, Mazzola F, Adamina M, Fahrner R. The distribution of robotic surgery in general and visceral surgery departments in Switzerland - a nationwide inquiry. Innov Surg Sci 2024; 9:55-62. [PMID: 38826632 PMCID: PMC11138402 DOI: 10.1515/iss-2023-0052] [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: 08/18/2023] [Accepted: 01/29/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives Since its introduction as a clinical technique, robotic surgery has been extended to different fields of surgery. However, the indications as well as the number of robotic procedures varied in different institutions. The aim of this investigation was to evaluate the current use of robotic surgery in general and digestive surgery in Switzerland. Methods All Swiss surgical departments that are recognized training institutes for postgraduate training in surgery by the Swiss Institute of Medical Education (SIWF) were queried with a detailed questionnaire regarding the use of robotic surgery techniques and were analyzed regarding hospital size and type of hospital. Results Ninety-three departments were queried, and 67 % (n=63) answered the survey. Fifty-eight were public, and five were private institutions. Seventeen (26 %) of the queried departments used robotic surgery in digestive surgery. Four out of 17 (23 %) of the departments that performed robotic surgery were private hospitals, while 13 (77 %) were public institutions. In the majority of departments, robotic surgery of the rectum (n=12; 70.6 %) and colon (n=11; 64.7 %) was performed, followed by hernia procedures (n=8; 47.1 %) and fundoplication (n=7; 41.2 %). Less frequently, pancreatic resections (n=5; 29.4 %), cholecystectomy (n=4; 23.5 %), adrenalectomy (n=4; 23.5 %), gastric bypass (n=3; 17.7 %), gastric sleeve (n=3; 17.7 %), hepatic procedures (n=2; 11.7 %), or small bowel resections (n=1; 5.9 %) were performed as robotic procedures. More than 25 procedures per year per department were performed for hernia surgery (n=5 departments), gastric bypass (n=2 departments), cholecystectomy, fundoplication, and colon surgery (each n=1 department). Conclusions The number and range of robotic procedures performed in Switzerland varied widely. Higher accreditation for general surgery or subspecialization of visceral surgery of the department was positively associated with the use of robotic techniques, reflecting an unequal availability of robotic surgery.
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Affiliation(s)
- Andreas Stalder
- Department of Medicine, Hospital of Fribourg, Fribourg, Switzerland
| | - Federico Mazzola
- Department of General and Transplant Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Michel Adamina
- Department of Surgery, Hospital of Winterthur, Winterthur, Switzerland
| | - René Fahrner
- Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
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Marchegiani F, Siragusa L, Zadoroznyj A, Laterza V, Mangana O, Schena CA, Ammendola M, Memeo R, Bianchi PP, Spinoglio G, Gavriilidis P, de'Angelis N. New Robotic Platforms in General Surgery: What's the Current Clinical Scenario? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1264. [PMID: 37512075 PMCID: PMC10386395 DOI: 10.3390/medicina59071264] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Orsalia Mangana
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, 88100 Catanzaro, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Giuseppe Spinoglio
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, Saint Helena STHL 1ZZ, South Atlantic Ocean, UK
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
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Zhao W, Hu C, Xu T. In vivo bioprinting: Broadening the therapeutic horizon for tissue injuries. Bioact Mater 2023; 25:201-222. [PMID: 36817820 PMCID: PMC9932583 DOI: 10.1016/j.bioactmat.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Tissue injury is a collective term for various disorders associated with organs and tissues induced by extrinsic or intrinsic factors, which significantly concerns human health. In vivo bioprinting, an emerging tissue engineering approach, allows for the direct deposition of bioink into the defect sites inside the patient's body, effectively addressing the challenges associated with the fabrication and implantation of irregularly shaped scaffolds and enabling the rapid on-site management of tissue injuries. This strategy complements operative therapy as well as pharmacotherapy, and broadens the therapeutic horizon for tissue injuries. The implementation of in vivo bioprinting requires targeted investigations in printing modalities, bioinks, and devices to accommodate the unique intracorporal microenvironment, as well as effective integrations with intraoperative procedures to facilitate its clinical application. In this review, we summarize the developments of in vivo bioprinting from three perspectives: modalities and bioinks, devices, and clinical integrations, and further discuss the current challenges and potential improvements in the future.
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Affiliation(s)
- Wenxiang Zhao
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
- Beijing Key Laboratory of Precision/Ultra-Precision Manufacturing Equipments and Control, Tsinghua University, Beijing, 100084, China
| | - Chuxiong Hu
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
- Beijing Key Laboratory of Precision/Ultra-Precision Manufacturing Equipments and Control, Tsinghua University, Beijing, 100084, China
| | - Tao Xu
- Center for Bio-intelligent Manufacturing and Living Matter Bioprinting, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, China
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Covaciu F, Crisan N, Vaida C, Andras I, Pusca A, Gherman B, Radu C, Tucan P, Al Hajjar N, Pisla D. Integration of Virtual Reality in the Control System of an Innovative Medical Robot for Single-Incision Laparoscopic Surgery. SENSORS (BASEL, SWITZERLAND) 2023; 23:5400. [PMID: 37420568 DOI: 10.3390/s23125400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
In recent years, there has been an expansion in the development of simulators that use virtual reality (VR) as a learning tool. In surgery where robots are used, VR serves as a revolutionary technology to help medical doctors train in using these robotic systems and accumulate knowledge without risk. This article presents a study in which VR is used to create a simulator designed for robotically assisted single-uniport surgery. The control of the surgical robotic system is achieved using voice commands for laparoscopic camera positioning and via a user interface developed using the Visual Studio program that connects a wristband equipped with sensors attached to the user's hand for the manipulation of the active instruments. The software consists of the user interface and the VR application via the TCP/IP communication protocol. To study the evolution of the performance of this virtual system, 15 people were involved in the experimental evaluation of the VR simulator built for the robotic surgical system, having to complete a medically relevant task. The experimental data validated the initial solution, which will be further developed.
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Affiliation(s)
- Florin Covaciu
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Pusca
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Corina Radu
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
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Walshaw J, Huo B, McClean A, Gajos S, Kwan JY, Tomlinson J, Biyani CS, Dimashki S, Chetter I, Yiasemidou M. Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery-a narrative review. Front Surg 2023; 10:1193486. [PMID: 37288133 PMCID: PMC10242011 DOI: 10.3389/fsurg.2023.1193486] [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: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort.
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Affiliation(s)
- Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adam McClean
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Samantha Gajos
- Emergency Medicine Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Jing Yi Kwan
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James Tomlinson
- Department of Spinal Surgery, SheffieldTeaching Hospitals, Sheffield, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Safaa Dimashki
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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Wu CT, Lin TY, Lin CJ, Hwang DK. The future application of artificial intelligence and telemedicine in the retina: A perspective. Taiwan J Ophthalmol 2023; 13:133-141. [PMID: 37484624 PMCID: PMC10361422 DOI: 10.4103/tjo.tjo-d-23-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
The development of artificial intelligence (AI) and deep learning provided precise image recognition and classification in the medical field. Ophthalmology is an exceptional department to translate AI applications since noninvasive imaging is routinely used for the diagnosis and monitoring. In recent years, AI-based image interpretation of optical coherence tomography and fundus photograph in retinal diseases has been extended to diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. The rapid development of portable ocular monitoring devices coupled with AI-informed interpretations allows possible home monitoring or remote monitoring of retinal diseases and patients to gain autonomy and responsibility for their conditions. This review discusses the current research and application of AI, telemedicine, and home monitoring devices on retinal disease. Furthermore, we propose a future model of how AI and digital technology could be implemented in retinal diseases.
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Affiliation(s)
- Chu-Ting Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Yi Lin
- Doctoral Degree Program of Translational Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Cheng-Jun Lin
- Department of Biological Science and Technology, Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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Feasibility of a Robot-Assisted Surgical Navigation System for Mandibular Distraction Osteogenesis in Hemifacial Microsomia: A Model Experiment. J Craniofac Surg 2023; 34:525-531. [PMID: 36173942 DOI: 10.1097/scs.0000000000009028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the feasibility and accuracy of osteotomy and distractor placement using a robotic navigation system in a model surgical experiment of mandibular distraction osteogenesis for hemifacial microsomia. Imaging data from 5 patients with Pruzansky-Kaban type II (IIa: 4; IIb: 1) mandibular deformities were used to print 3D models for simulated mandibular distraction osteogenesis. In the experimental group, a robot-assisted surgical navigation system was used to perform the surgery under robotic guidance following registration, according to the preoperative design. Conventional surgery was performed in the control group, in which the operation was based on intraoperative estimations of the preoperative design by experienced surgeons. The accuracies of the osteotomy and distractor placement were assessed based on distance and angular error. Osteotomy accuracy was higher in the experimental group than in the control group, and the distance error ( t =9.311, P <0.001) and angular error ( t =5.385, P =0.001) were significantly reduced. The accuracy of distractor placement was also significantly higher in the experimental group, while the distance error ( t =3.048, P =0.016) and angular error ( t =3.524, P =0.024) were significantly reduced. The present results highlight the feasibility of robot-assisted distraction osteogenesis combined with electromagnetic navigation for improved surgical precision in clinical settings.
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Puentes MC, Rojnica M, Sims T, Jones R, Bianco FM, Lobe TE. Senhance Robotic Platform in Pediatrics: Early US Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020178. [PMID: 36832307 PMCID: PMC9955020 DOI: 10.3390/children10020178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Different robotic systems have been used widely in human surgery since 2000, but pediatric patients require some features that are lacking in the most frequently used robotic systems. HYPOTHESIS The Senhance® robotic system is a safe and an effective device for use in infants and children that has some advantages over other robotic systems. METHODS All patients between 0 and 18 years of age whose surgery was amenable to laparoscopy were offered enrollment in this IRB-approved study. We assessed the feasibility, ease and safety of using this robotic platform in pediatric patients including: set-up time, operative time, conversions, complications and outcomes. RESULTS Eight patients, ranging from 4 months to 17 years of age and weighing between 8 and 130 kg underwent a variety of procedures including: cholecystectomy (3), inguinal herniorrhaphy (3), orchidopexy for undescended testes (1) and exploration for a suspected enteric duplication cyst (1). All robotic procedures were successfully performed. The 4-month-old (mo), 8 kg patient underwent an uneventful robotic exploration in an attempt to locate a cyst that was hidden in the mesentery at the junction of the terminal ileum and cecum, but ultimately the patient required an anticipated laparotomy to palpate the cyst definitively and to excise it completely. There was no blood loss and no complications. Robotic manipulation with the reusable 3 mm instruments proved successful in all cases. CONCLUSIONS Our initial experience with the Senhance® robotic platform suggests that this is a safe and effective device for pediatric surgery that is easy to use, and which warrants continued evaluation. Most importantly, there appears to be no lower age or weight restrictions to its use.
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Affiliation(s)
- Maria Consuelo Puentes
- Department of Surgery, The University of Illinois, 840 S Wood Street, Ste 416, Chicago, IL 60612, USA
- Hospital Luis Calvo Mackenna, Antonio Varas 360, Providencia 7500539, Chile
| | - Marko Rojnica
- Department of Surgery, The University of Illinois, 840 S Wood Street, Ste 416, Chicago, IL 60612, USA
- Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Thomas Sims
- Department of Surgery, The University of Illinois, 840 S Wood Street, Ste 416, Chicago, IL 60612, USA
- Mount Sinai Hospital, Chicago, IL 60608, USA
| | | | - Francesco M. Bianco
- Department of Surgery, The University of Illinois, 840 S Wood Street, Ste 416, Chicago, IL 60612, USA
- Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Thom E. Lobe
- Department of Surgery, The University of Illinois, 840 S Wood Street, Ste 416, Chicago, IL 60612, USA
- Mount Sinai Hospital, Chicago, IL 60608, USA
- Correspondence: ; Tel.: +1-(901)-550-1378
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14
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Lin Y, Zhang C, Liu C, Ma X, Yang Q, Guan B, Liu Z. Imaging-Navigated Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1199:87-106. [PMID: 37460728 DOI: 10.1007/978-981-32-9902-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
It is vitally important to guide or navigate therapeutic proceedings with a direct and visual approach in order to carefully undertake precision medical manipulations and efficiently evaluate the treatments. Imaging-navigated surgery is one of the common and prevailing technologies to realize this target, and more importantly it merges visualized medicine into next-generation theranostic paradigms in modern medicine. Endoscopes, surgical robots, and nanorobots are three major domains in terms of imaging-navigated surgery. The history of endoscopy has seen upgraded developments since the early 1800s. In contrast, surgical robots have been widely used and investigated in recent years, and they came into clinical uses only in the past decades. Nanorobots which closely depend on innovated and multifunctional biomaterials are still in their infancy. All these imaging-navigated technologies show similar and apparent advantages such as minimal invasiveness, minimized pain, positive prognosis, and relatively expected recovery, which have greatly improved surgery efficiency and patients' life quality. Therefore, the imaging-navigated surgery will be discussed in this chapter, and advanced clinical and preclinical medical applications will also be demonstrated for a diverse readers and comprehensive understanding.
