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Wan GY, Zhou XY, Duan HX, Zou ZY, Zhang MM, Mao JB. Comparison of robotic camera holders with human assistants in endoscopic surgery: a systematic review and meta-analysis. MINIM INVASIV THER 2023; 32:153-162. [PMID: 37051809 DOI: 10.1080/13645706.2023.2199332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Robotic camera holders can overcome the shortcomings of human assistants, such as shaking and accidental rotation in endoscopic surgery. Robotic camera holder is not affected by the operation time and surgical position and reduces the size of the team. However, there is still controversy over the practicality of robotic camera holders. MATERIAL AND METHODS We searched PubMed, Web of Science, Embase, Cochrane Library PubMed, Embase, Cochrane Library and Web of Science. The last database search was performed on 30 April 2022. Two reviewers independently reviewed the studies. RESULTS A total of eight studies (n = 698, 354 controls and 344 robotic camera holders) were included in our analysis. The results showed that the robotic camera holder significantly outperformed human assistants on the frequency of lens cleaning (SMD, -0.48; 95% CI, -0.90 to -0.05) and inappropriate movements (MD, -3.57; 95% CI, -4.93 to -2.21). There was no difference in total operation time (MD, 6.99; 95% CI, -2.47 to 16.72), preparation time (MD, 2.43; 95% CI, -0.32 to 5.18) or blood loss (MD, 34.47; 95% CI, -8.05 to 76.98) between the robotic camera holder and human assistant. However, the robotic camera holder was significantly slower in the core operation (MD, 5.06; 95% CI, 1.18 to 8.94), and surgeons had mixed reviews of robotic systems. CONCLUSIONS The robotic camera holder provided the surgeon with a highly stable environment. Although the robotic camera holder will not increase the total time, it still needs to improve the core operation time. There is much room for improvement in robotic camera holders. Further development of devices with intuitive control systems and a greater range of motion will be required to accommodate more complex surgeries.
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Affiliation(s)
- Guang-Ying Wan
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiao-Yang Zhou
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hong-Xiang Duan
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhen-Ya Zou
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Man-Man Zhang
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jin-Bao Mao
- Operating Room, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
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Abstract
Abstract
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.
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Gruijthuijsen C, Garcia-Peraza-Herrera LC, Borghesan G, Reynaerts D, Deprest J, Ourselin S, Vercauteren T, Vander Poorten E. Robotic Endoscope Control Via Autonomous Instrument Tracking. Front Robot AI 2022; 9:832208. [PMID: 35480090 PMCID: PMC9035496 DOI: 10.3389/frobt.2022.832208] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Many keyhole interventions rely on bi-manual handling of surgical instruments, forcing the main surgeon to rely on a second surgeon to act as a camera assistant. In addition to the burden of excessively involving surgical staff, this may lead to reduced image stability, increased task completion time and sometimes errors due to the monotony of the task. Robotic endoscope holders, controlled by a set of basic instructions, have been proposed as an alternative, but their unnatural handling may increase the cognitive load of the (solo) surgeon, which hinders their clinical acceptance. More seamless integration in the surgical workflow would be achieved if robotic endoscope holders collaborated with the operating surgeon via semantically rich instructions that closely resemble instructions that would otherwise be issued to a human camera assistant, such as “focus on my right-hand instrument.” As a proof of concept, this paper presents a novel system that paves the way towards a synergistic interaction between surgeons and robotic endoscope holders. The proposed platform allows the surgeon to perform a bimanual coordination and navigation task, while a robotic arm autonomously performs the endoscope positioning tasks. Within our system, we propose a novel tooltip localization method based on surgical tool segmentation and a novel visual servoing approach that ensures smooth and appropriate motion of the endoscope camera. We validate our vision pipeline and run a user study of this system. The clinical relevance of the study is ensured through the use of a laparoscopic exercise validated by the European Academy of Gynaecological Surgery which involves bi-manual coordination and navigation. Successful application of our proposed system provides a promising starting point towards broader clinical adoption of robotic endoscope holders.
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Affiliation(s)
| | - Luis C. Garcia-Peraza-Herrera
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Department of Surgical and Interventional Engineering, King’s College London, London, United Kingdom
- *Correspondence: Luis C. Garcia-Peraza-Herrera,
| | - Gianni Borghesan
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- Core Lab ROB, Flanders Make, Lommel, Belgium
| | | | - Jan Deprest
- Department of Development and Regeneration, Division Woman and Child, KU Leuven, Leuven, Belgium
| | - Sebastien Ourselin
- Department of Surgical and Interventional Engineering, King’s College London, London, United Kingdom
| | - Tom Vercauteren
- Department of Surgical and Interventional Engineering, King’s College London, London, United Kingdom
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An DH, Han JH, Jang MJ, Aum J, Kim YS, Jeong IG, Hong B, You D. Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder: IDEAL stage 2a study. BMC Urol 2022; 22:44. [PMID: 35337318 PMCID: PMC8957188 DOI: 10.1186/s12894-022-00996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solo-surgery can be defined as a practice of a surgeon operating alone using a camera holder, without other surgical members except for a scrub nurse. This study was designed to evaluate the feasibility and safety of solo-surgeon pure laparoscopic donor nephrectomy. METHODS The study protocol was approved by the Institutional Review Board of Asan Medical Center, Seoul, Korea. The brief study protocol was registered on the Clinical Research Information Service site of the Korea Centers for Disease Control and Prevention. Candidates fulfilling all inclusion and exclusion criteria were enrolled in the clinical trial and underwent solo-surgeon pure laparoscopic donor nephrectomy. The feasibility was assessed by the proportion of subjects who could undergo solo-surgeon pure laparoscopic donor nephrectomy without difficulty. The perioperative complications were identified to assess the safety of solo-surgeon pure laparoscopic donor nephrectomy. RESULTS Of the 47 potential candidates from November 2018 to August 2019, 40 were enrolled in the clinical trial and seven excluded due to declining participation. The feasibility of solo-surgeon pure laparoscopic donor nephrectomy was 100%, without an occasion of any difficulty requiring conversion to the human assisted pure laparoscopic donor nephrectomy. Fourteen intraoperative complications occurred in 10 patients. The most common intraoperative complication was spleen injury. Two of three cases classified as the Satava classification grade II were due to the incomplete stapling of endoscopic stapler. Seventy-eight postoperative complications occurred in 34 patients. The most common postoperative complication was nausea/vomiting and followed by aspartate aminotransferase/alanine aminotransferase elevation. Most postoperative complication was independent of the solo-surgery itself. CONCLUSIONS Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder is technically feasible. In terms of safety, it is necessary to adjust the scope of surgery performed alone. Trial Registration CRIS, KCT0003458. Registered 30/01/2019, Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do/15868 .
