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Yang L, Bu G, Zhao J, La X, Ma C. Comparison of 3D and 2D laparoscopy: Initial experience of perioperative outcomes and clinical assessment. J Gynecol Obstet Hum Reprod 2024; 53:102754. [PMID: 38395412 DOI: 10.1016/j.jogoh.2024.102754] [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: 03/15/2022] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION This study was designed to compare three-dimensional (3D) laparoscopy and conventional two-dimensional (2D) laparoscopy in surgical performance and clinical assessment during laparoscopic radical hysterectomy with pelvic lymphadenectomy (LRHND) for treating early-stage cervical cancer. MATERIAL AND METHODS In this study, we included 67 consecutive patients underwent LRHND for treating early-stage cervical cancer by the experienced laparoscopic surgeons between August 2018 and December 2020. amongst these patients, 32 patients underwent 3D laparoscopy (2D group) and 35 patients underwent 2D laparoscopy (2D group). Demographic data, clinical and surgical parameters were obtained from each patient. An end-of-operation questionnaire was administered regarding subjective perception of 3D laparoscopy system. RESULTS Patient characteristics, including age, BMI, FIGO stage, and histology, were comparable between the two groups. Compared with 2D imaging system, 3D system significantly shortened the operation time, especially bilateral lymph node dissection time. Blood loss was lower in 3D group compared with 2D group. There were no significant differences regarding pelvic nodes retrieved, incidence of complications, hospital stay, the recovery time of bowel, abdominal drainage fluid, hospitalization costs and visual symptoms. In addition, 3D system significantly improved depth perception and precision, and reduced surgical strain and eye strain for surgeon. No statistical difference was observed in visual symptoms and adverse events between the two groups. The surgeon was more willing to accept 3D laparoscopy. CONCLUSION The 3D laparoscopy is safe, feasible and comfortable, with obvious advantage in depth perception, precision and surgical strain. It triggered no increase in the complications and adverse events.
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Affiliation(s)
- Li Yang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China
| | - Guosen Bu
- Internal Medicine-Neurology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China
| | - Jing Zhao
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China
| | - Xiaolin La
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China; Research Center for Integrated Prevention and Treatment of Reproductive Diseases and Birth Defects, Urumqi, 830054, PR China; Xinjiang Clinical Research Centre for Reproductive Immunology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China; State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, 830054, PR China.
| | - Cailing Ma
- Department of Gynaecology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, PR China.
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Miura S, Seki M, Koreeda Y, Cao Y, Kawamura K, Kobayashi Y, Fujie MG, Miyashita T. Virtual Shadow Drawing System Using Augmented Reality for Laparoscopic Surgery. ADVANCED BIOMEDICAL ENGINEERING 2022. [DOI: 10.14326/abe.11.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satoshi Miura
- Department of Mechanical Engineering, Tokyo Institute of Technology
| | - Masaki Seki
- Department of Modern Mechanical Engineering, Waseda University
| | - Yuta Koreeda
- Department of Modern Mechanical Engineering, Waseda University
| | - Yang Cao
- Department of Modern Mechanical Engineering, Waseda University
| | | | - Yo Kobayashi
- Department of Modern Mechanical Engineering, Waseda University
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Giberti C, Schenone M, Cortese P, Gallo F, Gastaldi E, Ninotta G. Robot-Asssisted Laparoscopic Radical Prostatectomy (Ralp). Oncological and Functional Findings after 90 Cases. Urologia 2018. [DOI: 10.1177/039156030907600207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The RALP is the most modern technology available for the treatment of intracapsular prostate cancer (CaP), which can produce a shorter learning curve and better results than the traditional techniques. Methods Between March 2005 and March 2008, 90 patients (64.3 ys, range 52–71) with intracapsular CaP underwent RALP at our institute. Before surgery the patients underwent routine examinations and filled in IIEF, IPSS and EORTC-QLQC30/PR 25 questionnaires. Patients were followed up with PSA assay, physical examination and compilation of the questionnaires. Median follow-up was 12.5 months (range 1–35 months). Results Mean operative time was 230 min. Discharge and catheter removal were at day 7.4 and 8.2, respectively, after surgery. Pathological staging reported pT2 and pT3 in 57 (63%) and 33 patients (37%), respectively. Positive surgical margins were assessed in 30 patients (33%), particularly 8.7% in pT2 tumors. The one-year biochemical disease-free survival rate was 90%. Regarding the functional results, 81 patients (90%) were perfectly continent while a mild and a moderate incontinence were reported in 7 (8%) and 2 (2%) patients, respectively. Mean IPSS score decreased from 8 to 4; among the patients who underwent bilateral nerve sparing RALP and no adjuvant therapy, 31 (70.4%) reported satisfactory sexual intercourses. Concerning postoperative quality of life, mean EORTC-QLQC30/PR 25 questionnaires scores were very similar before and after RALP. Conclusions After 90 cases of RALP the oncological and functional results are definitely promising. However, a wider number of patients and a greater follow-up are needed to confirm these data particularly as regards the functional results.
