Use of a robotic camera holder (FreeHand®) for laparoscopic appendicectomy

Combining brain-computer interfaces with deep reinforcement learning for robot training: a feasibility study in a simulation environment

Deep reinforcement learning (RL) is used as a strategy to teach robot agents how to autonomously learn complex tasks. While sparsity is a natural way to define a reward in realistic robot scenarios, it provides poor learning signals for the agent, thus making the design of good reward functions challenging. To overcome this challenge learning from human feedback through an implicit brain-computer interface (BCI) is used. We combined a BCI with deep RL for robot training in a 3-D physical realistic simulation environment. In a first study, we compared the feasibility of different electroencephalography (EEG) systems (wet- vs. dry-based electrodes) and its application for automatic classification of perceived errors during a robot task with different machine learning models. In a second study, we compared the performance of the BCI-based deep RL training to feedback explicitly given by participants. Our findings from the first study indicate the use of a high-quality dry-based EEG-system can provide a robust and fast method for automatically assessing robot behavior using a sophisticated convolutional neural network machine learning model. The results of our second study prove that the implicit BCI-based deep RL version in combination with the dry EEG-system can significantly accelerate the learning process in a realistic 3-D robot simulation environment. Performance of the BCI-based trained deep RL model was even comparable to that achieved by the approach with explicit human feedback. Our findings emphasize the usage of BCI-based deep RL methods as a valid alternative in those human-robot applications where no access to cognitive demanding explicit human feedback is available.

Comparison of Single-Person Laparoscopic Appendectomy Using a Novel Brace-Assisted Camera Holding System and Conventional Laparoscopic Appendectomy: A Neural Network Algorithm Analysis

Background

Acute appendicitis represents one of the main causes of surgical emergencies. It can be approached as an open appendectomy or a laparoscopic appendectomy (LA). However, LA generally requires the cooperation of a surgeon and an assistant. This study aims to compare the safety and efficacy of the novel brace-assisted single-person laparoscopic appendectomy (BASPLA) with conventional laparoscopic appendectomy (CLA) in the treatment of patients diagnosed with acute appendicitis by neural network algorithm analysis.

Methods

Between January 2020 and December 2021,a total of 120 adult patients with acute appendicitis were randomized to the BASPLA group (62 cases) and the CLA group (58 cases).The clinical data were compared between the two groups, including demographics, clinical characteristics, and outcomes.

Results

There was no significant difference in patients' pain scores before operation (p = 0.68) and after operation (p = 0.81) and patient-reported cosmetic scores (p = 0.43) between the two groups. Operation time in the BASPLA group was longer than that in the CLA group (p<0.001). There were no significant differences in the conversion rate (p = 0.94), analgesics required before (p = 0.91) and after the operation (p = 0.78), intraoperative bleeding (p = 0.53), recovery of bowel movement time (p = 0.26), hospital stay (p = 0.06), and complication rate (p = 0.84) between the two groups.

Conclusions

BASPLA for adult acute appendicitis can be a substitute for CLA, BASPLA is comparable to CLA in postoperative pain and quality of life. Compared to surgical assistants, it not only provides a stable, clear image for the surgeon but also frees up personnel. Especially in emergency surgery, it can achieve satisfactory clinical efficacy without requiring an assistant.

Robotics in laparoscopic surgery - A review

Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.

Robotic operations in urgent general surgery: a systematic review

Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy is widely used in urgent general surgery, the significance of robotic assistance in urgent operations is of interest. Currently, there are few data on robotic-assisted operations in urgent surgery. The aim of this study was to collect and classify the existing studies. A two-stage, PRISMA-compliant literature search of PubMed and the Cochrane Library was conducted. We analyzed all articles on robotic surgery associated with urgent general surgery resp. acute surgical diseases of the abdomen. Gynecological and urological diseases so as vascular surgery, except mesenterial ischemia, were excluded. Studies and case reports/series published between 1980 and 2021 were eligible for inclusion. In addition to a descriptive synopsis, various outcome parameters were systematically recorded. Fifty-two studies of operations for acute appendicitis and cholecystitis, hernias and acute conditions of the gastrointestinal tract were included. The level of evidence is low. Surgical robots in the narrow sense and robotic camera mounts were used. All narrow-sense robots are nonautonomous systems; in 82%, the Da Vinci^® system was used. The most frequently published emergency operations were urgent cholecystectomies (30 studies, 703 patients) followed by incarcerated hernias (9 studies, 199 patients). Feasibility of robotic operations was demonstrated for all indications. Neither robotic-specific problems nor extensive complication rates were reported. Various urgent operations in general surgery can be performed robotically without increased risk. The available data do not allow a final evidence-based assessment.