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Affiliation(s)
- Dong Hyeon An
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyeon Han
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Myoung Jin Jang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Joomin Aum
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yu Seon Kim
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Wijsman PJM, Molenaar L, Voskens FJ, van’t Hullenaar CDP, Broeders IAMJ. Image-based laparoscopic camera steering versus conventional steering: a comparison study. J Robot Surg 2022; 16:1157-1163. [DOI: 10.1007/s11701-021-01342-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/21/2021] [Indexed: 01/30/2023]
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Yang YJ, Vadivelu AN, Pilgrim CHC, Kulic D, Abdi E. A Novel Perception Framework for Automatic Laparoscope Zoom Factor Control Using Tool Geometry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4700-4704. [PMID: 34892261 DOI: 10.1109/embc46164.2021.9629987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In conventional Minimally Invasive Surgery, the surgeon conducts the operation while a human or robot holds the laparoscope. Laparoscope control is returned to the surgeon in teleoperated camera holding robots, but simultaneously controlling the laparoscope and surgical tools might be cognitively demanding. On the other hand, fully automated camera holders are still limited in their performance. To help the surgeon to better focus on the main operation while maintaining their control authority, we propose an automatic laparoscope zoom factor control framework for Robot-Assisted Minimally Invasive Surgery. In this paper, we present the perception section of the framework. It extracts and uses the surgical tool's geometric characteristics to adjust the laparoscope's zoom factor, without any artificial markers. The acceptable range and tooltip's position frequency during operations are analysed based on the gallbladder removal surgery dataset (Cholec80). The common range and tooltip's heatmap are identified and presented quantitatively.
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Ghaderi I, Hsu CH, Hines EM, Alabagi A, Galvani CC. The Impact of Navigation Grid Overlay on Performance of Camera Assistants during Laparoscopic Abdominal Procedures: A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2021; 78:991-997. [PMID: 33020040 DOI: 10.1016/j.jsurg.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/06/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Camera assistance is important for proper visualization of the operative field in laparoscopic surgery. Navigation grid (NG) has been designed to help the camera assistants focus the camera on the target operative field. This is a randomized, controlled trial to study the effect of the NG on performance of camera assistants. DESIGN Minimally invasive operations were randomized (1:1) to either with or without use of NG for the camera assistant. The operations were recorded and the time spent inside and outside of the target area were reported. SETTING A tertiary care teaching hospital. RESULTS Fifty-eight operations (30 with and 28 without NG) were recorded. Sixteen camera assistants participated. Time spent outside the target area was significantly less with the use of NG (64.5 ± 63 seconds vs 396 ± 226.5 seconds; p < 0.0001). This impact of NG on performance of the camera assistants was significant regardless of their level of training. CONCLUSIONS NG improved performance of the camera assistant during laparoscopic abdominal procedures. This is a feasible tool that can help camera holders better assist the operating surgeons.
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Affiliation(s)
- Iman Ghaderi
- Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
| | - Chiu-Hsieh Hsu
- Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Eric M Hines
- Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Abdulla Alabagi
- Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Carlos C Galvani
- Department of Surgery, Tulane University, New Orleans, Louisiana
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Berges AJ, Razavi C, Shahbazi M, Taylor R, Carey JP, Creighton FX. Characterization of patient head motion in otologic surgery: Implications for TEES. Am J Otolaryngol 2021; 42:102875. [PMID: 33418180 DOI: 10.1016/j.amjoto.2020.102875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Middle ear disease is increasingly being managed via transcanal endoscopic ear surgery (TEES). A limitation of TEES is that it restricts the surgeon to single-handed dissection. One solution to this would be an endoscope holder to facilitate two-handed dissection. Current endoscope holders are stationary, and can cause potential damage from endoscope contact with the ossicles or ear canal if unintended head motion occurs from inadequate anesthetic. A dynamic device that could detect and react to patient motion would mitigate these concerns, but currently there is little formal characterization of the frequency, velocity and acceleration of unintended patient head motion during otologic procedures performed under general anesthesia. The present study aims to characterize intraoperative patient head motion kinematics during cases utilizing TEES. MATERIALS AND METHODS This is a prospective study of adults undergoing otologic procedures performed with general anesthesia and without paralysis. Head motion was characterized using a nine-axis inertial measurement unit (IMU), (LPMS-B2, Life Performance Research) mounted to each patient's forehead for the procedure duration. RESULTS Data was collected across 10 cases; 50% of patients were female and mean age was 50 ± 14 years. There was observed patient head motion in 40% of cases with maximum linear acceleration of 0.75 m/s2 and angular velocity of 12.50 degrees/s. CONCLUSIONS Patient movement during otologic procedures was commonly observed, demonstrating the need for a dynamic holder to allow two-handed TEES. Results from this study are the first objective characterization of patient head motion kinematics during otologic procedures performed under general anesthesia.
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9
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Lee B, Youn SI, Lee K, Won Y, Min S, Lee YT, Park YS, Ahn SH, Park DJ, Kim HH. Comparing the short-term outcomes and cost between solo single-incision distal gastrectomy and conventional multiport totally laparoscopic distal gastrectomy for early gastric cancer: a propensity score-matched analysis. Ann Surg Treat Res 2021; 100:67-75. [PMID: 33585351 PMCID: PMC7870426 DOI: 10.4174/astr.2021.100.2.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/11/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Single-incision laparoscopic distal gastrectomy (SIDG) requires experienced camera operators for a stable image. Since it is difficult for skilled camera operators to participate in all SIDG, we began performing solo surgery using mechanical camera holders. We aimed to compare the short-term outcomes and cost between solo SIDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for early gastric cancer (EGC). Methods From January 2014 to December 2016, a total of 938 consecutive patients underwent laparoscopic gastrectomy for EGC. Solo SIDG (n = 99) and MLDG patients (n = 198) were selected and 1:2 propensity score matching was done to compare the quality of operation and cost-effectiveness. All solo SIDG was performed by a surgeon using a camera holder, without any assistant. Results Mean operation time (120 ± 35.3 vs. 178 ± 53.4 minutes, P = 0.001) and estimated blood loss (24.6 ± 47.4 vs. 46.7 ± 66.5 mL, P = 0.001) were significantly lower in the solo SIDG group. Hospital stay, use of analgesics, and postoperative inflammatory markers (WBC, CRP) were similar between the 2 groups. The early (<30 days) complication rate in solo SIDG and MLDG groups was 21.2% and 23.7%, respectively (P = 0.240); the late (≥30 days) complication rate was 7.1% and 11.1%, respectively (P = 0.672). The manpower cost of solo SIDG was significantly lower than that of MLDG (P = 0.001). Conclusion This study demonstrated that solo SIDG performed by experienced laparoscopic surgeons is safe and feasible for EGC. Solo SIDG is expected to be a promising potential treatment for EGC.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Il Youn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kanghaeng Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yongjoon Won
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sahong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Taek Lee
- Department of Surgery, Ewha Womans University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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10
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Characterization of patient head motion in otologic surgery: Implications for TEES. Am J Otolaryngol 2021; 42:102827. [PMID: 33181483 DOI: 10.1016/j.amjoto.2020.102827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Middle ear disease is increasingly being managed via transcanal endoscopic ear surgery (TEES). A limitation of TEES is that it restricts the surgeon to single-handed dissection. One solution to this would be an endoscope holder to facilitate two-handed dissection. Current endoscope holders are stationary, and can cause potential damage from endoscope contact with the ossicles or ear canal if unintended head motion occurs from inadequate anesthetic. A dynamic device that could detect and react to patient motion would mitigate these concerns, but currently there is little formal characterization of the frequency, velocity and acceleration of unintended patient head motion during otologic procedures performed under general anesthesia. The present study aims to characterize intraoperative patient head motion kinematics during cases utilizing TEES. MATERIALS AND METHODS This is a prospective study of adults undergoing otologic procedures performed with general anesthesia and without paralysis. Head motion was characterized using a nine-axis inertial measurement unit (IMU), (LPMS-B2, Life Performance Research) mounted to each patient's forehead for the procedure duration. RESULTS Data was collected across 10 cases; 50% of patients were female and mean age was 50 ± 14 years. There was observed patient head motion in 40% of cases with maximum linear acceleration of 0.75 m/s2 and angular velocity of 12.50 degrees/s. CONCLUSIONS Patient movement during otologic procedures was commonly observed, demonstrating the need for a dynamic holder to allow two-handed TEES. Results from this study are the first objective characterization of patient head motion kinematics during otologic procedures performed under general anesthesia.
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11
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Rade M, Birkett D, Sherman J, Nepomnayshy D. Evaluation of a stand-alone robotic camera holding system: technology that improves laparoscopy. MINIM INVASIV THER 2020; 31:404-409. [PMID: 32852261 DOI: 10.1080/13645706.2020.1806078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Matthew Rade
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Desmond Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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Amin MSA, Aydin A, Abbud N, Van Cleynenbreugel B, Veneziano D, Somani B, Gözen AS, Redorta JP, Khan MS, Dasgupta P, Makanjuoala J, Ahmed K. Evaluation of a remote-controlled laparoscopic camera holder for basic laparoscopic skills acquisition: a randomized controlled trial. Surg Endosc 2020; 35:4183-4191. [PMID: 32851466 PMCID: PMC8263395 DOI: 10.1007/s00464-020-07899-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
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
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Affiliation(s)
- Mohammad S A Amin
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK
| | - Nurhan Abbud
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK
| | - Ben Van Cleynenbreugel
- Department of Urology, University Leuven, Leuven, Belgium.,European School of Urology (ESU) Training and Research Group, Barcelona, Spain
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.,European School of Urology (ESU) Training and Research Group, Barcelona, Spain
| | - Bhaskar Somani
- Department of Urology, Southampton University Hospital NHS Foundation Trust, Southampton, UK.,European School of Urology (ESU) Training and Research Group, Barcelona, Spain
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.,European School of Urology (ESU) Training and Research Group, Barcelona, Spain
| | - Juan Palou Redorta
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.,European School of Urology (ESU) Training and Research Group, Barcelona, Spain
| | - M Shamim Khan
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, Guy's Hospital, King's Health Partners, London, SE1 9RT, UK. .,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK. .,European School of Urology (ESU) Training and Research Group, Barcelona, Spain.
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Samar AM, Bond A, Ranaboldo C. Comparison of FreeHand ® robot-assisted with human-assisted laparoscopic fundoplication. MINIM INVASIV THER 2020; 31:24-27. [PMID: 32501153 DOI: 10.1080/13645706.2020.1771373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Ali Murtaza Samar
- Department of Upper GI Surgery, Salisbury Hospital NHS Trust, Salisbury, UK
| | - Amanda Bond
- Department of Upper GI Surgery, Salisbury Hospital NHS Trust, Salisbury, UK
| | - Charles Ranaboldo
- Department of Upper GI Surgery, Salisbury Hospital NHS Trust, Salisbury, UK
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Lee B, Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, Kim KH, Hyun IG, Han SJ. Solo single incision laparoscopic cholecystectomy using the parallel method; Surgical technique reducing a steep learning curve. Ann Hepatobiliary Pancreat Surg 2019; 23:344-352. [PMID: 31825000 PMCID: PMC6893057 DOI: 10.14701/ahbps.2019.23.4.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022] Open
Abstract
Backgrounds/Aims To describe the techniques, short-term outcomes, and learning curve of solo single-incision laparoscopic cholecystectomy (Solo-SILC) using a laparoscopic scope holder. Methods A total of 591 patients who underwent Solo-SILC from July 2014 to December 2016 performed by four experienced hepatobiliary surgeons were retrospectively assessed. Solo-SILC was performed using the parallel method using a scope holder. The moving average method was used to investigate the learning curve in terms of operative time. Results In total, 590 Solo-SILC procedures were performed. Very few procedures were converted to multi-port laparoscopic cholecystectomy. There was one case of bile duct injury. The mean operative time (59.93±25.77 min) was shorter than that in other studies of SILC. Three postoperative complications, delaying bile leakage, occurred in the patients treated by one surgeon. These cases were resolved by ultrasound-guided puncture and drainage. The learning curve for surgeons A, B, and C was overcome after 14, 12, and 12 cases. Surgeon D, who had the most experience with SILC, had no obvious learning curve. Conclusions Hepatobiliary surgeons experienced in LC can perform Solo-SILC almost immediately. Solo-SILC using the parallel technique represents a more stable option and is a promising treatment for gallbladder disease.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Suk-Won Suh
- Department of Surgery, Chung-Ang University, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil Hwan Kim
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Gun Hyun
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Jong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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De Pauw T, Kalmar A, Van De Putte D, Mabilde C, Blanckaert B, Maene L, Lievens M, Van Haver AS, Bauwens K, Van Nieuwenhove Y, Dewaele F. A novel hybrid 3D endoscope zooming and repositioning system: Design and feasibility study. Int J Med Robot 2019; 16:e2050. [PMID: 31677219 DOI: 10.1002/rcs.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Tim De Pauw
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Alain Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium
| | - Dirk Van De Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Cyriel Mabilde
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Bart Blanckaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Lieven Maene
- Department of Thoracic and Vascular Surgery, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Mauranne Lievens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Kevin Bauwens
- Division of Robotic Surgery and Training, ORSI Academy, Melle, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
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Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, Choi YS, Lee SE, Jeong J. Solo single-incision laparoscopic cholecystectomy: a safe substitute for conventional laparoscopic cholecystectomy. ANZ J Surg 2019; 89:900-904. [PMID: 31293047 DOI: 10.1111/ans.15347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the incremental application of single-incision laparoscopic cholecystectomy (SILC), this procedure has technical difficulties, including physical disturbance and an unstable surgical view through the small incision; therefore, we introduce the solo SILC (S-SILC) technique using a laparoscopic scope holder, as a simple, fixed and easy-to-perform procedure for an unassisted surgeon. METHODS We performed a comparative analysis of S-SILC (n = 566) and conventional three-incision laparoscopic cholecystectomy (n = 874) performed from January 2013 to December 2016 at multiple centres. RESULTS There was no significant difference of operative time between the two groups (P = 0.176); however, S-SILC showed a higher incidence of intraoperative gallbladder perforation, especially in the initial period (17.0% versus 2.3%, P < 0.001); and shorter post-operative hospital stay (3.3 ± 1.7 versus 1.9 ± 2.7 days, P < 0.001) than conventional three-incision laparoscopic cholecystectomy. There were no significant differences in major post-operative complications between the two groups (P = 0.909) and operation type (P = 0.971) was not a significant risk factor for major post-operative complications in multivariate analysis. CONCLUSION S-SILC is a feasible and safe procedure; however, careful selection of surgical candidates is necessary in the early period of the experience with this method.
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Affiliation(s)
- Suk-Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoo-Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Seung-Eun Lee
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Jaehong Jeong
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
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Intracorporeal overlap gastro-gastrostomy for solo single-incision pylorus-preserving gastrectomy in early gastric cancer. Surg Today 2019; 49:1074-1079. [PMID: 31115696 DOI: 10.1007/s00595-019-01820-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/03/2019] [Indexed: 12/29/2022]
Abstract
This report discusses the technique of solo single-incision pylorus-preserving gastrectomy (SIPPG) for early gastric cancer. To overcome difficulties regarding lymph node dissection (LND), a scope holder and an energy device were used, allowing fine dissection in a fixed field of view. The overlap gastro-gastrostomy technique was used for anastomosis. Seventeen patients underwent solo SIPGG. The mean operation time was 150.1 ± 28.7 min, and no patients developed postoperative complications or delayed gastric emptying within 30 days of the operation. Using scope holders and performing fine dissection with the energy device, challenges regarding LND in SIPPG can be overcome. INTACT anastomosis was initially used; however, due to its inconsistency and the high degree of surgical skill required, it was changed to the overlap method. Solo SIPPG with overlap gastro-gastrostomy may be safe and feasible with good cosmetic results and fast patient recovery.
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Feng G, Gao Z, Tian X, Zhuang Y, Lv W. Modified two-handed transnasal endoscopic surgery: Innovative instrument design and an experimental canine study. EAR, NOSE & THROAT JOURNAL 2018; 96:E24-E27. [PMID: 28846796 DOI: 10.1177/014556131709600807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study was conducted to design new instruments to solve the current issues of one-hand control and the obscuring of the endoscope by blood during transnasal endoscopic surgery. An endoscope holder and an electronically controlled irrigation-suction system were designed and manufactured. The feasibility and effectiveness of the designed instruments and operation models were verified in a model transnasal endoscopic surgery procedure performed on a mongrel dog. During the operation, one hand was used to perform the operation and move the endoscope, and the other hand was used for irrigation and suction to keep the surgical field and the endoscope clear. The combined use of an endoscope holder and an electronically controlled irrigation-suction system facilitates single-surgeon bimanual transnasal endoscopic surgery in a model surgical procedure. The clinical value of this technique warrants further research.
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Affiliation(s)
- Guodong Feng
- Department of Otolaryngology, Peking Union Medical College Hospital (East), No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China 100730
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Choi BJ, Jeong WJ, Kim SJ, Lee SC. Solo-Surgeon Single-Port Laparoscopic Anterior Resection for Sigmoid Colon Cancer: Comparative Study. J Laparoendosc Adv Surg Tech A 2018; 28:330-336. [PMID: 28829927 DOI: 10.1089/lap.2017.0375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Byung Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Won Jun Jeong
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
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20
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Eisenkop SM. Total Laparoscopic Hysterectomy with Pelvic/Aortic Lymph Node Dissection for Endometrial Cancer Using Passive Instrument Positioners: A Retrospective Case-Control Series. J Minim Invasive Gynecol 2017; 25:800-809. [PMID: 29246636 DOI: 10.1016/j.jmig.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To investigate the influence of the use of passive instrument positioners (PIPs) on laparoscopic operative outcomes for endometrial cancer relative to other independent variables. DESIGN Retrospective case-controlled study (Canadian Task Force classification II-2). SETTING Laparoscopies performed by the author in multiple community hospitals. PATIENTS A total of 297 consecutive patients between December 2009 and October 2016 with clinically isolated endometrial cancer or retroperitoneal lymphadenopathy on imaging studies. INTERVENTIONS Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and pelvic/aortic lymph node dissection using passive instrument positioners to secure the laparoscope (PIP group) and using instruments providing exposure and historical control by hand control of all instruments (HC group). MEASUREMENTS AND MAIN RESULTS The overall group mean age was 63.2 years (range, 32.4-90.9 years), and patient characteristics were equivalent in the 2 groups. In the PIP group, 1 procedure was converted to a laparotomy (0.5%), and in the HC group, 6 procedures were converted (5.4%; p = .008). The mean operative time was 140.1 minutes for the PIP group and 153.8 minutes for the HC group (p < .001). The mean length of hospital stay was 44.8 hours for the PIP group and 58.6 hours for the HC group (p < .001). Multivariate analysis confirmed that study group (PIP vs HC; p = .014) and the presence vs absence of metastatic disease (p = .001) influenced conversion; study group (PIP vs HC; p < .001), body mass index (p < .001), past surgical history (p = .010), and assistant training (p = .011) influenced operative time; and study group (PIP vs HC; p < .001), Eastern Cooperative Oncology Group performance status (p < .001), and operative time (p = .051) influenced hospital stay. CONCLUSION For clinically localized endometrial cancer managed laparoscopically, the use of PIPs reduces conversions, operative time, and hospital stay.
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Kang SH, Lee Y, Park YS, Ahn SH, Park DJ, Kim HH. Solo Single-Incision Laparoscopic Resectional Roux-en-Y Gastric Bypass for Morbid Obesity with Metabolic Syndrome. Obes Surg 2017; 27:3314-3319. [PMID: 28963663 DOI: 10.1007/s11695-017-2934-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With the advancement of laparoscopic devices and surgical technology, the era of minimal invasive surgery has progressed to reduced-port surgery, and finally to single-incision laparoscopic surgery (SILS). Several reports show successful application of SILS to various types of bariatric surgery. Oftentimes, this requires a skilled and experienced scopist to perform the procedure. To overcome the technical difficulties of single-incision Roux-en-Y gastric bypass, a manual scope holder was used instead of an assistant scopist, greatly stabilizing the field of view. This allows the surgery to be performed at any time without being influenced by the need of a highly experienced scopist. In this report, we describe in detail the world's first solo single-incision laparoscopic resectional Roux-en-Y gastric bypass.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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22
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Park SY, Suh JW, Narm KS, Lee CY, Lee JG, Paik HC, Chung KY, Kim DJ. Feasibility of four-arm robotic lobectomy as solo surgery in patients with clinical stage I lung cancer. J Thorac Dis 2017; 9:1607-1614. [PMID: 28740675 DOI: 10.21037/jtd.2017.05.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study was performed to investigate the feasibility of four-arm robotic lobectomy (FARL) as a solo surgical technique in patients with non-small cell lung cancer (NSCLC). Early outcome and long-term survival of FARL were compared with those of video-assisted thoracoscopic lobectomy (VATL). METHODS Prospective enrollment of patients with clinical stage I NSCLC undergoing FARL or VATL (20 patients in each group) was planned. Interim analysis for early postoperative outcome was performed after the initial 10 cases in each group. RESULTS The study was terminated early because of safety issues in the FARL group after enrollment of 12 FARL and 17 VATL patients from 2011 to 2012. There were no differences in clinical characteristics between groups. Lobectomy time and total operation time were significantly longer in the FARL group (P=0.003). There were three life-threatening events in the FARL group (2 bleedings, 1 bronchus tear) that necessitated thoracotomy conversion in 1 patient. There were no differences in other operative outcomes including pain score, complications, or length of hospital stay. Pathologic stage and number of dissected lymph nodes (LNs) were also comparable. During a follow-up of 48.9±9.5 months, recurrence was identified in 2 (16.7%) patients in FARL group and 3 (23.5%) in VATL group. Five-year overall survival (100% vs. 87.5%, P=0.386) and disease-free survival (82.5% vs. 75.6%, P=0.589) were comparable. CONCLUSIONS FARL as solo surgery could not be recommended because of safety issues. It required a longer operation time and had no benefits over VATL in terms of early postoperative outcome or long-term survival.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Suh
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Sik Narm
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Laparoscopic Cholecystectomy with Freehand Laparoscopic Camera Controller. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:159-162. [PMID: 30595872 PMCID: PMC6284172 DOI: 10.12865/chsj.43.02.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/21/2017] [Indexed: 11/18/2022]
Abstract
Introduction: Free hand laparoscopic camera controller (FHLCC) is a new innovative robotic device that has been recently implemented and adopted in laparoscopic surgery, providing the surgeon more comfort in carrying out his surgical skills without the difficulties related to the mutual understanding of the movements of the camera. Case presentation: We report the first case of laparoscopic cholecystectomy performed in our hospital with the aid of the free hand laparoscopic camera controller. Conclusion: Free hand laparoscopic camera controller provides the surgeon comfort in carrying out his surgical skills without the difficulties related to the mutual understanding of the movements of the camera. It combines the benefits of minimally invasive and robotic assisted surgery, increases efficiencies and improves patient recovery times.
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Lee DY, Baek SK, Jung KY. Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy. J Laparoendosc Adv Surg Tech A 2016; 27:63-66. [PMID: 27139938 DOI: 10.1089/lap.2016.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. MATERIALS AND METHODS For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. RESULTS Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). CONCLUSION Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital , Seoul, South Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital , Seoul, South Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital , Seoul, South Korea
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25
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Abdi E, Burdet E, Bouri M, Himidan S, Bleuler H. In a demanding task, three-handed manipulation is preferred to two-handed manipulation. Sci Rep 2016; 6:21758. [PMID: 26912293 PMCID: PMC4766403 DOI: 10.1038/srep21758] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/28/2016] [Indexed: 11/08/2022] Open
Abstract
Equipped with a third hand under their direct control, surgeons may be able to perform certain surgical interventions alone; this would reduce the need for a human assistant and related coordination difficulties. However, does human performance improve with three hands compared to two hands? To evaluate this possibility, we carried out a behavioural study on the performance of naive adults catching objects with three virtual hands controlled by their two hands and right foot. The subjects could successfully control the virtual hands in a few trials. With this control strategy, the workspace of the hands was inversely correlated with the task velocity. The comparison of performance between the three and two hands control revealed no significant difference of success in catching falling objects and in average effort during the tasks. Subjects preferred the three handed control strategy, found it easier, with less physical and mental burden. Although the coordination of the foot with the natural hands increased trial after trial, about two minutes of practice was not sufficient to develop a sense of ownership towards the third arm.
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Affiliation(s)
- Elahe Abdi
- Robotic Systems Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Mohamed Bouri
- Robotic Systems Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sharifa Himidan
- Pediatric General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hannes Bleuler
- Robotic Systems Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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26
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Bosma J, Boeken Kruger A, Jaspers J. A novel, intuitive instrument positioner for endoscopy, involving surgeons in design and feasibility. MINIM INVASIV THER 2015; 24:326-33. [DOI: 10.3109/13645706.2015.1039547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Assessment of the endoscopic range of motion for head and neck surgery using the SOLOASSIST endoscope holder. Int J Med Robot 2015; 11:418-23. [DOI: 10.1002/rcs.1643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 01/02/2023]
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28
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Deshpande SV. Innovation in robotic surgery: the Indian scenario. J Minim Access Surg 2015; 11:106-10. [PMID: 25598610 PMCID: PMC4290110 DOI: 10.4103/0972-9941.147724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/28/2014] [Indexed: 11/17/2022] Open
Abstract
Robotics is the science. In scientific words a “Robot” is an electromechanical arm device with a computer interface, a combination of electrical, mechanical, and computer engineering. It is a mechanical arm that performs tasks in Industries, space exploration, and science. One such idea was to make an automated arm — A robot — In laparoscopy to control the telescope-camera unit electromechanically and then with a computer interface using voice control. It took us 5 long years from 2004 to bring it to the level of obtaining a patent. That was the birth of the Swarup Robotic Arm (SWARM) which is the first and the only Indian contribution in the field of robotics in laparoscopy as a total voice controlled camera holding robotic arm developed without any support by industry or research institutes.
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Affiliation(s)
- Suresh V Deshpande
- Department of Surgery, Swarup Hospital, 154, Dudhali, Kolhapur, Maharashtra, India
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Prescher H, Biffar DE, Galvani CA, Rozenblit JW, Hamilton AJ. Evaluation of a Navigation Grid to Increase the Efficacy of Instrument Movement During Laparoscopic Surgery. J Laparoendosc Adv Surg Tech A 2014; 24:656-9. [DOI: 10.1089/lap.2014.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannes Prescher
- Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona, Tucson, Arizona
| | - David E. Biffar
- Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona, Tucson, Arizona
| | - Carlos A. Galvani
- Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona, Tucson, Arizona
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Jerzy W. Rozenblit
- Department of Surgery, University of Arizona, Tucson, Arizona
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona
| | - Allan J. Hamilton
- Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona, Tucson, Arizona
- Department of Surgery, University of Arizona, Tucson, Arizona
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona
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Tuschy B, Berlit S, Brade J, Sütterlin M, Hornemann A. Solo surgery – Early results of robot-assisted three-dimensional laparoscopic hysterectomy. MINIM INVASIV THER 2014; 23:230-4. [DOI: 10.3109/13645706.2014.893890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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He Y, Coonar A, Gelvez-Zapata S, Sastry P, Page A. Evaluation of a robot-assisted video-assisted thoracoscopic surgery programme. Exp Ther Med 2014; 7:873-876. [PMID: 24669243 PMCID: PMC3961121 DOI: 10.3892/etm.2014.1532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 12/30/2013] [Indexed: 01/22/2023] Open
Abstract
At present, there is increasing interest in surgical procedures using a robot-assisted device. The aim of this study was to investigate whether robot-assisted video-assisted thoracoscopic surgery (VATS) was more effective than conventional VATS. A total of 64 VATS lobectomies in Papworth Hospital (Cambridge, UK) were included in the study. In 34 cases the lobectomies were performed using conventional VATS (CV group), while in the remaining 30 cases the lobectomies were performed using robot-assisted VATS (Robotic group). In the robot-assisted VATS, FreeHand®, a thoracoscopic camera controller produced by Freehand 2010 Ltd. (Eastleigh, UK), was used. The duration of the thoracoscopic surgery in the Robotic group was 145.50±10.43 min, whereas in the CV group the duration was 162.79±9.40 min. The surgery duration in the Robotic group was 10.62% shorter than that in the CV group (P<0.05). The rates of bleeding, pulmonary infection, arrhythmia and prolonged air leak (≥5 days) in the Robotic group were 0, 3.33, 26.67 and 13.33%, respectively, while the corresponding rates in the CV group were 2.94, 5.88, 20.59 and 17.65%, respectively. No significant differences were identified in the postoperative complication rates between the two groups (P≥0.05). There was no perioperative mortality in the study. Compared with conventional VATS, FreeHand-assisted VATS provides a similar rate of postoperative complications and a reduced surgery duration, and may be beneficial for the recovery of the patients following VATS.
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Affiliation(s)
- Yong He
- Department of Thoracic Surgery, The Fifth Hospital of Dalian, Dalian, Liaoning 116021, P.R. China ; Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge University Partners, Cambridge CB23 3RE, UK
| | - Amans Coonar
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge University Partners, Cambridge CB23 3RE, UK
| | - Sabin Gelvez-Zapata
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge University Partners, Cambridge CB23 3RE, UK
| | - Post Sastry
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge University Partners, Cambridge CB23 3RE, UK
| | - Archer Page
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge University Partners, Cambridge CB23 3RE, UK
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Gillen S, Pletzer B, Heiligensetzer A, Wolf P, Kleeff J, Feussner H, Fürst A. Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case-control study. Surg Endosc 2013; 28:164-70. [PMID: 23990155 DOI: 10.1007/s00464-013-3142-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the implementation of a joystick-controlled camera holder (Soloassist; Actormed, Barbing, Germany) in laparoscopic cholecystectomy as so-called solo-surgery compared with the standard operation. METHODS Of the 123 patients included in this study, 63 underwent laparoscopic cholecystectomy using the Soloassist system and were compared with 60 patients who underwent laparoscopic cholecystectomy with human assistance. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification. The surgeons were divided into those highly experienced and those experienced with the new camera holder. The operation times were measured, including setup and dismantling of the system. The assessment also included complications, postoperative hospital stay, measurement of human resources in terms of personnel/minutes/operation, and subjective evaluation of the camera-guiding device by the surgeons. RESULTS The hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time (p = 0.008) and total operating time (p = 0.001) significantly favored the human assistant. Whereas the absolute duration of surgery was longer, the relative operating time (in personnel/minutes/operation) was significantly shorter (p < 0.001). In 4.8 % of the cases, the operation could not be performed completely with the camera-holding device. Clinically relevant postoperative complications did not occur. The experience of the surgeons did not differ significantly. The subjective evaluation regarding handling, image quality, effort, and satisfaction demonstrated high acceptance of the Soloassist system. CONCLUSIONS The camera-guiding device can be implemented without increased complications. The Soloassist system is safe and can be operated even by colleagues without system experience. All the surgeons rated their satisfaction with the system as very good to excellent. Although the operating times were longer than with the standard camera guidance, the absolute overall staff time was reduced.