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Affiliation(s)
- C. Giberti
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
| | - M. Schenone
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
| | - P. Cortese
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
| | - F. Gallo
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
| | - E Gastaldi
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
| | - G. Ninotta
- Dipartimento di Chirurgia, U.O. di Urologia, Ospedale San Paolo, Savona
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Jomoto W, Tanooka M, Doi H, Kikuchi K, Mitsuie C, Yamada Y, Suzuki T, Yamano T, Ishikura R, Kotoura N, Yamamoto S. Development of a Three-dimensional Surgical Navigation System with Magnetic Resonance Angiography and a Three-dimensional Printer for Robot-assisted Radical Prostatectomy. Cureus 2018. [PMID: 29531871 PMCID: PMC5837468 DOI: 10.7759/cureus.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We sought to develop a surgical navigation system using magnetic resonance angiography (MRA) and a three-dimensional (3D) printer for robot-assisted radical prostatectomy (RARP). Six patients with pathologically proven localized prostate cancer were prospectively enrolled in this study. Prostate magnetic resonance imaging (MRI), consisting of T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) and true fast imaging with steady-state precession (true FISP), reconstructed by volume rendering, was followed by dynamic contrast-enhanced MRA performed with a volumetric interpolated breath-hold examination (VIBE) during intravenous bolus injection of gadobutrol. Images of arterial and venous phases were acquired over approximately 210 seconds. Selected images were sent to a workstation for generation of 3D volume-rendered images and standard triangulated language (STL) files for 3D print construction. The neurovascular bundles (NVBs) were found in sequence on non-contrast images. Accessory pudendal arteries (APAs) were found in all cases in the arterial phase of contrast enhancement but were ill-defined on non-contrast enhanced MRA. Dynamic contrast-enhanced MRA helped to detect APAs, suggesting that this 3D system using MRI will be useful in RARP.
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Affiliation(s)
- Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine
| | - Keisuke Kikuchi
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Chiemi Mitsuie
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Toru Suzuki
- Department of Urology, Hyogo College of Medicine
| | | | | | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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Amirabdollahian F, Livatino S, Vahedi B, Gudipati R, Sheen P, Gawrie-Mohan S, Vasdev N. Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature. J Robot Surg 2017; 12:11-25. [PMID: 29196867 DOI: 10.1007/s11701-017-0763-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023]
Abstract
With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.
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Affiliation(s)
| | - Salvatore Livatino
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Behrad Vahedi
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Radhika Gudipati
- School of Computer Science, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Patrick Sheen
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | | | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
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Pentafecta Rates of Three-Dimensional Laparoscopic Radical Prostatectomy: Our Experience after 150 Cases. Urologia 2017; 84:93-97. [DOI: 10.5301/uj.5000239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/27/2023]
Abstract
Introduction Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision. The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature. Methods We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta. Results One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months. Conclusions Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.
