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Lee MJ, Eden J, Gurgone S, Berger DJ, Borzelli D, d'Avella A, Mehring C, Burdet E. Control limitations in the null-space of the wrist muscle system. Sci Rep 2024; 14:20634. [PMID: 39232018 PMCID: PMC11375119 DOI: 10.1038/s41598-024-69353-z] [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: 12/12/2023] [Accepted: 08/03/2024] [Indexed: 09/06/2024] Open
Abstract
The redundancy present within the musculoskeletal system may offer a non-invasive source of signals for movement augmentation, where the set of muscle activations that do not produce force/torque (muscle-to-force null-space) could be controlled simultaneously to the natural limbs. Here, we investigated the viability of extracting movement augmentation control signals from the muscles of the wrist complex. Our study assessed (i) if controlled variation of the muscle activation patterns in the wrist joint's null-space is possible; and (ii) whether force and null-space cursor targets could be reached concurrently. During the null-space target reaching condition, participants used muscle-to-force null-space muscle activation to move their cursor towards a displayed target while minimising the exerted force as visualised through the cursor's size. Initial targets were positioned to require natural co-contraction in the null-space and if participants showed a consistent ability to reach for their current target, they would rotate 5∘ incrementally to generate muscle activation patterns further away from their natural co-contraction. In contrast, during the concurrent target reaching condition participants were required to match a target position and size, where their cursor position was instead controlled by their exerted flexion-extension and radial-ulnar deviation, while its size was changed by their natural co-contraction magnitude. The results collected from 10 participants suggest that while there was variation in each participant's co-contraction behaviour, most did not possess the ability to control this variation for muscle-to-force null-space virtual reaching. In contrast, participants did show a direction and target size dependent ability to vary isometric force and co-contraction activity concurrently. Our results indicate the limitations of using the muscle-to-force null-space activity of joints with a low level of redundancy as a possible command signal for movement augmentation.
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Affiliation(s)
- Meng-Jung Lee
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany.
- Faculty of Biology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Jonathan Eden
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, W12 0BZ, UK.
- Mechanical Engineering Department, The University of Melbourne, Victoria, Australia.
| | - Sergio Gurgone
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology, 1-4, Yamadaoka, Suita, Osaka, Japan
| | - Denise J Berger
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Systems Medicine and Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Borzelli
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Andrea d'Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Carsten Mehring
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
- Faculty of Biology, University of Freiburg, Freiburg im Breisgau, Germany
- BrainLinks-BrainTools, University of Freiburg, Freiburg im Breisgau, Germany
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, W12 0BZ, UK
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Oh SE, Choi MG, Lee JH, Sohn TS, Bae JM, An JY. Feasibility of robotic total gastrectomy for patients with gastric cancer: A single-center retrospective cohort study of short-term outcomes. Curr Probl Surg 2024; 61:101524. [PMID: 39098334 DOI: 10.1016/j.cpsurg.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Sung Eun Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Levin G, Gotlieb WH, Zand B, Zaid T, Meyer R, Yates E, Ramirez PT. Robotic Surgery in Gynecologic Oncology-A Bibliometric Study. J Minim Invasive Gynecol 2024:S1553-4650(24)00298-X. [PMID: 38992749 DOI: 10.1016/j.jmig.2024.07.002] [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: 04/15/2024] [Revised: 06/01/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
STUDY OBJECTIVE To characterize robotic surgery publications in gynecologic oncology, and to identify factors associated with high citation metrics. DESIGN A cross-sectional study SETTING: Original articles on robotic surgery in gynecologic oncology. PATIENTS No patients involved. INTERVENTIONS Robotic surgeries in gynecologic oncology. MEASUREMENTS AND MAIN RESULTS We performed PubMed Medical Subject Headings search for original articles on robotic surgery in gynecologic oncology. We analyzed citation scores and income level of country of publication, as well as factors associated with high citation metrics. Overall, 566 studies during 2005 to 2023 were included. Of those 292, 51.6% were from North America, and 182 32.2% from Europe. The leading tumor site studied was endometrial cancer (57.4%). The majority (87.6%) of studies were retrospective and 13 (2.3%) were randomized controlled trials. Most studies (94.2%) originated in high-income countries. Articles from middle-income countries had lower citations per year as compared to high-income countries (median 1.6 vs 2.5, p =.002) and were published in lower-impact factor journals (median 2.6 vs 4.3, p < .001) when compared with high-income countries. Cervical cancer studies had higher representation in middle-income countries than in high-income countries (48.5% vs 18.4%, p < .001). In a multivariable regression analysis, journal's impact factor [aOR 95% CI 1.26 (1.12-1.40)], cervical cancer topic [aOR 95% CI 3.0 (1.58-5.91)], and North American publications [aOR 95% CI 2.07 (1.08-3.97)] were independently associated with higher number of citations per year. CONCLUSION The majority of robotic surgery research in gynecologic oncology is retrospective and from high-income countries. Middle-income countries are not as frequently cited and are predominantly in lower-impact factor journals.
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Affiliation(s)
- Gabriel Levin
- The Department of Gynecologic Oncology, Jewish General Hospital, McGill University (Drs. Levin and Gotlieb), Montreal, Canada.
| | - Walter H Gotlieb
- The Department of Gynecologic Oncology, Jewish General Hospital, McGill University (Drs. Levin and Gotlieb), Montreal, Canada
| | - Behrouz Zand
- Department of Obstetrics and Gynecology, Houston Methodist Hospital (Drs. Zand, Zaid, Yates, and Ramirez), Houston, Texas
| | - Tarrik Zaid
- Department of Obstetrics and Gynecology, Houston Methodist Hospital (Drs. Zand, Zaid, Yates, and Ramirez), Houston, Texas
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Cedars-Sinai Medical Center (Dr. Meyer), Los Angeles, California
| | - Elise Yates
- Department of Obstetrics and Gynecology, Houston Methodist Hospital (Drs. Zand, Zaid, Yates, and Ramirez), Houston, Texas
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital (Drs. Zand, Zaid, Yates, and Ramirez), Houston, Texas
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Acosta-Mérida MA. DATA GOVERNANCE in digital surgery. Cir Esp 2024; 102 Suppl 1:S8-S15. [PMID: 38042295 DOI: 10.1016/j.cireng.2023.10.007] [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: 06/23/2023] [Accepted: 10/12/2023] [Indexed: 12/04/2023]
Abstract
Technological and computer advances have led to a "new era" of Surgery called Digital Surgery. In it, the management of information is the key. The development of Artificial Intelligence requires "Big Data" to create its algorithms. The use of digital technology for the systematic capture of data from the surgical process raises ethical issues of privacy, property, and consent. The use of these out-of-control data creates uncertainty and can be a source of mistrust and refusal by surgeons to allow its use, requiring a framework for the correct management of them. This paper exposes the current situation of Data Governance in Digital Surgery, the challenges posed and the lines of action necessary to resolve the areas of uncertainty that have arisen in the process, in which the surgeon must play a relevant role.
