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Senatore AM, Mongelli F, Mion FU, Lucchelli M, Garofalo F. Costs of Robotic and Laparoscopic Bariatric Surgery: A Retrospective Propensity Score-matched Analysis. Obes Surg 2024:10.1007/s11695-024-07477-x. [PMID: 39190261 DOI: 10.1007/s11695-024-07477-x] [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: 04/22/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Robotic bariatric surgery has not shown significant advantages compared to laparoscopy, yet costs remain a major concern. The aim of our study was to assess costs of robotic and laparoscopic bariatric surgery. MATERIALS AND METHODS We retrospectively collected data of all patients who underwent either robotic or laparoscopic bariatric surgery at our institution. We retrieved demographics, clinical characteristics, postoperative data, and costs using a bottom-up approach. The primary endpoint was hospital costs in the robotic and laparoscopic groups. Data was analyzed using a propensity score matching. RESULTS Out of the total 122 patients enrolled in the study, 42 were subsequently chosen based on propensity scores, with 21 patients allocated to each group. No difference in clinical characteristics and postoperative outcomes were noted. Length of hospital stay was 2.4 ± 0.7 days vs. 2.6 ± 1.1 days (p = 0.520). In the robotic and laparoscopic groups, total costs were USD 16,275 ± 4018 vs. 12,690 ± 2834 (absolute difference USD 3585, 95%CI 1416-5753, p = 0.002), direct costs were USD 5037 ± 1282 vs. 3720 ± 1308 (absolute difference USD 1316, 95% CI 509-2214, p = 0.002), and indirect costs were USD 11,238 ± 3234 vs. 8970 ± 3021 (absolute difference USD 2,268, 95% CI 317-4220, p = 0.024). Subgroup analyses revealed a decreasing trend in the cost difference in patients undergoing primary gastric bypass and revisional surgery. CONCLUSIONS Overall hospital costs were higher in patients operated on with the robotic system than with laparoscopy, yet a clinical advantage has not been demonstrated so far. Subgroup analyses showed lesser disparity in costs among patients undergoing revisional bariatric surgery, where robotics are likely to be more worthwhile.
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Affiliation(s)
- Anna M Senatore
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via la Santa 1, 6900, Lugano, Switzerland.
| | - Federico U Mion
- Finance Department, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Massimo Lucchelli
- Finance Department, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
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Nare M, Jurewicz K. Assessing Patient Trust in Automation in Health Care Systems: Within-Subjects Experimental Study. JMIR Hum Factors 2024; 11:e48584. [PMID: 39106096 PMCID: PMC11336498 DOI: 10.2196/48584] [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: 04/30/2023] [Revised: 10/11/2023] [Accepted: 12/15/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Health care technology has the ability to change patient outcomes for the betterment when designed appropriately. Automation is becoming smarter and is increasingly being integrated into health care work systems. OBJECTIVE This study focuses on investigating trust between patients and an automated cardiac risk assessment tool (CRAT) in a simulated emergency department setting. METHODS A within-subjects experimental study was performed to investigate differences in automation modes for the CRAT: (1) no automation, (2) automation only, and (3) semiautomation. Participants were asked to enter their simulated symptoms for each scenario into the CRAT as instructed by the experimenter, and they would automatically be classified as high, medium, or low risk depending on the symptoms entered. Participants were asked to provide their trust ratings for each combination of risk classification and automation mode on a scale of 1 to 10 (1=absolutely no trust and 10=complete trust). RESULTS Results from this study indicate that the participants significantly trusted the semiautomation condition more compared to the automation-only condition (P=.002), and they trusted the no automation condition significantly more than the automation-only condition (P=.03). Additionally, participants significantly trusted the CRAT more in the high-severity scenario compared to the medium-severity scenario (P=.004). CONCLUSIONS The findings from this study emphasize the importance of the human component of automation when designing automated technology in health care systems. Automation and artificially intelligent systems are becoming more prevalent in health care systems, and this work emphasizes the need to consider the human element when designing automation into care delivery.
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Affiliation(s)
- Matthew Nare
- School of Industrial Engineering and Management, Oklahoma State University, Stillwater, OK, United States
| | - Katherina Jurewicz
- School of Industrial Engineering and Management, Oklahoma State University, Stillwater, OK, United States
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3
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Antarvedi Goda B, Ma Z, Fregonese S, Bacca M. Cutting soft matter: scaling relations controlled by toughness, friction, and wear. SOFT MATTER 2024. [PMID: 39028024 DOI: 10.1039/d4sm00279b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Cutting mechanics of soft solids is gaining rapid attention thanks to its promising benefits in material characterization and other applications. However, a full understanding of the physical phenomena is still missing, and several questions remain outstanding. E.g.: How can we directly and reliably measure toughness from cutting experiments? What is the role of blade sharpness? In this paper, we explore the simple problem of wire cutting, where blade sharpness is only defined by the wire radius. Through finite element analysis, we obtain a simple scaling relation between the wire radius and the steady-state cutting force per unit sample thickness. The cutting force is independent of the wire radius if the latter is below a transition length, while larger radii produce a linear force-radius correlation. The minimum cutting force, for small radii, is given by cleavage toughness, i.e., the surface energy required to break covalent bonds in the crack plane. The force-radius slope is instead given by the wear shear strength in the material. Via cutting experiments on polyacrylamide gels, we find that the magnitude of shear strength is close to the work of fracture of the material, i.e., the critical strain energy density required to break a pristine sample in uniaxial tension. The work of fracture characterizes the toughening contribution from the fracture process zone (FPZ), which adds to cleavage toughness. Our study provides two important messages, that answer the above questions: toughness can be estimated from wire-cutting experiments from the intercept of the force-radius linear correlation, as previously explored. However, as we discovered, this only estimates cleavage toughness. Additionally, the force-radius slope is correlated with the work of fracture, giving an estimation of the dissipative contributions from the FPZ.