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Affiliation(s)
- Rahila Essani
- Division of Colon & Rectal Surgery, State University of New York, Nichols Road, Stony Brook, NY 11794-819, USA
| | - Roberto Bergamaschi
- Division of Colon & Rectal Surgery, State University of New York, Nichols Road, Stony Brook, NY 11794-819, USA.
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Di Cerbo A, Morales-Medina JC, Palmieri B, Iannitti T. Narrative review of telemedicine consultation in medical practice. Patient Prefer Adherence 2015; 9:65-75. [PMID: 25609928 PMCID: PMC4298290 DOI: 10.2147/ppa.s61617] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of telemedicine has grown across several medical fields, due to the increasing number of "e-patients". OBJECTIVE This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care. METHODS A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty). RESULTS Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions. CONCLUSION Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time.
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Affiliation(s)
- Alessandro Di Cerbo
- Poliambulatorio del Secondo Parere, University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV, Universidad Autónoma de Tlaxcala, Tlaxcala de Xicohténcatl, Mexico
| | - Beniamino Palmieri
- Poliambulatorio del Secondo Parere, University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Tommaso Iannitti
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
- Correspondence: Tommaso Iannitti, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK, Tel +44 75 2147 1447, Email
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Qin Y, Hua H, Nguyen M. Characterization and in-vivo evaluation of a multi-resolution foveated laparoscope for minimally invasive surgery. BIOMEDICAL OPTICS EXPRESS 2014; 5:2548-62. [PMID: 25136485 PMCID: PMC4132988 DOI: 10.1364/boe.5.002548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/22/2014] [Accepted: 07/05/2014] [Indexed: 05/23/2023]
Abstract
The state-of-the-art laparoscope lacks the ability to capture high-magnification and wide-angle images simultaneously, which introduces challenges when both close- up views for details and wide-angle overviews for orientation are required in clinical practice. A multi-resolution foveated laparoscope (MRFL) which can provide the surgeon both high-magnification close-up and wide-angle images was proposed to address the limitations of the state-of-art surgical laparoscopes. In this paper, we present the overall system design from both clinical and optical system perspectives along with a set of experiments to characterize the optical performances of our prototype system and describe our preliminary in-vivo evaluation of the prototype with a pig model. The experimental results demonstrate that at the optimum working distance of 120mm, the high-magnification probe has a resolution of 6.35lp/mm and image a surgical area of 53 × 40mm(2); the wide-angle probe provides a surgical area coverage of 160 × 120mm(2) with a resolution of 2.83lp/mm. The in-vivo evaluation demonstrates that MRFL has great potential in clinical applications for improving the safety and efficiency of the laparoscopic surgery.
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Affiliation(s)
- Yi Qin
- 3D visualization and imaging system laboratory, College of Optical Sciences, University of Arizona, 1630 E University Blvd., Tucson, AZ, 85721, USA
| | - Hong Hua
- 3D visualization and imaging system laboratory, College of Optical Sciences, University of Arizona, 1630 E University Blvd., Tucson, AZ, 85721, USA
| | - Mike Nguyen
- Institute of Urology, University of Southern California, Los Angeles, CA, 90089, USA
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Saglam R, Muslumanoglu AY, Tokatlı Z, Caşkurlu T, Sarica K, Taşçi Aİ, Erkurt B, Süer E, Kabakci AS, Preminger G, Traxer O, Rassweiler JJ. A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b). Eur Urol 2014; 66:1092-100. [PMID: 25059998 DOI: 10.1016/j.eururo.2014.06.047] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. OBJECTIVE To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. DESIGN, SETTING, AND PARTICIPANTS Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2). SURGICAL PROCEDURE Robotic FURS was performed with the Roboflex Avicenna robotic device. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. RESULTS AND LIMITATIONS Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. CONCLUSIONS Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. PATIENT SUMMARY Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics.