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Affiliation(s)
- María Asunción Acosta-Mérida
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
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Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [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: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
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Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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Cesari V, Melfi F, Gemignani A, Menicucci D. Sensory substitution increases robotic surgical performance and sets the ground for a mediating role of the sense of embodiment: a systematic review. Heliyon 2023; 9:e21665. [PMID: 38027699 PMCID: PMC10656242 DOI: 10.1016/j.heliyon.2023.e21665] [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: 10/23/2022] [Revised: 09/17/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Sensory Substitution (SS) allows the elaboration of information via non preferential sensory modalities. This phenomenon occurs in robotic-assisted surgery (RAS), in which haptic feedback is lacking. It has been suggested that SS could sustain surgeons' proficiency by means of visual clues for inferring tactile information, that also promotes the feeling of haptic phantom sensations. A critical role in reaching a good performance in procedural tasks is also sustained by the Sense of Embodiment (SE), that is, the capacity to integrate objects into subjective bodily self-representation. As SE is enhanced by haptic sensations, we hypothesize a role of SS in promoting SE in RAS. Accordingly, the goal of this systematic review is to summarize the evidence pertaining the study of SS in RAS in order to highlight the impact on the performance, and to identify a mediating role of the SE in increasing dexterity in RAS. Eight studies selected from the MEDLINE and Scopus® databases met inclusion criteria for a qualitative synthesis. Results indicated that haptic to other modalities SS enhanced force consistency and accuracy, and decreased surgeon fatigue. Expert surgeons, as compared to novices, showed a better natural SS processing, testified by a proficient performance with and without SS aids. No studies investigated the mediating role of SE. These findings indicate that SS is subjected to learning and memory processes that help surgeons to rapidly derive haptic-correlates from visual clues, which are highly required for a good performance. Also, the higher ability of doing SS and the associated perception of haptic sensations might increase multisensory integration, which might sustain performance.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Franca Melfi
- Robotic Multispecialty Center for Surgery Robotic, Minimally Invasive Thoracic Surgery, University of Pisa, 56124 Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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Hamedani Z, Moradi M, Kalroozi F, Manafi Anari A, Jalalifar E, Ansari A, Aski BH, Nezamzadeh M, Karim B. Evaluation of acceptance, attitude, and knowledge towards artificial intelligence and its application from the point of view of physicians and nurses: A provincial survey study in Iran: A cross-sectional descriptive-analytical study. Health Sci Rep 2023; 6:e1543. [PMID: 37674620 PMCID: PMC10477406 DOI: 10.1002/hsr2.1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Background and Aims The prospect of using artificial intelligence (AI) in healthcare is bright and promising, and its use can have a significant impact on cost reduction and decrease the possibility of error and negligence among healthcare workers. This study aims to investigate the level of knowledge, attitude, and acceptance among Iranian physicians and nurses. Methods This cross-sectional descriptive-analytical study was conducted in eight public university hospitals located in Tehran on 400 physicians and nurses. To conduct the study, convenient sampling was used with the help of researcher-made questionnaires. Statistical analysis was done by SPSS 21 The mean and standard deviation and Chi-square and Fisher's exact tests were used. Results In this study, the level of knowledge among the research subjects was average (14.66 ± 4.53), the level of their attitude toward AI was relatively favorable (47.81 ± 6.74), and their level of acceptance of AI was average (103.19 ± 13.70). Moreover, from the participant's perspective, AI in medicine is most widely used in increasing the accuracy of diagnostic tests (86.5%), identifying drug interactions (82.75%), and helping to analyze medical tests and imaging (80%). There was a statistically significant relationship between the variable of acceptance of AI and the participant's level of education (p = 0.028), participation in an AI training course (p = 0.022), and the hospital department where they worked (p < 0.001). Conclusion In this study, both the knowledge and the acceptance of the participants towards AI were proved to be at an average level and the attitude towards AI was relatively favorable, which is in contrast with the very rapid and inevitable expansion of AI. Although our participants were aware of the growing use of AI in medicine, they had a cautious attitude toward this.
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Affiliation(s)
- Zeinab Hamedani
- Department of Midwifery, College of Nursing and MidwiferyKaraj Islamic Azad UniversityKarajIran
| | - Mohsen Moradi
- Department of Psychiatric Nursing, School of Nursing & MidwiferyShahrekord University of Medical SciencesShahrekordIran
| | - Fatemeh Kalroozi
- Department of Pediatric Nursing, College of NursingAja University of Medical SciencesTehranIran
| | - Ali Manafi Anari
- Department of Pediatrics, School of Medicine, Ali Asghar Children's HospitalIran University of Medical ScienceTehranIran
| | - Erfan Jalalifar
- Student Research CommitteeTabriz University of Medical SciencesTabrizIran
| | - Arina Ansari
- Student Research CommitteeNorth Khorasan University of Medical SciencesBojnurdIran
| | - Behzad H. Aski
- Department of Pediatrics, School of Medicine, Ali Asghar Children's HospitalIran University of Medical ScienceTehranIran
| | - Maryam Nezamzadeh
- Department of Critical Care Nursing, Faculty of NursingAja University of Medical SciencesTehranIran
| | - Bardia Karim
- Student Research CommitteeBabol University of Medical SciencesBabolMazandaranIran
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Gantschnigg A, Koch OO, Singhartinger F, Tschann P, Hitzl W, Emmanuel K, Presl J. Short-term outcomes and costs analysis of robotic-assisted versus laparoscopic cholecystectomy-a retrospective single-center analysis. Langenbecks Arch Surg 2023; 408:299. [PMID: 37552295 PMCID: PMC10409838 DOI: 10.1007/s00423-023-03037-6] [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: 03/17/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Robotic-assisted surgery is an alternative technique for patients undergoing minimal invasive cholecystectomy (CHE). The aim of this study is to compare the outcomes and costs of laparoscopic versus robotic CHE, previously described as the major disadvantage of the robotic system, in a single Austrian tertiary center. METHODS A retrospective single-center analysis was carried out of all patients who underwent an elective minimally invasive cholecystectomy between January 2010 and August 2020 at our tertiary referral institution. Patients were divided into two groups: robotic-assisted CHE (RC) and laparoscopic CHE (LC) and compared according to demographic data, short-term postoperative outcomes and costs. RESULTS In the study period, 2088 elective minimal invasive cholecystectomies were performed. Of these, 220 patients met the inclusion criteria and were analyzed. One hundred ten (50%) patients underwent LC, and 110 patients RC. There was no significant difference in the mean operation time between both groups (RC: 60.2 min vs LC: 62.0 min; p = 0.58). Postoperative length of stay was the same in both groups (RC: 2.65 days vs LC: 2.65 days, p = 1). Overall hospital costs were slightly higher in the robotic group with a total of €2088 for RC versus €1726 for LC. CONCLUSIONS Robotic-assisted cholecystectomy is a safe and feasible alternative to laparoscopic cholecystectomy. Since there are no significant clinical and cost differences between the two procedures, RC is a justified operation for training the whole operation team in handling the system as a first step procedure. Prospective randomized trials are necessary to confirm these conclusions.
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Affiliation(s)
- Antonia Gantschnigg
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria.
| | - Oliver Owen Koch
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Franz Singhartinger
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Jaroslav Presl
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
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Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J, Acevedo-Rodríguez J, Dorado-Avila G, Osorio-Romero L, Chavez-Campos C, Acero-Alvarracín K. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus 2023; 15:e42370. [PMID: 37621804 PMCID: PMC10445506 DOI: 10.7759/cureus.42370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.
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Affiliation(s)
| | | | | | - Luigi Pianetti
- General Surgery, Universidad Nacional del Litoral, Argentina, ARG
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10
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Liang K, Tang Y, Jiang X, Wang S, Li J, Wang Y, Pan M. Time-varying modeling and intelligent compensation control of singletendon-sheath structure of surgical robot. Proc Inst Mech Eng H 2023; 237:451-466. [PMID: 36882972 DOI: 10.1177/09544119231158237] [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: 03/09/2023]
Abstract
The inaccurate force and position control of tendon sheath system (TSS) due to nonlinear friction during surgery seriously hinders its development in the field of precision surgical robots. To this end, this paper proposes a time-varying bending angle estimation method under the state of sensorless offline identification combined with robot kinematics by analyzing the friction of the TSS and the deformation of the robot during the movement, and establishes a force and position transfer model with time-varying path trajectory (SJM model). The model uses B-spline curve to fit tendon-sheath trajectory. In order to further improve the control accuracy of force and position, a new intelligent feedforward control strategy that integrates the SJM model and a neural network algorithm is proposed. In order to gain an in-depth understanding of the transmission process of force and position and to demonstrate the validity of the SJM model, an experimental platform for the TSS was built. A feedforward control system under the MATLAB environment was built with the aim of verifying the accuracy of the intelligent feedforward control strategy. The system innovatively combines the SJM model with BP and RBF neural networks, respectively. The experimental results showed that the correlation coefficients (R2) of force and position transfer are above 99.10% and 99.48%, respectively. Ultimately, we compared the intelligent feedforward and intelligent control strategy under a single neural network, and observed that the intelligent feedforward control strategy has a better effect.
