1
|
Wahlstedt ER, Kronstedt SM, Saffati G, Hinojosa-Gonzalez DE, Mucher ZR. Overview of Robotic Surgery in the U.S. Military: From Conception to Utilization, and Future Applications. Mil Med 2024:usae222. [PMID: 38771002 DOI: 10.1093/milmed/usae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
This column explores the inception, challenges, and prospects of robotic surgery in the military. It highlights the military's role in developing early prototypes, current utilization, training struggles, partnerships with civilian organizations, and potential future applications. The military's influence on the evolving landscape of robotic surgery is emphasized.
Collapse
Affiliation(s)
- Eric R Wahlstedt
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Shane M Kronstedt
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gal Saffati
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Zachary R Mucher
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA
| |
Collapse
|
2
|
Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-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: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
Collapse
Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
| |
Collapse
|
3
|
Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A, Bove AM, Anceschi U, Proietti F, D’Annunzio S, Flammia RS, Chiacchio G, Ferriero M, Guaglianone S, Mastroianni R, Misuraca L, Tuderti G, Simone G. Robotic Surgery in Urology: History from PROBOT ® to HUGO TM. SENSORS (BASEL, SWITZERLAND) 2023; 23:7104. [PMID: 37631641 PMCID: PMC10458477 DOI: 10.3390/s23167104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
The advent of robotic surgical systems had a significant impact on every surgical area, especially urology, gynecology, and general and cardiac surgery. The aim of this article is to delineate robotic surgery, particularly focusing on its historical background, its evolution, its present status, and its future perspectives. A comprehensive literature review was conducted upon PubMed/MEDLINE, using the keywords "robotic surgical system", "robotic surgical device", "robotics AND urology". Additionally, the retrieved articles' reference lists were investigated. Analysis concentrated on urological surgical systems for laparoscopic surgery that have been given regulatory approval for use on humans. From the late 1980s, before daVinci® Era in 2000s, ancestor platform as Probot® and PUMA 560 were described to outline historical perspective. Thus, new robotic competitors of Intuitive Surgical such as Senhance®, Revo-I®, Versius®, Avatera®, Hinotori®, and HugoTM RAS were illustrated. Although daVinci® had high level competitiveness, and for many years represented the most plausible option for robotic procedures, several modern platforms are emerging in the surgical market. Growing competition through unique features of the new robotic technologies might extend applications fields, improve diffusion, and increase cost-effectiveness procedures. More experiences are needed to identify the role of these new advancements in surgical branches and in healthcare systems.
Collapse
Affiliation(s)
| | - Alberto Ragusa
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (A.B.); (F.T.); (F.P.); (L.C.); (A.I.); (A.M.B.); (U.A.); (F.P.); (S.D.); (R.S.F.); (G.C.); (M.F.); (S.G.); (R.M.); (L.M.); (G.T.); (G.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Lee CM, Park S, Park SH, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Short-term outcomes and cost-effectiveness of laparoscopic gastrectomy with articulating instruments for gastric cancer compared with the robotic approach. Sci Rep 2023; 13:9355. [PMID: 37291374 PMCID: PMC10250398 DOI: 10.1038/s41598-023-36601-7] [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: 01/14/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023] Open
Abstract
To overcome the limitations of laparoscopic surgery, robotic systems have been commonly used in the era of minimally invasive surgery despite their high cost. However, the articulation of instruments can be achieved without a robotic system at lower cost using articulating laparoscopic instruments (ALIs). Between May 2021 and May 2022, perioperative outcomes following laparoscopic gastrectomy using ALIs versus robotic gastrectomy were compared. A total of 88 patients underwent laparoscopic gastrectomy using ALIs, while 96 underwent robotic gastrectomy. Baseline characteristics were similar between the groups except for a higher proportion of patients with a medical history in the ALI group (p = 0.013). Clinicopathologic and perioperative outcomes were not significantly different between the groups. However, the operation time was significantly shorter in the ALI group (p = 0.026). No deaths occurred in either group. In conclusion, laparoscopic gastrectomy using ALIs was associated with comparable perioperative surgical outcomes and a shorter operation time compared to robotic gastrectomy in this prospective cohort study.
Collapse
Affiliation(s)
- Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.
| |
Collapse
|
5
|
Das R, Baishya NJ, Bhattacharya B. A review on tele-manipulators for remote diagnostic procedures and surgery. CSI TRANSACTIONS ON ICT 2023. [PMCID: PMC10040908 DOI: 10.1007/s40012-023-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
With modern medicine and healthcare services improving in leaps and bounds, the integration of telemedicine has helped in expanding these specialised healthcare services to remote locations. Healthcare telerobotic systems form a component of telemedicine, which allows medical intervention from a distance. It has been nearly 40 years since a robotic technology, PUMA 560, was introduced to perform a stereotaxic biopsy in the brain. The use of telemanipulators for remote surgical procedures began around 1995, with the Aesop, the Zeus, and the da Vinci robotic surgery systems. Since then, the utilisation of robots has steadily increased in diverse healthcare disciplines, from clinical diagnosis to telesurgery. The telemanipulator system functions in a master–slave protocol mode, with the doctor operating the master system, aided by audio-visual and haptic feedback. Based on the control commands from the master, the slave system, a remote manipulator, interacts directly with the patient. It eliminates the requirement for the doctor to be physically present in the spatial vicinity of the patient by virtually bringing expert-guided medical services to them. Post the Covid-19 pandemic, an exponential surge in the utilisation of telerobotic systems has been observed. This study aims to present an organised review of the state-of-the-art telemanipulators used for remote diagnostic procedures and surgeries, highlighting their challenges and scope for future research and development.
Collapse
Affiliation(s)
- Ratnangshu Das
- grid.417965.80000 0000 8702 0100Department of Mechanical Engineering, Indian Institute of Technology, Kanpur, Kalyanpur, Kanpur, Uttar Pradesh 208016 India
| | - Nayan Jyoti Baishya
- grid.417965.80000 0000 8702 0100Department of Mechanical Engineering, Indian Institute of Technology, Kanpur, Kalyanpur, Kanpur, Uttar Pradesh 208016 India
| | - Bishakh Bhattacharya
- grid.417965.80000 0000 8702 0100Department of Mechanical Engineering, Indian Institute of Technology, Kanpur, Kalyanpur, Kanpur, Uttar Pradesh 208016 India
| |
Collapse
|
6
|
Gupta R, Chopra D, Hemal AK, Mukherjee S, Rogers CG, Sundaram CP, Tewari AK. The first SURS World Congress of Robotic Surgery at Mount Sinai Hospital in New York City: A tribute to the past and the future of robotic urologic surgery. BJUI COMPASS 2023; 4:243-245. [PMID: 37025466 PMCID: PMC10071073 DOI: 10.1002/bco2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Raghav Gupta
- Department of Urology Icahn School of Medicine at Mount Sinai New York New York USA
| | | | - Ashok K. Hemal
- Department of Urology Wake Forest University School of Medicine Winston‐Salem North Carolina USA
| | - Siddhartha Mukherjee
- Department of Medicine Columbia University Irving Medical Center New York New York USA
| | - Craig G. Rogers
- Department of Urology Henry Ford Health System Detroit Michigan USA
| | - Chandru P. Sundaram
- Department of Urology Indiana University School of Medicine Indianapolis Indiana USA
| | - Ashutosh K. Tewari
- Department of Urology Icahn School of Medicine at Mount Sinai New York New York USA
| |
Collapse
|
7
|
Alafaleq M. Robotics and cybersurgery in ophthalmology: a current perspective. J Robot Surg 2023:10.1007/s11701-023-01532-y. [PMID: 36637738 PMCID: PMC9838251 DOI: 10.1007/s11701-023-01532-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
Ophthalmology is one of the most enriched fields, allowing the domain of artificial intelligence to be part of its point of interest in scientific research. The requirement of specialized microscopes and visualization systems presents a challenge to adapting robotics in ocular surgery. Cyber-surgery has been used in other surgical specialties aided by Da Vinci robotic system. This study focuses on the current perspective of using robotics and cyber-surgery in ophthalmology and highlights factors limiting their progression. A review of literature was performed with the aid of Google Scholar, Pubmed, CINAHL, MEDLINE (N.H.S. Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, and Web of Science. Keywords: Cybersurgery, Telesurgery, ophthalmology robotics, Da Vinci robotic system, artificial intelligence in ophthalmology, training on robotic surgery, ethics of the use of robots in medicine, legal aspects, and economics of cybersurgery and robotics. 150 abstracts were reviewed for inclusion, and 68 articles focusing on ophthalmology were included for full-text review. Da Vinci Surgical System has been used to perform a pterygium repair in humans and was successful in ex vivo corneal, strabismus, amniotic membrane, and cataract surgery. Gamma Knife enabled effective treatment of uveal melanoma. Robotics used in ophthalmology were: Da Vinci Surgical System, Intraocular Robotic Interventional Surgical System (IRISS), Johns Hopkins Steady-Hand Eye Robot and smart instruments, and Preceyes' B.V. Cybersurgery is an alternative to overcome distance and the shortage of surgeons. However, cost, availability, legislation, and ethics are factors limiting the progression of these fields. Robotic and cybersurgery in ophthalmology are still in their niche. Cost-effective studies are needed to overcome the delay. Technologies, such as 5G and Tactile Internet, are required to help reduce resource scheduling problems in cybersurgery. In addition, prototype development and the integration of artificial intelligence applications could further enhance the safety and precision of ocular surgery.
Collapse
Affiliation(s)
- Munirah Alafaleq
- grid.411975.f0000 0004 0607 035XOphthalmology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia ,Artificial Intelligence and Business School, 18 Rue du Dôme, 92100 Boulogne Billancourt, France ,grid.412134.10000 0004 0593 9113Ophthalmology Department and Centre for Rare Ophthalmological Diseases OPHTARA, Necker Enfants-Malades University Hospital, AP-HP, University Paris Cité, Paris, France
| |
Collapse
|
8
|
Li Y, Yang C, Bahl A, Persad R, Melhuish C. A review on the techniques used in prostate brachytherapy. COGNITIVE COMPUTATION AND SYSTEMS 2022. [DOI: 10.1049/ccs2.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yanlei Li
- Bristol Robotics Laboratory University of the West of England Bristol UK
| | - Chenguang Yang
- Bristol Robotics Laboratory University of the West of England Bristol UK
| | - Amit Bahl
- University Hospitals Bristol and Weston NHS Trust and Bristol Robotics Laboratory University of the West of England Bristol UK
| | - Raj Persad
- University Hospitals Bristol and Weston NHS Trust and Bristol Robotics Laboratory University of the West of England Bristol UK
| | - Chris Melhuish
- Bristol Robotics Laboratory University of the West of England Bristol UK
| |
Collapse
|
9
|
Soputro N, Dias BH, Khochikar M, Corcoran N, Agarwal D. A Historical Perspective of The Evolution of Laparoscopic Surgeries in Urology. J Endourol 2022; 36:1277-1284. [PMID: 35713272 DOI: 10.1089/end.2022.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recent decades have seen the rapid progression of minimally invasive surgery in urology with continuing developments in robotic technology paving ways into a new era. In addition to these technological innovations, interests from urologists in developing and embracing new techniques have become a forefront in the ongoing evolution of the field allowing for improvement intraoperative experience as well as morbidity and mortality outcomes. This article aims to provide an overview of the historical development of laparoscopic surgery in urology whilst also providing a brief look into its future.
Collapse
Affiliation(s)
- Nicolas Soputro
- Western Health, 95317, Urology, 160 Gordon Street, Footscray, Victoria, Australia, 3011.,Austin Health, 3805, Surgery, 162 Studley Road, Heidelberg, Victoria, Australia, 3084;
| | - Brendan Hermenigildo Dias
- Western Health, 95317, Urology, Footscray, Victoria, Australia.,The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, 85084, Department of Surgery, Parkville, Victoria, Australia;
| | - Makarand Khochikar
- Siddhi Vinayak Ganapati Cancer Hospital, Uro Oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, Miraj, ---Select a State---, India, 416410;
| | - Niall Corcoran
- University of Melbourne, Surgery, 5th Floor Clinical Sciences Building, Royal Melbourne Hospital, Parkville, Victoria, Australia, 3052;
| | - Dinesh Agarwal
- Royal Melbourne Hospital, 90134, Urology, 300 Grattan Street, Parkville Victoria 3050, Melbourne, Victoria, Australia, 3050.,Epworth Hospital, 72536, Richmond, Victoria, Australia.,Western Health, 95317, Footscray, Victoria, Australia;
| |
Collapse
|
10
|
Pandav K, Te AG, Tomer N, Nair SS, Tewari AK. Leveraging 5G technology for robotic surgery and cancer care. Cancer Rep (Hoboken) 2022; 5:e1595. [PMID: 35266317 PMCID: PMC9351674 DOI: 10.1002/cnr2.1595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/09/2021] [Accepted: 11/10/2021] [Indexed: 01/20/2023] Open
Abstract
Background The field of robotic surgery has seen significant advancements in the past few years and it has been adopted in many large hospitals in the United States and worldwide as a standard for various procedures in recent years. However, the location of many hospitals in urban areas and a lack of surgical expertise in the rural areas could lead to increased travel time and treatment delays for patients in need of robotic surgical management, including cancer patients. The fifth generation (5G) networks have been deployed by various telecom companies in multiple countries worldwide. Our aim is to update the readers about the novel technology and the current scenario of surgical procedures performed using 5G technology. In this article, we also discuss how the technology could aid cancer patients requiring surgical management, the future perspectives, the potential challenges, and the limitations, which would need to overcome prior to widespread real‐life use of the technology for cancer care. Recent findings The expansion of 5G technology has enabled some countries to conduct remote surgical procedures, tele‐mentored and real‐time interactive procedures on animal models, cadavers, and humans, demonstrating that 5G networks could offer a potential solution to previously experienced latency and reliability hurdles during the remote surgeries performed in the 2000s. Conclusion New technological advancements could serve as a ground for emerging novel therapeutic applications. While limitations and challenges related to the 5G infrastructure, cost, compatibility, and security exist; researching to overcome the limitations and comprehend the potential benefits of integrating the technology into practice would be imminent before widespread clinical use. Remote and tele‐mentored 5G‐powered procedures could offer a new tool in improving the care of patients requiring robotic surgical management such as prostate cancer patients.
Collapse
Affiliation(s)
- Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Austen G Te
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University, New York, NY, USA
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sujit S Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
11
|
Ayoub CH, El-Asmar JM, Abdulfattah S, El-Hajj A. Telemedicine and Telementoring in Urology: A Glimpse of the Past and a Leap Into the Future. Front Surg 2022; 9:811749. [PMID: 35273996 PMCID: PMC8901873 DOI: 10.3389/fsurg.2022.811749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Telemedicine is the process of utilizing telecommunications and digital relay to perform, teach, or share medical knowledge. The digital era eased the incorporation of telemedicine to different areas of medical care, including the surgical care of Urologic patient mainly through telementoring, telesurgery, and telerobotics. Over the years, Telemedicine has played an integral part in a physicians' ability to provide high quality medical care to remote patients, as well as serve as an educational tool for trainee physicians, in the form of telementoring. During the COVID-19 pandemic, telemedicine has played a vital role in combatting the health implications of confinements. Challenges of telemedicine implementation include cost, ethical considerations, security, bandwidth, latency, legal, and licensure difficulties. Nevertheless, the future of telemedicine, specifically telementoring, promises several improvements and innovative advancements that aim to bridge the gap in technological divides of urologic care. In this review, we build on what is already known about telemedicine focusing specifically on aspects related to telementoring, telestration, and telesurgery. Furthermore, we discuss its historical role in healthcare with a special emphasis on current and future use in urology.
Collapse
Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M. El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Albert El-Hajj
| |
Collapse
|
12
|
Affiliation(s)
- Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, 980118, Richmond, VA, 23298-0118, USA.
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| |
Collapse
|
13
|
Connor MJ, Dasgupta P, Ahmed HU, Raza A. Autonomous surgery in the era of robotic urology: friend or foe of the future surgeon? Nat Rev Urol 2020; 17:643-649. [DOI: 10.1038/s41585-020-0375-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
|
14
|
Wen YC, Tung MC, Ou YC, Lu CH, Chang YK. The expansion condition of amount and complexity of urologic robotic surgery in 2000 patients: A 13-year experience sharing. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_101_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Troccaz J, Dagnino G, Yang GZ. Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation. Annu Rev Biomed Eng 2019; 21:193-218. [DOI: 10.1146/annurev-bioeng-060418-052502] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medical robotics is poised to transform all aspects of medicine—from surgical intervention to targeted therapy, rehabilitation, and hospital automation. A key area is the development of robots for minimally invasive interventions. This review provides a detailed analysis of the evolution of interventional robots and discusses how the integration of imaging, sensing, and robotics can influence the patient care pathway toward precision intervention and patient-specific treatment. It outlines how closer coupling of perception, decision, and action can lead to enhanced dexterity, greater precision, and reduced invasiveness. It provides a critical analysis of some of the key interventional robot platforms developed over the years and their relative merit and intrinsic limitations. The review also presents a future outlook for robotic interventions and emerging trends in making them easier to use, lightweight, ergonomic, and intelligent, and thus smarter, safer, and more accessible for clinical use.
Collapse
Affiliation(s)
- Jocelyne Troccaz
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France
| | - Giulio Dagnino
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, United Kingdom;,
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, United Kingdom;,
| |
Collapse
|
16
|
Ohmura Y, Suzuki H, Kotani K, Teramoto A. Laparoscopic inguinal hernia repair with a joystick-guided robotic scope holder (Soloassist II®): retrospective comparative study with human assistant. Langenbecks Arch Surg 2019; 404:495-503. [PMID: 31129765 DOI: 10.1007/s00423-019-01793-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical usefulness of a joystick-guided robotic scope holder (Soloassist II®) in laparoscopic inguinal hernia repair. METHODS Among 182 inguinal hernia patients treated by laparoscopic transabdominal preperitoneal repair, 82 cases were completed with a human scope assistant, while Soloassist was used in 100 cases. We retrospectively compared perioperative results of Soloassist group and human scope assistant group. In 139 unilateral cases, we also used logistic regression of perioperative factors for the propensity score calculation to balance the bias. RESULTS All operations with Soloassist were carried out laparoscopically as solo-surgery without any system-specific complications. A statistically significant decrease in operation time was observed in Soloassist group compared with human assistant group (93.6 vs 85.9 min, p = 0.05). There was no prolongation of preoperative time or difference in the amount of intraoperative blood loss. Operation time was also significantly shorter in Soloassist group, when analyzing unilateral cases (85.5 vs 76.3 min, p = 0.02) and bilateral cases (126.9 vs 111.8 min, p = 0.01), independently. However, after propensity score matching in unilateral cases, there was no statistically significant difference between the two groups (83.8 vs 77.2 min, p = 0.23). CONCLUSIONS The feasibility of Soloassist in laparoscopic inguinal hernia repair was demonstrated with no adverse device-related events. All surgeries could be completed as solo-surgery, while no additional time for preoperative setting was required. The mean operation time tends to be shorter in Soloassist group compared with human assistant group. Soloassist could be an effective device in laparoscopic inguinal hernia repair.
Collapse
Affiliation(s)
- Yasushi Ohmura
- Department of Cancer Treatment Support Center, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan. .,Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.
| | - Hiromitsu Suzuki
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.,Department of Surgery, Yakage Hospital, 2695 Yakage, Yakage-chou, Oda, Okayama, 714-1201, Japan
| | - Kazutoshi Kotani
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.,Department of Surgery, Kasaoka Daiichi Hospital, 1945 Yokoshima, Kasaoka, Okayama, 714-0043, Japan
| | - Atsushi Teramoto
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan
| |
Collapse
|
17
|
Zhou X, Zhang H, Feng M, Zhao J, Fu Y. New remote centre of motion mechanism for robot-assisted minimally invasive surgery. Biomed Eng Online 2018; 17:170. [PMID: 30453983 PMCID: PMC6245885 DOI: 10.1186/s12938-018-0601-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/09/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Robot-assisted minimally invasive surgery (RMIS) is promising for improving surgical accuracy and dexterity. As the end effector of the robotic arm, the remote centre of motion mechanism is one of the requisite terms for guaranteeing patient safety. The existing remote centre of motion mechanisms are complex and large in volume, as well as high assembly requirement and unsatisfactory precise. This paper aimed to present a new remote centre of motion mechanism for solving these problems. METHODS A new mechanism based on the RMIS requirements is proposed for holding the laparoscope and generating a remote centre of motion for the laparoscope. The mechanism kinematics is then analysed from the perspective of the structural function, and its inverse kinematics is determined with a small number of calculations. Finally, the position deviation of the laparoscope rotational point is chosen as the index to evaluate the mechanism performance. The experiments are performed to test the deviation. RESULTS The position deviations of the laparoscope rotational point do not exceed 2 mm, which is lower than that of the existing remote centre of motion mechanism. The 2 mm positioning error of the laparoscope won't affect surgeon observation of the surgical field, and the pressure caused by the positioning error was acceptable for the skin elasticity. The proposed mechanism meets the RMIS requirement. CONCLUSIONS The proposed mechanism can achieve the remote centre of motion for the laparoscope. Its simple and compact structure is beneficial to avoid the collision of robotic arms, and it can be applied on other robots for providing the instrument necessary motion in minimally invasive surgery.
Collapse
Affiliation(s)
- Xiaoqin Zhou
- Jilin University, Nan Guan District, Changchun, China
| | - Haijun Zhang
- Jilin University, Nan Guan District, Changchun, China
| | - Mei Feng
- Jilin University, Nan Guan District, Changchun, China
| | - Ji Zhao
- Jilin University, Nan Guan District, Changchun, China
| | - Yili Fu
- Harbin Institute of Technology, Nan Gang District, Harbin, China
| |
Collapse
|
18
|
George EI, Brand TC, LaPorta A, Marescaux J, Satava RM. Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS 2018; 22:e2018.00039. [PMID: 30524184 PMCID: PMC6261744 DOI: 10.4293/jsls.2018.00039] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The uses of robotics in surgery were hypothesized as far back as 1967, but it took nearly 30 years and the nation's largest agency, the Department of Defense, in conjunction with innovative startups and established research agencies to complete the first fully functional multipurpose surgical robot. Currently, the most prominently available multipurpose robotic surgery system with US Food and Drug Administration approval is Intuitive Surgical Inc.'s da Vinci Surgical System, which is found in operating rooms across the globe. Although now ubiquitous for minimally invasive surgery, early surgical robot prototypes were specialty focused. Originally, multipurpose robotic systems were intended for long-distance trauma surgery in battlefield settings. While there were impressive feats of telesurgery, the marketable focus has veered from this goal. Initially developed through SRI International and Defense Advanced Research Projects Agency, surgical robotics reached private industry through two major competitors, who later merged. METHODS A thorough search of PubMed, Clinical Key, EBSCO, Ovid, ProQuest, and industry manufacturers' websites yielded 62 relevant articles, of which 51 were evaluated in this review. CONCLUSION We analyzed the literature and referred to primary sources by conducting interviews with present and historical leaders in the field to yield a detailed chronology of surgical robotics development. As minimally invasive robotic procedures are becoming the standard of care, it is crucial to comprehensively document their historical context and importance as an emerging and evolving discipline.
Collapse
Affiliation(s)
- Evalyn I George
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | - Timothy C Brand
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | | | - Jacques Marescaux
- Research Institute against Digestive Cancer, Image Guided Surgery, Strasbourg, France
| | | |
Collapse
|
19
|
Abstract
The monopoly of robotic surgical devices of the last 15 years will end in 2019 when key patents of Intuitive Surgical expire. Thus, we can expect an interesting competitive situation in the coming years. Based on personal experience with robot-assisted surgery since 2001, we conducted a search of the current literature together with a search of relevant patents in this field. Finally, we visited the websites of manufacturers of existing and future robotic surgical devices with possible applications in urology. Such devices have to prove that they meet the high-quality standard of the current Da Vinci series (SI, X, XI). For this purpose, we propose to classify the main features of the different devices, such as type of console (closed/open), arrangement of robotic arms (single/multiple carts/attached to operating room table), type of three-dimensional videosystem (by mirror/ocular/using polarizing glasses) or degrees of freedom (DOF) of end effectors (5 vs. 7 DOF). In the meantime, there are also robotic systems used in endourology: Avicenna Roboflex® and the AquaBeam® system for robot-assisted aquablation therapy of the prostate. While Roboflex® improves the ergonomics of flexible ureteroscopy-similar to the Da Vinci robot, AquaBeam® may for the first time eliminate the surgeon, who might only be needed to manage severe postoperative bleeding.
Collapse
|
20
|
Le HND, Opfermann JD, Kam M, Raghunathan S, Saeidi H, Leonard S, Kang JU, Krieger A. Semi-Autonomous Laparoscopic Robotic Electro-surgery with a Novel 3D Endoscope. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2018; 2018:6637-6644. [PMID: 31475074 PMCID: PMC6716798 DOI: 10.1109/icra.2018.8461060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper reports a robotic laparoscopic surgery system performing electro-surgery on porcine cadaver kidney, and evaluates its accuracy in an open loop control scheme to conduct targeting and cutting tasks guided by a novel 3D endoscope. We describe the design and integration of the novel laparoscopic imaging system that is capable of reconstructing the surgical field using structured light. A targeting task is first performed to determine the average positioning error of the system as guided by the laparoscopic camera. The imaging system is then used to reconstruct the surface of a porcine cadaver kidney, and generate a cutting trajectory with consistent depth. The paper concludes by using the robotic system in open loop control to cut this trajectory using a multi degree of freedom electro-surgical tool. It is demonstrated that for a cutting depth of 3 mm, the robotic surgical system follows the trajectory with an average depth of 2.44 mm and standard deviation of 0.34 mm. The average positional accuracy of the system was 2.74±0.99 mm.
Collapse
Affiliation(s)
- Hanh N D Le
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211. , ,
| | - Justin D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010.
| | - Michael Kam
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742. , , ,
| | - Sudarshan Raghunathan
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742. , , ,
| | - Hamed Saeidi
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742. , , ,
| | - Simon Leonard
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211. , ,
| | - Jin U Kang
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211. , ,
| | - Axel Krieger
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742. , , ,
| |
Collapse
|
21
|
Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
Collapse
|
22
|
Opfermann JD, Leonard S, Decker RS, Uebele NA, Bayne CE, Joshi AS, Krieger A. Semi-Autonomous Electrosurgery for Tumor Resection Using a Multi-Degree of Freedom Electrosurgical Tool and Visual Servoing. PROCEEDINGS OF THE ... IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS. IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS 2017; 2017:3653-3659. [PMID: 29503760 DOI: 10.1109/iros.2017.8206210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper specifies a surgical robot performing semi-autonomous electrosurgery for tumor resection and evaluates its accuracy using a visual servoing paradigm. We describe the design and integration of a novel, multi-degree of freedom electrosurgical tool for the smart tissue autonomous robot (STAR). Standardized line tests are executed to determine ideal cut parameters in three different types of porcine tissue. STAR is then programmed with the ideal cut setting for porcine tissue and compared against expert surgeons using open and laparoscopic techniques in a line cutting task. We conclude with a proof of concept demonstration using STAR to semi-autonomously resect pseudo-tumors in porcine tissue using visual servoing. When tasked to excise tumors with a consistent 4mm margin, STAR can semi-autonomously dissect tissue with an average margin of 3.67 mm and a standard deviation of 0.89mm.
Collapse
Affiliation(s)
- Justin D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - Simon Leonard
- Electrical Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - Ryan S Decker
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - Nicholas A Uebele
- Electrical Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - Christopher E Bayne
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - Arjun S Joshi
- Division of Otolaryngology - Head and Neck Surgery at The George Washington University, Washington, DC 20052
| | - Axel Krieger
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| |
Collapse
|
23
|
Muradore R, Fiorini P, Akgun G, Barkana DE, Bonfe M, Boriero F, Caprara A, De Rossi G, Dodi R, Elle OJ, Ferraguti F, Gasperotti L, Gassert R, Mathiassen K, Handini D, Lambercy O, Li L, Kruusmaa M, Manurung AO, Meruzzi G, Nguyen HQP, Preda N, Riolfo G, Ristolainen A, Sanna A, Secchi C, Torsello M, Yantac AE. Development of a Cognitive Robotic System for Simple Surgical Tasks. INT J ADV ROBOT SYST 2017. [DOI: 10.5772/60137] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Paolo Fiorini
- Department of Computer Science, University of Verona, Italy
| | - Gokhan Akgun
- Cognitive Science Department, Yeditepe University, Istanbul, Turkey
| | - Duygun Erol Barkana
- Electrical and Electronics Engineering Department, Yeditepe University, Istanbul, Turkey
| | | | | | - Andrea Caprara
- Department of Legal Studies, School of Law, University of Verona, Italy
| | | | - Riccardo Dodi
- e-Services for Life and Health Research Department, Fondazione Centro San Raffaele, Italy
| | - Ole Jakob Elle
- Department of Informatics, University of Oslo, and The Intervention Center, Oslo University Hospital, Oslo, Norway
| | - Federica Ferraguti
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, Italy
| | | | - Roger Gassert
- Rehabilitation Engineering Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Kim Mathiassen
- Department of Informatics, University of Oslo, and The Intervention Center, Oslo University Hospital, Oslo, Norway
| | - Dilla Handini
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Norway
| | - Olivier Lambercy
- Rehabilitation Engineering Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Lin Li
- Tallinn University of Technology, Faculty of Information Technology, Centre for Biorobotics, Tallinn, Estonia
| | - Maarja Kruusmaa
- Tallinn University of Technology, Faculty of Information Technology, Centre for Biorobotics, Tallinn, Estonia
| | - Auralius Oberman Manurung
- Rehabilitation Engineering Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Giovanni Meruzzi
- Department of Legal Studies, School of Law, University of Verona, Italy
| | | | - Nicola Preda
- Engineering Department, University of Ferrara, Italy
| | - Gianluca Riolfo
- Department of Legal Studies, School of Law, University of Verona, Italy
| | - Asko Ristolainen
- Tallinn University of Technology, Faculty of Information Technology, Centre for Biorobotics, Tallinn, Estonia
| | - Alberto Sanna
- e-Services for Life and Health Research Department, Fondazione Centro San Raffaele, Italy
| | - Cristian Secchi
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, Italy
| | - Marco Torsello
- Department of Legal Studies, School of Law, University of Verona, Italy
| | | |
Collapse
|
24
|
|
25
|
Raison N, Khan MS, Challacombe B. Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential? Curr Urol Rep 2016; 16:43. [PMID: 26025497 DOI: 10.1007/s11934-015-0522-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring. However, barriers to the further implementation of telemedicine remain. In this review, the developments and recent advances of telemedicine across the three domains are discussed together with the challenges and limitations that need to be overcome.
Collapse
Affiliation(s)
- Nicholas Raison
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK,
| | | | | |
Collapse
|
26
|
Stark M, Pomati S, D'Ambrosio A, Giraudi F, Gidaro S. A new telesurgical platform--preliminary clinical results. MINIM INVASIV THER 2015; 24:31-6. [PMID: 25627435 DOI: 10.3109/13645706.2014.1003945] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new European telesurgical system, the Telelap Alf-x, is introduced. Its main features are individual arms, which enable free access to the patient throughout surgery, a large range of reusable surgical instruments, an open console with eye-tracking system, where the camera follows the eye and head movements of the surgeon, and the existing force feedback enables for the first time to feel the consistency of the tissues and avoid tearing of the stitches while suturing. The system combines the benefits of open surgery and endoscopy. The first clinical application, which involved 146 operations at the gynecological department of the Gemelli University Hospital in Rome, proved the safety and the surgical team's quick adaptation to the system.
Collapse
Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA) , Berlin , Germany
| | | | | | | | | |
Collapse
|
27
|
Kassahun Y, Yu B, Tibebu AT, Stoyanov D, Giannarou S, Metzen JH, Vander Poorten E. Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions. Int J Comput Assist Radiol Surg 2015; 11:553-68. [PMID: 26450107 DOI: 10.1007/s11548-015-1305-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/21/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Advances in technology and computing play an increasingly important role in the evolution of modern surgical techniques and paradigms. This article reviews the current role of machine learning (ML) techniques in the context of surgery with a focus on surgical robotics (SR). Also, we provide a perspective on the future possibilities for enhancing the effectiveness of procedures by integrating ML in the operating room. METHODS The review is focused on ML techniques directly applied to surgery, surgical robotics, surgical training and assessment. The widespread use of ML methods in diagnosis and medical image computing is beyond the scope of the review. Searches were performed on PubMed and IEEE Explore using combinations of keywords: ML, surgery, robotics, surgical and medical robotics, skill learning, skill analysis and learning to perceive. RESULTS Studies making use of ML methods in the context of surgery are increasingly being reported. In particular, there is an increasing interest in using ML for developing tools to understand and model surgical skill and competence or to extract surgical workflow. Many researchers begin to integrate this understanding into the control of recent surgical robots and devices. CONCLUSION ML is an expanding field. It is popular as it allows efficient processing of vast amounts of data for interpreting and real-time decision making. Already widely used in imaging and diagnosis, it is believed that ML will also play an important role in surgery and interventional treatments. In particular, ML could become a game changer into the conception of cognitive surgical robots. Such robots endowed with cognitive skills would assist the surgical team also on a cognitive level, such as possibly lowering the mental load of the team. For example, ML could help extracting surgical skill, learned through demonstration by human experts, and could transfer this to robotic skills. Such intelligent surgical assistance would significantly surpass the state of the art in surgical robotics. Current devices possess no intelligence whatsoever and are merely advanced and expensive instruments.
Collapse
Affiliation(s)
- Yohannes Kassahun
- Robotics Innovation Center, German Research Center for Artificial Intelligence, Robert-Hooke-Str. 1, 28359, Bremen, Germany.
| | - Bingbin Yu
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Abraham Temesgen Tibebu
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Danail Stoyanov
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Jan Hendrik Metzen
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Emmanuel Vander Poorten
- Department of Mechanical Engineering, University of Leuven, Celestijnenlaan 300B, 3001, Heverlee, Belgium
| |
Collapse
|
28
|
Diana M, Marescaux J. Robotic surgery. Br J Surg 2015; 102:e15-28. [PMID: 25627128 DOI: 10.1002/bjs.9711] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Proficiency in minimally invasive surgery requires intensive and continuous training, as it is technically challenging for unnatural visual and haptic perceptions. Robotic and computer sciences are producing innovations to augment the surgeon's skills to achieve accuracy and high precision during complex surgery. This article reviews the current use of robotically assisted surgery, focusing on technology as well as main applications in digestive surgery, and future perspectives. METHODS The PubMed database was interrogated to retrieve evidence-based data on surgical applications. Internal and external consulting with key opinion leaders, renowned robotics laboratories and robotic platform manufacturers was used to produce state-of-the art business intelligence around robotically assisted surgery. RESULTS Selected digestive procedures (oesophagectomy, gastric bypass, pancreatic and liver resections, rectal resection for cancer) might benefit from robotic assistance, although the current level of evidence is insufficient to support widespread adoption. The surgical robotic market is growing, and a variety of projects have recently been launched at both academic and corporate levels to develop lightweight, miniaturized surgical robotic prototypes. CONCLUSION The magnified view, and improved ergonomics and dexterity offered by robotic platforms, might facilitate the uptake of minimally invasive procedures. Image guidance to complement robotically assisted procedures, through the concepts of augmented reality, could well represent a major revolution to increase safety and deal with difficulties associated with the new minimally invasive approaches.
Collapse
Affiliation(s)
- M Diana
- Research Institute Against Cancer of the Digestive System (IRCAD), European Institute of TeleSurgery (EITS) and International Institute for Image-Guided Surgery (IHU Strasbourg), Strasbourg, France
| | | |
Collapse
|
29
|
Russo S, Dario P, Menciassi A. A Novel Robotic Platform for Laser-Assisted Transurethral Surgery of the Prostate. IEEE Trans Biomed Eng 2015; 62:489-500. [DOI: 10.1109/tbme.2014.2358711] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
30
|
|
31
|
Bergeles C, Yang GZ. From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots. IEEE Trans Biomed Eng 2013; 61:1565-76. [PMID: 24723622 DOI: 10.1109/tbme.2013.2293815] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within only a few decades from its initial introduction, the field of surgical robotics has evolved into a dynamic and rapidly growing research area with increasing clinical uptake worldwide. Initially introduced for stereotaxic neurosurgery, surgical robots are now involved in an increasing number of procedures, demonstrating their practical clinical potential while propelling further advances in surgical innovations. Emerging platforms are also able to perform complex interventions through only a single-entry incision, and navigate through natural anatomical pathways in a tethered or wireless fashion. New devices facilitate superhuman dexterity and enable the performance of surgical steps that are otherwise impossible. They also allow seamless integration of microimaging techniques at the cellular level, significantly expanding the capabilities of surgeons. This paper provides an overview of the significant achievements in surgical robotics and identifies the current trends and future research directions of the field in making surgical robots safer, smaller, and smarter.