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Affiliation(s)
- Remzi Saglam
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | | | - Zafer Tokatlı
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | - Turhan Caşkurlu
- Department of Urology, Medeniyet University Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Kartal Training Hospital, Istanbul, Turkey
| | - Ali İhsan Taşçi
- Department of Urology, Bakırköy Training Hospital, Istanbul, Turkey
| | - Bülent Erkurt
- Department of Urology, Medipol University Medical School Hospital, Istanbul, Turkey
| | - Evren Süer
- Department of Urology, Ankara University Medical School Hospital, Ankara, Turkey
| | | | - Glenn Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Olivier Traxer
- Department of Urology, Université Pierre et Marie Curie, Hôpital Tenon, Paris, France
| | - Jens J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany; Department of Urology, University of Heidelberg, Heidelberg, Germany.
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Aykan S, Singhal P, Nguyen DP, Yigit A, Tuken M, Yakut E, Colakerol A, Sulejman S, Semercioz A. Perioperative, Pathologic, and Early Continence Outcomes Comparing Three-Dimensional and Two-Dimensional Display Systems for Laparoscopic Radical Prostatectomy—A Retrospective, Single-Surgeon Study. J Endourol 2014; 28:539-43. [DOI: 10.1089/end.2013.0630] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Paras Singhal
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Daniel P. Nguyen
- Department of Urology, Berne University Hospital, Berne, Switzerland
| | - Akin Yigit
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Emrah Yakut
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Suhejb Sulejman
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Rassweiler J, Rassweiler MC, Kenngott H, Frede T, Michel MS, Alken P, Clayman R. The past, present and future of minimally invasive therapy in urology: A review and speculative outlook. MINIM INVASIV THER 2013; 22:200-9. [DOI: 10.3109/13645706.2013.816323] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sengül A, van Elk M, Rognini G, Aspell JE, Bleuler H, Blanke O. Extending the body to virtual tools using a robotic surgical interface: evidence from the crossmodal congruency task. PLoS One 2012; 7:e49473. [PMID: 23227142 PMCID: PMC3515602 DOI: 10.1371/journal.pone.0049473] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/09/2012] [Indexed: 11/18/2022] Open
Abstract
The effects of real-world tool use on body or space representations are relatively well established in cognitive neuroscience. Several studies have shown, for example, that active tool use results in a facilitated integration of multisensory information in peripersonal space, i.e. the space directly surrounding the body. However, it remains unknown to what extent similar mechanisms apply to the use of virtual-robotic tools, such as those used in the field of surgical robotics, in which a surgeon may use bimanual haptic interfaces to control a surgery robot at a remote location. This paper presents two experiments in which participants used a haptic handle, originally designed for a commercial surgery robot, to control a virtual tool. The integration of multisensory information related to the virtual-robotic tool was assessed by means of the crossmodal congruency task, in which subjects responded to tactile vibrations applied to their fingers while ignoring visual distractors superimposed on the tip of the virtual-robotic tool. Our results show that active virtual-robotic tool use changes the spatial modulation of the crossmodal congruency effects, comparable to changes in the representation of peripersonal space observed during real-world tool use. Moreover, when the virtual-robotic tools were held in a crossed position, the visual distractors interfered strongly with tactile stimuli that was connected with the hand via the tool, reflecting a remapping of peripersonal space. Such remapping was not only observed when the virtual-robotic tools were actively used (Experiment 1), but also when passively held the tools (Experiment 2). The present study extends earlier findings on the extension of peripersonal space from physical and pointing tools to virtual-robotic tools using techniques from haptics and virtual reality. We discuss our data with respect to learning and human factors in the field of surgical robotics and discuss the use of new technologies in the field of cognitive neuroscience.
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Affiliation(s)
- Ali Sengül
- Center for Neuroprosthetics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Anderson SM, Kapp BB, Angell JM, Abd TT, Thompson NJ, Ritenour CWM, Issa MM. Remote monitoring and supervision of urology residents utilizing integrated endourology suites-a prospective study of patients' opinions. J Endourol 2012; 27:96-100. [PMID: 22905788 DOI: 10.1089/end.2012.0406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To report on integrated endourology suites (IES), remote monitoring and supervision (RMS) of urology residents and to evaluate patients' opinions, acceptance, and satisfaction level with IES and RMS. PATIENTS AND METHODS Patients undergoing flexible cystoscopy in the IES with RMS were surveyed using a questionnaire. All procedures were performed by junior urology residents (UR-1 level) using RMS. Patients were studied using a nine-question survey to evaluate their comfort level, acceptance, and level of satisfaction with RMS. Six questions used a scale of 1 to 10 (1=strongly disagree; 10=strongly agree), and the remaining three questions solicited a "yes" or "no" response. RESULTS 100 patients were studied (59% Caucasians, 40% African Americans, and 1% Hispanic). Median age was 63 years. The highest level of education was middle school in 2% of patients, high school in 55%, undergraduate in 33%, and postgraduate in 10%. Patients scored a mean of 9.50/10 (highly satisfactory) regarding their comfort with RMS; 96% scored ≥ 7, 4% scored 5 to 6, and none scored <5. Patients were satisfied having a urology resident perform the procedure (9.48/10), other residents and medical students watch the procedure (9.41/10), a video camera in the room (9.40/10), and two-way sound communication (9.40/10). None perceived compromise to their privacy or quality of care. CONCLUSIONS RMS in IES is highly acceptable to patients undergoing endoscopic procedures. RMS has the potential to positively impact residency training, efficiency, regulatory compliance, safety, and productivity.
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Affiliation(s)
- Stephen M Anderson
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia 30033, USA
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Abstract
Surgery has increasingly become a technology-driven specialty. Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy. The dramatic evolution of robotic surgery over the past 10 years is likely to be eclipsed by even greater advances over the next decade. We review the current status of robotic technology in surgery. The Medline database was searched for the terms "robotic surgery, telesurgery, and laparoscopy." A total of 2,496 references were found. All references were considered for information on robotic surgery in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. There is a paucity of control studies on a sufficient number of subjects in robot-assisted surgeries in all fields. Studies that meet more stringent clinical trials criteria show that robot-assisted surgery appears comparable to traditional surgery in terms of feasibility and outcomes but that costs associated with robot-assisted surgery are higher because of longer operating times and expense of equipment. While a limited number of studies on the da Vinci robotic system have proven the benefit of this approach in regard to patient outcomes, including significantly reduced blood loss, lower percentage of postoperative complications, and shorter hospital stays, there are mechanical and institutional risks that must be more fully addressed. Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers.
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Fujii M, Sugita N, Ishimaru T, Iwanaka T, Mitsuishi M. A novel approach to the design of a needle driver with multiple DOFs for pediatric laparoscopic surgery. MINIM INVASIV THER 2012; 22:9-16. [PMID: 22554033 DOI: 10.3109/13645706.2012.680890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The objective of our research was to design and develop a novel needle driver with multiple degrees of freedom (DOFs) for pediatric laparoscopic surgery. Pediatric laparoscopic surgery has many advantages for patients, but the difficulty of the operation is increased due to many restrictions. For example, the motion of the needle driver is restricted by the insertion points, and the operation workspace is smaller in children than in adults. MATERIAL AND METHODS A needle driver with 3 DOFs and a 3.5-mm diameter is proposed and implemented in this study. Grasping DOF is achieved using a piston mechanism actuated by a wire. Deflection and rotation DOFs are actuated by gears. RESULTS Experiments were conducted to evaluate the workspace and ligation force, and the results confirmed that the needle driver meets all the necessary requirements. Finally, a first reaction of a pediatric surgeon on the suturing and ligaturing capabilities of the prototype is reported. CONCLUSION A multi-DOF needle driver with a new mechanism was proposed for pediatric laparoscopic surgery and a first prototype was developed. It is expected that further elaboration of the developed first prototype of the needle driver may contribute to the advancement of pediatric laparoscopic surgery.
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Affiliation(s)
- Masahiro Fujii
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
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Kenngott HG, Fischer L, Nickel F, Rom J, Rassweiler J, Müller-Stich BP. Status of robotic assistance--a less traumatic and more accurate minimally invasive surgery? Langenbecks Arch Surg 2011; 397:333-41. [PMID: 22038293 DOI: 10.1007/s00423-011-0859-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact. METHODS The Medline database was searched for the terms "robot, telemanipulat, and laparoscop." A total of 2,573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. RESULTS In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers. CONCLUSION Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.
