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Tappero S, Fallara G, Chierigo F, Micalef A, Ambrosini F, Diaz R, Dorotei A, Pompeo E, Limena A, Bravi CA, Longoni M, Piccinelli ML, Barletta F, Albano L, Mazzone E, Dell'Oglio P. Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes? Eur J Nucl Med Mol Imaging 2024; 51:3061-3078. [PMID: 38607386 DOI: 10.1007/s00259-024-06706-w] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. METHODS A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. RESULTS Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). CONCLUSIONS Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Chierigo
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Micalef
- Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Francesca Ambrosini
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Raquel Diaz
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Dorotei
- Department of Orthopaedics, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Limena
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Northampton General Hospital, Northampton, UK
- Department of Urology, Royal Marsden Foundation Trust, London, UK
| | - Mattia Longoni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Huang S, Huang X, Liu Z, Yao C, Liu J, He M, Xu X, Zhang T, Wang J, Jiang L, Chen HJ, Xie X. Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery. ACS NANO 2024; 18:18129-18150. [PMID: 38954632 DOI: 10.1021/acsnano.4c03871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.
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Affiliation(s)
- Shuang Huang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Zhengjie Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Chuanjie Yao
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Jing Liu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Mengyi He
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xingyuan Xu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Tao Zhang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Ji Wang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lelun Jiang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xi Xie
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
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Choo SP, Jeon MS, Kim YM, Choi SK, Yi JW, Lee T. The Role of Robotics in Meeting Institutional Goals: A Unified Strategy to Facilitate Program Excellence. Int Neurourol J 2024; 28:127-137. [PMID: 38956772 PMCID: PMC11222821 DOI: 10.5213/inj.2448146.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE The rapid expansion of robotic surgical equipment necessitates a review of the needs and challenges faced by hospitals introducing robots for the first time to compete with experienced institutions. The aim of this study was to analyze the impact of robotic surgery on our hospital compared to open and laparoscopic surgery, examine internal transformations, and assess regional, domestic, and international implications. METHODS A retrospective review was conducted of electronic medical records (EMRs) from 2019 to 2022 at Inha University Hospital, including patients who underwent common robotic procedures and equivalent open and laparoscopic operations. The study investigated clinical and operational performance changes in the hospital after the introduction of robotic technology. It also evaluated the operational effectiveness of robot implementation in local, national, and international contexts. To facilitate comparison with other hospitals, the data were transmitted to Intuitive Surgical, Inc. for analysis. The study was conducted in compliance with domestic personal information regulations and received approval from our Institutional Review Board. RESULTS We analyzed EMR data from 3,147 patients who underwent surgical treatment. Over a period of 3.5 years, the adoption of robotic technology in a hospital setting significantly enhanced the technical skills of all professors involved. The introduction of robotic systems led to increased patient utilization of conventional surgical techniques, as well as a rise in the number of patients choosing robotic surgery. This collective trend contributed to an overall increase in patient numbers. This favorable evaluation of the operational effectiveness of our hospital's robot implementation in the context of local, national, and global factors is expected to positively influence policy changes. CONCLUSION Stakeholders should embrace data science and evidence-based techniques to generate valuable insights from objective data, assess the health of robot-assisted surgery programs, and identify opportunities for improvement and excellence.
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Affiliation(s)
- Sung Pil Choo
- Department of Obstetrics and Gynecology, Inha University Hospital, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
| | - Mi Sook Jeon
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
| | - Young Mi Kim
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
| | - Sun Keun Choi
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Tack Lee
- Robot Surgery Center, Inha University Hospital, Incheon, Korea
- Department of Urology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Tsumanuma FK, Hembecker PK, Claus CMP, Loureiro MDP, Reinert F, Abreu de Souza M. Effect of laparoscopic handle size on surgical performance: A randomized crossover trial. Med Eng Phys 2024; 127:104165. [PMID: 38692768 DOI: 10.1016/j.medengphy.2024.104165] [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: 10/25/2023] [Revised: 03/02/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.
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Affiliation(s)
- Fernanda Keiko Tsumanuma
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Paula Karina Hembecker
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - Christiano Marlo Paggi Claus
- Department of Surgery, Nossa Senhora das Graças Hospital, Alcides Munhoz St., 433, Curitiba, Paraná, 80810-040, Brazil
| | - Marcelo de Paula Loureiro
- Graduate Program in Industrial Biotechnology, Positivo University, Prof. Pedro Viriato Parigot de Souza St., 5.300, Curitiba, Paraná, 80740-050, Brazil
| | - Fabíola Reinert
- Department of Design and Graphic Expression, Federal University of Santa Catarina (UFSC), Campus Universitário Reitor João David Ferreira Lima, s/n, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Mauren Abreu de Souza
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil
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Takahashi Y, Higashiguchi T, Wakayama T. Calibration for endoscopic 3D shape measurement with cone beam projection. APPLIED OPTICS 2024; 63:3058-3068. [PMID: 38856449 DOI: 10.1364/ao.516747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 06/11/2024]
Abstract
We demonstrate a calibration method for endoscopic three-dimensional shape measurement with cone beam projection. In this method, changes in the shape of the optical sectioning profiles are quantified and fitted while scanning a calibration board in the depth direction, using a cubic function. In accuracy tests using a flat plate and a ring reference gauge, the proposed method obtains an accuracy of 0.02 mm in the depth dimension and 0.09 mm in the radial dimension. These results represent 88% and 55% improvements compared to previous analysis. For medical applications, an ear examination simulator was employed, and our measurement results were compared to ground truth data obtained by microfocus X-ray computed tomography. The surface deviation of our method relative to the ground truth data was ±0.36m m during manual operation. A comparison of the measurement results before and after calibration revealed an improvement in the peak agreement with the ground truth data, with the deviation shifting from 0.2 mm to -0.05m m. Our strategy achieves a digital transformation of 3D endoscopy, which would benefit a number of medical fields.
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Kwon S, Adin V, Park C, Chun H, Kim K, Kim C. Camera sheath with transformable head for minimally invasive surgical instruments. MINIM INVASIV THER 2024:1-9. [PMID: 38602475 DOI: 10.1080/13645706.2024.2335540] [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: 04/17/2023] [Accepted: 02/25/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip. MATERIAL AND METHODS The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera's line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath. RESULTS The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype. CONCLUSIONS The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons.
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Affiliation(s)
- Seongil Kwon
- Center for Augmented Safety System with Intelligence Sensing and Tracking (ASSIST), Korea Institute of Science and Technology, Seoul, Korea
| | - Veysi Adin
- Department of Electronics Design, Mid Sweden University, Sundsvall, Sweden
| | - Chulmin Park
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | | | - Keri Kim
- Center for Augmented Safety System with Intelligence Sensing and Tracking (ASSIST), Korea Institute of Science and Technology, Seoul, Korea
- Division of Bio-Medical Science and Technology, University of Science and Technology, Daejeon, Korea
| | - Chunwoo Kim
- Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, Korea
- Division of AI-Robot, University of Science and Technology, Daejeon, Korea
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Altwaijri A. Minimally Invasive Approaches in Orthognathic Surgery: A Narrative Review of Contemporary Techniques and their Clinical Outcomes. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1652-S1656. [PMID: 38882864 PMCID: PMC11174174 DOI: 10.4103/jpbs.jpbs_1226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 06/18/2024] Open
Abstract
Maxillofacial surgery has evolved significantly, particularly in orthognathic procedures, shifting from invasive methods to minimally invasive techniques (MITs). Innovations, like 3D imaging, computer-aided simulations, piezoelectric surgery, and endoscopic assistance, have revolutionized patient care. These methods notably reduce bleeding, scarring, hospital stays, and recovery time, while enhancing surgical precision and outcomes. Our review focuses on modern MITs, including endoscopically assisted maxillomandibular advancement (EAMMA) and CAD/CAM technology. We conducted a thorough literature search, identifying 21 relevant articles from an initial pool of 423. The review evaluates the efficacy, complication rates, and long-term stability of these techniques, addressing challenges and future prospects. Emphasizing the significance of MI methods in orthognathic surgery, it advocates for further research and clinical adoption.