Evaluation of a stand-alone robotic camera holding system: technology that improves laparoscopy

INTRODUCTION

In order to perform laparoscopic procedures, a surgeon requires an assistant to hold the camera. Problems with this approach include table crowding leading to poor ergonomics, and miscommunication leading to poor images. AutoLap is a novel FDA-approved camera navigation system. We present our experience with this device and compare it to human camera holders.

MATERIALS AND METHODS

The study design included an initial training period followed by a non-randomized allocation between robotic and human camera holder cohort. Data included set up time, ergonomics and usability (via nurse, surgeon and camera holder questionnaire) and image stability recorded via the Inertial Measurement Unit (IMU), describing linear acceleration (in unit gravity [g]) and horizontal acceleration (Angular Velocity in rad/s).

RESULTS

Twenty-six patients were equally divided between human and robotic camera holders. Image stability were significantly better for the robotic camera holder. Median angular velocity was 0.029 and 0.005 rad/s for human and the AutoLap system, respectively (p-value <.001). Linear acceleration was 0.011 and 0.007 [g] (p-value .015). Positive feedback for the robotic system included greater surgeon comfort (92%) and improved nurse - surgeon interaction (100%).

CONCLUSIONS

The AutoLap system provides improved image stability, team-work, and ergonomic comfort for the surgical team with minimum set-up time.

Evaluation of a remote-controlled laparoscopic camera holder for basic laparoscopic skills acquisition: a randomized controlled trial

Background

Unsteady camera movement and poor visualization contribute to a difficult learning curve for laparoscopic surgery. Remote-controlled camera holders (RCHs) aim to mitigate these factors and may be used to overcome barriers to learning. Our aim was to evaluate performance benefits to laparoscopic skill acquisition in novices using a RCH.

Methods

Novices were randomized into groups using a human camera assistant (HCA) or the FreeHand v1.0 RCH and trained in the (E-BLUS) curriculum. After completing training, a surgical workload questionnaire (SURG-TLX) was issued to participants.

Results

Forty volunteers naïve in laparoscopic skill were randomized into control and intervention groups (n = 20) with intention-to-treat analysis. Each participant received up to 10 training sessions using the E-BLUS curriculum. Competency was reached in the peg transfer task in 5.5 and 7.6 sessions for the ACH and HCA groups, respectively (P = 0.015), and 3.6 and 6.8 sessions for the laparoscopic suturing task (P = 0.0004). No significance differences were achieved in the circle cutting (P = 0.18) or needle guidance tasks (P = 0.32). The RCH group experienced significantly lower workload (P = 0.014) due to lower levels of distraction (P = 0.047).

Conclusions

Remote-controlled camera holders have demonstrated the potential to significantly benefit intra-operative performance and surgical experience where camera movement is minimal. Future high-quality studies are needed to evaluate RCHs in clinical practice.

Trial registration

ISRCTN 83733979

Comparison of FreeHand® robot-assisted with human-assisted laparoscopic fundoplication

Objective: To compare the safety, operative time and feasibilty of FreeHand^® robot (FreeHand Ltd, Guildford, United Kingdom) with manual camera control approach for Laparoscopic Fundoplication.Material and methods: A case control study was performed for patients undergoing laparoscopic fundoplication. Primary outcome was operative time; secondary outcomes included length of stay, post-operative morbidity, symptoms at first follow-up and total post-operative out-patient visits.Results: Forty-four patients underwent laparoscopic fundoplication between January 2014 and June 2016. Twenty-six (59%) underwent conventional human-assisted fundoplication while 18 (41%) had FreeHand^® robot assisted procedures. Mean operative time for conventional laparoscopic fundoplication was 165 min compared with 129 min in the robot-assisted group, saving 36 min (p < .001).The median length of stay was 1.5 days in the robot-assisted as compared to two days in the conventional group. Sixteen percent of robot-assisted as opposed to 30% of conventional group patients experienced complications. There was no 30-day mortality. Two patients required more than one post-operative clinic visit in robot-assisted against six in conventional group.Conclusion: Robot-assisted fundoplication is safe, feasible and reduces operative time. Furthermore, this negates need of assistant. Mean operative time for robot-assisted fundoplication was 36 min less than for conventional fundoplication. Advantages also include fewer adverse events, shorter length of stay and less post-operative clinic visits.

A novel hybrid 3D endoscope zooming and repositioning system: Design and feasibility study

BACKGROUND

Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation.

METHODS AND MATERIALS

Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials.

RESULTS

Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported.

CONCLUSIONS

The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon.