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Lohse A, Deininger MM, Loeser J, Roehren F, Ziles D, Breuer T, Leonhardt S, Walter M. A physiological model of phrenic nerve excitation by electrical stimulation. Biomed Phys Eng Express 2024; 10:025017. [PMID: 38232399 DOI: 10.1088/2057-1976/ad1fa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Mechanical ventilation is essential in intensive care treatment but leads to diaphragmatic atrophy, which in turn contributes to prolonged weaning and increased mortality. One approach to prevent diaphragmatic atrophy while achieving pulmonary ventilation is electrical stimulation of the phrenic nerve. To automize phrenic nerve stimulation resulting in lung protective tidal volumes with lowest possible currents, mathematical models are required. Nerve stimulation models are often complex, so many parameters have to be identified prior to implementation. This paper presents a novel, simplified approach to model phrenic nerve excitation to obtain an individualized patient model using a few data points. The latter is based on the idea that nerve fibers are excited when the electric field exceeds a threshold. The effect of the geometry parameter on the model output was analyzed, and the model was validated with measurement data from a pig trial (RMSE in between 0.44 × 10-2and 1.64 × 10-2for parameterized models). The modeled phrenic nerve excitation behaved similarly to the measured tidal volumes, and thus could be used to develop automated phrenic nerve stimulation systems for lung protective ventilation.
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Affiliation(s)
- Arnhold Lohse
- Chair for Medical Information Technology, Faculty of Electrical Engineering and Information Technology, RWTH Aachen University, Aachen, 52074, Germany
| | - Matthias Manfred Deininger
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, 52074, Germany
| | - Johannes Loeser
- Institute of Automatic Control, Faculty of Mechanical Engineering, RWTH Aachen University, Aachen, 52074, Germany
| | - Felix Roehren
- Chair for Medical Information Technology, Faculty of Electrical Engineering and Information Technology, RWTH Aachen University, Aachen, 52074, Germany
| | - Dmitrij Ziles
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, 52074, Germany
| | - Thomas Breuer
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, 52074, Germany
| | - Steffen Leonhardt
- Chair for Medical Information Technology, Faculty of Electrical Engineering and Information Technology, RWTH Aachen University, Aachen, 52074, Germany
| | - Marian Walter
- Chair for Medical Information Technology, Faculty of Electrical Engineering and Information Technology, RWTH Aachen University, Aachen, 52074, Germany
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Parham MJ, Cole SH, Yim NH, Pederson WC. Robotic Nerve Surgery: Brachial Plexus. Semin Plast Surg 2023; 37:199-205. [PMID: 38444952 PMCID: PMC10911901 DOI: 10.1055/s-0043-1772847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Management of closed brachial plexus injuries has traditionally favored conservative approaches with lengthy intervals between initial injury and surgical reconstruction. The complex anatomy of this region often requires large incisions with extensive dissection. Recently, the use of robotic systems in plastic and reconstructive surgery has been increasing, and robot-assisted brachial plexus reconstruction is a novel application that is currently being explored. Current literature describing this application is primarily comprised of feasibility studies using animal and cadaver models, and literature describing use in human subjects is limited. Advantages demonstrated by these early studies include the reduction of physiologic tremor, 3D visualization of anatomical structures, and ergonomic positioning; this allows for increased surgical dexterity and the ability to perform minimally invasive microsurgical procedures within the confined anatomical spaces of the brachial plexus. Limitations revolve around inadequate instrumentation, large learning curves, and increased costs that restrict the ability to perform these complex microsurgical procedures reliably and efficiently. As companies continue to develop instrumentation specific to robot-assisted microsurgery, more extensive longitudinal studies outlining long-term costs, changes in operating time, and functional outcomes will be required before a conclusion about the utility of these systems in brachial plexus surgery can be made.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Samuel H. Cole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Nicholas H. Yim
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - William C. Pederson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Chen LWY, Goh M, Goh R, Chao YK, Huang JJ, Kuo WL, Sung CWH, Chuieng-Yi Lu J, Chuang DCC, Chang TNJ. Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review. J Reconstr Microsurg 2021; 37:503-513. [PMID: 33401326 DOI: 10.1055/s-0040-1722183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. METHODS A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. RESULTS Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. CONCLUSION Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.
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Affiliation(s)
- Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei Goh
- Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Queensland, Australia
| | - Raymond Goh
- Valley Plastic Surgery, Queensland, Australia
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Johnny Chuieng-Yi Lu
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Tan YPA, Liverneaux P, Wong JKF. Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery. Front Surg 2018; 5:22. [PMID: 29740585 PMCID: PMC5931136 DOI: 10.3389/fsurg.2018.00022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/27/2018] [Indexed: 12/27/2022] Open
Abstract
Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within this surgical subspeciality.
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Affiliation(s)
- Youri P. A. Tan
- The Manchester Centre for Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Philippe Liverneaux
- Department of Hand Surgery, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS, Illkirch, France
| | - Jason K. F. Wong
- The Manchester Centre for Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
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Bijon C, Chih-Sheng L, Chevallier D, Tran N, Xavier F, Liverneaux P. Endoscopic robot-assisted C7 nerve root retrophalangeal transfer from the contralateral healthy side: A cadaver feasibility study. ANN CHIR PLAST ESTH 2018. [DOI: 10.1016/j.anplas.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Dobbs TD, Cundy O, Samarendra H, Khan K, Whitaker IS. A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery-From Inception to the Future. Front Surg 2017; 4:66. [PMID: 29188219 PMCID: PMC5694772 DOI: 10.3389/fsurg.2017.00066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background The use of robots in surgery has become commonplace in many specialties. In this systematic review, we report on the current uses of robotics in plastic and reconstructive surgery and looks to future roles for robotics in this arena. Methods A systematic literature search of Medline, EMBASE, and Scopus was performed using appropriate search terms in order to identify all applications of robot-assistance in plastic and reconstructive surgery. All articles were reviewed by two authors and a qualitative synthesis performed of those articles that met the inclusion criteria. The systematic review and results were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Results A total of 7,904 articles were identified for title and abstract review. Sixty-eight studies met the inclusion criteria. Robotic assistance in plastic and reconstructive surgery is still in its infancy, with areas such as trans-oral robotic surgery and microvascular procedures the dominant areas of interest currently. A number of benefits have been shown over conventional open surgery, such as improved access and greater dexterity; however, these must be balanced against disadvantages such as the lack of haptic feedback and cost implications. Conclusion The feasibility of robotic plastic surgery has been demonstrated in several specific indications. As technology, knowledge, and skills in this area improve, these techniques have the potential to contribute positively to patient and provider experience and outcomes.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Olivia Cundy
- Oxford University Medical School, Oxford, United Kingdom
| | | | - Khurram Khan
- Department of Plastic Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Iain Stuart Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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[Chirurgie de la main: a journal in English for French hand surgeons, and much more]. ACTA ACUST UNITED AC 2015; 34:1-2. [PMID: 25616358 DOI: 10.1016/j.main.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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