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Affiliation(s)
- Abdulrahman Altwaijri
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Qassim, Saudi Arabia
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Yoon D, Yoo M, Kim BS, Kim YG, Lee JH, Lee E, Min GH, Hwang DY, Baek C, Cho M, Suh YS, Kim S. Automated deep learning model for estimating intraoperative blood loss using gauze images. Sci Rep 2024; 14:2597. [PMID: 38297011 PMCID: PMC10830489 DOI: 10.1038/s41598-024-52524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
The intraoperative estimated blood loss (EBL), an essential parameter for perioperative management, has been evaluated by manually weighing blood in gauze and suction bottles, a process both time-consuming and labor-intensive. As the novel EBL prediction platform, we developed an automated deep learning EBL prediction model, utilizing the patch-wise crumpled state (P-W CS) of gauze images with texture analysis. The proposed algorithm was developed using animal data obtained from a porcine experiment and validated on human intraoperative data prospectively collected from 102 laparoscopic gastric cancer surgeries. The EBL prediction model involves gauze area detection and subsequent EBL regression based on the detected areas, with each stage optimized through comparative model performance evaluations. The selected gauze detection model demonstrated a sensitivity of 96.5% and a specificity of 98.0%. Based on this detection model, the performance of EBL regression stage models was compared. Comparative evaluations revealed that our P-W CS-based model outperforms others, including one reliant on convolutional neural networks and another analyzing the gauze's overall crumpled state. The P-W CS-based model achieved a mean absolute error (MAE) of 0.25 g and a mean absolute percentage error (MAPE) of 7.26% in EBL regression. Additionally, per-patient assessment yielded an MAE of 0.58 g, indicating errors < 1 g/patient. In conclusion, our algorithm provides an objective standard and streamlined approach for EBL estimation during surgery without the need for perioperative approximation and additional tasks by humans. The robust performance of the model across varied surgical conditions emphasizes its clinical potential for real-world application.
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Affiliation(s)
- Dan Yoon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Byeong Soo Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Young Gyun Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Jong Hyeon Lee
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, 14353, Korea
| | - Guan Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Du-Yeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Changhoon Baek
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, 03080, Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, 03080, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, 03080, Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, Korea.
- Institute of Bioengineering, Seoul National University, Seoul, 08826, Korea.
- Artificial Intelligence Institute, Seoul National University, Seoul, 08826, Korea.
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Manoli E, Higginson J, Tolley N, Darzi A, Kinross J, Temelkuran B, Takats Z. Human robotic surgery with intraoperative tissue identification using rapid evaporation ionisation mass spectrometry. Sci Rep 2024; 14:1027. [PMID: 38200062 PMCID: PMC10781715 DOI: 10.1038/s41598-023-50942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Instantaneous, continuous, and reliable information on the molecular biology of surgical target tissue could significantly contribute to the precision, safety, and speed of the intervention. In this work, we introduced a methodology for chemical tissue identification in robotic surgery using rapid evaporative ionisation mass spectrometry. We developed a surgical aerosol evacuation system that is compatible with a robotic platform enabling consistent intraoperative sample collection and assessed the feasibility of this platform during head and neck surgical cases, using two different surgical energy devices. Our data showed specific, characteristic lipid profiles associated with the tissue type including various ceramides, glycerophospholipids, and glycerolipids, as well as different ion formation mechanisms based on the energy device used. This platform allows continuous and accurate intraoperative mass spectrometry-based identification of ablated/resected tissue and in combination with robotic registration of images, time, and anatomical positions can improve the current robot-assisted surgical platforms and guide surgical strategy.
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Affiliation(s)
- Eftychios Manoli
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Higginson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Neil Tolley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Burak Temelkuran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), Univ. Lille, INSERM U1192, Lille, France.
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Zhao X, Guo J, He Z, Jiang X, Lou H, Li D. CLAD-Net: cross-layer aggregation attention network for real-time endoscopic instrument detection. Health Inf Sci Syst 2023; 11:58. [PMID: 38028959 PMCID: PMC10678866 DOI: 10.1007/s13755-023-00260-9] [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: 09/18/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
As medical treatments continue to advance rapidly, minimally invasive surgery (MIS) has found extensive applications across various clinical procedures. Accurate identification of medical instruments plays a vital role in comprehending surgical situations and facilitating endoscopic image-guided surgical procedures. However, the endoscopic instrument detection poses a great challenge owing to the narrow operating space, with various interfering factors (e.g. smoke, blood, body fluids) and inevitable issues (e.g. mirror reflection, visual obstruction, illumination variation) in the surgery. To promote surgical efficiency and safety in MIS, this paper proposes a cross-layer aggregated attention detection network (CLAD-Net) for accurate and real-time detection of endoscopic instruments in complex surgical scenarios. We propose a cross-layer aggregation attention module to enhance the fusion of features and raise the effectiveness of lateral propagation of feature information. We propose a composite attention mechanism (CAM) to extract contextual information at different scales and model the importance of each channel in the feature map, mitigate the information loss due to feature fusion, and effectively solve the problem of inconsistent target size and low contrast in complex contexts. Moreover, the proposed feature refinement module (RM) enhances the network's ability to extract target edge and detail information by adaptively adjusting the feature weights to fuse different layers of features. The performance of CLAD-Net was evaluated using a public laparoscopic dataset Cholec80 and another set of neuroendoscopic dataset from Sun Yat-sen University Cancer Center. From both datasets and comparisons, CLAD-Net achieves the A P 0.5 of 98.9% and 98.6%, respectively, that is better than advanced detection networks. A video for the real-time detection is presented in the following link: https://github.com/A0268/video-demo.
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Affiliation(s)
- Xiushun Zhao
- School of Automation, Guangdong University of Technology, Guangzhou, 510006 China
| | - Jing Guo
- School of Automation, Guangdong University of Technology, Guangzhou, 510006 China
| | - Zhaoshui He
- School of Automation, Guangdong University of Technology, Guangzhou, 510006 China
| | - Xiaobing Jiang
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510006 China
| | - Haifang Lou
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006 China
| | - Depei Li
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510006 China
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11
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Bapna T, Valles J, Leng S, Pacilli M, Nataraja RM. Eye-tracking in surgery: a systematic review. ANZ J Surg 2023; 93:2600-2608. [PMID: 37668263 DOI: 10.1111/ans.18686] [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: 04/11/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Surgery is constantly evolving with the assistance of rapidly developing novel technology. Eye-tracking devices provide opportunities to monitor the acquisition of surgical skills, gain insight into performance, and enhance surgical practice. The aim of this review was to consolidate the available evidence for the use of eye-tracking in the surgical disciplines. METHODS A systematic literature review was conducted in accordance with PRISMA guidelines. A search of OVID Medline, EMBASE, Cochrane library, Scopus, and Science Direct was conducted January 2000 until December 2022. Studies involving eye-tracking in surgical training, assessment and technical innovation were included in the review. Non-surgical procedures, animal studies, and studies not involving surgical participants were excluded from the review. RESULTS The search returned a total of 12 054 articles, 80 of which were included in the final analysis and review. Seventeen studies involved eye-tracking in surgical training, 48 surgical assessment, and 20 were focussing on technical aspects of this technology. Twenty-six different eye-tracking devices were used in the included studies. Metrics such as the number of fixations, duration of fixations, dwell time, and cognitive workload were able to differentiate between novice and expert performance. Eight studies demonstrated the effectiveness of gaze-training for improving surgical skill. CONCLUSION The current literature shows a broad range of utility for a variety of eye-tracking devices in surgery. There remains a lack of standardization for metric parameters and gaze analysis techniques. Further research is required to validate its use to establish reliability and create uniform practices.
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Affiliation(s)
- Tanay Bapna
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - John Valles
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Samantha Leng
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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12
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Thakur VS, Kankar PK, Parey A, Jain A, Jain PK. Health prediction of reciprocating endodontic instrument based on the machine learning and exponential degradation models. Proc Inst Mech Eng H 2023; 237:1202-1214. [PMID: 37668014 DOI: 10.1177/09544119231196285] [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] [Indexed: 09/06/2023]
Abstract
This study proposes an intelligent health prediction and fault prognosis of the endodontic file during the root canal treatment. Root canal treatment is the procedure of disinfecting the infected pulp through the canal with the help of an endodontic instrument. Force signals are acquired with the help of a dynamometer during the canal preparation, and statistical features are extracted. The extracted features are selected through the window-wise feature extraction process. Characteristic features for endodontic file prognostics include time-domain features of the signals are evaluated. The extracted feature has inappropriate information, that is, noise between the signals; hence the smoothing of the feature is required at this stage to observe a trend in the signals. Based on the smoothing feature and post-processing of the feature, defined the health index to calculate the health condition of the endodontic instruments. A machine learning algorithm and exponential degradation model are used to predict the health of the endodontic instrument during the root canal treatment. This model is used to forecast the degradation of the endodontic file so that actions can be taken before actual failures happen. The proposed methodology can analyze the failures and micro-crack initiation of the endodontic instruments. Endodontics practitioners can use the machine learning models as well as an exponential model for estimating the health condition of the endodontic instrument. This study may help the clinician to progress the efficiency of the root canal treatment and the competence of the endodontic instruments.
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Affiliation(s)
- Vinod Singh Thakur
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Pavan Kumar Kankar
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Anand Parey
- Solid Mechanics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Arpit Jain
- Department of Oral Medicine and Radiology, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India
| | - Prashant Kumar Jain
- PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur, Madhya Pradesh, India
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13
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Hashemi N, Svendsen MBS, Bjerrum F, Rasmussen S, Tolsgaard MG, Friis ML. Acquisition and usage of robotic surgical data for machine learning analysis. Surg Endosc 2023:10.1007/s00464-023-10214-7. [PMID: 37389741 PMCID: PMC10338401 DOI: 10.1007/s00464-023-10214-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The increasing use of robot-assisted surgery (RAS) has led to the need for new methods of assessing whether new surgeons are qualified to perform RAS, without the resource-demanding process of having expert surgeons do the assessment. Computer-based automation and artificial intelligence (AI) are seen as promising alternatives to expert-based surgical assessment. However, no standard protocols or methods for preparing data and implementing AI are available for clinicians. This may be among the reasons for the impediment to the use of AI in the clinical setting. METHOD We tested our method on porcine models with both the da Vinci Si and the da Vinci Xi. We sought to capture raw video data from the surgical robots and 3D movement data from the surgeons and prepared the data for the use in AI by a structured guide to acquire and prepare video data using the following steps: 'Capturing image data from the surgical robot', 'Extracting event data', 'Capturing movement data of the surgeon', 'Annotation of image data'. RESULTS 15 participant (11 novices and 4 experienced) performed 10 different intraabdominal RAS procedures. Using this method we captured 188 videos (94 from the surgical robot, and 94 corresponding movement videos of the surgeons' arms and hands). Event data, movement data, and labels were extracted from the raw material and prepared for use in AI. CONCLUSION With our described methods, we could collect, prepare, and annotate images, events, and motion data from surgical robotic systems in preparation for its use in AI.
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Affiliation(s)
- Nasseh Hashemi
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
- Nordsim-Centre for Skills Training and Simulation, Aalborg, Denmark.
- ROCnord-Robot Centre, Aalborg University Hospital, Aalborg, Denmark.
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark.
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Denmark
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Martin G Tolsgaard
- Nordsim-Centre for Skills Training and Simulation, Aalborg, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Denmark
| | - Mikkel Lønborg Friis
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Nordsim-Centre for Skills Training and Simulation, Aalborg, Denmark
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Fountain C, Ghuman H, Paldino M, Tamber M, Panigrahy A, Modo M. Acquisition and Analysis of Excised Neocortex from Pediatric Patients with Focal Cortical Dysplasia Using Mesoscale Diffusion MRI. Diagnostics (Basel) 2023; 13:1529. [PMID: 37174921 PMCID: PMC10177920 DOI: 10.3390/diagnostics13091529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
Non-invasive classification of focal cortical dysplasia (FCD) subtypes remains challenging from a radiology perspective. Quantitative imaging biomarkers (QIBs) have the potential to distinguish subtypes that lack pathognomonic features and might help in defining the extent of abnormal connectivity associated with each FCD subtype. A key motivation of diagnostic imaging is to improve the localization of a "lesion" that can guide the surgical resection of affected tissue, which is thought to cause seizures. Conversely, surgical resections to eliminate or reduce seizures provided unique opportunities to develop magnetic resonance imaging (MRI)-based QIBs by affording long scan times to evaluate multiple contrast mechanisms at the mesoscale (0.5 mm isotropic voxel dimensions). Using ex vivo hybrid diffusion tensor imaging on a 9.4 T MRI scanner, the grey to white matter ratio of scalar indices was lower in the resected middle temporal gyrus (MTG) of two neuropathologically confirmed cases of FCD compared to non-diseased control postmortem fixed temporal lobes. In contrast, fractional anisotropy was increased within FCD and also adjacent white matter tracts. Connectivity (streamlines/mm3) in the MTG was higher in FCD, suggesting that an altered connectivity at the lesion locus can potentially provide a tangible QIB to distinguish and characterize FCD abnormalities. However, as illustrated here, a major challenge for a robust tractographical comparison lies in the considerable differences in the ex vivo processing of bioptic and postmortem samples. Mesoscale diffusion MRI has the potential to better define and characterize epileptic tissues obtained from surgical resection to advance our understanding of disease etiology and treatment.
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Affiliation(s)
- Chandler Fountain
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, Chartlottesville, VA 22903, USA
| | - Harmanvir Ghuman
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O’Hara Street, Pititsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
| | - Michael Paldino
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Mandeep Tamber
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite B 400, Pittsburgh, PA 15213, USA
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Michel Modo
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O’Hara Street, Pititsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Centre for the Neural Basis of Behavior, University of Pittsburgh and Carnegie Mellon University, 4074 Biomedical Science Tower 3, Pittsburgh, PA 15261, USA
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15
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Gong S, Rao X, Yuan Y, Yao X, Li G, Wang N, Li D, Jiang L. Clinical-pathological features and perioperative outcomes of mediastinoscopy vs. thoracoscopy esophagectomy in esophageal cancer: A meta-analysis. Front Surg 2023; 10:1039615. [PMID: 36865627 PMCID: PMC9971490 DOI: 10.3389/fsurg.2023.1039615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To compare the clinicopathological features and perioperative outcomes of video-assisted mediastinoscopy esophagectomy (VAME) compared to video-assisted thoracoscopy esophagectomy (VATE) in esophageal cancer. Methods We comprehensively searched online databases (PubMed, Embase, Web of Science and Wiley online library) to find available studies exploring the clinicopathological features and perioperative outcomes between VAME and VATE in esophageal cancer. Relative risk (RR) with 95% confidence interval (CI) and standardized mean difference (SMD) with 95% CI were used to evaluate the perioperative outcomes and clinicopathological features. Results A total of seven observational studies and one randomized controlled trial involving 733 patients were considered eligible for this meta-analysis, of which 350 patients underwent VAME in contrast to 383 patients underwent VATE. Patients in the VAME group had more pulmonary comorbidities (RR = 2.18, 95% CI 1.37-3.46, P = 0.001). The pooled results showed that VAME shortened the operation time (SMD = -1.53, 95% CI -2.308--0.76, P = 0.000), and retrieved less total lymph nodes (SMD = -0.70, 95% CI -0.90--0.50, P = 0.000). No differences were observed in other clinicopathological features, postoperative complications or mortality. Conclusions This meta-analysis revealed that patients in the VAME group had more pulmonary disease before surgery. The VAME approach significantly shortened the operation time and retrieved less total lymph nodes and did not increase intra- or postoperative complications.
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Affiliation(s)
- Sheng Gong
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Xin Rao
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Ye Yuan
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Xiaojun Yao
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Gang Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Ning Wang
- Department of Public Health, Chengdu Medicine College, Chengdu, China
| | - Dan Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Liangshuang Jiang
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China,Correspondence: Liangshuang Jiang
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Jørgensen RJ, Olsen RG, Svendsen MBS, Stadeager M, Konge L, Bjerrum F. Comparing Simulator Metrics and Rater Assessment of Laparoscopic Suturing Skills. JOURNAL OF SURGICAL EDUCATION 2023; 80:302-310. [PMID: 37683093 DOI: 10.1016/j.jsurg.2022.09.020] [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: 04/21/2022] [Revised: 08/17/2022] [Accepted: 09/25/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND Laparoscopic intracorporeal suturing is important to master and competence should be ensured using an optimal method in a simulated environment before proceeding to real operations. The objectives of this study were to gather validity evidence for two tools for assessing laparoscopic intracorporeal knot tying and compare the rater-based assessment of laparoscopic intracorporeal suturing with the assessment based on simulator metrics. METHODS Twenty-eight novices and 19 experienced surgeons performed four laparoscopic sutures on a Simball Box simulator twice. Two surgeons used the Intracorporeal Suturing Assessment Tool (ISAT) for blinded video rating. RESULTS Composite Simulator Score (CSS) had higher test-retest reliability than the ISAT. The correlation between the number performed procedures including suturing and ISAT score was 0.51, p<0.001, and 0.59 p<0.001 for CSS. We found an inter-rater reliability (0.72, p<0.001 for test 1 and 0.53 p<0.001 for test 2). The pass/fail rates for ISAT and CSS were similar. CONCLUSION CSS and ISAT provide similar results for assessing laparoscopic suturing but assess different aspects of performance. Using simulator metrics and raters' assessments in combination should be considered for a more comprehensive evaluation of laparoscopic knot-tying competency.
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Affiliation(s)
- Rikke Jeong Jørgensen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark.
| | - Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark; Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region, Copenhagen, Denmark; Department of Surgery, Herlev-Gentofte Hospital, Herlev, Denmark
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Measuring interaction forces in surgical telemanipulation using conventional instruments. ROBOTICA 2022. [DOI: 10.1017/s0263574722001758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Minimally invasive surgery (MIS) has been an essential tool in the surgical sector for many years due to its crucial advantages compared to open surgery. To overcome remaining limitations, teleoperated MIS experienced a strong emergence. However, the widespread usage of such systems is hindered by the enormous financial hurdle. The use of standard components and conventional tools for teleoperated MIS can facilitate integration into existing hospital workflows and can be a cost-efficient and versatile approach for research purposes. To compensate for the lack of haptic feedback, some teleoperation setups inherit a sensor system allowing them to record interaction forces and display them at the user interface. In research and in commercially available systems, different positions for the sensor can be found. In this paper, mechanical interfaces for the guidance and actuation of non-wristed and wristed standard instruments are presented. Furthermore, a method for the extracorporeal measurement of interaction forces is presented, characterized, and discussed. The overall mean relative error of the magnitude of the interaction force is 9.4%, while the overall mean absolute error of the force vector is 14.4
$^{\circ }$
, both below the respective human differential perception threshold. The presented measurement method is a simple, yet sufficiently accurate approach to measure interaction forces in surgical telemanipulation.
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18
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Karimi S, Konh B. Kinematics modelling and dynamics analysis of an SMA-actuated active flexible needle for feedback-controlled manipulation in phantom. Med Eng Phys 2022; 107:103846. [PMID: 36068028 PMCID: PMC9851425 DOI: 10.1016/j.medengphy.2022.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 01/21/2023]
Abstract
Percutaneous needle-based procedures such as prostate brachytherapy demands for accurate placement of the needle tip at target locations. Recently, robotic needle insertion systems have been made available to help physicians in needle guidance and control inside tissue. It is often challenging to obtain an accurate and real-time position of the needle tip in clinical practice using medical imaging techniques. However, this information is vital for closed-loop control of the needles inside tissue. This work presents an SMA-actuated active flexible needle that is controlled inside a phantom without a need for a position sensor or a medical imaging device. The needle tip position feedback is found using shape sensing capabilities of the embedded SMA-wire actuators and a force sensor at the needle base. Three models were characterized and used to estimate needle tip position in real time. The control scheme was then tested on the active flexible needle to track a desired triangular trajectory in a phantom. It was shown that the control scheme presented in this work was able to manipulate the needle in this path with a reasonable accuracy.
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Affiliation(s)
- Saeed Karimi
- Department of Mechanical Engineering, University of Hawaii at Manoa, United States
| | - Bardia Konh
- Department of Mechanical Engineering, University of Hawaii at Manoa, United States.
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19
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Kendel NE, Belsky JA, Stanek JR, Streby KA, Shah N. Caregiver Perspectives on Patient Participation in Biological Pediatric Cancer Research. CHILDREN 2022; 9:children9060901. [PMID: 35740838 PMCID: PMC9221797 DOI: 10.3390/children9060901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/18/2022]
Abstract
Adolescent cancer patients and their caregivers have demonstrated willingness to participate in invasive biological sampling, either for their own potential benefit or for research purposes. However, many malignancies occur primarily in prepubescent patients and there are no similar studies in this population. Our study objective was to assess the willingness of caregivers to consent to research studies involving invasive biological sampling in children ≤ 13 years of age. Participants completed a survey assessing their willingness to allow various procedures both with and without clinical benefit to their children. Most respondents were willing to allow additional blood draws regardless of potential benefit to their children (95.6% were willing when there would be benefits and 95.6% were willing when there would not). Although the overall willingness was lower with other hypothetical procedures, the majority of respondents were still willing to allow additional biopsies for research purposes. Caregivers of young children with cancer will allow their children to undergo additional invasive procedures for research purposes. This willingness decreased with more invasive procedures without potential direct benefit, but interest remained in more than half of participants. Caregivers for young patients with cancer should be approached for participation in future biological/correlative studies.
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Affiliation(s)
- Nicole E. Kendel
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA; (N.E.K.); (J.A.B.); (J.R.S.); (K.A.S.)
| | - Jennifer A. Belsky
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA; (N.E.K.); (J.A.B.); (J.R.S.); (K.A.S.)
- Riley Hospital for Children, Indiana University, Indianapolis, IN 46202, USA
| | - Joseph R. Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA; (N.E.K.); (J.A.B.); (J.R.S.); (K.A.S.)
- Biostatistics Resource at Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Keri A. Streby
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA; (N.E.K.); (J.A.B.); (J.R.S.); (K.A.S.)
| | - Nilay Shah
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA; (N.E.K.); (J.A.B.); (J.R.S.); (K.A.S.)
- Correspondence: ; Tel.: +1-614-722-2876
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20
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Allgaier M, Chheang V, Saalfeld P, Apilla V, Huber T, Huettl F, Neyazi B, Sandalcioglu IE, Hansen C, Preim B, Saalfeld S. A comparison of input devices for precise interaction tasks in VR-based surgical planning and training. Comput Biol Med 2022; 145:105429. [DOI: 10.1016/j.compbiomed.2022.105429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/06/2022] [Accepted: 03/19/2022] [Indexed: 01/22/2023]
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21
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Emerging Trends and Knowledge Structures of Smart Urban Governance. SUSTAINABILITY 2022. [DOI: 10.3390/su14095275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The concept of smart cities peaked in 2015, bringing an increased influx of ‘smart’ devices in the form of the Internet of Things (IoT) and sensors in cities. As a result, interest in smart urban governance has become more prevalent in administrative, organisational, and political circles. This is sustained by both local and global demands for an increased contribution to the goals of sustainability through urban governance processes in response to climate change urgencies. Cities generate up to 70% of global emissions, and in light of societal pressures for more inclusivity and democratic processes, the need for sound urban governance is merited. Further knowledge on the theme of smart urban governance is required to better understand the trends and knowledge structures and better assist policy design. Therefore, this study was undertaken to understand and map the evolution of the concept of smart urban governance through a bibliometric analysis and science mapping techniques using VOSviewer. In total, 1897 articles were retrieved from the Web of Science database over 5 decades, from 1968 to 2021, and divided into three subperiods, namely 1978 to 2015, 2016 to 2019, and 2020 to early 2022. Results indicate that the overall emerging themes across the three periods highlight the need for citizen participation in urban policies, especially in relation to smart cities, and for sustained innovation for e-participation, e-governance, and policy frameworks. The results of this study can aid both researchers exploring the concept of urban governance and policy makers rendering more inclusive urban policies, especially those hosting technological and digital domains.
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22
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Han J, Davids J, Ashrafian H, Darzi A, Elson DS, Sodergren M. A systematic review of robotic surgery: From supervised paradigms to fully autonomous robotic approaches. Int J Med Robot 2022; 18:e2358. [PMID: 34953033 DOI: 10.1002/rcs.2358] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND From traditional open surgery to laparoscopic surgery and robot-assisted surgery, advances in robotics, machine learning, and imaging are pushing the surgical approach to-wards better clinical outcomes. Pre-clinical and clinical evidence suggests that automation may standardise techniques, increase efficiency, and reduce clinical complications. METHODS A PRISMA-guided search was conducted across PubMed and OVID. RESULTS Of the 89 screened articles, 51 met the inclusion criteria, with 10 included in the final review. Automatic data segmentation, trajectory planning, intra-operative registration, trajectory drilling, and soft tissue robotic surgery were discussed. CONCLUSION Although automated surgical systems remain conceptual, several research groups have developed supervised autonomous robotic surgical systems with increasing consideration for ethico-legal issues for automation. Automation paves the way for precision surgery and improved safety and opens new possibilities for deploying more robust artificial intelligence models, better imaging modalities and robotics to improve clinical outcomes.
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Affiliation(s)
- Jinpei Han
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
| | - Joseph Davids
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Hutan Ashrafian
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
| | - Ara Darzi
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
| | - Daniel S Elson
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
| | - Mikael Sodergren
- Hamlyn Centre for Robotic Surgery and Artificial Intelligence, Imperial College London, London, UK
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Wang C, Puranam VR, Misra S, Venkiteswaran VK. A Snake-Inspired Multi-Segmented Magnetic Soft Robot Towards Medical Applications. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3160753] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Chen Wang
- Surgical Robotics Laboratory, Department of Biomedical Engineering, University of Groningen and University Medical Centre Groningen, Groningen, GZ, The Netherlands
| | - Venkata Rithwick Puranam
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, AE, The Netherlands
| | - Sarthak Misra
- Surgical Robotics Laboratory, Department of Biomedical Engineering, University of Groningen and University Medical Centre Groningen, Groningen, GZ, The Netherlands
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Ma L, Tomii N, Wang J, Kiyomatsu H, Tsukihara H, Kobayashi E, Sakuma I. Robust and fast laparoscopic vision-based ultrasound probe tracking using a binary dot array marker. Comput Biol Med 2022; 145:105406. [PMID: 35339847 DOI: 10.1016/j.compbiomed.2022.105406] [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: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
Laparoscopic vision-based ultrasound probe tracking systems have gained considerable attention in ultrasound-guided laparoscopic surgeries as replacements for external tracking systems (e.g. optical tracking and electromagnetic tracking systems), which increase cost and setting time, require additional operation space, and introduce new limitations. Most existing laparoscopic ultrasound (LUS) probe tracking systems rely on fiducial markers, which cannot easily realise fast and robust vision-based tracking in laparoscopic surgery owing to their design limitations. Therefore, we propose a novel binary dot array marker to realise a robust and fast LUS probe tracking system. The binary dot array marker comprises two dots (green and blue), which form multiple unique identification dot subarrays in the binary dot array. The binary dot array marker can be tracked when one of the identification dot subarrays is detected and identified; this novel design makes the binary dot array marker-based probe tracking system robust against occlusions during surgery. The evaluation results indicate that the proposed binary dot marker performs better in terms of robustness, computational efficiency, and tracking accuracy compared to the state-of-the-art fiducial markers used for vision-based probe tracking.
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Affiliation(s)
- Lei Ma
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Naoki Tomii
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Junchen Wang
- School of Mechanical Engineering, Beihang University, Beijing, China
| | | | | | - Etsuko Kobayashi
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.
| | - Ichiro Sakuma
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
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25
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Thakur VS, Kankar PK, Parey A, Jain A, Kumar Jain P. Numerical analysis of WaveOne Gold and 2Shape endodontic files during root canal treatment. Proc Inst Mech Eng H 2022; 236:329-340. [DOI: 10.1177/09544119211068950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to develop and analyse a finite element model of the endodontic nickel-titanium (NiTi) instrument during the root canal treatment (RCT). The 3D model of the tooth and the endodontic instrument has been created using computer-aided design software. The nonlinear explicit dynamic analysis in the CAE package (ANSYS) has been used to analyse the mechanical behaviour of endodontic instruments such as total deformation, equivalent elastic strain, and equivalent stress during canal preparation. The mechanical behaviour of three commercially available endodontic NiTi alloy instruments such as WaveOne Gold (WOG), 2Shape 1 (TS1) and 2Shape 2 (TS2) endodontic files was evaluated using FEA. Consequently, the effect of deformation, equivalent stress and equivalent elastic strain on endodontic files during cleaning and shaping are investigated and compared. The results show that the total deformation and equivalent elastic strain are maximum in the TS1 endodontic file in comparison to TS2 and WOG files.
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Affiliation(s)
- Vinod Singh Thakur
- Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Pavan Kumar Kankar
- Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Anand Parey
- Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Arpit Jain
- Department of Oral Medicine and Radiology, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India
| | - Prashant Kumar Jain
- PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur, Madhya Pradesh, India
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26
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Rho J, Quan YH, Choi BH, Han KN, Kim BM, Choi YH, Kim HK. Near-infrared fluorescent imaging with indocyanine green in rabbit and patient specimens of esophageal cancer. J Thorac Dis 2022; 13:6314-6322. [PMID: 34992811 PMCID: PMC8662470 DOI: 10.21037/jtd-21-790] [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: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
Background We aimed to assess the possibility of detecting esophageal cancer after intravenous injection of indocyanine green (ICG) in preclinical and clinical models. Methods Forty-five rabbits were surgically implanted with VX2 tumors into the esophageal muscular layer 2 weeks before esophagectomy. The rabbits received intravenous injection of ICG at doses of 1, 2, or 5 mg/kg at 3, 6, 12, 24, or 48 h before surgical removal of esophagus. Twelve patients scheduled to undergo esophagectomy were also enrolled, and all received 2 mg/kg of ICG intravenously at 3, 6, 12, or 24 h before surgical removal of esophagus. The fluorescence intensity was measured in all resected specimens from the rabbits and patients using a near-infrared (NIR) fluorescence imaging system after surgery. Results Esophageal tumors were successfully established in all rabbits, and fluorescent signals were detected in all animal and patient specimens. Tumor-to-normal ratio (TNR) analysis showed that higher doses resulted in a greater TNR. Injection of at least 2 mg/kg of ICG was required for clear visualization of the tumor, and the TNR was highest at 12 h after injection. The TNR in patients was also highest at 12 h (P=0.0004), with 2 mg/kg of ICG. None of the patients had major complications following ICG injection. Conclusions NIR fluorescence imaging can be used to visualize esophageal cancer after systemic injection of ICG. ICG at 2 mg/kg at 12 h is optimal for tumor detection. However, since the clinical trials were conducted in a small number of patients, further studies are needed in larger populations.
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Affiliation(s)
- Jiyun Rho
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Yu Hua Quan
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Byeong Hyeon Choi
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Beop-Min Kim
- Department of Interdisciplinary Bio/Micro Technology, College of Engineering, Korea University, Seoul, South Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
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27
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Ficuciello F, Villani A, Lisini Baldi T, Prattichizzo D. A Human Gesture Mapping Method to Control a Multi-Functional Hand for Robot-Assisted Laparoscopic Surgery: The MUSHA Case. Front Robot AI 2022; 8:741807. [PMID: 34993237 PMCID: PMC8725602 DOI: 10.3389/frobt.2021.741807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
This work presents a novel technique to control multi-functional hand for robot-assisted laparoscopic surgery. We tested the technique using the MUSHA multi-functional hand, a robot-aided minimally invasive surgery tool with more degrees of freedom than the standard commercial end-effector of the da Vinci robot. Extra degrees of freedom require the development of a proper control strategy to guarantee high performance and avoid an increasing complexity of control consoles. However, developing reliable control algorithms while reducing the control side’s mechanical complexity is still an open challenge. In the proposed solution, we present a control strategy that projects the human hand motions into the robot actuation space. The human hand motions are tracked by a LeapMotion camera and mapped into the actuation space of the virtualized end-effector. The effectiveness of the proposed method was evaluated in a twofold manner. Firstly, we verified the Lyapunov stability of the algorithm, then an user study with 10 subjects assessed the intuitiveness and usability of the system.
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Affiliation(s)
- Fanny Ficuciello
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Napoli, Italy
| | - Alberto Villani
- Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
| | - Tommaso Lisini Baldi
- Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
| | - Domenico Prattichizzo
- Department of Information Engineering and Mathematics, University of Siena, Siena, Italy.,Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
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28
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Bash LD, Black W, Turzhitsky V, Urman RD. Neuromuscular Blockade and Reversal Practice Variability in the Outpatient Setting: Insights From US Utilization Patterns. Anesth Analg 2021; 133:1437-1450. [PMID: 34784330 DOI: 10.1213/ane.0000000000005657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neuromuscular blockade (NMB) is a critical part of many surgical procedures. Data on practice patterns of NMB agents (NMBAs) and NMB reversal in recent years in the US ambulatory surgical care setting are limited. METHODS This retrospective analysis of US adult outpatients was conducted using the Premier Healthcare Database. We describe anesthesia practice trends in NMB management and assess the association of patient, procedural, and site characteristics with NMB reversal approach using multivariable logistic regression. RESULTS Approximately 5.2 million outpatient surgical encounters involving NMB and 4.6 million involving rocuronium or vecuronium between January 2014 and June 2019 were included. Following the introduction of sugammadex to US clinical practice (~2016), there was an increased use of rocuronium or vecuronium and a decrease in succinylcholine alone. Before 2016, NMB was pharmacologically reversed with neostigmine in approximately two-thirds of outpatient encounters. Over time, active reversal increased; by 2019, 42.3% and 36.0% of encounters were reversed by neostigmine and sugammadex, respectively, with 21.7% undergoing spontaneous recovery. Choice of NMBA (rocuronium or vecuronium alone), time since 2016, obesity, peripheral vascular disease, and procedures on the digestive, ocular, and female genital systems (vs musculoskeletal procedures) were independently and positively associated with pharmacologic reversal (versus spontaneous reversal). Conversely, advanced age; Western geography; and cardiovascular, endocrine, hemic/lymphatic, respiratory, and ear, nose, and throat procedures were independently and negatively associated with pharmacologic reversal of NMB.Among pharmacologic reversals, time since 2016 was positively and independently associated with sugammadex compared with neostigmine (odds ratios [ORs], ranged from 1.8 in 2017 to 3.2, P < .0001 in 2019). Those administered rocuronium or vecuronium without succinylcholine, with increased age and history of certain comorbidities, and those undergoing ocular or respiratory procedures (compared with musculoskeletal) were positively associated with reversal with sugammadex and endocrine procedure negatively and independently associated with reversal with sugammadex. There was variability in the association of several factors with NMB reversal choices by geographic region, particularly in patients' race, ethnicity, and size of affiliated hospital. CONCLUSIONS Overall, active pharmacological reversal of NMB increased in US adult outpatients following the introduction of sugammadex, although there remains significant practice variability. The multifactorial relationship between patient-, procedural-, and environmental-level characteristics and NMB management is rapidly evolving. Additional research on how these anesthesia practice patterns may be impacted by the shift to the ambulatory care setting and how they may impact patient outcomes and health disparities is warranted.
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Affiliation(s)
- Lori D Bash
- From the Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, New Jersey
| | - Wynona Black
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Boston, Massachusetts
| | - Vladimir Turzhitsky
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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29
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Yang Y, Li J, Kong K, Wang S. Design of a dexterous robotic surgical instrument with a novel bending mechanism. Int J Med Robot 2021; 18:e2334. [PMID: 34551453 DOI: 10.1002/rcs.2334] [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: 04/15/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The robot-assisted minimally invasive surgery (RMIS) has developed rapidly in recent years, requiring highly articulated instruments to enable surgeons to perform complicated and precise procedures. METHODS A novel wrist-type surgical instrument was proposed for RMIS. The wrist consists of superelastic-wire-driven snake-like joints and universal joints, which could perform two deflections and one distal rotation. The bending mechanism and the kinematics of universal joints were analysed. The forward and inverse kinematics of the wrist were derived. RESULTS The performances of the instrument were evaluated using a prototype by experiments. The average motion deviation of the wrist's deflection was 0.15 ± 0.08 mm, and the maximum deviation was 0.52 mm. The maximum payload capability was 10 N. The suture task and ex vivo procedure verified the effectiveness of the instrument. CONCLUSIONS The proposed instrument has high dexterity and payload capability, which contributes to improving the quality of the RMIS procedures.
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Affiliation(s)
- Yingkan Yang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Jianmin Li
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Kang Kong
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Shuxin Wang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
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30
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Braun D, Weik D, Elsner S, Hunger S, Werner M, Drossel WG. Position Control and Force Estimation Method for Surgical Forceps Using SMA Actuators and Sensors. MATERIALS 2021; 14:ma14175111. [PMID: 34501197 PMCID: PMC8434184 DOI: 10.3390/ma14175111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgery is increasingly used in many medical operations because of the benefits for the patients. However, for the surgeons, accessing the situs through a small incision or natural orifice comes with a reduction of the degrees of freedom of the instrument. Due to friction of the mechanical coupling, the haptic feedback lacks sensitivity that could lead to damage of the tissue. The approach of this work to overcome these problems is to develop a control concept for position control and force estimation with shape memory alloys (SMA) which could offer haptic feedback in a novel handheld instrument. The concept aims to bridge the gap between manually actuated laparoscopic instruments and surgical robots. Nickel-titanium shape memory alloys are used for actuation because of their high specific energy density. The work includes the manufacturing of a functional model as a proof of concept comprising the development of a suitable forceps mechanism and electronic circuit for position control and gripping force measurement, as well as designing an ergonomic user interface with haptic force feedback.
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Affiliation(s)
- Dennis Braun
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Correspondence:
| | - David Weik
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sophia Elsner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Professorship for Adaptronics and Lightweight Design in Production, Chemnitz University of Technology, Straße der Nationen 62, 09111 Chemnitz, Germany
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31
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Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M. Mitral valve diseases: Pathophysiology and interventions. Prog Cardiovasc Dis 2021; 67:98-104. [PMID: 33812859 DOI: 10.1016/j.pcad.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Bianca Botezatu
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Sahil Kakar
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Moliu Ren
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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32
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Mazer L, Varban O, Montgomery JR, Awad MM, Schulman A. Video is better: why aren't we using it? A mixed-methods study of the barriers to routine procedural video recording and case review. Surg Endosc 2021; 36:1090-1097. [PMID: 33616730 DOI: 10.1007/s00464-021-08375-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Video-based case review for minimally invasive surgery is immensely valuable for education and quality improvement. Video review can improve technical performance, shorten the learning curve, disseminate new procedures, and improve learner satisfaction. Despite these advantages, it is underutilized in many institutions. So far, research has focused on the benefits of video, and there is relatively little information on barriers to routine utilization. METHODS A 36-question survey was developed on video-based case review and distributed to the SAGES email list. The survey included closed and open-ended questions. Numeric responses and Likert scales were compared with t-test; open-ended responses were reviewed qualitatively through rapid thematic analysis to identify themes and sub-themes. RESULTS 642 people responded to the survey for a response rate of 11%. 584 (91%) thought video would improve the quality of educational conferences. 435 qualitative responses on the value of video were analyzed, and benefits included (1) improved understanding, (2) increased objectivity, (3) better teaching, and (4) better audience engagement. Qualitative comments regarding specific barriers to recording and editing case video identified challenges at all stages of the process, from (1) the decision to record a case, (2) starting the recording in the OR, (3) transferring and storing files, and (4) editing the file. Each step had its own specific challenges. CONCLUSION Minimally invasive surgeons want to increase their utilization of video-based case review, but there are multiple practical challenges to overcome. Understanding these barriers is essential in order to increase use of video for education and quality improvement.