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Affiliation(s)
- Ke Liang
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Yu Tang
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Xianbao Jiang
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Shuo Wang
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Jing Li
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Yupeng Wang
- School of Mechanical Engineering, Guangxi University, Nanning, China
| | - Mingzhang Pan
- School of Mechanical Engineering, Guangxi University, Nanning, China
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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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12
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Garcia JC. Robotic Transfer of the Latissimus Dorsi for Irreparable Subscapularis Tear. Arthrosc Tech 2022; 11:e1059-e1064. [PMID: 35782843 PMCID: PMC9244639 DOI: 10.1016/j.eats.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
This Technical Note presents an endoscopic robotic anterior axillary shoulder approach using of the DaVinci (Intuitive Surgical, Sunnyvale, CA) robot, which allows one to endoscopically access and harvest the latissimus dorsi tendon for occasions in which the patient presents an irreparable lesion of the subscapularis tendon. Harvesting the latissimus dorsi through an anterior axillary approach is specially desirable when one needs to access the anterior portion of the shoulder, as happens for subscapularis irreparable lesions.
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Affiliation(s)
- Jose Carlos Garcia
- NAEON Institute, São Paulo-Brazil and Moriah Hospital, São Paulo, Brazil,Address correspondence to Jose Carlos Garcia, Jr., M.D., Ph.D., NAEON-São Paulo, Brazil, Avenida Ibirapuera 2144, cj 82, Sao Paulo-SP-Brazil 04028-001.
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13
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Watson G, Niang L, Chandresekhar S, Natchagande G, Payne SR. The feasibility of endourological surgery in low-resource settings. BJU Int 2022; 130:18-25. [PMID: 35524768 DOI: 10.1111/bju.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically, or restricted by the abilities of the surgeons in sub-Saharan Africa. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. They are, however, largely dependent upon the supply of equipment from non-governmental organisations in high income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.
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Affiliation(s)
- Graham Watson
- East Sussex Hospitals NHS Trust, Eastbourne, UK.,Medi Tech Trust, Eastbourne, UK
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14
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Valdés Olmos R, Vidal-Sicart S, Fuertes Cabero S, Goñi Gironés E, Paredes P. Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Valdés Olmos R, Vidal-Sicart S, Fuertes Cabero S, Goñi Gironés E, Paredes P. Interventional nuclear medicine's contribution to molecularly targeted precision surgery. Rev Esp Med Nucl Imagen Mol 2022; 41:179-187. [PMID: 35484078 DOI: 10.1016/j.remnie.2021.12.006] [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: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
Abstract
The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from "maximum tolerable treatments to minimum effective treatments" and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say. A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient.
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Affiliation(s)
- R Valdés Olmos
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - S Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain; Servicio de Medicina Nuclear, Imatge Mèdica Intercentres S. L. (IMI), Parc de Salut Mar, Barcelona, Spain
| | - S Fuertes Cabero
- Servicio de Medicina Nuclear, Hospital Vall d'Hebron, Barcelona, Spain
| | - E Goñi Gironés
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - P Paredes
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain; Facultad de Medicina, Universitat de Barcelona (UB), Barcelona, Spain.
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16
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17
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Eden J, Bräcklein M, Ibáñez J, Barsakcioglu DY, Di Pino G, Farina D, Burdet E, Mehring C. Principles of human movement augmentation and the challenges in making it a reality. Nat Commun 2022; 13:1345. [PMID: 35292665 PMCID: PMC8924218 DOI: 10.1038/s41467-022-28725-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/04/2022] [Indexed: 12/23/2022] Open
Abstract
Augmenting the body with artificial limbs controlled concurrently to one's natural limbs has long appeared in science fiction, but recent technological and neuroscientific advances have begun to make this possible. By allowing individuals to achieve otherwise impossible actions, movement augmentation could revolutionize medical and industrial applications and profoundly change the way humans interact with the environment. Here, we construct a movement augmentation taxonomy through what is augmented and how it is achieved. With this framework, we analyze augmentation that extends the number of degrees-of-freedom, discuss critical features of effective augmentation such as physiological control signals, sensory feedback and learning as well as application scenarios, and propose a vision for the field.
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Affiliation(s)
- Jonathan Eden
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Mario Bräcklein
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Jaime Ibáñez
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- BSICoS, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | | | - Giovanni Di Pino
- NEXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Dario Farina
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.
| | - Carsten Mehring
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
- Faculty of Biology, University of Freiburg, Freiburg im Breisgau, 79104, Germany
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18
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Othman W, Lai ZHA, Abril C, Barajas-Gamboa JS, Corcelles R, Kroh M, Qasaimeh MA. Tactile Sensing for Minimally Invasive Surgery: Conventional Methods and Potential Emerging Tactile Technologies. Front Robot AI 2022; 8:705662. [PMID: 35071332 PMCID: PMC8777132 DOI: 10.3389/frobt.2021.705662] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
As opposed to open surgery procedures, minimally invasive surgery (MIS) utilizes small skin incisions to insert a camera and surgical instruments. MIS has numerous advantages such as reduced postoperative pain, shorter hospital stay, faster recovery time, and reduced learning curve for surgical trainees. MIS comprises surgical approaches, including laparoscopic surgery, endoscopic surgery, and robotic-assisted surgery. Despite the advantages that MIS provides to patients and surgeons, it remains limited by the lost sense of touch due to the indirect contact with tissues under operation, especially in robotic-assisted surgery. Surgeons, without haptic feedback, could unintentionally apply excessive forces that may cause tissue damage. Therefore, incorporating tactile sensation into MIS tools has become an interesting research topic. Designing, fabricating, and integrating force sensors onto different locations on the surgical tools are currently under development by several companies and research groups. In this context, electrical force sensing modality, including piezoelectric, resistive, and capacitive sensors, is the most conventionally considered approach to measure the grasping force, manipulation force, torque, and tissue compliance. For instance, piezoelectric sensors exhibit high sensitivity and accuracy, but the drawbacks of thermal sensitivity and the inability to detect static loads constrain their adoption in MIS tools. Optical-based tactile sensing is another conventional approach that facilitates electrically passive force sensing compatible with magnetic resonance imaging. Estimations of applied loadings are calculated from the induced changes in the intensity, wavelength, or phase of light transmitted through optical fibers. Nonetheless, new emerging technologies are also evoking a high potential of contributions to the field of smart surgical tools. The recent development of flexible, highly sensitive tactile microfluidic-based sensors has become an emerging field in tactile sensing, which contributed to wearable electronics and smart-skin applications. Another emerging technology is imaging-based tactile sensing that achieved superior multi-axial force measurements by implementing image sensors with high pixel densities and frame rates to track visual changes on a sensing surface. This article aims to review the literature on MIS tactile sensing technologies in terms of working principles, design requirements, and specifications. Moreover, this work highlights and discusses the promising potential of a few emerging technologies towards establishing low-cost, high-performance MIS force sensing.
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Affiliation(s)
- Wael Othman
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Mechanical and Aerospace Engineering, New York University, New York, NY, United States
| | - Zhi-Han A. Lai
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan S. Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ricard Corcelles
- Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, OH, United States
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohammad A. Qasaimeh
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Mechanical and Aerospace Engineering, New York University, New York, NY, United States
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19
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Inra ML, Lazzaro RS. Commentary: Do. Share. Discuss. Improve. Repeat. JTCVS Tech 2021; 10:582-583. [PMID: 34977815 PMCID: PMC8691790 DOI: 10.1016/j.xjtc.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 10/28/2022] Open
Affiliation(s)
- Matthew L. Inra
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY
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20
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Loughlin KR. One Small Step for a Urologist, One Giant Leap for Urologic Surgery. Urol Clin North Am 2021; 49:xi-xii. [PMID: 34776056 DOI: 10.1016/j.ucl.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin R Loughlin
- Vascular Biology Program at Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115, USA.
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21
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Mohan R, Yeow M, Wong JYS, Syn N, Wijerathne S, Lomanto D. Robotic versus laparoscopic ventral hernia repair: a systematic review and meta-analysis of randomised controlled trials and propensity score matched studies. Hernia 2021; 25:1565-1572. [PMID: 34557961 DOI: 10.1007/s10029-021-02501-w] [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] [Received: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE There has not been a consensus on the superiority of a surgical approach for minimally invasive ventral hernia repair. This systematic review and meta-analysis (SRMA) aims to compare clinical, and patient-reported outcomes of robotic-assisted ventral hernia repair (rVHR) to traditional endo-laparoscopic ventral hernia repair (lapVHR). METHODS We searched PubMed, EMBASE, Cochrane and Scopus from inception to 16th March 2021. We selected randomised controlled trials and propensity score matched studies comparing rVHR to lapVHR. A meta-analysis was done for the outcomes of operative time, length of hospital stay, open conversion, recurrence, surgical site occurrence and cost. RESULTS A total of 5 studies (3732 patients) were included in the qualitative and quantitative synthesis. Significantly shorter operative times were reported with the lapVHR as compared to rVHR (weighted mean difference (WMD): 62.52, 95% CI: 50.84-74.19). There was also significantly less rates of open conversion with rVHR as compared to lapVHR (WMD: 0.22, 95% CI: 0.09-0.54). No significant differences in patient-reported outcomes that was discernible from the two papers that reported them. CONCLUSION Overall, rVHR is comparable to lapVHR with longer operative times but less open conversion. It is, therefore, important to have proper patient selection to maximise the utility of rVHR.
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Affiliation(s)
- Ramkumar Mohan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcus Yeow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joel Yat Seng Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sujith Wijerathne
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Surgery, Alexandra Hospital, Singapore, Singapore
| | - Davide Lomanto
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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22
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A meta-analysis of robotic gastrectomy versus open gastrectomy in gastric cancer treatment. Asian J Surg 2021; 45:698-706. [PMID: 34366190 DOI: 10.1016/j.asjsur.2021.07.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/04/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022] Open
Abstract
Robotic gastrectomy (RG) shows potential as an alternative to open gastrectomy (OG), the gold standard in the surgical management of gastric cancer (GC). This meta-analysis was conducted to compare the short-term efficacy and safety of RG versus OG for GC.A systematic literature search was conducted on RG with OG for GC in randomized and semi-randomized controlled trials and observational studies. Published materials and conference papers in English and trace references included in the literature were manually searched. The retrieval period was set to end in February 2021. The quality of the included studies was evaluated, and meta-analysis was conducted using the software STATA 15.1. Eleven studies with 6693 patients were included. Major blood loss (weighted mean differences (WMD) = -114.63, 95 % CI, -182.37-46.88, P = 0.001), hospital stay (WMD = -2.21, 95 % CI, -4.32-0.09, P = 0.041), and postoperative complications (odds ratio (OR) = OR = 0.57, 95 % CI, 0.35-0.93, P = 0.025) were fewer in the RS group, and R0 resection (odds ratio (OR) = 6.26, 95 % CI, 2.733-14.35, P = 0.000) occurred more frequently in the RG group than in the OG group. But positive lymph nodes (WMD = -2.09, 95 % CI,-3.73-0.45, P = 0.012) occurred less frequently in the RG group than in the OG group, and operative time was longer in the RG group than in the OG group (WMD = 83.21, 95 % CI, 19.88-146.55, P = 0.010). RG not only provides a technique for the treatment of GC but is also safe and feasible. This finding needs to be verified by multicenter, large-sample randomized controlled trials in the future.
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23
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Anvari M, Manoharan B, Barlow K. From telementorship to automation. J Surg Oncol 2021; 124:246-249. [PMID: 34245577 DOI: 10.1002/jso.26562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/05/2022]
Abstract
The effective integration of robotic technology and surgical tools has played a vital role in advancing surgical care by enabling telepresence in surgery to provide mentorship and surgical care across long distances in the absence of surgeons. This article describes our experiences with advancing surgical education and innovation through telementoring community surgeons, establishing the world's first telerobotic surgical service, and the integration of Artificial Intelligence and robotics to provide remote surgical care and training.
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Affiliation(s)
- Mehran Anvari
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Baanu Manoharan
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Karen Barlow
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
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24
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Doria D, Fani S, Giannini A, Simoncini T, Bianchi M. Enhancing the Localization of Uterine Leiomyomas Through Cutaneous Softness Rendering for Robot-Assisted Surgical Palpation Applications. IEEE TRANSACTIONS ON HAPTICS 2021; 14:503-512. [PMID: 33556016 DOI: 10.1109/toh.2021.3057796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Integrating tactile feedback for lump localization in Robot-assisted Minimally Invasive Surgery (RMIS) represents an open research issue, which is still far to be solved. Main reasons for this are related e.g. to the need for a transparent connection with the teleoperating console, and an intuitive decoding of the delivered information. In this article, we focus on the specific case of RMIS treatment of uterine leiomyomas or fibroids, where little has been done in haptics to improve the outcomes of robotics-enabled palpation tasks. In this article, we propose the usage of a wearable haptic interface for softness rendering as a lump display. The device was integrated in a teleoperation architecture that simulates a robot-assisted surgical palpation task of leiomyomas. This article moved from an ex-vivo sample characterization of uterine tissues to show the effectiveness of our interface in conveying meaningful softness information. We extensively tested our system with gynecologic surgeons in palpation tasks with silicone specimens, which replicated the characteristics of uterine tissues with embedded leyomiomas. Results show that our system enables a softness-based discrimination of the embedded fibroids comparable to the one that physicians would achieve using directly their fingers in palpation tasks. Furthermore, the feedback provided by the haptic interface was perceived as comfortable, intuitive, and highly useful for fibroid localization.
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25
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Collins JW, Marcus HJ, Ghazi A, Sridhar A, Hashimoto D, Hager G, Arezzo A, Jannin P, Maier-Hein L, Marz K, Valdastri P, Mori K, Elson D, Giannarou S, Slack M, Hares L, Beaulieu Y, Levy J, Laplante G, Ramadorai A, Jarc A, Andrews B, Garcia P, Neemuchwala H, Andrusaite A, Kimpe T, Hawkes D, Kelly JD, Stoyanov D. Ethical implications of AI in robotic surgical training: A Delphi consensus statement. Eur Urol Focus 2021; 8:613-622. [PMID: 33941503 DOI: 10.1016/j.euf.2021.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them. OBJECTIVES To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in surgical training that address current recognised ethical implications of utilising AI on surgical data. We aim to describe an ethical approach based on the current evidence, understanding of AI and available technologies, by seeking consensus from an expert committee. EVIDENCE ACQUISITION The project was carried out in 3 phases: (1) A steering group was formed to review the literature and summarize current evidence. (2) A larger expert panel convened and discussed the ethical implications of AI application based on the current evidence. A survey was created, with input from panel members. (3) Thirdly, panel-based consensus findings were determined using an online Delphi process to formulate guidance. 30 experts in AI implementation and/or training including clinicians, academics and industry contributed. The Delphi process underwent 3 rounds. Additions to the second and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. EVIDENCE SYNTHESIS There was 100% response from all 3 rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of >0.8. There was 100% consensus that there is currently a lack of guidance on the utilisation of AI in the setting of robotic surgical training. Consensus was reached in multiple areas, including: 1. Data protection and privacy; 2. Reproducibility and transparency; 3. Predictive analytics; 4. Inherent biases; 5. Areas of training most likely to benefit from AI. CONCLUSIONS Using the Delphi methodology, we achieved international consensus among experts to develop and reach content validation for guidance on ethical implications of AI in surgical training. Providing an ethical foundation for launching narrow AI applications in surgical training. This guidance will require further validation. PATIENT SUMMARY As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.In this paper we provide guidance on ethical implications of AI in surgical training.