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Affiliation(s)
- H G Kenngott
- Department of General, Abdominal and Transplant Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Bhatia PD, Bottoni DA, Malthaner RA. Telesurgical evaluation of stable thoracic trauma patients: a feasibility study. Eur J Trauma Emerg Surg 2011; 37:297. [PMID: 26815111 DOI: 10.1007/s00068-011-0094-5] [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: 01/31/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND We evaluated a robotic telesurgical platform in managing thoracic trauma in an animal model. STUDY DESIGN The da Vinci(®) robot was used to evaluate and treat a random number of blinded injuries in ten porcine thoraces. RESULTS Ninety-five percent of injuries were correctly identified. The median survey time was 20.5 min (range 16-63 min). The mean time to repair lung lacerations was 19.8 min (range 14-27.5 min) and to evacuate the hemothoraces, it was 5.3 min (range 4.5-6.5 min). Diaphragmatic lacerations required repositioning of the ports and the robot. Only two out of five lacerations were successfully repaired (mean time 38.8 min, range 32.5-45 min). All aortic injuries were correctly identified. One subject died of a pre-existing pneumonia. CONCLUSIONS A robotic telesurgical approach to the evaluation of stable thoracic trauma patients is safe and feasible in a porcine model. Diaphragmatic injuries can be repaired but require repositioning of the robot.
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Affiliation(s)
- P D Bhatia
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada
| | - D A Bottoni
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada
| | - R A Malthaner
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada.
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Stefanidis D, Hope WW, Scott DJ. Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 2010; 25:2141-6. [DOI: 10.1007/s00464-010-1512-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 05/23/2010] [Indexed: 10/18/2022]
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Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, Kang SH, Cheon J. The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy. Korean J Radiol 2010; 10:587-95. [PMID: 19885315 PMCID: PMC2770828 DOI: 10.3348/kjr.2009.10.6.587] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 05/27/2009] [Indexed: 11/18/2022] Open
Abstract
Objective To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64-channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.
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Affiliation(s)
- Beom Jin Park
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, Korea
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Abstract
OBJECTIVES This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology. METHODS The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery. RESULTS A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required. CONCLUSIONS Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.
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Affiliation(s)
- Goedele van Haasteren
- Hayes Inc, Independent Health Technology Assessment Company, Lansdale, Pennsylvania 19446, USA.
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D'Alonzo RC, Gan TJ, Moul JW, Albala DM, Polascik TJ, Robertson CN, Sun L, Dahm P, Habib AS. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth 2009; 21:322-8. [DOI: 10.1016/j.jclinane.2008.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 08/27/2008] [Accepted: 09/04/2008] [Indexed: 10/20/2022]
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Kenngott HG, Müller‐Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: Technique and benefit in advanced laparoscopic surgery. MINIM INVASIV THER 2009; 17:160-7. [DOI: 10.1080/13645700802103381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 2008; 23:438-43. [PMID: 19037694 DOI: 10.1007/s00464-008-0202-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 10/13/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments. METHODS At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i-v):1-88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa. RESULTS As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci((R)): 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324 ). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics. CONCLUSION While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
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Bittner JG, Hathaway CA, Brown JA. Three-dimensional visualisation and articulating instrumentation: Impact on simulated laparoscopic tasks. J Minim Access Surg 2008; 4:31-8. [PMID: 19547678 PMCID: PMC2699064 DOI: 10.4103/0972-9941.41938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/18/2008] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Laparoscopy requires the development of technical skills distinct from those used in open procedures. Several factors extending the learning curve of laparoscopy include ergonomic and technical difficulties, such as the fulcrum effect and limited degrees of freedom. This study aimed to establish the impact of four variables on performance of two simulated laparoscopic tasks. METHODS Six subjects including novice (n=2), intermediate (n=2) and expert surgeons completed two tasks: 1) four running sutures, 2) simple suture followed by surgeon's knot plus four square knots. Task variables were suturing angle (left/right), needle holder type (standard/articulating) and visualisation (2D/3D). Each task with a given set of variables was completed twice in random order. The endpoints included suturing task completion time, average and maximum distance from marks and knot tying task completion time. RESULTS Suturing task completion time was prolonged by 45-degree right angle suturing, articulating needle holder use and lower skill levels (all P < 0.0001). Accuracy also decreased with articulating needle holder use (both P < 0.0001). 3D vision affected only maximum distance (P=0.0108). For the knot tying task, completion time was greater with 45-degree right angle suturing (P=0.0015), articulating needle holder use (P < 0.0001), 3D vision (P=0.0014) and novice skill level (P=0.0003). Participants felt that 3D visualisation offered subjective advantages during training. CONCLUSIONS Results suggest construct validity. A 3D personal head display and articulating needle holder do not immediately improve task completion times or accuracy and may increase the training burden of laparoscopic suturing and knot tying.