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Affiliation(s)
- Laura Mazer
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Oliver Varban
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - John R Montgomery
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Michael M Awad
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, USA
| | - Allison Schulman
- Department of Gastroenterology, Division of Interventional Gastroenterology, University of Michigan, Ann Arbor, USA
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33
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Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. Cir Esp 2020; 99:222-228. [PMID: 33198944 DOI: 10.1016/j.ciresp.2020.10.005] [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: 06/23/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.
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34
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Ma L, Wang J, Kiyomatsu H, Tsukihara H, Sakuma I, Kobayashi E. Surgical navigation system for laparoscopic lateral pelvic lymph node dissection in rectal cancer surgery using laparoscopic-vision-tracked ultrasonic imaging. Surg Endosc 2020; 35:6556-6567. [PMID: 33185764 DOI: 10.1007/s00464-020-08153-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery requires considerable skill because the pelvic arteries, which need to be located to guide the dissection, are covered by other tissues and cannot be observed on laparoscopic views. Therefore, surgeons need to localize the pelvic arteries accurately before dissection, to prevent injury to these arteries. METHODS This report proposes a surgical navigation system to facilitate artery localization in laparoscopic LPLND by combining ultrasonic imaging and laparoscopy. Specifically, free-hand laparoscopic ultrasound (LUS) is employed to capture the arteries intraoperatively in this approach, and a laparoscopic vision-based tracking system is utilized to track the LUS probe. To extract the artery contours from the two-dimensional ultrasound image sequences efficiently, an artery extraction framework based on local phase-based snakes was developed. After reconstructing the three-dimensional intraoperative artery model from ultrasound images, a high-resolution artery model segmented from preoperative computed tomography (CT) images was rigidly registered to the intraoperative artery model and overlaid onto the laparoscopic view to guide laparoscopic LPLND. RESULTS Experiments were conducted to evaluate the performance of the vision-based tracking system, and the average reconstruction error of the proposed tracking system was found to be 2.4 mm. Then, the proposed navigation system was quantitatively evaluated on an artery phantom. The reconstruction time and average navigation error were 8 min and 2.3 mm, respectively. A navigation system was also successfully constructed to localize the pelvic arteries in laparoscopic and open surgeries of a swine. This demonstrated the feasibility of the proposed system in vivo. The construction times in the laparoscopic and open surgeries were 14 and 12 min, respectively. CONCLUSIONS The experimental results showed that the proposed navigation system can guide laparoscopic LPLND and requires a significantly shorter setting time than the state-of-the-art navigation systems do.
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Affiliation(s)
- Lei Ma
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Junchen Wang
- School of Mechanical Engineering, Beihang University, Beijing, China
| | | | | | - Ichiro Sakuma
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Etsuko Kobayashi
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.
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35
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Zherebtsov E, Zajnulina M, Kandurova K, Potapova E, Dremin V, Mamoshin A, Sokolovski S, Dunaev A, Rafailov EU. Machine Learning Aided Photonic Diagnostic System for Minimally Invasive Optically Guided Surgery in the Hepatoduodenal Area. Diagnostics (Basel) 2020; 10:E873. [PMID: 33121013 PMCID: PMC7693603 DOI: 10.3390/diagnostics10110873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/29/2022] Open
Abstract
Abdominal cancer is a widely prevalent group of tumours with a high level of mortality if diagnosed at a late stage. Although the cancer death rates have in general declined over the past few decades, the mortality from tumours in the hepatoduodenal area has significantly increased in recent years. The broader use of minimal access surgery (MAS) for diagnostics and treatment can significantly improve the survival rate and quality of life of patients after surgery. This work aims to develop and characterise an appropriate technical implementation for tissue endogenous fluorescence (TEF) and assess the efficiency of machine learning methods for the real-time diagnosis of tumours in the hepatoduodenal area. In this paper, we present the results of the machine learning approach applied to the optically guided MAS. We have elaborated tissue fluorescence approach with a fibre-optic probe to record the TEF and blood perfusion parameters during MAS in patients with cancers in the hepatoduodenal area. The measurements from the laser Doppler flowmetry (LDF) channel were used as a sensor of the tissue vitality to reduce variability in TEF data. Also, we evaluated how the blood perfusion oscillations are changed in the tumour tissue. The evaluated amplitudes of the cardiac (0.6-1.6 Hz) and respiratory (0.2-0.6 Hz) oscillations was significantly higher in intact tissues (p < 0.001) compared to the cancerous ones, while the myogenic (0.2-0.06 Hz) oscillation did not demonstrate any statistically significant difference. Our results demonstrate that a fibre-optic TEF probe accompanied with ML algorithms such as k-Nearest Neighbours or AdaBoost is highly promising for the real-time in situ differentiation between cancerous and healthy tissues by detecting the information about the tissue type that is encoded in the fluorescence spectrum. Also, we show that the detection can be supplemented and enhanced by parallel collection and classification of blood perfusion oscillations.
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Affiliation(s)
- Evgeny Zherebtsov
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Optoelectronics and Measurement Techniques Unit, 90570 Oulu, Finland
| | - Marina Zajnulina
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (M.Z.); (S.S.); (E.U.R.)
| | - Ksenia Kandurova
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
| | - Elena Potapova
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
| | - Viktor Dremin
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (M.Z.); (S.S.); (E.U.R.)
| | - Andrian Mamoshin
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
- Department of X-ray Surgical Methods of Diagnosis and Treatment, Orel Regional Clinical Hospital, 302028 Orel, Russia
| | - Sergei Sokolovski
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (M.Z.); (S.S.); (E.U.R.)
| | - Andrey Dunaev
- Research and Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia; (K.K.); (E.P.); (V.D.); (A.M.); (A.D.)
| | - Edik U. Rafailov
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (M.Z.); (S.S.); (E.U.R.)
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Direkwatana C, Suthakorn J, Wilasrussamee C. MU-LapaRobot: A Corporative Surgical Robot for Laparoscopic Surgery. Open Biomed Eng J 2020. [DOI: 10.2174/1874120702014010043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
Development of surgical instrument robot (MU-LapaRobot) for assisting in conventional laparoscopic surgery.
Methods:
A robot was designed based on instrument movement for a conventional procedure. The mechanism mimics and constrains manipulation movement through the wire-driven transmission. It is flexible for robot end-effector, which has a lightweight and small size. The usability of the robot is passive and active robot tasks with an interconnected driving system. Three main parts of the robot are robot end-effector, transmission, and a driving system.
Results:
On a robot platform, a parameter for setup is robot posture. The adjustment of robot position and projection of manipulation area is influenced by the accuracy of movement. To verify movement, command and exact movements are measured. Compensation with the control system is improved in order to improve the accuracy of the system.
Conclusion:
MU-LapaRobot provides surgical instrument manipulation by using wire-driven transmission with an effective system and requires less interference in the conventional operation.
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Alfalahi H, Renda F, Stefanini C. Concentric Tube Robots for Minimally Invasive Surgery: Current Applications and Future Opportunities. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3000899] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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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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Chen F, Cui X, Liu J, Han B, Zhang X, Zhang D, Liao H. Tissue Structure Updating for In Situ Augmented Reality Navigation Using Calibrated Ultrasound and Two-Level Surface Warping. IEEE Trans Biomed Eng 2020; 67:3211-3222. [PMID: 32175853 DOI: 10.1109/tbme.2020.2979535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In minimally invasive surgery (MIS), in situ augmented reality (AR) navigation systems are usually implemented using a glasses-free 3D display to represent the preoperative tissue structure, and can provide intuitive see-through guidance information. However, due to changes in intraoperative tissue, the preoperative tissue structure is not able to exactly correspond to reality, which influences the precision of in situ AR navigation. To solve this problem, we propose a method to update the tissue structure for in situ AR navigation in such way to reflect changes in intraoperative tissue. METHODS The proposed method to update the tissue structure is based on the calibrated ultrasound and two-level surface warping technologies. Firstly, the particle filter-based calibration is implemented to perform ultrasound calibration and obtain intraoperative position of anatomical points. Secondly, intraoperative positions of anatomical points are inputted in the two-level surface warping method to update the preoperative tissue structure. Finally, the glasses-free real 3-D display of the updated tissue structure is finished, and is superimposed onto a patient by a translucent mirror for in situ AR navigation. RESULTS we validated the proposed method by simulating liver tissue intervention, and achieved the tissue updating accuracy of 92.86%. Furthermore, the targeting error of AR navigation based on the proposed method was also evaluated through minimally invasive liver surgery, and the acquired mean targeting error was 1.92 mm. CONCLUSION The results demonstrate that the proposed AR navigation method is effective. SIGNIFICANCE The proposed method can facilitate MIS, as it provides accurate 3D navigation.