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Affiliation(s)
- Justin W Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London; University College London Hospital, Division of Uro-oncology.
| | - Hani J Marcus
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, University of Rochester, USA
| | - Ashwin Sridhar
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; University College London Hospital, Division of Uro-oncology
| | - Daniel Hashimoto
- Surgical Artificial Intelligence and Innovation Laboratory, Massachusetts General Hospital, USA
| | - Gregory Hager
- Malone Center for engineering in healthcare, Department of Computer Science, John Hopkins University, Baltimore, USA
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Italy
| | | | - Lena Maier-Hein
- Deutsches Krebsforschungszentrum, Division of Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Keno Marz
- Deutsches Krebsforschungszentrum, Division of Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Pietro Valdastri
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Kensaku Mori
- Director of Information Technology Center, Nagoya University, Japan
| | - Daniel Elson
- Hamlyn Centre for robotic surgery, Department of Surgery and cancer, Imperial College London, UK
| | - Stamatia Giannarou
- Hamlyn Centre for robotic surgery, Department of Surgery and cancer, Imperial College London, UK
| | - Mark Slack
- Honorary Senior Lecturer, University of Cambridge, Cambridge UK; CMO CMR Surgical, Cambridge, UK
| | - Luke Hares
- Chief technology director, CMR Surgical, Cambridge, UK
| | - Yanick Beaulieu
- Division of Cardiology and Critical Care, Sacré-Coeur Hospital, University of Montreal, Montreal, Canada
| | - Jeff Levy
- Institute for Surgical Excellence, Philadelphia, USA
| | - Guy Laplante
- Director, Global Medical Affairs at Medtronic Minimally Invasive Therapies, Brampton, Canada
| | - Arvind Ramadorai
- Director, Digital-Assisted Surgery (DAS), Medtronic Surgical Robotics, North Haven, CT, USA
| | - Anthony Jarc
- Applied Research, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | - Ben Andrews
- Strategy, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | | | | | | | - Tom Kimpe
- BARCO NV - Healthcare division, Kortrijk, Belgium
| | - David Hawkes
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
| | - John D Kelly
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London; University College London Hospital, Division of Uro-oncology
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
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26
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Horgan CC, Bergholt MS, Thin MZ, Nagelkerke A, Kennedy R, Kalber TL, Stuckey DJ, Stevens MM. Image-guided Raman spectroscopy probe-tracking for tumor margin delineation. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200321R. [PMID: 33715315 PMCID: PMC7960531 DOI: 10.1117/1.jbo.26.3.036002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/17/2021] [Indexed: 06/01/2023]
Abstract
SIGNIFICANCE Tumor detection and margin delineation are essential for successful tumor resection. However, postsurgical positive margin rates remain high for many cancers. Raman spectroscopy has shown promise as a highly accurate clinical spectroscopic diagnostic modality, but its margin delineation capabilities are severely limited by the need for pointwise application. AIM We aim to extend Raman spectroscopic diagnostics and develop a multimodal computer vision-based diagnostic system capable of both the detection and identification of suspicious lesions and the precise delineation of disease margins. APPROACH We first apply visual tracking of a Raman spectroscopic probe to achieve real-time tumor margin delineation. We then combine this system with protoporphyrin IX fluorescence imaging to achieve fluorescence-guided Raman spectroscopic margin delineation. RESULTS Our system enables real-time Raman spectroscopic tumor margin delineation for both ex vivo human tumor biopsies and an in vivo tumor xenograft mouse model. We then further demonstrate that the addition of protoporphyrin IX fluorescence imaging enables fluorescence-guided Raman spectroscopic margin delineation in a tissue phantom model. CONCLUSIONS Our image-guided Raman spectroscopic probe-tracking system enables tumor margin delineation and is compatible with both white light and fluorescence image guidance, demonstrating the potential for our system to be developed toward clinical tumor resection surgeries.
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Affiliation(s)
- Conor C. Horgan
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - Mads S. Bergholt
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - May Zaw Thin
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Anika Nagelkerke
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - Robert Kennedy
- King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, Oral/Head and Neck Pathology Laboratory, London, United Kingdom
| | - Tammy L. Kalber
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Daniel J. Stuckey
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Molly M. Stevens
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
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Feng M, Ni ZX, Li A, Lu X, Fu YL. Master manipulator optimisation for robot assisted minimally invasive surgery. Int J Med Robot 2021; 17:e2208. [PMID: 33345436 DOI: 10.1002/rcs.2208] [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] [Received: 09/07/2020] [Revised: 11/10/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND In robot-assisted minimally invasive surgery, the surgeon controls a robot by operating a pair of master manipulators. Thus, the performance of a master manipulator directly affects the work of the surgeon physiologically and psychologically. AIMS In order to improve the operability and quality of operation, a structure optimisation method of master manipulator is proposed. MATERIALS & METHODS The optimisation index of workspace and dexterity of main manipulator based on ergonomics and kinematics is established, and the reasonable weight coefficient of optimisation index is determined by using combination weighting method. RESULTS Experiments verified that the proposed optimisation method ensures a large workspace and good kinematic performance for the master manipulator. CONCLUSION This improves the comfort of the surgeon and can effectively avoid the problem of cutting off master-slave communication to adjust the position of the master manipulator owing to the small workspace.
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Affiliation(s)
- Mei Feng
- Key Laboratory of CNC Equipment Reliability, Ministry of Education, School of Mechanical and Aerospace Engineering, Jilin University, Changchun, Jilin, China
| | - Zhi Xue Ni
- Key Laboratory of CNC Equipment Reliability, Ministry of Education, School of Mechanical and Aerospace Engineering, Jilin University, Changchun, Jilin, China
| | - Ang Li
- Key Laboratory of CNC Equipment Reliability, Ministry of Education, School of Mechanical and Aerospace Engineering, Jilin University, Changchun, Jilin, China
| | - Xiuquan Lu
- Key Laboratory of CNC Equipment Reliability, Ministry of Education, School of Mechanical and Aerospace Engineering, Jilin University, Changchun, Jilin, China
| | - Yi Li Fu
- Harbin Institute of Technology Harbin Inst Technol, State Key Lab Robot & Syst, Harbin, Heilongjiang, China
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Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy. Arthrosc Tech 2020; 9:e1721-e1726. [PMID: 33294332 PMCID: PMC7695592 DOI: 10.1016/j.eats.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023] Open
Abstract
Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezium muscle palsy. This technique is an alternative to Eden-Lange and triple-tendon transfer.
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Abstract
OBJECTIVE To define criteria for robotic credentialing using expert consensus. BACKGROUND A recent review of institutional robotic credentialing policies identified significant variability and determined current policies are largely inadequate to ensure surgeon proficiency and may threaten patient safety. METHODS 28 national robotic surgery experts were invited to participate in a consensus conference. After review of available institutional policies and discussion, the group developed a 91 proposed criteria. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed criteria in three electronic survey rounds after the conference. Criteria that achieved 80% or more in agreement (consensus) in all rounds were included in the final list. RESULTS All experts agreed that there is a need for standardized robotic surgery credentialing criteria across institutions that promote surgeon proficiency. 49 items reached consensus in the first round, 19 in the second, and 8 in the third for a total of 76 final items. Experts agreed that privileges should be granted based on video review of surgical performance and attainment of clearly defined objective proficiency benchmarks. Parameters for ongoing outcome monitoring were determined and recommendations for technical skills training, proctoring, and performance assessment were defined. CONCLUSIONS Using a systematic approach, detailed credentialing criteria for robotic surgery were defined. Implementation of these criteria uniformly across institutions will promote proficiency of robotic surgeons and has the potential to positively impact patient outcomes.
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Qureshi AH, Dong J, Choe A, Yip MC. Neural Manipulation Planning on Constraint Manifolds. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.3010220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vasudevan MK, Isaac JHR, Sadanand V, Muniyandi M. Novel virtual reality based training system for fine motor skills: Towards developing a robotic surgery training system. Int J Med Robot 2020; 16:1-14. [PMID: 32976695 DOI: 10.1002/rcs.2173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/20/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Training surgeons to use surgical robots are becoming part of surgical training curricula. We propose a novel method of training fine-motor skills such as Microscopic Selection Task (MST) for robot-assisted surgery using virtual reality (VR) with objective quantification of performance. We also introduce vibrotactile feedback (VTFB) to study its impact on training performance. METHODS We use a VR-based environment to perform MST with varying degrees of difficulties. Using a well-known human-computer interaction paradigm and incorporating VTFB, we quantify the performance: speed, precision and accuracy. RESULTS MST with VTFB showed statistically significant improvement in performance metrics leading to faster completion of MST with higher precision and accuracy compared to that without VTFB. DISCUSSION The addition of VTFB to VR-based training for robot-assisted surgeries may improve performance outcomes in real robotic surgery. VTFB, along with proposed performance metrics, can be used in training curricula for robot-assisted surgeries.