Collapse
|
32
|
Gillen S, Pletzer B, Heiligensetzer A, Wolf P, Kleeff J, Feussner H, Fürst A. Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case-control study. Surg Endosc 2013; 28:164-70. [PMID: 23990155 DOI: 10.1007/s00464-013-3142-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the implementation of a joystick-controlled camera holder (Soloassist; Actormed, Barbing, Germany) in laparoscopic cholecystectomy as so-called solo-surgery compared with the standard operation. METHODS Of the 123 patients included in this study, 63 underwent laparoscopic cholecystectomy using the Soloassist system and were compared with 60 patients who underwent laparoscopic cholecystectomy with human assistance. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification. The surgeons were divided into those highly experienced and those experienced with the new camera holder. The operation times were measured, including setup and dismantling of the system. The assessment also included complications, postoperative hospital stay, measurement of human resources in terms of personnel/minutes/operation, and subjective evaluation of the camera-guiding device by the surgeons. RESULTS The hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time (p = 0.008) and total operating time (p = 0.001) significantly favored the human assistant. Whereas the absolute duration of surgery was longer, the relative operating time (in personnel/minutes/operation) was significantly shorter (p < 0.001). In 4.8 % of the cases, the operation could not be performed completely with the camera-holding device. Clinically relevant postoperative complications did not occur. The experience of the surgeons did not differ significantly. The subjective evaluation regarding handling, image quality, effort, and satisfaction demonstrated high acceptance of the Soloassist system. CONCLUSIONS The camera-guiding device can be implemented without increased complications. The Soloassist system is safe and can be operated even by colleagues without system experience. All the surgeons rated their satisfaction with the system as very good to excellent. Although the operating times were longer than with the standard camera guidance, the absolute overall staff time was reduced.
Collapse
Affiliation(s)
- Sonja Gillen
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | | | | | | | | |
Collapse
|
33
|
Healy DA, Murphy SP, Burke JP, Coffey JC. Artificial interfaces (“AI”) in surgery: Historic development, current status and program implementation in the public health sector. Surg Oncol 2013; 22:77-85. [DOI: 10.1016/j.suronc.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/04/2012] [Accepted: 12/22/2012] [Indexed: 02/07/2023]
|
34
|
Du X, Assadi MZ, Jowitt F, Brett PN, Henshaw S, Dalton J, Proops DW, Coulson CJ, Reid AP. Robustness analysis of a smart surgical drill for cochleostomy. Int J Med Robot 2012; 9:119-26. [PMID: 23081742 DOI: 10.1002/rcs.1462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a need for sensor-guided robotic devices that discriminate working conditions and media, and control interaction of tool-points with respect to tissues. At the micro-surgical scale the need is to control exact penetration through flexible tissues and to control relative motion with respect to moving or deforming tissue targets and interfaces. METHODS This paper describes a smart surgical drill that is able to control interaction with respect to the flexing tissue to avoid penetration or to control the extent of protrusion with respect to the position of the flexible tissue interface under drilling. The sensing scheme used is able to discriminate between the variations in types of conditions posed in the drilling environment. RESULTS The fully autonomous system is able to respond to tissue type, behaviour and deflection in real time. The system is robust in terms of different drilling angle, thickness, stiffness, and disturbances encountered. Also it is intuitive to use, efficient to set up and uses standard drill bits. CONCLUSIONS The smart drill has been used to prepare cochleostomies in theatre and was used to remove bone tissue leaving the endosteal membrane intact. This has enabled preservation of sterility and the drilling debris to be removed prior to insertion of the electrode. Results presented in this paper suggest that the robotic smart drill is tolerant and robust on various angled drilling trajectories with respect to tissues, tissue thickness, environmental disturbances, and has been used within the operating theatre.
Collapse
Affiliation(s)
- Xinli Du
- Brunel Institute for Bioengineering, Brunel University, Uxbridge, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Stark M, Benhidjeb T, Gidaro S, Morales ER. The future of telesurgery: a universal system with haptic sensation. J Turk Ger Gynecol Assoc 2012; 13:74-6. [PMID: 24627681 DOI: 10.5152/jtgga.2012.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Tahar Benhidjeb
- The New European Surgical Academy (NESA), Berlin, Germany ; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Gidaro
- Department of Surgical Science University "G. D'Annunzio" Chieti-Pescara, Italy
| | | |
Collapse
|
36
|
Abstract
First used medically in 1985, robots now make an impact in laparoscopy, neurosurgery, orthopedic surgery, emergency response, and various other medical disciplines. This paper provides a review of medical robot history and surveys the capabilities of current medical robot systems, primarily focusing on commercially available systems while covering a few prominent research projects. By examining robotic systems across time and disciplines, trends are discernible that imply future capabilities of medical robots, for example, increased usage of intraoperative images, improved robot arm design, and haptic feedback to guide the surgeon.
Collapse
|
37
|
Yates DR, Vaessen C, Chartier-Kastler E, Richard F, Haertig A, Bitker MO, Rouprêt M. [History of robotic surgery in surgery: a progressive evolution towards a surgical revolution]. Presse Med 2011; 41:427-33. [PMID: 22079307 DOI: 10.1016/j.lpm.2011.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 07/28/2011] [Indexed: 10/15/2022] Open
Affiliation(s)
- David R Yates
- Assistance Publique-Hôpitaux de Paris, université Paris VI, faculté de médecine Pierre-et-Marie-Curie, service d'urologie de l'hôpital Pitié-Salpêtrière, 75013 Paris, France
| | | | | | | | | | | | | |
Collapse
|
38
|
Kenngott HG, Fischer L, Nickel F, Rom J, Rassweiler J, Müller-Stich BP. Status of robotic assistance--a less traumatic and more accurate minimally invasive surgery? Langenbecks Arch Surg 2011; 397:333-41. [PMID: 22038293 DOI: 10.1007/s00423-011-0859-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact. METHODS The Medline database was searched for the terms "robot, telemanipulat, and laparoscop." A total of 2,573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. RESULTS In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers. CONCLUSION Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.
Collapse
Affiliation(s)
- H G Kenngott
- Department of General, Abdominal and Transplant Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
• Robotics of the current day have advanced significantly from early computer-aided design/manufacturing systems to modern master-slave robotic systems that replicate the surgeon's exact movements onto robotic instruments in the patient. • Globally >300,000 robotic procedures were completed in 2010, including ≈98,000 robot-assisted radical prostatectomies. • Broadening applications of robotics for urological procedures are being investigated in both adult and paediatric urology. • The use of the current robotic system continues to be further refined. Increasing experience has optimized port placement reducing arm collisions to allow for more expedient surgery. Improved three-dimensional camera magnification provides improved intraoperative identification of structures. • Robotics has probably improved the learning curve of laparoscopic surgery while still maintaining its patient recovery advantages and outcomes. • The future of robotic surgery will take this current platform forward by improving haptic (touch) feedback, improving vision beyond even the magnified eye, improving robot accessibility with a reduction of entry ports and miniaturizing the slave robot. • Here, we focus on the possible advancements that may change the future landscape of robotic surgery.
Collapse
Affiliation(s)
- Alexei Wedmid
- Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
40
|
Yates DR, Vaessen C, Roupret M. From Leonardo to da Vinci: the history of robot-assisted surgery in urology. BJU Int 2011; 108:1708-13; discussion 1714. [DOI: 10.1111/j.1464-410x.2011.10576.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Abstract
Robotic surgery is one of the most significant advances in urology in recent years. It promises to make urological surgeries safer with far superior results as compared to laparoscopic or open surgeries. It holds great promise for the surgeons and patients alike. However like any other technological advance, it too comes with a heavy price tag. Aggressive marketing by the manufacturers and urologists may lead to unethical practices. This article analyses the applicability of robotics to urology and India in particular taking into consideration the financial aspects involved. At present, the scope for robotics in India is limited because of cost considerations. The future of robotic surgery in India also will depend on the same factor.
Collapse
|
42
|
Abstract
This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery.
Collapse
|
43
|
Abstract
SUMMARYA brief history of robotic surgery is provided, which describes the transition from autonomous robots to hands-on systems that are under the direct control of the surgeon. An example of the latter is the Acrobot (for active-constraint robot) system used in orthopaedics, whilst soft-tissue surgery is illustrated by the daVinci telemanipulator system. Non-technological aspects of robotic surgery have often been a major impediment to their widespread clinical use. These are discussed in detail, together with the role of navigation systems, which are considered a major competitor to surgical robots. A detailed description is then given of a registration method for robots to achieve improved accuracy. Registration is a major source of error in robotic surgery, particularly in orthopaedics. The paper describes the design and clinical implementation of a novel method, coined the bounded registration method, applied to minimally invasive registration of the femur. Results of simulations which compare the performance of bounded registration with a standard implementation of the iterative closest point algorithm are also presented, alongside a description of their application in the Acrobot hands-on robot, used clinically for uni-condylar knee arthroplasty.
Collapse
|
44
|
Samad MD, Hu Y, Sutherland GR. Effect of force feedback from each DOF on the motion accuracy of a surgical tool in performing a robot-assisted tracing task. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2093-2096. [PMID: 21095684 DOI: 10.1109/iembs.2010.5626171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In robot-assisted surgery, it may be important to provide force feedback to the hand of the surgeon. Here we examine how force feedback from each degree of freedom (DOF) on a hand controller affects the motion accuracy of a surgical tool. We studied the motion accuracy of a needle-shaped tool in performing a robot-assisted tracing task. On a virtual simulation of the tool and neuroArm robot, human participants manipulated a hand controller to move the tool attached to the end-effector of the robot. They used the tool to trace a line on pipes (mimicking blood vessels) along 3 orthogonal directions, corresponding to 3 DOF on the hand controller. We observed that force feedback from each DOF on the hand controller had a significant effect on the motion accuracy of the tool during tracing. Varying force conditions yielded insignificant difference in motion accuracy. These results indicate a need of revising the hand controller for achieving improved motion accuracy in performing robot-assisted tasks.
Collapse
Affiliation(s)
- Manar D Samad
- Dept. of Electrical and Computer Engineering (ECE), University of Calgary (U of C), AB, CANADA.
| | | | | |
Collapse
|
45
|
Bova F. Computer Based Guidance in the Modern Operating Room: A Historical Perspective. IEEE Rev Biomed Eng 2010; 3:209-22. [DOI: 10.1109/rbme.2010.2089370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
46
|
Lum MJH, Friedman DCW, Sankaranarayanan G, King H, Fodero K, Leuschke R, Hannaford B, Rosen J, Sinanan MN. The RAVEN: Design and Validation of a Telesurgery System. Int J Rob Res 2009. [DOI: 10.1177/0278364909101795] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The collaborative effort between fundamental science, engineering and medicine provides physicians with improved tools and techniques for delivering effective health care. Minimally invasive surgery (MIS) techniques have revolutionized the way a number of surgical procedures are performed. Recent advances in surgical robotics are once again revolutionizing MIS interventions and open surgery. In an earlier research endeavor, 30 surgeons performed 7 different MIS tasks using the Blue Dragon system to collect measurements of position, force, and torque on a porcine model. This data served as the foundation for a kinematic optimization of a spherical surgical robotic manipulator. Following the optimization, a seven-degree-of-freedom cable-actuated surgical manipulator was designed and integrated, providing all degrees of freedom present in manual MIS as well as wrist joints located at the surgical end-effector. The RAVEN surgical robot system has the ability to teleoperate utilizing a single bi-directional UDP socket via a remote master device. Preliminary telesurgery experiments were conducted using the RAVEN. The experiments illustrated the system’s ability to operate in extreme conditions using a variety of network settings.
Collapse
Affiliation(s)
- Mitchell J. H. Lum
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Diana C. W. Friedman
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Ganesh Sankaranarayanan
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Hawkeye King
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Kenneth Fodero
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Rainer Leuschke
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Blake Hannaford
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Jacob Rosen
- Department of Computer Engineering Baskin School of Engineering University of California Santa Cruz, CA 95064, USA, ,
| | - Mika N. Sinanan
- Department of Surgery, Center for Video Endoscopic Surgery, University of Washington, Seattle, WA 98195, USA,
| |
Collapse
|
47
|
|
48
|
|
49
|
Monsarrat N, Collinet P, Narducci F, Leblanc E, Vinatier D. [Robotic assistance in gynaecological surgery: State-of-the-art]. ACTA ACUST UNITED AC 2009; 37:415-24. [PMID: 19398363 DOI: 10.1016/j.gyobfe.2009.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 03/25/2009] [Indexed: 11/19/2022]
Abstract
From the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm which operates the laparoscope, to the robots Zeus and da Vinci, robotic assistance in gynaecological endoscopic surgery has continuously evolved for the last fifteen years or so. It has brought about new technical advancements: the last generation robots offer a steady three-dimensional image, improved instrument dexterity and precision, higher ergonomics and comfort for the surgeon. The da Vinci robotic system has been used without evincing any specific morbidity in various cases, notably for tubal reanastomosis, myomectomy, hysterectomy, pelvic and para-aortic lymphadenectomy or sacrocolpopexy amongst others. Robotic assistance in gynaecology is thus feasible. Like conventional laparoscopic surgery, it allows decreased blood loss and morbidity as well as shorter hospital stay, as compared to laparotomy. It might indeed allow many surgical teams to perform minimally invasive surgical procedures which they were not used to performing by laparoscopy. Randomized prospective studies are needed to define its indications more precisely. Besides, its medico-financial impact should be evaluated too.
Collapse
Affiliation(s)
- N Monsarrat
- Pôle de gynécologie-obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
| | | | | | | | | |
Collapse
|
50
|
|