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Affiliation(s)
- James G Bittner
- Virtual Education and Surgical Simulation Laboratory (VESSL), Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - Christopher A Hathaway
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - James A Brown
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
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Baumhauer M, Feuerstein M, Meinzer HP, Rassweiler J. Navigation in Endoscopic Soft Tissue Surgery: Perspectives and Limitations. J Endourol 2008; 22:751-66. [PMID: 18366319 DOI: 10.1089/end.2007.9827] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Matthias Baumhauer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - Marco Feuerstein
- Computer Aided Medical Procedures (CAMP), Technical University Munich (TUM), Munich, Germany
| | - Hans-Peter Meinzer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - J. Rassweiler
- Department of Urology, Clinic Heilbronn, University of Heidelberg, Heilbronn, Germany
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Hagen ME, Meehan JJ, Inan I, Morel P. Visual clues act as a substitute for haptic feedback in robotic surgery. Surg Endosc 2007; 22:1505-8. [DOI: 10.1007/s00464-007-9683-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 10/16/2007] [Indexed: 12/22/2022]
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Mao SP, Lai HC, Chang FW, Yu MH, Chang CC. Laparoscopy-assisted Robotic Myomectomy Using the DA Vinci System. Taiwan J Obstet Gynecol 2007; 46:174-6. [PMID: 17638628 DOI: 10.1016/s1028-4559(07)60014-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report a case of a woman with a large uterine myoma who underwent laparoscopy-assisted robotic myomectomy using the da Vinci system. CASE REPORT A 38-year-old, gravida 2, para 2, female patient presented to our office with a chief complaint of lower abdominal pressure and pain. A pelvic sonogram disclosed a subserosal myoma with a broad base, measuring approximately 9 x 8 x 7 cm, which was located at the anterior uterine wall. The patient insisted on preserving her uterus and was concerned with the cosmetic results after the surgery. She showed willingness to undergo myomectomy using the newly developed laparoscopy-assisted robotic system (da Vinci) and signed the consent form. The operation time was about 3 hours, with an estimated blood loss of 150 mL. The patient passed flatus and resumed oral intake on the following day. CONCLUSION Minimally invasive surgery is the trend of the future. Robot-assisted laparoscopic surgery is a new technique for myomectomy. This robotic system provides a three-dimensional operative field and an easy-to-use control panel, which may be of great help when applying the suturing techniques and may shorten the learning curve. More experience with and long-term follow-up of robotic surgery may be warranted to further validate the role the robot-assisted approach in gynecologic surgery.