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Affiliation(s)
- Madhan Kumar Vasudevan
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Joseph H R Isaac
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.,Reconfigurable Intelligent Systems Engineering (RISE) Lab, Department of Computer Science and Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Venkatraman Sadanand
- Department of Neurosurgery, Loma Linda University Health System, Loma Linda, California, USA
| | - Manivannan Muniyandi
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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Avila-Tomás JF, Mayer-Pujadas MA, Quesada-Varela VJ. [Artificial intelligence and its applications in medicine I: introductory background to AI and robotics]. Aten Primaria 2020; 52:778-784. [PMID: 32660768 PMCID: PMC8054276 DOI: 10.1016/j.aprim.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/25/2020] [Indexed: 11/25/2022] Open
Abstract
La tecnología y la medicina siguen un camino paralelo durante las últimas décadas. Los avances tecnológicos van modificando el concepto de salud y las necesidades sanitarias están influyendo en el desarrollo de la tecnología. La inteligencia artificial (IA) está formada por una serie de algoritmos lógicos suficientemente entrenados a partir de los cuales las máquinas son capaces de tomar decisiones para casos concretos a partir de normas generales. Esta tecnología tiene aplicaciones en el diagnóstico y seguimiento de pacientes con una evaluación pronóstica individualizada de los mismos. Además,si combinamos esta tecnología con la robótica, podemos crear máquinas inteligentes que hagan propuestas diagnósticas o que sean mucho más eficientes en su trabajo. Por lo tanto la IA va a ser una tecnología presente en nuestro trabajo cotidiano a través de máquinas o programas informáticos, que de manera más o menos transparente para el usuario, van a ir siendo una realidad cotidiana en los procesos sanitarios. Los profesionales sanitarios tenemos que conocer esta tecnología, sus ventajas y sus inconvenientes, porque va a ser una parte integral de nuestro trabajo. En estos dos artículos pretendemos dar una visión básica de esta tecnología adaptada a los médicos con un repaso de su historia y evolución, de sus aplicaciones reales en el momento actual y una visión de un futuro en el que la IA y el Big Data van a conformar la medicina personalizada que caracterizará al siglo XXI.
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Affiliation(s)
- J F Avila-Tomás
- Medicina de Familia y Comunitaria, Centro de Salud Santa Isabel, DASur, Madrid, España; Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Móstoles, Madrid, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC.
| | - M A Mayer-Pujadas
- Medicina de Familia y Comunitaria, Research Programme on Biomedical Informatics (GRIB), Instituto Hospital del Mar de Investigaciones Médicas y Universitat Pompeu Fabra, Barcelona, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
| | - V J Quesada-Varela
- Medicina de Familia y Comunitaria, Centro de Salud A Guarda. EOXI Vigo, A Guarda, Pontevedra, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
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Okuda H, Okamoto J, Takumi Y, Kakehata S, Muragaki Y. The iArmS Robotic Armrest Prolongs Endoscope Lens–Wiping Intervals in Endoscopic Sinus Surgery. Surg Innov 2020; 27:515-522. [DOI: 10.1177/1553350620929864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Fouling of the endoscope lens is a major problem in endoscopic sinus surgery (ESS). We examined whether the use of the intelligent arm support system (iArmS), a robotic armrest, could prolong endoscope lens–wiping intervals in ESS and thus allow for continuously clear endoscopic images. Study Design. This study is a prospective, nonrandomized crossover study. Methods. Three surgeons who performed ESS at 2 centers each conducted 3 operations with the iArmS and 3 operations without the iArmS; thus, 18 operations were assessed. To blind the assessments, we performed them prospectively without informing subjects of the endpoints. We recorded the operations and observed the recordings at a later date; endoscope lens–wiping times were noted in seconds to determine the endoscope lens–wiping intervals. Our examination was based on the null hypothesis that endoscope lens–wiping intervals would not differ according to the use or nonuse of the iArmS. Results. The median endoscope lens–wiping intervals with and without using the iArmS were 361 seconds and 135 seconds, respectively. Based on the Wilcoxon rank-sum test, this difference was significant ( P = 0.001); thus, the null hypothesis was rejected. This result indicated that endoscope lens–wiping intervals are greatly prolonged by the use of the iArmS. Conclusion. The iArmS robotic armrest is suitable for ESS, prolongs endoscope lens–wiping intervals, and facilitates obtaining continuous clear endoscopic images.
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Affiliation(s)
- Hideki Okuda
- Social Solutions Business Development Division, DENSO Corporation, Japan
| | - Jun Okamoto
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Japan
| | - Yutaka Takumi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Japan
| | - Yoshihiro Muragaki
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Japan
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Garcia JC, Cordeiro EF, Raffaelli MDP, Dumans Mello MB, Kozonara ME, Cardoso ÁDM, Torres MC. Robotic Transfer of the Latissimus Dorsi. Arthrosc Tech 2020; 9:e769-e773. [PMID: 32577350 PMCID: PMC7301275 DOI: 10.1016/j.eats.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/04/2020] [Indexed: 02/03/2023] Open
Abstract
Robotic surgery has been used for a long time; it is earning space and its use is expanding in daily medical practice in several surgical specialties, with advantages over traditional surgical methods. This Technical Note presents an endoscopic robotic posterior shoulder approach that allows the surgeon to perform latissimus dorsi transfer endoscopically. This Technical Note describes the use of the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) for transfers related to rotator cuff tears.
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Affiliation(s)
- Jose Carlos Garcia
- NAEON Institute, São Paulo, Brazil,Address correspondence to Jose Carlos Garcia Jr, M.D., Ph.D., NAEON Institute, Avenida Ibirapuera 2144, cj 82, Sao Paulo (SP), Brazil, 04028-001.
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SuPer: A Surgical Perception Framework for Endoscopic Tissue Manipulation With Surgical Robotics. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2970659] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol 2020; 17:177-188. [PMID: 32086498 DOI: 10.1038/s41585-020-0287-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.
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Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis. Surg Endosc 2019; 34:4041-4047. [PMID: 31617088 DOI: 10.1007/s00464-019-07193-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022]
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Rai BP, Bondad J, Vasdev N, Adshead J, Lane T, Ahmed K, Khan MS, Dasgupta P, Guru K, Chlosta PL, Aboumarzouk OM. Robot-assisted vs open radical cystectomy for bladder cancer in adults. BJU Int 2019; 125:765-779. [PMID: 31309688 DOI: 10.1111/bju.14870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been suggested that, in comparison with open radical cystectomy (ORC), robot-assisted radical cystectomy (RARC) results in less blood loss, shorter convalescence and fewer complications, with equivalent short-term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits. OBJECTIVES To assess the effects of RARC vs ORC in adults with bladder cancer. SEARCH METHODS We conducted a comprehensive search, with no restrictions on language of publication or publication status, for randomized controlled trials (RCTs) that compared RARC with ORC. The date of the last search was 1 July 2018. Databases searched included the Cochrane Central Register of Controlled Trials, MEDLINE (1999 to July 2018), PubMed Embase (1999 to July 2018), Web of Science (1999 to July 2018), Cancer Research UK (www.cancerresearchuk.org/), and the Institute of Cancer Research (www.icr.ac.uk/). We also searched the following trial registers: ClinicalTrials.gov (clinicaltrials.gov/); BioMed Central International Standard Randomized Controlled Trials Number (ISRCTN) Registry (www.isrctn.com); and the World Health Organization International Clinical Trials Registry Platform. The review was based on a published protocol. Primary outcomes of the review were recurrence-free survival and major postoperative complications (Clavien grade III to V). Secondary outcomes were minor postoperative complications (Clavien grades I and II), transfusion requirement, length of hospital stay (days), quality of life, and positive surgical margins (%). Three review authors independently assessed relevant titles and abstracts of records identified by the literature search to determine which studies should be assessed further. Two review authors assessed risk of bias using the Cochrane risk-of-bias tool and rated the quality of evidence according to GRADE. We used Review Manager 5 to analyse the data. RESULTS We included in the review five RCTs comprising a total of 541 participants. Total numbers of participants included in the ORC and RARC cohorts were 270 and 271, respectively. We found that RARC and ORC may result in a similar time to recurrence (hazard ratio 1.05, 95% confidence interval [CI] 0.77 to 1.43; two trials, low-certainty evidence). In absolute terms at 5 years of follow-up, this corresponds to 16 more recurrences per 1000 participants (95% CI 79 fewer to 123 more) with 431 recurrences per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in similar rates of major complications (risk ratio [RR] 1.06, 95% CI 0.76 to 1.48; five trials, low-certainty evidence). This corresponds to 11 more major complications per 1000 participants (95% CI 44 fewer to 89 more). We downgraded the certainty of evidence because of study limitations and imprecision. We were very uncertain whether RARC reduces minor complications (very-low-certainty evidence). We downgraded the certainty of evidence because of study limitations and very serious imprecision. RARC probably results in substantially fewer transfusions than ORC (RR 0.58, 95% CI 0.43 to 0.80; two trials, moderate-certainty evidence). This corresponds to 193 fewer transfusions per 1000 participants (95% CI 262 fewer to 92 fewer) based on 460 transfusion per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations. RARC may result in a slightly shorter hospital stay than ORC (mean difference -0.67, 95% CI -1.22 to -0.12; five trials, low-certainty evidence). We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in a similar quality of life (standardized mean difference 0.08, 95% CI 0.32 lower to 0.16 higher; three trials, low-certainty evidence). We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in similar positive surgical margin rates (RR 1.16, 95% CI 0.56 to 2.40; five trials, low-certainty evidence). This corresponds to eight more (95% CI 21 fewer to 67 more) positive surgical margins per 1000 participants, based on 48 positive surgical margins per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations and imprecision. CONCLUSIONS We conclude that RARC and ORC may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive surgical margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very-low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body habitus, or surgeon expertise on outcomes. This review did not address issues of cost-effectiveness.
