What robot for tomorrow and what improvement can we expect?

Feasibility evaluation of the Versius surgical system: robot-assisted hysterectomy for benign and malignant gynaecological lesions

INTRODUCTION

The application of minimally invasive surgery allows for radical and precise removal of the gynaecological lesion while simultaneously reducing the side effects and complications associated with surgical treatment. This paper aims to share our direct experience with the implementation of the CMR Versius robotic platform in the treatment of benign and malignant gynaecological lesions.

METHODS

This study included patients who underwent hysterectomy in the Department of Obstetrics, Gynaecology, and Gynaecologic Oncology at the Regional Polyclinical Hospital in Grudziadz, Poland. A total of 50 patients were included in the study: 29 underwent laparoscopic surgery and 21 underwent robot-assisted surgery using the CMR Versius system.

RESULTS

It was found that in the case of non-radical hysterectomy, the duration of surgery differed significantly (96.5 vs. 134.6 min, p < 0.01) in the groups of patients undergoing laparoscopic and robotic surgery. There were also no statistically significant differences in loss of blood parameters, rate of complications and conversions to other type of surgery after the laparoscopic and robotic surgeries. Both groups did not differ significantly in terms of hospitalisation time after surgery.

CONCLUSION

Versius CMR surgical robot assistance provides safe and effective support for MIS procedures in gynaecology.

Anterior pushing technique for a broken scalpel blade in lumbar discectomy: a case report

The presence of broken surgical blades or other surgically uncontrolled sharp and pointed objects in the disc space is a rare but potentially severe complication of posterior lumbar spine procedures. Herein, we report the case of a 59-year-old female patient with a history of lumbar decompression and interspinous process device implantation who underwent an instrumented revision of the lumbosacral junction. During the L5-S1 discectomy, the scalpel blade broke, and the broken fragment could not be retrieved through the posterior approach. With regard to the vascular anatomy, we partially pushed the fragment through the anterior annulus into the retroperitoneal space. In addition, pedicle screws were locked to ensure the stability of the construct. The fractured blade fragment was eventually removed by laparoscopy 1 week after the initial procedure. This experience suggests that the anterior pushing technique with fluoroscopy is an option in rare cases where a broken scalpel blade cannot be reached through the posterior approach. In such cases, computed tomography angiography is recommended.

New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology

Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.

Robot-enhanced diabetes care for middle-aged and older adults living with diabetes in the community: A small sample size mixed-method evaluation

Purpose

This study assessed robot-enhanced healthcare in practical settings for the purpose of community diabetes care.

Methods

A mixed method evaluation collected quantitative and qualitative data on diabetes patients over 45 (N = 30) and community pharmacists (N = 10). It took 15–20 min for the diabetes patients to interact with the robot. Before and after the interaction, questionnaires including a diabetes knowledge test, self-efficacy for diabetes, and feasibility of use of the robot was administered. In-depth interviews with both pharmacists and patients were also conducted.

Results

After interacting with the robot, a statistically significant improvement in diabetes knowledge (p < .001) and feasibility of the robot (p = .012) was found, but self-efficacy (p = .171) was not significantly improved. Five themes emerged from interviewing the diabetes patients: Theme 1: meets the needs of self-directed learning for the elderly; Theme 2: reduces alertness and creates comfortable interaction; Theme 3: vividness and richness enhance interaction opportunities; Theme 4: Robots are not without disadvantages, and Theme 5: Every person has unique tastes. Three themes emerged from interviewing pharmacists: Theme 1: Technology must meet the real needs of the patient; Theme 2: creates new services, and Theme 3: The use of robots must conform to real-life situations.

Conclusions

Both the diabetes patients and the pharmacist reported more positive feedback on the robot-enhanced diabetes care than concerns. Self-directed learning, comfortable interaction, and vividness were the most focuses when using robot to enhance self-management for the patients. Pharmacists were most receptive to fit conforming with reality and creating new services.

The role of simulator and digital technologies in head and neck reconstruction

This review summarizes the development of digital technology in the field of head and neck surgeries. Advances in digital technology assist surgeons during preoperative planning, where they can simulate their surgeries with improvement in the resulting accuracy of the surgery. In addition to digital technologies having many applications in the surgical field, they can be used in medical devices, surgical and educational models, and tissue engineering.

Robot-Assisted Removal of a Broken Scalpel Blade following Discectomy

The risk of a broken scalpel blade during discectomy is considered extremely rare, while no guidelines exist regarding this complication. We report a case of a robotic broken blade removal following lumbar discectomy. A 52-year-old female was subjected to L4-L5 discectomy. During the annulus resection, the scalpel blade broke and was retained within the disc space. The broken blade migrated towards the abdominal cavity and viscera. Emergency CT angiography scan revealed that the main vessels were intact, while the broken surgical knife was located anterior to the lumbar spine at the L4/L5 level, to the left of the aorta and superiorly of the left common iliac artery. At that point, robot-assisted laparoscopy was performed. The broken instrument was located and carefully removed. It seems more proper that such foreign bodies should be removed, while robotic surgery may play a significant role in cases that the foreign body is near major vessels.

Overview on the Evolution of Laser Welding of Vascular and Nervous Tissues

Laser welding presents a core position in the health sector. This process has had an outstanding impact on the surgical procedures from many medical areas, such as on vascular and nervous surgeries. The aim of the present research is to present an overview on the evolution of laser welding of vascular and nervous tissues. These surgeries present many advantages, such as an absence of foreign-body reactions and aneurysms and good tensile strengths. However, despite the sutureless nature of the process, complementary sutures have been applied to support the procedure success. An important concern in vascular and nervous laser welding is the thermal damage. The development of temperature-controlled feedback systems has reduced this concern with a very precise control of the laser parameters. The bonding strength of vascular and nerve laser welds can be enhanced with the application of solder solutions, bonding materials, and laser-activated dyes. Alternative techniques to laser welding, such as photochemical tissue bonding and electrosurgical high-frequency technologies, have also been tested for vascular and nervous repairs.

Enabling single-site laparoscopy: the SPORT platform

BACKGROUND

The Single Port Orifice Robotic Technology (SPORT) Surgical System by Titan Medical Inc. is designed to overcome the inherent challenges of minimally invasive single-access procedures. The aim of this preclinical study was to evaluate the feasibility of various digestive surgery procedures using this novel surgical robotic platform.

METHODS

A total of 12 minimally invasive procedures were performed on six pigs (5 cholecystectomies, 3 Nissen fundoplications, 1 splenectomy and 1 hepatic pedicle dissection) and on one human cadaver (1 cholecystectomy and 1 Nissen fundoplication), by four laparoscopic surgeons. The usability of the device was assessed by means of the modified objective structured assessment of technical skills (OSATS) score that was calculated and analyzed by two independent observers on the recorded videos. Surgeon feedback and recommendations were systematically recorded.

RESULTS

All procedures were successfully completed with the SPORT system. In general, surgeons reported to appreciate the intuitive interface and controls, the high-resolution 3D imaging, the dexterity of the end-effectors, and the ergonomic open control platform. Some features requiring optimization were also identified. The modified OSATS score demonstrated a learning curve effect for all device-related tasks.

CONCLUSIONS

A variety of abdominal procedures could be safely completed with the current SPORT prototype, in the preclinical setting. This preliminary feasibility experience is promising and encourages further development of single-port robotically assisted surgery.