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Wang H, Chen Z, Zuo S. Flexible Manipulator with Low-Melting-Point Alloy Actuation and Variable Stiffness. Soft Robot 2021; 9:577-590. [PMID: 34152857 DOI: 10.1089/soro.2020.0143] [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] [Indexed: 01/10/2023] Open
Abstract
Flexible manipulators offer significant advantages over traditional rigid manipulators in minimally invasive surgery, because they can flexibly navigate around obstacles and pass cramped or tortuous paths. However, due to the inherent low stiffness, the ability to control/obtain higher stiffness when required remains to be further explored. In this article, we propose a flexible manipulator that exploits the phase transformation property of low-melting-point alloy to hydraulically drive and change the stiffness by heating and cooling. A prototype was fabricated, and experiments were conducted to evaluate the motion characteristics, stiffness performance, and rigid-flexible transition efficiency. The experimental results demonstrate that the proposed manipulator can freely adjust heading direction in the three-dimensional space. The experimental results also indicate that it took 9.2-10.3 s for the manipulator to transform from a rigid state to a flexible state and 15.4 s to transform from a flexible state to a rigid state. The lateral stiffness and flexural stiffness of the manipulator were 95.54 and 372.1 Ncm2 in the rigid state and 7.26 and 0.78 Ncm2 in the flexible state. The gain of the lateral stiffness and flexural stiffness was 13.15 and 477.05, respectively. In the rigid state, the ultimate force without shape deformation was more than 0.98 N in the straight condition (0°) and 1.36 N in the bending condition (90°). By assembling flexible surgical tools, the manipulator can enrich the diagnosis or treatment functions, which demonstrated the potential clinical value of the proposed manipulator.
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Affiliation(s)
- Haibo Wang
- Key Lab of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin, China
| | - Zhiwei Chen
- Key Lab of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin, China
| | - Siyang Zuo
- Key Lab of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin, China
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Méndez-Bailón M, Jiménez-García R, Muñoz-Rivas N, Hernández-Barrera V, de Miguel-Yanes JM, de Miguel-Díez J, Andrès E, Lorenzo-Villalba N, López-de-Andrés A. Trends and Clinical Impact of Gastrointestinal Endoscopic Procedures on Acute Heart Failure in Spain (2002-2017). J Clin Med 2021; 10:jcm10030546. [PMID: 33540753 PMCID: PMC7867243 DOI: 10.3390/jcm10030546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions. Objectives: The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy. Methods: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy. Results: A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04–1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41–0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55–0.64). Conclusion: In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitalized HF population seen over the course of the study could have contributed to this. Both procedures seemed to be associated with lower in-hospital mortality, but in the case of colonoscopy, the risk of in-hospital mortality was higher in elderly patients with heart failure and associated neoplasms. Colonoscopy and EGD seemed not to increase IHM in patients with heart failure.
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Affiliation(s)
- Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (A.L.-d.-A.)
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Valentín Hernández-Barrera
- Department of Preventive Medicine and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon Madrid, 28922 Madrid, Spain;
| | | | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (A.L.-d.-A.)
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Sivananthan A, Glover B, Ayaru L, Patel K, Darzi A, Patel N. The evolution of lower gastrointestinal endoscopy: where are we now? Ther Adv Gastrointest Endosc 2020; 13:2631774520979591. [PMID: 33426522 PMCID: PMC7754801 DOI: 10.1177/2631774520979591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Lower gastrointestinal endoscopy has evolved over time, fulfilling a widening diagnostic and therapeutic remit. As our understanding of colorectal cancer and its prevention has improved, endoscopy has progressed with improved diagnostic technologies and advancing endoscopic therapies. Despite this, the fundamental design of the endoscope has remained similar since its inception. This review presents the important role lower gastrointestinal endoscopy serves in the prevention of colorectal cancer and the desirable characteristics of the endoscope that would enhance this. A brief history of the endoscope is presented. Current and future robotic endoscopic platforms, which may fulfil these desirable characteristics, are discussed. The incorporation of new technologies from allied scientific disciplines will help the endoscope fulfil its maximum potential in preventing the increasing global burden of colorectal cancer. There are a number of endoscopic platforms under development, which show significant promise.
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Affiliation(s)
| | | | | | - Kinesh Patel
- Chelsea and Westminster NHS Healthcare Trust, UK
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Wang S, Zhang K, Hu JL, Wu WC, Liu X, Ge N, Guo JT, Wang GX, Sun SY. Endoscopic resection of the pancreatic tail and subsequent wound healing mechanisms in a porcine model. World J Gastroenterol 2019; 25:2623-2635. [PMID: 31210714 PMCID: PMC6558443 DOI: 10.3748/wjg.v25.i21.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations; its safety and surgical planning are relatively mature, but it remains a complex and high-precision surgical operation, requiring abundant experience and skills in laparoscopic surgery, with a 10% rate of complications.
AIM To verify the feasibility and safety, as well as to examine the complications of endoscopic pancreatectomy and healing mechanisms of pancreatic wounds after endoscopic resection.
METHODS Transgastric endoscopic resections of varying sizes of pancreases were performed in 15 healthy Bama miniature pigs. The technical success rate, the incidence of serious complications, and the survival of the animals were studied. The healing of the wounds was evaluated by sacrificing the animals at various time points. Finally, the expression of transforming growth factor-β1 and Smad3/Smad7 in the surgical site was examined by immunohistochemistry to explore the role of these factors in wound healing of the pancreas.
RESULTS Partial and total resections were successfully performed in two groups of animals, respectively. The technical success rate and the survival rate of the pigs were both 100%. We obtained 12 pancreatic tissue samples by endoscopic resection. The pancreatic wounds were closed with metal clips in one group and the wounds healed well by forming scars. There was a small amount of pancreatic leakage in the other group, but it can be fully encapsulated. The level of transforming growth factor-β1 (TGF-β1) in the wounds increased during the inflammatory and fibrous hyperplasia phases, and decreased in the scar phase. The expression of Smad3 paralleled that of TGF-β1, while the expression of Smad7 had an inverse relationship with the expression of TGF-β1.
CONCLUSION Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure, but the incidence of pancreatic leakage in total pancreatic tail resection is high. The expression of TGF-β1 and Smad3/Samd7 is related to the progression of pancreatic wound healing.
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Affiliation(s)
- Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Kai Zhang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei-Chao Wu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Tao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Guo-Xin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Wire-driven flexible manipulator with constrained spherical joints for minimally invasive surgery. Int J Comput Assist Radiol Surg 2019; 14:1365-1377. [PMID: 30997634 DOI: 10.1007/s11548-019-01976-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE One of the main factors that affect the rigidity of flexible robots is the twist deformation because of the external force exerted on the end effector. Another important factor that affects accuracy is the fact that such robots do not have a constant curvature. The conventional kinematic model assumes that the curvature is constant; however, in reality, it is not. To improve the rigidity and accuracy of flexible robots used in minimally invasive surgery via preventing the twist deformation while ensuring a constant curvature, we propose a novel flexible manipulator with ball-constrained spherical (BCS) joints and a spring. METHODS The BCS joints are used to prevent the twist deformation in the flexible robot. The joints have two degrees of freedom (DOFs), which limit the rotation about the axial direction. The rotation is limited because the ball that is inserted into a BCS joint can move only along the ball guide. To obtain a constant curvature, springs are installed among the BCS joints. The springs receive the uniform compression force generated among the joints, thus achieving a constant curvature. The proposed BCS joint is designed based on the diameter of the forceps, desired workspace, and desired bending angle. RESULTS To evaluate the proposed mechanism, three experiments were performed using a 20-mm-diameter prototype consisting of 13 BCS joints with a two-DOF motion. The experimental results showed that the prototype can realize a constant curvature with a mean error of 0.21°, which can support up to 5 N with no apparent twist deformation. CONCLUSIONS We developed a flexible manipulator with BCS joints for minimally invasive surgery. The proposed mechanism is anticipated to help prevent the twist deformation of the robot and realize a constant curvature. Accordingly, it is expected that rigidity is improved to ensure accuracy.
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Shi C, Luo X, Qi P, Li T, Song S, Najdovski Z, Fukuda T, Ren H. Shape Sensing Techniques for Continuum Robots in Minimally Invasive Surgery: A Survey. IEEE Trans Biomed Eng 2017; 64:1665-1678. [DOI: 10.1109/tbme.2016.2622361] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Díaz CE, Fernández R, Armada M, García F. A research review on clinical needs, technical requirements, and normativity in the design of surgical robots. Int J Med Robot 2017; 13. [PMID: 28105687 DOI: 10.1002/rcs.1801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/04/2016] [Accepted: 11/21/2016] [Indexed: 12/14/2022]
Abstract
Nowadays robots play an important role in society, mainly due to the significant benefits they provide when utilized for assisting human beings in the execution of dangerous or repetitive tasks. Medicine is one of the fields in which robots are gaining greater use and development, especially those employed in minimally invasive surgery (MIS). However, due to the particular conditions of the human body where robots have to act, the design of these systems is complex, not only from a technical point of view, but also because the clinical needs and the normativity aspects are important considerations that have to be taken into account in order to achieve better performances and more secure systems for patients and surgeons. Thus, this paper explores the clinical needs and the technical requirements that will trace the roadmap for the next scientific and technological advances in the field of robotic surgery, the metrics that should be defined for safe technology development and the standards that are being elaborated for boosting the industry and facilitating systems integration.
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Affiliation(s)
- Carlos Eduardo Díaz
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
| | - Roemi Fernández
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Manuel Armada
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Felipe García
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
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Kurniawan N, Keuchel M. Flexible Gastro-intestinal Endoscopy - Clinical Challenges and Technical Achievements. Comput Struct Biotechnol J 2017; 15:168-179. [PMID: 28179979 PMCID: PMC5294716 DOI: 10.1016/j.csbj.2017.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Flexible gastro-intestinal (GI) endoscopy is an integral diagnostic and therapeutic tool in clinical gastroenterology. High quality standards for safety, patients' comfort, and efficiency have already been achieved. Clinical challenges and technical approaches are discussed in this short review. Image enhanced endoscopy for further characterization of mucosal and vascular patterns includes dye-spray or virtual chromoendoscopy. For confocal laser endoscopy, endocytoscopy, and autofluorescence clinical value has not yet been finally evaluated. An extended viewing field provided by additional cameras in new endoscopes can augment detection of polyps behind folds. Attachable caps, flaps, or balloons can be used to flatten colonic folds for better visualization and stable position. Variable stiffness endoscopes, radiation-free visualization of endoscope position, and different overtube devices help reducing painful loop formation in clinical routine. Computer assisted and super flexible self-propelled colonoscopes for painless sedation-free endoscopy need further research. Single-use devices might minimize the risk of infection transmission in the future. Various exchangeable accessories are available for resection, dissection, tunneling, hemostasis, treatment of stenosis and closure of defects, including dedicated suturing devices. Multiple arm flexible devices controlled via robotic platforms for complex intraluminal and transmural endoscopic procedures require further improvement.
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Affiliation(s)
- Niehls Kurniawan
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Akademisches Lehrkrankenhaus der Universität Hamburg, Glindersweg 80, 21029, Hamburg, Germany
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Akademisches Lehrkrankenhaus der Universität Hamburg, Glindersweg 80, 21029, Hamburg, Germany
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Shi H, Chen SY, Wang YG, Jiang SJ, Cai HL, Lin K, Xie ZF, Dong FF. Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model. World J Gastroenterol 2016; 22:8375-8381. [PMID: 27729743 PMCID: PMC5055867 DOI: 10.3748/wjg.v22.i37.8375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To introduce natural orifice transgastric endoscopic surgery (NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.
METHODS Six live pigs (three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cm transversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.
RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min (range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.
CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.
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Kvasha A, Khalifa M, Biswas S, Hamoud M, Nordkin D, Bramnik Z, Willenz U, Farraj M, Waksman I. Unlimited-Length Proctocolectomy Utilizing Sequential Intussusception and Pull-Through. Surg Innov 2016; 23:456-62. [DOI: 10.1177/1553350616643614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transanal, hybrid natural orifice translumenal endoscopic surgery (NOTES) and NOTES-assisted natural orifice specimen extraction techniques hold promise as leaders in the field of natural orifice surgery. We report the feasibility of a novel NOTES assisted technique for unlimited length, clean, endolumenal proctocolectomy in a porcine model. This technique is a modification of a transanal intussusception and pull-through procedure recently published by our group. Rectal mobilization was achieved laparoscopically; this was followed by a transanal recto-rectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached laparoscopically to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. To achieve an unlimited-length proctocolectomy, the IPT step was repeated several times prior to bowel resection. This was facilitated by removing the ligature applied in the first step of this procedure. Once sequential IPT established the desired length of bowel to be resected, a second ligature was placed around the rectum approximating the proximal and distal resection margins. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls. The anastomosis was achieved by deploying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. The minimally invasive nature of this evolving technique as well as its aseptic bowel manipulation has the potential to limit the complications associated with abdominal wall incision and surgical site infection.
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Nakadate R, Arata J, Hashizume M. Next-generation robotic surgery--from the aspect of surgical robots developed by industry. MINIM INVASIV THER 2015; 24:2-7. [PMID: 25627433 DOI: 10.3109/13645706.2014.1003140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.
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Affiliation(s)
- Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University , Kyushu , Japan
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