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Affiliation(s)
- Yandai Lin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chen Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chenxi Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xinyong Ma
- Division of Academic & Cultural Activities, Academic Divisions of the Chinese Academy of Sciences, Beijing, China
| | - Qiang Yang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Binggang Guan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhe Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
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15
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Surgeon perception of factors affecting the efficiency of conventional and robotic laparoscopy: A Pan India study. Heliyon 2022; 8:e12561. [PMID: 36619437 PMCID: PMC9813728 DOI: 10.1016/j.heliyon.2022.e12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Background Laparoscopic surgery, being minimally invasive, offers many benefits including faster patient recovery, reduced scarring and lower mortality rate. It is, however, technically challenging and requires a long learning curve. These issues can be overcome by Robot-Assisted Surgery (RAS) systems, which incorporate computer-controlled motions enabling enhanced precision and accuracy. Methods This study involves identifying and verifying various difficulties related to laparoscopy and the role of RAS in their mitigation. It involved 93 surgeons across India, covering a range of demographics, medical specialties and experience. They were interviewed to understand the current status and to compare RAS with conventional laparoscopy. The questionnaire developed for the purpose tests a set of hypotheses related to instruments, comfort, and other factors derived from the available literature as well as inputs from leading laparoscopy surgeons and domain experts. Results A grading system was adopted to evaluate the hypotheses based on the surgeons' responses. A statistical method based on T-test was employed to gain useful inferences from the study. The results showed that early-career surgeons preferred haptic enabled systems. As the experience of the surgeon increases, tissue identification becomes easier, thereby reducing the need for haptic feedback-enabled instruments. Conclusions The surgeons from across the demographics were strongly in the favour of the need for articulated instruments with surgeon-controlled camera systems. They reported a reduction in physical and mental discomfort during surgical procedures using RAS. They also confirmed the similarity in patient outcomes for both conventional laparoscopy and RAS. These insights are expected to be interesting and useful for further research and development in this field.
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16
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Chitwood WR. Historical evolution of robot-assisted cardiac surgery: a 25-year journey. Ann Cardiothorac Surg 2022; 11:564-582. [PMID: 36483613 PMCID: PMC9723535 DOI: 10.21037/acs-2022-rmvs-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 08/18/2023]
Abstract
Many patients and surgeons today favor the least invasive access to an operative site. The adoption of robot-assisted cardiac surgery has been slow, but now has come to fruition. The development of modern surgical robots took surgeons close collaboration with mechanical, electrical, and optical engineers. Moreover, the necessary project funding required entrepreneurs, federal grants, and venture capital. Non-robotic minimally invasive cardiac surgery paved the way to the application of surgical robots by making changes in operative approaches, instruments, visioning modalities, cardiopulmonary perfusion techniques, and especially surgeons' attitudes. In this article, the serial development of robot-assisted cardiac surgery is detailed from the beginning and through clinical application. Included are references to the historical and most recent clinical series that have given us the evidence that robot-assisted cardiac surgery is safe and provides excellent outcomes. To this end, in many institutions these procedures now have become a new standard of care. This evolution reflects Sir Isaac Newton's famous 1676 quote when referring to Rene Descartes, "If have seen further [sic] than others, it is by standing on the shoulders of giants".
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Affiliation(s)
- W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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17
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Scognamiglio P, Stüben BO, Heumann A, Li J, Izbicki JR, Perez D, Reeh M. Advanced Robotic Surgery: Liver, Pancreas, and Esophagus - The State of the Art? Visc Med 2022; 37:505-510. [PMID: 35087901 DOI: 10.1159/000519753] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
Background The trend in performing robotic-assisted operations in visceral surgery has been increasing in the last decade, also reaching the challenging field of hepatic, pancreatic, and esophageal surgery. Nevertheless, solid data about advantages and disadvantages of the robotic approach are still missing. The aim of this review is to analyze the benefit and impact of robotic surgery in the field of hepatic, pancreatic, and esophageal surgery, focusing on the comparison with the conventional laparoscopic or open approach. Summary The well-known advantages of laparoscopic surgery in comparison to the open approach are also valid for robotic surgery, with the addition of a 3D-view camera, wristed instrumentation, and an ergonomic console. On the other hand, the use of a robotic system leads to longer operating time and higher costs. Randomized controlled trials comparing the robotic approach with the laparoscopic one are still missing. Key Message Recent meta-analyses show promising results of the usage of robotic systems in advanced surgical procedures, like hepatic, pancreatic, and esophageal resections. Further randomized studies are needed to validate the postulated benefit.
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Affiliation(s)
- Pasquale Scognamiglio
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Björn-Ole Stüben
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Asmus Heumann
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Li
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Perez
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Judy BF, Pennington Z, Botros D, Tsehay Y, Kopparapu S, Liu A, Theodore N, Zakaria HM. Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve. Int J Spine Surg 2021; 15:S28-S37. [PMID: 34675029 DOI: 10.14444/8138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David Botros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Baptiste YM. Digital Feast and Physical Famine: The Altered Ecosystem of Anatomy Education due to the Covid-19 Pandemic. ANATOMICAL SCIENCES EDUCATION 2021; 14:399-407. [PMID: 33961346 PMCID: PMC8239895 DOI: 10.1002/ase.2098] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 05/21/2023]
Abstract
This article explores the effects of the coronavirus disease 2019 (Covid-19) pandemic on the evolution of both physical and digital cadavers within the unique ecosystem of the anatomy laboratory. A physical cadaver is a traditional and established learning tool in anatomy education, whereas a digital cadaver is a relatively recent phenomenon. The Covid-19 pandemic presented a major disturbance and disruption to all levels and types of education, including anatomy education. This article constructs a conceptual metaphor between a typical anatomy laboratory and an ecosystem, and considers the affordances, constraints, and changing roles of physical and digital cadavers within anatomy education through an ecological lens. Adaptation of physical and digital cadavers during the disturbance is analyzed, and the resiliency of digital cadaver technology is recognized. The evolving role of the digital cadaver is considered in terms of increasing accessibility and inclusivity within the anatomy laboratory ecosystem of the future.