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Ashley CW, Donaldson K, Evans KM, Nielsen B, Everett EN. Surgical Cross-Training With Surgery Naive Learners: Implications for Resident Training. JOURNAL OF SURGICAL EDUCATION 2019; 76:1469-1475. [PMID: 31303542 DOI: 10.1016/j.jsurg.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/26/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE While current literature has explored the transferability of laparoscopic surgical skills to robotic surgery, this study looks to investigate the transferability of surgical skills between robotic surgical simulation and simulated traditional laparoscopy. DESIGN Participants completed a survey regarding prior surgery exposure and other confounding factors including previous video game experience and self-assessed hand-eye coordination. Following orientation to the laparoscopic simulator (LS) and robotic surgical simulator (RoSS), participants were timed performing the Balloon Grasp and Ball Drop tasks on the RoSS and the Peg Transfer and Ball Drop tasks on the LS. Participants were then randomized to either the laparoscopic or RoSS arm and timed performing the Ball Drop task 10 times and then reassessed performing the Ball Drop using the unpracticed modality. SETTING Clinical Simulation Laboratory at the University of Vermont PARTICIPANTS: A total of 31 medical students with limited experience in laparoscopic and robotic surgery. RESULTS There were no statistically significant differences in the demographics or prior surgical and videogame experience between the participants in the laparoscopic and robotic arms of the study (X2 = 0.72, p = 0.75). Timed initial assessment of the RoSS Balloon Grasp (p = 0.84) and Ball Drop (p = 0.79) tasks and the LS Peg Transfer (p = 0.14) and Ball Drop (p = 0.44) tasks were not statistically different between the 2 arms. The simulator modality which was practiced yielded the greatest improvement. The degree of improvement on the unpracticed modality was not statistically different between the groups (p = 0.57), and it was not significantly better than 2 rounds of sequential practice on the practiced modality (LS, p = 0.98 and RoSS, p = 0.55). CONCLUSIONS With practice, both groups increased surgical skill on the unpracticed modality. However, this degree of improvement was equal, suggesting there is no transferability of skills between laparoscopy and robotics.
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Affiliation(s)
- Charles W Ashley
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Katherine M Evans
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Brian Nielsen
- Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. College of Medicine, Kalamazoo, Michigan
| | - Elise N Everett
- Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, Vermont.
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Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-matched Study From a National Cohort of Patients. Ann Surg 2019; 268:151-157. [PMID: 28486387 DOI: 10.1097/sla.0000000000002259] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients. BACKGROUND Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD. METHODS Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. OPD and MIPD patients were matched 3:1 using propensity score, and perioperative outcomes were compared. RESULTS A total of 4484 patients were identified with 334 (7.4%) undergoing MIPD. MIPD patients were younger, more likely to be White, and had a lower rate of weight loss. They were more likely to undergo classic Whipple and to have a drain placed. After 3:1 matching, 1002 OPD patients were compared with 334 MIPD patients. MIPD was associated with longer mean operative time (426.6 vs 359.6 minutes; P < 0.01), higher readmission rate (19.2% vs 14.3%; P = 0.04) and lower rate of prolonged length of stay >14 days (16.5% vs 21.6%; P = 0.047). The 2 groups had a similar rate of 30-day mortality (MIPD 1.8% vs OPD 1.3%; P = 0.51), overall complications, postoperative pancreatic fistula, and delayed gastric emptying. A secondary analysis comparing MIPD without conversion or open assist with OPD showed that MIPD patients had lower rates of overall surgical site infection (13.4% vs 19.6%; P = 0.04) and transfusion (7.9% vs 14.4%; P = 0.02). CONCLUSIONS MIPD had an equivalent morbidity and mortality rate to OPD, with the benefit of a decreased rate of prolonged length of stay, though this is partially offset by an increased readmission rate.
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Siu ICH, Li Z, Ng CSH. Latest technology in minimally invasive thoracic surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:35. [PMID: 30854388 DOI: 10.21037/atm.2018.12.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
From the introduction of video-assisted thoracoscopic surgery (VATS) in the 1990s, to performing major lung resections using a uniportal VATS approach, technology has paved the way for the development of minimally invasive thoracic surgery. Natural orifice access to achieve a 'no port' approach, is also on the rise, with advancements in bronchoscopic techniques for diagnosis and therapy, as well as development of soft robotics to achieve desired flexibility, dexterity and stability in future platforms, which may involve in vivo deployment to bring the surgeon totally inside the body. Development of haptic feedback in robotic platforms to enhance the surgical experience is also a major goal, with vibrotactile and mechanical feedback generation, to replicate the traditional touch. In addition, the aid of technology in the form of procedural guidance mechanisms, like augmented reality, will further improve the safety and accuracy of future operations.
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Affiliation(s)
- Ivan Chi Hin Siu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Zheng Li
- Department of Surgery, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Alhossaini RM, Altamran AA, Seo WJ, Hyung WJ. Robotic gastrectomy for gastric cancer: Current evidence. Ann Gastroenterol Surg 2017; 1:82-89. [PMID: 29863139 PMCID: PMC5881341 DOI: 10.1002/ags3.12020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/16/2017] [Indexed: 12/14/2022] Open
Abstract
The robotic system has gained wide acceptance in specialties such as urological and gynecological surgery. It has also been applied in the field of upper gastrointestinal surgery. Since the first implementation of the robotic system for the treatment of gastric adenocarcinoma, the procedure has been found to be safe and feasible. Although robotic gastrectomy does not meet our expectations and yield better results than laparoscopic gastrectomy, this procedure seems to provide several advantages over laparoscopy such as reduced blood loss, shorter learning curves and increased number of retrieved lymph nodes. However, as many case series, including a recent multicenter study, have revealed, higher cost and longer operation time are the major limitations of robotic gastrectomy. Furthermore, there are no results from well-designed randomized clinical trials comparing the two procedures. New procedures in much more technically demanding cases will test the genuine benefits of robotic gastrectomy.
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Affiliation(s)
- Rana M Alhossaini
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Abdulaziz A Altamran
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Won Jun Seo
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Woo Jin Hyung
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
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Criss CN, Ralls MW, Johnson KN, Awtar S, Jarboe MD, Geiger JD. A Novel Intuitively Controlled Articulating Instrument for Reoperative Foregut Surgery: A Case Report. J Laparoendosc Adv Surg Tech A 2017; 27:983-986. [PMID: 28727949 DOI: 10.1089/lap.2017.0107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The field of laparoscopic surgery has continued to grow exponentially over the years, prompting new innovative technologies. Despite substantial advancements, standard laparoscopic tools have undergone little design changes and fail to optimize mobility in limited spaces. Advancements in robotics have attempted to address this, allowing for increasing degrees of freedom and articulation of instruments. Even so, this system has proven to be cumbersome with questionable cost-effectiveness. In this study, we present the first use of a solely mechanical intuitively controlled articulating laparoscopic needle driver. The ability to naturally articulate allowed for ease during suturing and knot tying during the critical portions of the operation. The FlexDex surgical instrument demonstrates promise in the field of foregut surgery in addition to other areas of minimally invasive specialties.
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Affiliation(s)
- Cory N Criss
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Matthew W Ralls
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Kevin N Johnson
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Shorya Awtar
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Marcus D Jarboe
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - James D Geiger
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
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