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Affiliation(s)
- Sonja Gillen
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Jarry J, Moreau Gaudry A, Long JA, Chipon E, Cinquin P, Faucheron JL. Miniaturized robotic laparoscope-holder for rectopexy: first results of a prospective study. J Laparoendosc Adv Surg Tech A 2013; 23:351-5. [PMID: 23477369 DOI: 10.1089/lap.2012.0233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Thanks to the technical progress in instrumentation, laparoscopic surgery has made considerable advances over the last decade. Various robotic systems have been introduced to assist laparoscopic procedures. A new prototype of miniaturized laparoscope-holder (called the Light Endoscope Robot [LER]) has been developed by the TIMC-IMAG-CNRS Laboratory in Grenoble, France and is now currently marketed by the French company Endocontrol™ (La Tronche, Grenoble). The aim of this pilot study was to assess the LER in clinical practice. SUBJECTS AND METHODS This was a prospective, single-center study. The LER had already been successfully validated on preclinical laboratory and cadaveric trials. The study was conducted at the Grenoble University Hospital during standardized laparoscopic rectopexies on adult patients. Demographic and operative data and qualitative results were collected prospectively and analyzed retrospectively. All patients provided written informed consent, and the study was approved by the Regional Committee for Medical and Health Research Ethics. RESULTS Between March 2008 and September 2010, 16 adult patients underwent laparoscopic rectopexy assisted by the LER. All the patients were women with an average age of 63.6 years and an average body mass index of 24 kg/m(2). The procedure was completed in 15 patients. No conversion to open surgery was required. The postoperative mortality rate was 0%, and a complication occurred in 1 patient. The surgeon graded ease of use as 7 ± 2, global comfort as 8 ± 2, and quality of vision as 8 ± 2. CONCLUSIONS This pilot study demonstrated the feasibility, safety, and comfort for the surgeon of the laparoscopic rectopexy assisted by the miniaturized light endoscope-holder LER.
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Affiliation(s)
- Julien Jarry
- Department of Surgery, Desgenettes Hospital, Lyon, France.
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Long JA, Tostain J, Lanchon C, Voros S, Medici M, Descotes JL, Troccaz J, Cinquin P, Rambeaud JJ, Moreau-Gaudry A. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder. J Endourol 2013; 27:58-63. [DOI: 10.1089/end.2012.0357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Jacques Tostain
- Department of Urology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Cecilia Lanchon
- Urology Department, Grenoble University Hospital, Grenoble, France
| | | | - Maud Medici
- Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
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Kranzfelder M, Staub C, Fiolka A, Schneider A, Gillen S, Wilhelm D, Friess H, Knoll A, Feussner H. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc 2012; 27:1681-8. [PMID: 23239307 DOI: 10.1007/s00464-012-2656-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Kranzfelder
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 München, Germany.
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Kristin J, Geiger R, Knapp FB, Schipper J, Klenzner T. [Use of a mechatronic robotic camera holding system in head and neck surgery]. HNO 2012; 59:575-81. [PMID: 21509620 DOI: 10.1007/s00106-011-2273-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND It has been shown that a third hand is useful for holding the endoscope during endoscopic surgery so that both hands of the surgeon are free for instrumentation. MATERIAL AND METHODS Experimental tests were performed with the mechatronic robotic camera holding system Soloassist on anatomical specimens in the area of the nose, nasopharynx and larynx. RESULTS An ergonomic set-up and the practical application are easily possible. The third hand enables a still and clear picture without undesired camera movement and all instruments can be controlled by the surgeon. There would appear to be some room for improvement as the working area is limited due to an additional instrument. The camera holding system shows a very high velocity for head and neck surgery. CONCLUSION Until the active holder can be used regularly in clinical practice in the field of head and neck surgery, more technical modifications have to be implemented.
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Affiliation(s)
- J Kristin
- HNO-Universitätsklinikum, Moorenstrasse 5, 40225, Düsseldorf, Deutschland.
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Stolzenburg JU, Franz T, Kallidonis P, Minh D, Dietel A, Hicks J, Nicolaus M, Al-Aown A, Liatsikos E. Comparison of the FreeHand® robotic camera holder with human assistants during endoscopic extraperitoneal radical prostatectomy. BJU Int 2010; 107:970-4. [PMID: 20973908 DOI: 10.1111/j.1464-410x.2010.09656.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE • To assess, in a prospective randomized study, the efficiency of the FreeHand® (Prosurgics Ltd, Bracknell, UK) compared to manual camera control during the performance of endoscopic extraperitoneal radical prostatectomy (EERPE). PATIENTS AND METHODS • Three surgeons performed 50 EERPE for localized prostate cancer. In group A (n= 25), procedures were performed with manual control of the camera by the assistant, whereas group B (n= 25) patients were treated with the assistance of the FreeHand® robotic device. • The EERPE procedure was divided into several steps. • Total operation duration, time for each surgical step, number of camera movements, number of movement errors, number of times the lens was cleaned, blood loss and margin status were compared. RESULTS • No statistically significant difference was observed in terms of patient age, preoperative prostate-specific antigen level, Gleason score, positive cores and prostate volume. • The average operation duration required for the performance of each step did not differ significantly between the two groups. • Significant differences in favour of the FreeHand® camera holder were observed in case of horizontal and zooming camera movement, camera cleaning and camera errors. • Vertical camera movements were performed significantly faster by the human assistant compared to the robotic camera holder. • The average total operation duration was similar for both groups. • Positive surgical margins were detected in one patient in each group (4% of the patients). CONCLUSIONS • A comparison of the FreeHand® robotic camera holder with human camera control during EERPE showed a similar time requirement for the performance of each step of the procedure. • The robotic system provided accurate and fast movements of the camera without compromising the outcome of the procedure.
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Tchartchian G, Dietzel J, Bojahr B, Hackethal A, De Wilde R. Decreasing strain on the surgeon in gynecologic minimally invasive surgery by using semi-active robotics. Int J Gynaecol Obstet 2010; 112:72-5. [PMID: 20947079 DOI: 10.1016/j.ijgo.2010.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/29/2010] [Accepted: 09/14/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the advantages of a surgeon-controlled robotic endoscope holder in gynecologic minimally invasive solo-surgery as compared with conventional assistance with a second surgeon. METHODS One hundred gynecologic laparoscopies were consecutively allocated to surgery with either a robot as the surgical assistant or a conventional assistant surgeon. Total operation time, image stability, and frequency of corrective maneuvers of the camera, in addition to the surgeon's satisfaction regarding the ergonomics of the intervention, were recorded. All interventions were performed by the same surgeon. All laparoscopic surgery was classified as either easy or advanced surgery. RESULTS The image stability score was significantly higher (10 vs 7; P<0.001) and fewer corrective maneuvers of the robotic endoscope were necessary (1 vs 5; P<0.001) with the robotic laparoscope holder; in addition, the surgeon recorded a significantly higher satisfaction score for the ergonomics of the semi-active robot (10 vs 7; P<0.001). CONCLUSION The robot does not prolong total operation time and increases the surgeon's comfort by improving image stability and laparoscope handling. It could provide major benefit, especially in complex gynecologic laparoscopic surgery.
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Affiliation(s)
- Garri Tchartchian
- Department of Obstetrics and Gynecology, Pius-Clinic, Oldenburg, Germany
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The feasibility of solo-surgeon living donor nephrectomy: initial experience using video-assisted minilaparotomy surgery. Surg Endosc 2010; 24:2755-9. [PMID: 20383533 DOI: 10.1007/s00464-010-1040-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 03/17/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND Today, many kinds of surgery are being conducted without human assistants. Living donor nephrectomy (LDN) using video-assisted minilaparotomy surgery (VAM) has been performed by solo-surgeon using Unitrac® (Aesculap Surgical Instrument, Germany). We examined the results from VAM-solo-surgeon living donor nephrectomy (SLDN) and conventional VAM-human-assisted living donor nephrectomy (HLDN). METHODS Between July 2007 and April 2008, 82 cases of VAM-LDN were performed by two surgeons. From these cases, we randomly assigned 35 cases to undergo solo-surgery (group I) and the other 47 cases to undergo surgery with one human assistant (group II). All VAM-LDN procedures were performed in the same manner. Only the roles of a first assistant were substituted by the Unitrac® in group I. We compared the perioperative and postoperative data, including operative time, estimated blood loss, and hospital stay, between the two groups. We also investigated cases that developed complications. RESULTS There were no significant differences in the patient demographic data between the two groups (P > 0.05). The mean operative time was 201.9 ± 32.9 min in group I and 202.4 ± 48.3 min in group II (P = 0.954), whereas mean blood loss was 209.7 ± 167.3 ml in group I and 179.6 ± 87.8 ml in group II (P = 0.294). Postoperative hospital stay were 5.4 ± 1.1 days in group I and 5.5 ± 1.6 days in group II (P = 0.813). The incidence of perioperative complications was not significantly different between the two groups. CONCLUSIONS Our study demonstrates that VAM-SLDN can be performed safely, is economically beneficial, and is comparable to VAM-HLDN in terms of postoperative outcomes.
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Herman B, Dehez B, Duy KT, Raucent B, Dombre E, Krut S. Design and preliminary in vivo validation of a robotic laparoscope holder for minimally invasive surgery. Int J Med Robot 2009; 5:319-26. [PMID: 19455594 DOI: 10.1002/rcs.263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Manual manipulation of the camera is a major source of difficulties encountered by surgeons while performing minimally invasive laparoscopic surgery. METHODS A survey of laparoscopic procedures and a review of existing active and passive holders were conducted. Based on these analyses, essential requirements were highlighted for such devices. Pursuant to this, a novel active laparoscope manipulator was designed, paying particular attention to ergonomics and ease of use. Several trials on the pelvitrainer and a first in vivo procedure were performed to validate the original design of our device. RESULTS Phantom experiments demonstrated ease of use of the robot and advantages of the intuitive joystick with omnidirectional displacements and speed control. The compactness of the device and image stability were appreciated during the surgical trial. CONCLUSIONS A novel robotic laparoscope holder has been developed and produced. An in vivo trial proved its value in clinical practice, enabling surgeons to work more comfortably.
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Affiliation(s)
- Benoît Herman
- Center for Research in Mechatronics, Université catholique de Louvain, Belgium.
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Herman B, Duy KT, Dehez B, Polet R, Raucent B, Dombre E, Donnez J. Development and First In Vivo Trial of EvoLap, an Active Laparoscope Positioner. J Minim Invasive Gynecol 2009; 16:344-9. [DOI: 10.1016/j.jmig.2009.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/24/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
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Strauss G, Hofer M, Kehrt S, Grunert R, Korb W, Trantakis C, Winkler D, Meixensberger J, Bootz F, Dietz A, Wahrburg J. [Manipulator assisted endoscope guidance in functional endoscopic sinus surgery: proof of concept]. HNO 2007; 55:177-84. [PMID: 16773352 DOI: 10.1007/s00106-006-1434-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) is characterized by single-handed preparation and guidance of the endoscope by the nondominant hand. This results in an additional extension of operation time by up to 15% and ergonomic deficits. The aim of this study is the conception of an automated assistance system for FESS in view of the following questions: (1) Which degree of surgical automation is suitable for FESS? (2) Which design is suitable? (3) What are the properties of the technical system (planning, time, accuracy, precision) of the selected system? (4) Does the system offer potential for a clinical application? METHODS In all 49 FESS were analyzed for surgical workflows. Measurement of the maximum forces within FESS was performed with 40 trials on an anatomical model. Three different mechanical systems were used in ten FESS and evaluated using the ICCAS Human-Machine Evaluation Scale. For realization of automated endoscope guidance an engine-driven and -braked manipulator (PA10-6c, Mitsubishi, Japan) was used. The technical parameters determined were expenditure of time for the preoperative planning of workspace, surgical accuracy and precision of the intraoperative endoscope positioning, maximal forces, and time. RESULTS Concept-conditioned instrument changes amount to an average of 41.1 and 18.9% (5.21 min) time requirement for each FESS side. Maximum forces on the mucous membrane during a conventional FESS were measured at 9.8 N (5.9-9.8). Usability of the mechanical endoscope holder was estimated in 18 of 20 cases to be inferior to the standard procedure. The time needed for segmenting the intranasal workspace was 15.2 min (10.0-23.0). The maximum deviation of the automatically driven endoscope from a planned position amounted to 0.85 mm (manually 4.64 mm). The maximum force was measured with 1.1 N in the z direction (manually 9.8 N). Automated guidance of the endoscope to an intranasal position needed 7.25 s (6.4-7.9); manually 12.64 s (5.9-43.0). CONCLUSION Guidance of the endoscope for FESS by an automated motor-driven system is possible. The conception which is based on workflow analysis favors a system with automatic definition of the workspace and a manual movement of the endoscope. The examined system offers a potential for clinical application. Definition of the automation level and development of a man-machine interface is more important than selection or reconstruction of a special manipulator for endoscope guidance in FESS from a surgical point of view.
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Affiliation(s)
- G Strauss
- Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig.
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