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Affiliation(s)
- Yvonne M. Baptiste
- Division of Science, Health, and MathematicsNiagara County Community CollegeSanbornNew York
- Curriculum, Instruction, and the Science of Learning PhD ProgramState University of New York at BuffaloBuffaloNew York
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20
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Krüger CM, Rückbeil O, Sebestyen U, Schlick T, Kürbis J, Riediger H. [DeRAS I-German situation of robotic-assisted surgery-an online survey]. Chirurg 2021; 92:1107-1113. [PMID: 34170354 PMCID: PMC8629862 DOI: 10.1007/s00104-021-01404-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Die robotische Assistenz hat sich in der Chirurgie etabliert, ist aber noch kein Standard. Der aktuelle Stand der klinischen Verbreitung in Deutschland ist weiter unklar. Industrieunabhängige Quellen sind rar. Ziel der Arbeit Ziel dieser Umfrage ist es, den aktuellen Stand der robotisch assistierten Chirurgie (RAS) fachübergreifend in Deutschland im Zeitraum von 2014 bis 2018 zu untersuchen. Materialien und Methoden Mit einer Internetrecherche wurden Krankenhäuser (KH) und Fachabteilungen (FA) mit Zugang zur RAS identifiziert. Die FA wurden aufgefordert, ihre Daten aus den Jahren 2014 bis 2018 zu teilen. Neben klinischen Daten wurden Daten zu Nutzung, Implementierung, Training und Finanzierung abgefragt. Ergebnisse Am 31.12.2018 wurde die RAS an 121 KH in Deutschland angeboten. 383 FA mit Zugang zur RAS wurden identifiziert. 26 % (n = 98) der FA haben geantwortet. Im Mittel verfügte jede FA über zwei Konsolenchirurgen. 10 % der KH verfügten über mehr als 1 RAS-System. 100 % der erfassten RAS-Systeme stammten von der Firma Intuitive Surgical Inc., CA, USA. Die RAS wurde zu 65 % in der Urologie implementiert, zu 12 % in der Viszeralchirurgie (VC). 21 % der Programme erfolgten interdisziplinär und 4 % multidisziplinär (> 3). 83 % der Systeme wurden gekauft, 17 % anderweitig finanziert. Bei den Operationsmehrkosten gaben 74 % der Kliniken an, diese selbst zu tragen. 14 % wählten eine Umlage. Seit 2014 steigerten sich die Eingriffe um den Faktor 4 auf ca. 8000. Der Anteil der VC steigerte sich um das Fünffache seit 2016. Schlussfolgerung Die RAS erlebte in Deutschland bis 2018 ein starkes Wachstum. Das Eingriffsspektrum entspricht dem der Laparoskopie. Bei aktuell fehlender Kostenerstattung für den technischen Mehraufwand, wird die RAS überwiegend im mittel- und hochkomplexen Bereich eingesetzt. Der Online-Survey ist eine gute Methode, ohne hohen administrativen Aufwand unabhängige Daten zu erheben.
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Affiliation(s)
- C M Krüger
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland.
| | - O Rückbeil
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - U Sebestyen
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - T Schlick
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - J Kürbis
- SurgiData UG, Mahlow, Deutschland
| | - H Riediger
- Department für Chirurgie, Vivantes Humboldt Klinikum, Berlin, Deutschland
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Rondelli F, Sanguinetti A, Polistena A, Avenia S, Marcacci C, Ceccarelli G, Bugiantella W, De Rosa M. Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art. J Pers Med 2021; 11:jpm11060584. [PMID: 34205596 PMCID: PMC8233761 DOI: 10.3390/jpm11060584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Alessandro Sanguinetti
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Andrea Polistena
- Department of General and Laparoscopic Surgery–University Hospital, University of Rome, “Umberto I”, 00161 Rome, Italy;
| | - Stefano Avenia
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Claudio Marcacci
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Graziano Ceccarelli
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Walter Bugiantella
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Michele De Rosa
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
- Correspondence:
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22
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Han JJ, Woo SY, Yi WJ, Hwang SJ. Robot-Assisted Maxillary Positioning in Orthognathic Surgery: A Feasibility and Accuracy Evaluation. J Clin Med 2021; 10:jcm10122596. [PMID: 34208399 PMCID: PMC8231103 DOI: 10.3390/jcm10122596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
Several methods enabling independent repositioning of the maxilla have been introduced to reduce intraoperative errors inherent in the intermediate splint. However, the accuracy is still to be improved and a different approach without time-consuming laboratory process is needed, which can allow perioperative modification of unoptimized maxillary position. The purpose of this study is to assess the feasibility and accuracy of a robot arm combined with intraoperative image-guided navigation in orthognathic surgery. The experiments were performed on 12 full skull phantom models. After Le Fort I osteotomy, the maxillary segment was repositioned to a different target position using a robot arm and image-guided navigation and stabilized. Using the navigation and the postoperative computed tomography (CT) images, the achieved maxillary position was compared with the planned position. Although the maxilla showed mild displacement during the fixation, the mean absolute deviations from the target position were 0.16 mm, 0.18 mm, and 0.20 mm in medio-lateral, antero-posterior, and supero-inferior directions, respectively, in the intraoperative navigation. Compared with the target position using postoperative CT, the achieved maxillary position had a mean absolute deviation of less than 0.5 mm for all dimensions and the mean root mean square deviation was 0.79 mm. The results of this study suggest that the robot arm combined with the intraoperative image-guided navigation may have great potential for surgical plan transfer with the accurate repositioning of the maxilla in the orthognathic surgery.
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Affiliation(s)
- Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 03080, Korea;
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 03080, Korea;
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 03080, Korea
- Correspondence: (W.-J.Y.); (S.J.H.); Tel.: +82-2-2072-3049 (W.-J.Y.); +82-2-595-4737 (S.J.H.); Fax: +82-2-744-3919 (W.-J.Y.); +82-2-525-4738 (S.J.H.)
| | - Soon Jung Hwang
- Hwang Soon Jung’s Dental Clinic for Oral and Maxillofacial Surgery, Woonam Building, 2,3 F, 349, Gangnam-daero, Seocho-gu, Seoul 06626, Korea
- Correspondence: (W.-J.Y.); (S.J.H.); Tel.: +82-2-2072-3049 (W.-J.Y.); +82-2-595-4737 (S.J.H.); Fax: +82-2-744-3919 (W.-J.Y.); +82-2-525-4738 (S.J.H.)
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23
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Twenty years of robotic surgery: a challenge for human limits. Updates Surg 2021; 73:789-793. [PMID: 34019248 PMCID: PMC8184697 DOI: 10.1007/s13304-021-01071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 10/28/2022]
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Experience with 10 years of a robotic surgery program at an Academic Medical Center. Surg Endosc 2021; 36:1950-1960. [PMID: 33844089 PMCID: PMC8847263 DOI: 10.1007/s00464-021-08478-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/28/2021] [Indexed: 01/18/2023]
Abstract
Background Few studies have examined robotic surgery from a programmatic standpoint, yet this is how hospitals evaluate return on investment clinically and fiscally. This study examines the 10-year experience of a robotic program at a single academic institution. Study design All robotic operations performed at our institution from August 2005 to December 2016 were reviewed. Data were collected from the robotic system and hospital databases. Results A total of 3485 robotic operations were performed. Yearly case volume nearly quadrupled. There have been 37 robotic-trained surgeons in 5 specialties performing 53 different operations. Rate of conversion to open was 4.2%. American Society of Anesthesiologists (ASA) class increased over time, with ASA class 3 increasing from 20% of patients to 45% of patients. Average case time in 2005 was 453 min, but decreased by 46% to 246 min by 2007, then remained relatively stable (range 226–247). Operating efficiency improved, with room time and case time decreasing by 9% in the past 4 years. Average cost for robotic supplies was $1519 per case. Additional costs per case related to equipment and contracts totaled an average of $11,822. Average length of stay (LOS) for robotic cases was 3.3 days, compared to 3.0 days for laparoscopic and 7.0 for open. Cost per day for admission after robotic surgery was 1.7 times greater than the cost of open or laparoscopic surgery. Total admission costs of robotic operations were 1.5 times those of laparoscopic surgery, but less than open operations. Readmissions following robotic cases were lower than open (15% v 26%, p < 0.0001). Conclusions Over 10 years, the use of robotic technology has grown significantly at our institution, with good fiscal and clinical outcomes. Operating room costs are high; however, efficiency has improved, LOS is shorter, admission costs are lower than open operations, and readmission rates are lower.