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Affiliation(s)
- Bhavan Prasad Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jasper Bondad
- Department of Urology, Southend Hospital, Westcliff-on-Sea, UK
| | - Nikhil Vasdev
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Jim Adshead
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Tim Lane
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine, King's College London, London, UK
| | - Mohammed S Khan
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine, King's College London, London, UK
| | - Khurshid Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Piotr L Chlosta
- Department of Urology, Jagiellonian University, Collegium Medicum, Krakow, Poland
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Kim YY, Lee Y, Lee CM, Park S. Lymphadenectomy using two instrument arms during robotic surgery for gastric cancer: A strategy to facilitate reduced-port robotic gastrectomy. Asian J Surg 2019; 43:459-466. [PMID: 31227438 DOI: 10.1016/j.asjsur.2019.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/26/2019] [Accepted: 12/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Three instrument arms are used in the current form of reduced-port robotic gastrectomy (RPRG) for gastric cancer. Based on our experience in performing reduced-port laparoscopic gastrectomy (RPLG), we have recently performed RPRG using two instrument arms. METHODS From February 2018 to January 2019, we performed RPRG using two instrument arms for gastric cancer. One endoscope arm and two instrument arms of da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) were applied in robotic lymphadenectomy. A commercial multi-lumen single-port trocar was used for the endoscopy port. RESULTS A total of 18 patients underwent the planned robotic surgery using two instrument arms. Median operation time was 288.5 (213.0-446.0) minutes, and median hospital stay was 11.0 (7-18) days. Four patients experienced postoperative complications: one Clavien-Dindo grade IIIa, and the other three grade II. No mortality was reported. The number of retrieved lymph nodes did not differ between patients who underwent RPRG and RPLG (p = 0.412). CONCLUSION Gastric cancer surgery using two instrument arms of a robotic surgical system can be performed by surgeons with expertise of RPLG. If this technique is successfully introduced in robotic surgery, it is expected to shorten the path to pure single-port robotic gastrectomy.
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Affiliation(s)
- Yong Yeup Kim
- Department of Surgery, Korea University College of Medicine, South Korea
| | - Yoontaek Lee
- Department of Surgery, Korea University College of Medicine, South Korea
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, South Korea.
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, South Korea
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Ota T, Degani A, Zubiate B, Wolf A, Choset H, Schwartzman D, Zenati MA. Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 1:335-340. [PMID: 17895961 PMCID: PMC1993852 DOI: 10.1097/imi.0b013e31802f43b1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. Methods In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. Results Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. Conclusions We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype.
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Affiliation(s)
- Takeyoshi Ota
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amir Degani
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Brett Zubiate
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Alon Wolf
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Howie Choset
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - David Schwartzman
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marco A. Zenati
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Vidal-Sicart S, Fuertes Cabero S, Danús Lainez M, Valdés Olmos R, Paredes Barranco P, Rayo Madrid J, Rioja Martín M, Díaz Expósito R, Goñi Gironés E. Update on radioguided surgery: From international consensus on sentinel node in head and neck cancer to the advances on gynecological tumors and localization of non-palpable lesions. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rai BP, Bondad J, Vasdev N, Adshead J, Lane T, Ahmed K, Khan MS, Dasgupta P, Guru K, Chlosta PL, Aboumarzouk OM. Robotic versus open radical cystectomy for bladder cancer in adults. Cochrane Database Syst Rev 2019; 4:CD011903. [PMID: 31016718 PMCID: PMC6479207 DOI: 10.1002/14651858.cd011903.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND It has been suggested that in comparison with open radical cystectomy, robotic-assisted radical cystectomy results in less blood loss, shorter convalescence, and fewer complications with equivalent short-term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits. OBJECTIVES To assess the effects of robotic-assisted radical cystectomy versus open radical cystectomy in adults with bladder cancer. SEARCH METHODS Review authors conducted a comprehensive search with no restrictions on language of publication or publication status for studies comparing open radical cystectomy and robotic-assisted radical cystectomy. The date of the last search was 1 July 2018 for the Cochrane Central Register of Controlled Trials, MEDLINE (1999 to July 2018), PubMed Embase (1999 to July 2018), Web of Science (1999 to July 2018), Cancer Research UK (www.cancerresearchuk.org/), and the Institute of Cancer Research (www.icr.ac.uk/). We searched the following trials registers: ClinicalTrials.gov (clinicaltrials.gov/), BioMed Central International Standard Randomized Controlled Trials Number (ISRCTN) Registry (www.isrctn.com), and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We searched for randomised controlled trials that compared robotic-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). DATA COLLECTION AND ANALYSIS This study was based on a published protocol. Primary outcomes of the review were recurrence-free survival and major postoperative complications (class III to V). Secondary outcomes were minor postoperative complications (class I and II), transfusion requirement, length of hospital stay (days), quality of life, and positive margins (%). Three review authors independently assessed relevant titles and abstracts of records identified by the literature search to determine which studies should be assessed further. Two review authors assessed risk of bias using the Cochrane risk of bias tool and rated the quality of evidence according to GRADE. We used Review Manager 5 to analyse the data. MAIN RESULTS We included in the review five randomised controlled trials comprising a total of 541 participants. Total numbers of participants included in the ORC and RARC cohorts were 270 and 271, respectively.Primary outomesTime-to-recurrence: Robotic cystectomy and open cystectomy may result in a similar time to recurrence (hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.77 to 1.43); 2 trials; low-certainty evidence). In absolute terms at 5 years of follow-up, this corresponds to 16 more recurrences per 1000 participants (95% CI 79 fewer to 123 more) with 431 recurrences per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations and imprecision.Major complications (Clavien grades 3 to 5): Robotic cystectomy and open cystectomy may result in similar rates of major complications (risk ratio (RR) 1.06, 95% CI 0.76 to 1.48); 5 trials; low-certainty evidence). This corresponds to 11 more major complications per 1000 participants (95% CI 44 fewer to 89 more). We downgraded the certainty of evidence for study limitations and imprecision.Secondary outcomesMinor complications (Clavien grades 1 and 2): We are very uncertain whether robotic cystectomy may reduce minor complications (very low-certainty evidence). We downgraded the certainty of evidence for study limitations and for very serious imprecision.Transfusion rate: Robotic cystectomy probably results in substantially fewer transfusions than open cystectomy (RR 0.58, 95% CI 0.43 to 0.80; 2 trials; moderate-certainty evidence). This corresponds to 193 fewer transfusions per 1000 participants (95% CI 262 fewer to 92 fewer) based on 460 transfusion per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations.Hospital stay: Robotic cystectomy may result in a slightly shorter hospital stay than open cystectomy (mean difference (MD) -0.67, 95% CI -1.22 to -0.12); 5 trials; low-certainty evidence). We downgraded the certainty of evidence for study limitations and imprecision.Quality of life: Robotic cystectomy and open cystectomy may result in a similar quality of life (standard mean difference (SMD) 0.08, 95% CI 0.32 lower to 0.16 higher; 3 trials; low-certainty evidence). We downgraded the certainty of evidence for study limitations and imprecision.Positive margin rates: Robotic cystectomy and open cystectomy may result in similar positive margin rates (RR 1.16, 95% CI 0.56 to 2.40; 5 trials; low-certainty evidence). This corresponds to 8 more (95% CI 21 fewer to 67 more) positive margins per 1000 participants based on 48 positive margins per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations and imprecision. AUTHORS' CONCLUSIONS Robotic cystectomy and open cystectomy may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body habitus, or surgeon expertise on outcomes. This review did not address issues of cost-effectiveness.