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Affiliation(s)
- Shih-Peng Mao
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, Taipei, Taiwan
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Frede T, Hammady A, Klein J, Teber D, Inaki N, Waseda M, Buess G, Rassweiler J. The radius surgical system - a new device for complex minimally invasive procedures in urology? Eur Urol 2006; 51:1015-22; discussion 1022. [PMID: 17150300 DOI: 10.1016/j.eururo.2006.11.046] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 11/22/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Complex laparoscopic procedures in urology are technically demanding with an extended learning curve. Robotic systems add significant cost to laparoscopic procedures. We therefore evaluated the use of the Radius Surgical System (RSS), a mechanical manipulator, for complex laparoscopic cases in urology. MATERIAL AND METHODS The RSS (Tuebingen Scientific) consists of two hand-guided surgical manipulators and provides a deflectable and rotatable tip allowing six degrees of freedom. We evaluated the system by using a series of standardized models in the pelvitrainer. We analyzed the effectiveness of the system and the learning curve. We then evaluated the system in the clinical setting during laparoscopic radical prostatectomy. RESULTS Surgeons with experience on the RSS were compared to surgeons without previous experience on the system. We identified a learning curve in those participants without experience on the system only when performing complete anastomoses in the pelvitrainer. However, this learning curve included less than 10 anastomoses. The first clinical experiences during laparoscopic extraperitoneal radical prostatectomy (n=10) are promising. All anastomoses were patent on routine (X-ray) examination 8 days after surgery. CONCLUSIONS The RSS system is easy to use and we identified a very short learning curve. We now optimize the system for use in urology. This device may facilitate complex laparoscopic procedures without the use of costly robotic systems and should be further evaluated in the experimental and clinical setting.
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Affiliation(s)
- Thomas Frede
- Department of Urology, HELIOS-Klinik Müllheim, Germany
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Abstract
PURPOSE OF REVIEW Laparoscopic reconstructive urology is a challenging and technically demanding field of urology. As urologists' experience strengthened and technical modifications developed, urologic laparoscopy was applied in the treatment of malignancies and evolved from simple to technically demanding reconstructive techniques. This article reviews the latest published literature in the field of laparoscopic reconstructive urology and introduces our own persuasion for the role of this approach in urology. RECENT FINDINGS Some laparoscopic procedures like orchidopexy, ureterolithotomy, pyelolithotomy and pyeloplasty require "a middle class level of laparoscopic skills" whereas other reconstructive techniques such as radical prostatectomy and cystectomy and partial nephrectomy are technically demanding and are still being developed with promising results. The reconstructive part of partial nephrectomy is small and refers to good hemostasis whereas in radical prostatectomy and cystectomy, the reconstructive part--urethrovesical anastomosis and urinary diversion, respectively--is an important factor, affecting the patient's postoperative quality of life. SUMMARY The development of new instrumentation as well as the amelioration of urologists' laparoscopic skills will pave the way for the establishment of laparoscopic reconstructive urology in everyday practice. So far, laparoscopic reconstructive urology seems to be a well tolerated and effective treatment modality but still with not a completely clear role.
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Affiliation(s)
- Jens-Uwe Stolzenburg
- Department of Urology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
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Rassweiler J, Hruza M, Teber D, Su LM. Laparoscopic and Robotic Assisted Radical Prostatectomy – Critical Analysis of the Results. Eur Urol 2006; 49:612-24. [PMID: 16442210 DOI: 10.1016/j.eururo.2005.12.054] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 12/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the role of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RLRP) based on personal experience and a review of the literature. MATERIAL AND METHODS Own experience at one European and one American LRP-center includes more than 2000 cases. We performed a MEDLINE search reviewing the literature on LRP and RLRP between 1992 and 2005 with special emphasis on historical aspects, technical considerations, comparison to open retropubic (RRP) and perineal radical prostatectomy (PRP), laparoscopic training, and the cost-efficiency of the techniques. RESULTS Based on sophisticated training programs a continuous dissemination of the technique took place. In the United States, this process was accelerated by the use of the daVinci-robot. There is a trend towards the extraperitoneal access. Mid-term outcomes of LRP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower rate of complications, shorter convalescence, and better cosmesis. In contrast to RLRP, LRP may reach cost-equivalence with open surgery (i.e. by reduction of OR-time, use of multi-usable instruments). CONCLUSIONS LRP reproduces the excellent results of open surgery providing the advantages of minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow. In contrast the United States, the use of robots is likely to remain limited in Europe.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Germany.
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