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Kim JH, Um R, Liu J, Patel J, Curry E, Aghabaglou F, Mahapatra S, Ainechi A, Tsehay Y, Ehresman J, Hwang B, Tyler B, Iyer R, Theodore N, Manbachi A. Development of a Smart Hospital Assistant: Integrating Artificial Intelligence and a Voice-User Interface for Improved Surgical Outcomes. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11601:116010U. [PMID: 35341075 PMCID: PMC8957208 DOI: 10.1117/12.2580995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patient safety and efficiency are top priorities in any surgical procedure. One effective way to achieve these objectives is to automate the logistical and routine tasks that occur in the operating suite. Inspired by smart assistant technology already widely used in the consumer sector, we engineered the Smart Hospital Assistant (SHA), a smart, voice-controlled virtual assistant that handles natural speech recognition while executing non-surgical functions to aid any surgery. In simulated procedures, the SHA reduced operating time, optimized surgical staff resources, and reduced the number of major touch-points that can lead to surgical site infections. The SHA holds promise not only for use in the operating theater, but also in understaffed healthcare environments where automation can improve healthcare delivery.
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Affiliation(s)
- Jeong Hun Kim
- Dept. of Electrical and Computer Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Richard Um
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Jonathan Liu
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - Japesh Patel
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Eli Curry
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | | | | | - Ana Ainechi
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Yohannes Tsehay
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Jeff Ehresman
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Brian Hwang
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Betty Tyler
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Rajiv Iyer
- Dept. of Orthopedic Surgery, Columbia University Irving Medical Center, New York City NY
| | - Nicholas Theodore
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Amir Manbachi
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
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Abstract
This paper provides a brief history of medical robotic systems. Since the first use of robots in medical procedures, there have been countless companies competing to developed robotic systems in hopes to dominate a field. Many companies have succeeded, and many have failed. This review paper shows the timeline history of some of the old and most successful medical robots and new robotic systems. As the patents of the most successful system, i.e., Da Vinci® Surgical System, have expired or are expiring soon, this paper can provide some insights for new designers and manufacturers to explore new opportunities in this field.
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Robot-assisted retroperitoneal lymphadenectomy: The state of art. Asian J Urol 2020; 8:27-37. [PMID: 33569270 PMCID: PMC7859427 DOI: 10.1016/j.ajur.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To perform a narrative review about the role of robot-assisted retroperitoneal lymphadenectomy (R-RPLND) in the management of testicular cancer. Methods A PubMed search for all relevant publications regarding the R-RPLND series up until August 2019 was performed. The largest series were identified, and weighted means calculated for outcomes using the number of patients included in each study as the weighting factor. Results Fifty-six articles of R-RPLND were identified and eight series with more than 10 patients in each were included. The weighted mean age was 31.12 years; primary and post chemotherapy R-RPLND were performed in 50.59% and 49.41% of patients. The clinical stage was I, II and III in 47.20%, 39.57% and 13.23% of patients. A modified R-RPLND template was used in 78.02% of patients, while 21.98% underwent bilateral full template. The weighted mean node yield, operative time and estimated blood loss were, respectively, 22.15 nodes, 277.35 min and 131.94 mL. The weighted mean length of hospital stay was 2 days and antegrade ejaculation was preserved in 92.12% of patients. Major post-operative complications (Clavien III or IV) occurred in 5.34%. Positive pathological nodes were detected in 24.54%, while the recurrence free survival was 95.77% with a follow-up of 21.81 months. Conclusion R-RPLND has proven to be a reproducible and safe approach in experienced centers; short-term oncologic outcomes are similar to the open approach with less morbidity and shorter convalescence related to its minimal invasiveness. However, longer follow-up and new trials comparing head-to-head both techniques are expected.
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Jank BJ, Haas M, Riss D, Baumgartner WD. Acceptance of patients towards task-autonomous robotic cochlear implantation: An exploratory study. Int J Med Robot 2020; 17:1-6. [PMID: 32949426 PMCID: PMC7900970 DOI: 10.1002/rcs.2172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/03/2023]
Abstract
Background Recently, task‐autonomous image‐guided robotic cochlear implantation has been successfully completed in patients. However, no data exist on patients' perspective of this new technology. The aim of this study was to evaluate the acceptance of patients towards task‐autonomous robotic cochlear implantation (TARCI). Methods We prospectively surveyed 63 subjects (51 patients and 12 parents of infants) scheduled for manual cochlear implantation. We collected sociodemographic and clinico‐pathological characteristics and their attitude towards TARCI for themselves or their child using a questionnaire. Differences between variables were analysed using one‐way analysis of variance and Spearman's rho was used to test for correlation. Results Seventy‐three percent of patients and 84% of parents expressed a high acceptance towards TARCI for themselves, or their child, respectively. Interestingly, patients with a negative attitude towards TARCI were significantly younger. Conclusion The attitude of patients and parents likely does not represent a barrier towards application of this new technology.
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Affiliation(s)
- Bernhard J Jank
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Haas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Yu K, Wegele T, Ostler D, Wilhelm D, Feußner H. EyeRobot: enabling telemedicine using a robot arm and a head-mounted display. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1515/cdbme-2020-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Telemedicine has become a valuable asset in emergency responses for assisting paramedics in decision making and first contact treatment. Paramedics in unfamiliar environments or time-critical situations often encounter complications for which they require external advice. Modern ambulance vehicles are equipped with microphones, cameras, and vital sensors, which allow experts to remotely join the local team. However, the visual channels are rarely used since the statically installed cameras only allow broad views at the patient. They neither allow a close-up view nor a dynamic viewpoint controlled by the remote expert. In this paper, we present EyeRobot, a concept which enables dynamic viewpoints for telepresence using the intuitive control of the user’s head motion. In particular, EyeRobot utilizes the 6 degrees of freedom pose estimation capabilities of modern head-mounted displays and applies them in real-time to the pose of a robot arm. A stereo-camera, installed on the end-effector of the robot arm, serves as the eyes of the remote expert at the local site. We put forward an implementation of EyeRobot and present the results of our pilot study which indicates its intuitive control.