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Affiliation(s)
- Bhavan Prasad Rai
- Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation TrustDepartment of UrologyNewcastle Upon TyneUK
| | - Jasper Bondad
- Southend HospitalDepartment of UrologyPrittlewell ChaseWestcliff‐on‐SeaUKSS0 0RY
| | | | - Jim Adshead
- Lister HospitalDepartment of UrologyStevenageUK
| | - Tim Lane
- Lister HospitalDepartment of UrologyStevenageUK
| | - Kamran Ahmed
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Mohammed S Khan
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Prokar Dasgupta
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Khurshid Guru
- Roswell Park Cancer InstituteDepartment of UrologyBuffaloNew YorkUSA
| | - Piotr L Chlosta
- Jagiellonian University, Collegium MedicumDepartment of UrologyGrzegorzecka 18KrakowPoland31531
| | - Omar M Aboumarzouk
- NHS Greater Glasgow and ClydeDepartment of UrologyQueen Elizabeth University HospitalGlasgowScotlandUK
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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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Tan X, Chng CB, Su Y, Lim KB, Chui CK. Robot-Assisted Training in Laparoscopy Using Deep Reinforcement Learning. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2019.2891311] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries. J Robot Surg 2019; 14:115-121. [PMID: 30863913 DOI: 10.1007/s11701-019-00933-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Laparoscopic surgery (LS) may lead to musculoskeletal disorders (MSDs) and an increase in physical and mental workloads to the surgeon. Robot-assisted surgery (RAS) should improve the ergonomy of the surgeon. This study assesses the experience influence in surgical ergonomics between LS and RAS. METHODS LS and RAS lasting more than 60 min of effective operative time were compared. During the surgical procedure, the physical discomfort was evaluated using the Borg scale. At the end, the mental workload was evaluated using the NASA-TLX index. After global analysis, the experienced and young surgeons were assessed. RESULTS 88 RAS and 82 LS were evaluated. During LS, the physical discomfort was significantly higher in all segments, and the pain increased significantly during the procedure in all segments compared to that evaluated in the RAS (p < 0.05). Forearms and the back were the most painful. The young surgeons did not display any improvement in the physical ergonomics of the RAS compared to the LS. Concerning the mental ergonomics, the overall workload and performance were significantly greater during the LS compared to the RAS (p < 0.05). For the young surgeons, the overall workload, the effort, the mental and the physical demands were greater during LS (p < 0.05). For the experienced surgeons, the physical demand was lower during the RAS compared to the LS (p < 0.05). However, the experienced surgeons expressed a feeling of greater performance after the LS (p < 0.01). RAS significantly reduces the onset of MSDs compared to LS, especially for the experienced surgeons. CONCLUSION RAS significantly reduces the onset of MSDs compared to LS, especially for the experienced surgeons.
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Song J, He Z, Ma S, Ma C, Yu T, Li J. Clinical Comparison of Spleen-Preserving Distal Pancreatectomy With or Without Splenic Vessel Preservation: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2019; 29:323-332. [PMID: 30312137 DOI: 10.1089/lap.2018.0135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Jian Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Zhigang He
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Sunqiang Ma
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Cheng Ma
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Tianyu Yu
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Jiyu Li
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
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Sdiri B, Kaaniche M, Cheikh FA, Beghdadi A, Elle OJ. Efficient Enhancement of Stereo Endoscopic Images Based on Joint Wavelet Decomposition and Binocular Combination. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:33-45. [PMID: 29994612 DOI: 10.1109/tmi.2018.2853808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The success of minimally invasive interventions and the remarkable technological and medical progress have made endoscopic image enhancement a very active research field. Due to the intrinsic endoscopic domain characteristics and the surgical exercise, stereo endoscopic images may suffer from different degradations which affect its quality. Therefore, in order to provide the surgeons with a better visual feedback and improve the outcomes of possible subsequent processing steps, namely, a 3-D organ reconstruction/registration, it would be interesting to improve the stereo endoscopic image quality. To this end, we propose, in this paper, two joint enhancement methods which operate in the wavelet transform domain. More precisely, by resorting to a joint wavelet decomposition, the wavelet subbands of the right and left views are simultaneously processed to exploit the binocular vision properties. While the first proposed technique combines only the approximation subbands of both views, the second method combines all the wavelet subbands yielding an inter-view processing fully adapted to the local features of the stereo endoscopic images. Experimental results, carried out on various stereo endoscopic datasets, have demonstrated the efficiency of the proposed enhancement methods in terms of perceived visual image quality.
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Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions. Rev Esp Med Nucl Imagen Mol 2018; 38:173-182. [PMID: 30579916 DOI: 10.1016/j.remn.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022]
Abstract
The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.
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Safe adoption of robotic colorectal surgery using structured training: early Irish experience. J Robot Surg 2018; 13:657-662. [PMID: 30536134 DOI: 10.1007/s11701-018-00911-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
Robotic surgery enhances the precision of minimally invasive surgery through improved three-dimensional views and articulated instruments. There has been increasing interest in adopting this technology to colorectal surgery and this has recently been introduced to the Irish health system. This paper gives an account of our early institutional experience with adoption of robotic colorectal surgery using structured training. Analysis was conducted of a prospectively maintained database of our first 55 consecutive robotic colorectal cases, performed by four colorectal surgeons, each at the beginning of his robotic surgery experience, using the Da Vinci Si® system and undergoing training as per the European Academy of Robotic Colorectal Surgery (EARCS) programme. Overall surgical and oncological outcomes were interrogated. Fifty-five patients underwent robotic surgery between January 2017 and January 2018, M:F 34:21, median age (range) 60 (35-87) years. Thirty-three patients had colorectal cancer and 22 had benign pathologies. Eleven rectal cancer patients had neoadjuvant chemoradiotherapy. BMI was > 30 in 21.8% of patients and 56.4% of patients had previous abdominal surgery. Operative procedures performed were low anterior resection (n = 19), sigmoid colectomy (n = 9), right colectomy (n = 22), ventral mesh rectopexy (n = 3), abdominoperineal resection (n = 1) and reversal of Hartmann's procedure (n = 1). Median blood loss was 40 ml (range 0-400). Mean operative time (minutes) was 233 (SD 79) for right colectomy and 368 (SD 105) for anterior resection. Median length of hospital stay was 6 days (IQR 5-7). There was no 30-day mortality, intraoperative complications, conversion to laparoscopic or open, or anastomotic leakage. Median lymph nodes harvest was 15 in non-neoadjuvant cases (range 7-23) and 8 in neoadjuvant cases (2-14). Our early results demonstrate that colorectal robotic surgery can be adopted safely for both benign and neoplastic conditions using a structured training programme without compromising clinical or oncological outcomes. The early learning curve can be time intensive.
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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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