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Affiliation(s)
- Kevin Yu
- University Hospital Klinikum Rechts der Isar, Technical University of Munich , Munich , Germany
| | - Thomas Wegele
- University Hospital Klinikum Rechts der Isar, Technical University of Munich , Munich , Germany
| | - Daniel Ostler
- University Hospital Klinikum Rechts der Isar, Technical University of Munich , Munich , Germany
| | - Dirk Wilhelm
- University Hospital Klinikum Rechts der Isar, Technical University of Munich , Munich , Germany
| | - Hubertus Feußner
- University Hospital Klinikum Rechts der Isar, Technical University of Munich , Munich , Germany
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Lowenstein L, Matanes E, Weiner Z, Baekelandt J. Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy. Eur J Obstet Gynecol Reprod Biol X 2020; 7:100113. [PMID: 32715294 PMCID: PMC7379144 DOI: 10.1016/j.eurox.2020.100113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives The vaginal surgical approach has not become the standard of care, despite its advantages. The Hominis™ Surgical System is a humanoid shaped robot-assisted system that was designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We aimed to present our experience with the first RvNOTES bilateral salpingo-oophorectomy (BSO) performed by the Hominis system. Study design A two-center prospective study of BSO by RvNOTES in women with nonmalignant indications conducted between August and December 2018. Women older than 18 years were offered to participate. Exclusion criteria included a history of abdominal malignancy, pelvic or abdominal irradiation, Crohn's disease, pelvic inflammatory disease, severe infections in the lower abdomen, active diverticulitis, deep infiltrating recto-vaginal endometriosis, and an active vaginal infection. The primary outcome of the study was the rate of conversion to open or laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. Results Eight women aged 50–70 years with BMI of 19–30 kg/m2 were recruited. All the procedures were completed successfully without conversions to open surgery. No intraoperative complications were observed. Median blood loss was 10 mL (range: 10−50). The median duration of the procedure was 45 min (range: 38−91), and decreased over the study period. Surgeons’ usability assessment was very favorable, with a median of 5 on a 1–5 scale. The median visual analog scale (VAS) score was 1 (range: 1–3). Conclusions This is the first documentation of a surgery performed via the vagina using robotic instrumentation developed for this purpose. The disruptive technology of RvNOTES, with its fast learning curve, will make gynecological surgeries accessible to more women.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Corresponding author at: Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jan Baekelandt
- Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium
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Munshi A. Do not use robotic surgery in oncology patients when conventional surgical approaches are equally effective. Lancet Oncol 2020; 20:e240. [PMID: 31044715 DOI: 10.1016/s1470-2045(19)30147-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospital, Dwarka, New Delhi 110075, India.
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Wallace DJ, Vardiman AB, Booher GA, Crawford NR, Riggleman JR, Greeley SL, Ledonio CG. Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution. Int J Med Robot 2019; 16:e2054. [PMID: 31677227 DOI: 10.1002/rcs.2054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation. METHODS A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. Radiographic evaluation of preoperative and postoperative computerized tomography (CT) scans were collected. RESULTS In the first 106 cases, 630 lumbosacral pedicle screws were placed. Thirty screws were placed in five patients without the robot because of surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance, only 1.5% (9/600) were repositioned intraoperatively. CONCLUSION This study demonstrated a high level of accuracy (98.2%) in terms of grade A or B pedicle screw breach scores in the clinical use of navigated, robot-assisted surgery in its first 101 cases.
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Affiliation(s)
- David J Wallace
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Arnold B Vardiman
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Grant A Booher
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Neil R Crawford
- Musculoskeletal Education and Research Center (MERC), Globus Medical, Inc, Audubon, Pennsylvania
| | - Jessica R Riggleman
- Musculoskeletal Education and Research Center (MERC), Globus Medical, Inc, Audubon, Pennsylvania
| | - Samantha L Greeley
- Musculoskeletal Education and Research Center (MERC), Globus Medical, Inc, Audubon, Pennsylvania
| | - Charles G Ledonio
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas
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Giampaolino P, Della Corte L, Improda FP, Perna L, Granata M, Di Spiezio Sardo A, Bifulco G. Robotic Hysterectomy as a Step of Gender Affirmative Surgery in Female-to-Male Patients. J INVEST SURG 2019; 34:645-650. [PMID: 31588839 DOI: 10.1080/08941939.2019.1669744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION To evaluate the feasibility and safety of robotic hysterectomy in the "transgender male/non-conforming" population and the short and long-term surgical outcomes of robotic surgery in these patients. MATERIALS AND METHODS A retrospective analysis was carried out from February 2016 to January 2018. Twenty female transgender patients with a previous psychiatric diagnosis of gender dysphoria who did not present genital pathologies were included in the study. The robotic hysterectomies were performed from June 2016 to March 2018 using a Da Vinci Xi Robot (Intuitive Surgical, Sunnyvale, CA, USA). RESULTS No intraoperative or postoperative complications were recorded. The median duration of the intervention was of 90 minutes, including docking which lasted 16 minutes, while the median stay in the operating room was of 140 minutes. The median time of duration of intervention was of 90 minutes. The median blood loss was about 90 ml with a percentage decrease in hemoglobin between pre- and post-operative of about 8%. Postoperative pain was assessed using the VAS scale in the immediate postoperative period, on the first and second day, resulting of 3 and 2, respectively. The pathological examination of surgical specimens confirmed the absence of malignancy. CONCLUSIONS The robotic approach represents a feasible, safe, and effective surgical option for hysterectomy for "transgender male" affected by gender dysphoria.
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Affiliation(s)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Luca Perna
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marcello Granata
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Moncayo S, Compagnon R, Caire F, Grosos C, Bahans C, Ilhero P, Fourcade L, Ballouhey Q. Transition effects from laparocscopic to robotic surgery skills in small cavities. J Robot Surg 2019; 14:525-530. [PMID: 31515680 DOI: 10.1007/s11701-019-01024-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
Conventional laparoscopic surgery (LS) is being challenged by the ever-increasing use of robotic surgery (RS) to perform reconstructive procedures. The purpose of this study was to assess the acquisition of skills in both techniques and the potential transfer of skills from one technique to the other when restricted spaces are involved. A preclinical randomized crossover study design was implemented. Twelve subjects performed two different reproducible drill procedures: "Thread the Ring" (TR) and "Transfer the Plot" (TP). To assess surgical proficiency in confined workspaces, these exercises were performed with LS and RS technology in a pediatric laparoscopic surgery (PLS) simulator. Each performance was recorded and evaluated by two reviewers using objective structured assessment of technical skills (OSATS). The times to complete the TP and the TR procedure were significantly shorter with RS compared to LS (64 s vs. 319 s; p < 0.0001 for both TP and TR). A significant transfer effect of skills between LS and RS was noted for the TP exercise (p = 0.006). The percentage improvement was greater overall with LS, meaning a higher number of trials were required to adequately master the procedure. This study demonstrated that RS performed significantly better compared to LS on pediatric simulation devices. A transfer effect was identified from LS to RS exclusively. The learning curves showed that progression was definitely longer with LS. These results, indicate that novice surgeons should be encouraged to persist with learning LS, and they support the use of a pediatric robotic simulation device.
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Affiliation(s)
- S Moncayo
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - R Compagnon
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - F Caire
- Service de Neurochirurgie, Hôpital Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - C Grosos
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - C Bahans
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - P Ilhero
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - L Fourcade
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - Q Ballouhey
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France.
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Connelly TM, Malik Z, Sehgal R, Byrnes G, Coffey JC, Peirce C. The 100 most influential manuscripts in robotic surgery: a bibliometric analysis. J Robot Surg 2019; 14:155-165. [PMID: 30949890 DOI: 10.1007/s11701-019-00956-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
Abstract
Since the first robotic assisted surgery in 1985, the number of procedures performed annually has steadily increased. Bibliometric analysis highlights the key studies that have influenced current practice in a field of interest. We use bibliometric analysis to evaluate the 100 most cited manuscripts on robotic surgery and discuss their content and influence on the evolution of the platform. The terms 'robotic surgery,' 'robot assisted surgery' and 'robot-assisted surgery' were used to search Thomson Reuters Web of Science database for full length, English language manuscripts. The top 100 cited manuscripts were analyzed by manuscript type, surgical specialty, first and last author, institution, year and journal of publication. 14,980 manuscripts were returned. Within the top 100 cited manuscripts, the majority featured urological surgery (n = 28), followed by combined results from multiple surgical subspecialties (n = 15) and colorectal surgery (n = 13). The majority of manuscripts featured case series/reports (n = 42), followed by comparative studies (n = 24). The most cited paper authored by Nelson et al. (432 citations) reviewed technological advances in the field. The year and country with the greatest number of publications were 2009 (n = 15) and the USA (n = 68). The Johns Hopkins University published the most top 100 manuscripts (n = 18). The 100 most cited manuscripts reflect the progression of robotic surgery from a basic instrument-holding platform to today's articulated instruments with 3D technology. From feasibility studies to multicenter trials, this analysis demonstrates how robotic assisted surgery has gained acceptance in urological, colorectal, general, cardiothoracic, orthopedic, maxillofacial and neuro surgery.
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Affiliation(s)
- Tara M Connelly
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
| | - Zoya Malik
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rishabh Sehgal
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Gerrard Byrnes
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - J Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Solving the Time-Varying Inverse Kinematics Problem for the Da Vinci Surgical Robot. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9030546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A dialytic-elimination and Newton-iteration based quasi-analytic inverse kinematics approach is proposed for the 6 degree of freedom (DOF) active slave manipulator in the Da Vinci surgical robot and other similar systems. First, the transformation matrix-based inverse kinematics model is derived; then, its high-dimensional nonlinear equations are transformed to a high-order nonlinear equation with only one unknown variable by using the dialytic elimination with a unitary matrix. Finally, the quasi-analytic solution is eventually obtained by the Newton iteration method. Simulations are conducted, and the result show that the proposed quasi-analytic approach has advantages in terms of accuracy (error < 0.00004 degree (or mm)), solution speed (< 20 ms) and is barely affected by the singularity during intermediate calculations, which proves that the approach meets the real-time and high-accuracy requirements of master‒slave mapping control for the Da Vinci surgical robots and other similar systems. In addition, the proposed approach can also serve as a design reference for other types of robotic arms that do not satisfy the Pieper principle.
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Weitman E, Saleh M, Marescaux J, Martin TR, Ballantyne GH. Reprints of: Robotic colorectal surgery: Evolution and future. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Esen E, Aytac E, Ozben V, Bas M, Bilgin IA, Aghayeva A, Baca B, Hamzaoglu I, Karahasanoglu T. Adoption of robotic technology in Turkey
: A nationwide analysis on caseload and platform used. Int J Med Robot 2018; 15:e1962. [DOI: 10.1002/rcs.1962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/20/2018] [Accepted: 09/21/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Eren Esen
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Erman Aytac
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Volkan Ozben
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Mustafa Bas
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Ismail Ahmet Bilgin
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Afag Aghayeva
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Bilgi Baca
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, School of Medicine; Acıbadem Mehmet Ali Aydınlar University; İstanbul Turkey
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Wang J, Zeng Q. Sir Run Run Shaw Hospital steps into the era of robotic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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40
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Affiliation(s)
- Jeongeun Kim
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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41
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Abstract
Robotic technology currently offers some technical advantages in pelvic dissection compared with competing minimally invasive techniques, and adoption for the surgical treatment of rectal cancer is rapidly increasing worldwide. While there are some early data demonstrating modest improvement in patient outcomes, benefits in terms of long-term oncological outcomes, as well as potential improvements in surgeon-centered outcomes such as fatigue and repetitive stress injury are actively being investigated. Rapid innovation, with the impending release of several new robotic platforms, is likely to further expand the application of these technologies, improve on current limitations, and reduce capital and consumable costs. It is imperative that, as the technology develops and adoption increases further, clinician and research led programs drive safe implementation with a patient-first approach.
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Affiliation(s)
- Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA - .,Minimally Invasive and New Technologies in Oncologic Surgery (MINTOS) Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Marino MV, Shabat G, Gulotta G, Komorowski AL. From Illusion to Reality: A Brief History of Robotic Surgery. Surg Innov 2018; 25:291-296. [PMID: 29701135 DOI: 10.1177/1553350618771417] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Robotic surgery is currently employed for many surgical procedures, yielding interesting results. METHODS We performed an historical review of robots and robotic surgery evaluating some critical phases of its evolution, analyzing its impact on our life and the steps completed that gave the robotics its current popularity. RESULTS The origins of robotics can be traced back to Greek mythology. Different aspects of robotics have been explored by some of the greatest inventors like Leonardo da Vinci, Pierre Jaquet-Droz, and Wolfgang Von-Kempelen. Advances in many fields of science made possible the development of advanced surgical robots. Over 3000 da Vinci robotic platforms are installed worldwide, and more than 200 000 robotic procedures are performed every year. CONCLUSION Despite some potential adverse events, robotic technology seems safe and feasible. It is strictly linked to our life, leading surgeons to a new concept of surgery and training.
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Affiliation(s)
| | - Galyna Shabat
- 1 P. Giaccone Hospital, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- 1 P. Giaccone Hospital, University of Palermo, Palermo, Italy
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43
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Anesthesia for Robot Assisted Gynecological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Robot-Assisted Surgery for Mandibular Angle Split Osteotomy Using Augmented Reality: Preliminary Results on Clinical Animal Experiment. Aesthetic Plast Surg 2017; 41:1228-1236. [PMID: 28725963 DOI: 10.1007/s00266-017-0900-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
Mandibular angle split osteotomy (MASO) is a procedure widely used for prominent mandibular angles. However, conventional mandibular plastic surgery is invasive and high risk. It may induce postoperative neurosensory disturbance of the inferior alveolar nerve, fractures and infection due to the complexity of the anatomical structure and the narrow surgical field of view. The success rate of MASO surgery usually depends on the clinical experience and skills of the surgeon. To evaluate the performance of inexperienced plastic surgeons conducting this surgery, a self-developed and constructed robot system based on augmented reality is used. This robot system provides for sufficient accuracy and safety within the clinical environment. To evaluate the accuracy and safety of MASO surgery, an animal study using this robot was performed in the clinical room, and the results were then evaluated. Four osteotomy planes were successfully performed on two dogs; that is, twenty tunnels (each dog drilled on bilaterally) were drilled in the dogs' mandible bones. Errors at entrance and target points were 1.04 ± 0.19 and 1.22 ± 0.24 mm, respectively. The angular error between the planned and drilled tunnels was 6.69° ± 1.05°. None of the dogs experienced severe complications. Therefore, this technique can be regarded as a useful approach for training inexperienced plastic surgeons on the various aspects of plastic surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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45
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Madureira FAV, Varela JLS, Madureira D, D'Almeida LAV, Madureira FAV, Duarte AM, Vaz OP, Ramos JR. Model of a training program in robotic surgery and its initial results. Rev Col Bras Cir 2017; 44:302-307. [PMID: 28767807 DOI: 10.1590/0100-69912017003013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/27/2017] [Indexed: 01/29/2023] Open
Abstract
Objective: to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. Methods: we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. Results: two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major complications. Conclusion: the robotic surgery program of the Samaritan Hospital was safely implemented and with initial results better than the ones described in the current literature. There seems to be benefits in using the robotic platform in super-obese patients, re-operations of obesity surgery and hiatus hernias, giant and paraesophageal hiatus hernias, ventral hernias with multiple defects and rectal resections.
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Affiliation(s)
- Fernando Athayde Veloso Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil.,Hospital Gaffrée Guinle da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brasil
| | | | - Delta Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Otávio Pires Vaz
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | - José Reinan Ramos
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
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46
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Infant Robotic Cleft Palate Surgery: A Feasibility Assessment Using a Realistic Cleft Palate Simulator. Plast Reconstr Surg 2017; 139:455e-465e. [PMID: 28121879 DOI: 10.1097/prs.0000000000003010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A surgical robot offers enhanced precision, visualization, and access and the potential to improve outcomes in cleft palate surgery. The goal of this study was to investigate the feasibility of using the da Vinci robot for cleft palate repair in infants using a cleft palate simulator test bed. METHODS A high-fidelity cleft palate simulator was developed that allows performance of a robotic cleft palate repair procedure. A complete cleft palate repair was performed with the da Vinci Si with 5-mm instruments and the da Vinci Xi with 8-mm instruments. The advantages of the robotic approach were assessed in comparison with using standard instruments. For each system, arm repositioning, collisions, instrument and endoscope excursion, wrist orientation, and vision were compared for 12 steps of the repair. RESULTS The cleft palate simulator provided a reproducible platform for testing robotic cleft palate surgery. The advantages of the robotic approach were the ability to articulate a miniature wrist intraorally with superior visualization, increased ambidexterity, and improved ergonomics compared with using standard instruments. Cleft palate repair with the Xi was superior to the Si with respect to arm repositioning, instrument collisions and excursion, and wrist orientation. However, Xi performance remained suboptimal because of the larger instruments. CONCLUSIONS Robotic cleft palate repair using the da Vinci system offers advantages compared with the traditional approach. Cleft palate repair is more feasible with the Xi and 8-mm instruments. However, performance is limited by the instrumentation, which requires modification to ensure safety and efficacy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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47
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Lenihan JP. How to set up a robotic-assisted laparoscopic surgery center and training of staff. Best Pract Res Clin Obstet Gynaecol 2017; 45:19-31. [PMID: 28566135 DOI: 10.1016/j.bpobgyn.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic Systemtm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery.
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Affiliation(s)
- John P Lenihan
- University of Washington School of Medicine, Seattle, WA, USA; MultiCare Health Systems, Tacoma WA 98405, USA.
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48
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Van't Hullenaar CDP, Hermans B, Broeders IAMJ. Ergonomic assessment of the da Vinci console in robot-assisted surgery. Innov Surg Sci 2017; 2:97-104. [PMID: 31579742 PMCID: PMC6753997 DOI: 10.1515/iss-2017-0007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background Robot-assisted surgery is considered to improve ergonomics over standard endoscopic surgery. Nevertheless, previous research demonstrated ergonomic deficits in the current console set-up. Aim This study was designed to objectively assess body posture in the da Vinci console during robot-assisted endoscopic surgery. Methods Multiple sagittal photographs from six physicians were taken during robot-assisted procedures. Trunk, neck, shoulder, elbow, hip, and knee angles were calculated and compared to ergonomic preferable joint angles. A 2D geometric model was developed using individual anthropometrics. Optimal seat height, armrest height, and viewer height were calculated. These results were compared to the findings of the sagittal photographs. Results Mean joint angles show potentially harmful neck angles for all participants. Trunk angles vary between surgeons, from inadequate to correct. In short and very tall individuals, optimal armrest height is outside the adjustment range of the console. Conclusion The da Vinci Surgical System console seating position results in a nonergonomic neck and trunk angle. The developed geometric model revealed that armrest height has a limited adjustment range. Adjustments to the console and optimization of preoperative settings are goals to further improve ergonomics in robot-assisted surgery.
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Affiliation(s)
- Cas D P Van't Hullenaar
- Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.,Department of Technical Medicine, Twente University, Noordhorst (NH101), Postbus 217, Enschede, The Netherlands
| | - Ben Hermans
- Department of Technical Medicine, Twente University, Noordhorst (NH101), Postbus 217, Enschede, The Netherlands
| | - Ivo A M J Broeders
- Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.,Department of Technical Medicine, Twente University, Noordhorst (NH101), Postbus 217, Enschede, The Netherlands
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Dickey RM, Srikishen N, Lipshultz LI, Spiess PE, Carrion RE, Hakky TS. Augmented reality assisted surgery: a urologic training tool. Asian J Androl 2017; 18:732-4. [PMID: 26620455 PMCID: PMC5000796 DOI: 10.4103/1008-682x.166436] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass® optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a 10-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.
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Affiliation(s)
- Ryan M Dickey
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Neel Srikishen
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Philippe E Spiess
- University of South Florida, Department of Urology, Tampa 33606, USA
| | - Rafael E Carrion
- University of South Florida, Department of Urology, Tampa 33606, USA
| | - Tariq S Hakky
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
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50
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Weitman E, Saleh M, Marescaux J, Martin TR, Ballantyne GH. Robotic colorectal surgery: Evolution and future. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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