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Affiliation(s)
- Bharath Antarvedi Goda
- Mechanical Engineering Department, University of British Columbia, Vancouver, BC V6T1Z4, Canada.
| | - Zhenwei Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | - Stefano Fregonese
- Mechanical Engineering Department, University of British Columbia, Vancouver, BC V6T1Z4, Canada.
| | - Mattia Bacca
- Mechanical Engineering Department, University of British Columbia, Vancouver, BC V6T1Z4, Canada.
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Handa A, Gaidhane A, Choudhari SG. Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges. Cureus 2024; 16:e62958. [PMID: 39050344 PMCID: PMC11265954 DOI: 10.7759/cureus.62958] [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: 04/16/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.
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Affiliation(s)
- Alisha Handa
- Community Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sonali G Choudhari
- School of Epidemiology and Public Health, Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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de’Angelis N, Marchegiani F, Martínez-Pérez A, Biondi A, Pucciarelli S, Schena CA, Pellino G, Kraft M, van Lieshout AS, Morelli L, Valverde A, Lupinacci RM, Gómez-Abril SA, Persiani R, Tuynman JB, Espin-Basany E, Ris F. Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study. BJS Open 2024; 8:zrae044. [PMID: 38805357 PMCID: PMC11132137 DOI: 10.1093/bjsopen/zrae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/11/2024] [Accepted: 04/01/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME). METHODS Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival. RESULTS A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival. CONCLUSION In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.
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Affiliation(s)
- Nicola de’Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Annabel S van Lieshout
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alain Valverde
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Renato Micelli Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Segundo A Gómez-Abril
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eloy Espin-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frederic Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. APPLIED ERGONOMICS 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [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: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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7
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Adhikari K, Penmetsa GK, Krishnappa D, Taori R, Raghunath SK. Revolutionizing urology: the advancements and applications of robotic platforms. J Robot Surg 2024; 18:106. [PMID: 38436766 DOI: 10.1007/s11701-023-01758-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: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 03/05/2024]
Abstract
Robot-assisted surgery is developing as an acme of minimally invasive surgery, given its utmost dominance over laparoscopic surgery. The objective was to review the status of robotic surgery in urological practice with its advantages and disadvantages in current scenario. We conducted a literature search using MEDLINE and identified 72 articles which were relevant to urology. Single-port and various multiport robotic platforms like Da Vinci, Versius, Hugo RAS, Revo-I, Senhance, Mantra, Avatera, Hinotori, and MicroSurge are described with pros and cons. With a surge in different medical surgical robots purging into the market and a race to become the next standard of care in robotic surgery, it is only a matter of time when robotic surgery becomes financially comparable to laparoscopic surgeries.
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Affiliation(s)
- Kinju Adhikari
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | | | - Deepak Krishnappa
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | - Ravi Taori
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | - S K Raghunath
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India.
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8
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Mokhtari L, Hosseinzadeh F, Nourazarian A. Biochemical implications of robotic surgery: a new frontier in the operating room. J Robot Surg 2024; 18:91. [PMID: 38401027 DOI: 10.1007/s11701-024-01861-6] [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: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.
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Affiliation(s)
- Leila Mokhtari
- Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran.
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9
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Read MD, Torikashvili J, Janjua H, Grimsley EA, Kuo PC, Docimo S. The downtrending cost of robotic bariatric surgery: a cost analysis of 47,788 bariatric patients. J Robot Surg 2024; 18:63. [PMID: 38308699 DOI: 10.1007/s11701-023-01809-2] [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: 11/12/2023] [Accepted: 12/23/2023] [Indexed: 02/05/2024]
Abstract
The surgical robot is assumed to be a fixed, indirect cost. We hypothesized rising volume of robotic bariatric procedures would decrease cost per patient over time. Patients who underwent elective, initial gastric bypass (GB) or sleeve gastrectomy (SG) for morbid obesity were selected from Florida Agency for Health Care Administration database from 2017 to 2021. Inflation-adjusted cost per patient was collected. Cost-over-time ($/patient year) and change in cost-over-time were calculated for open, laparoscopic, and robotic cases. Linear regression on cost generated predictive parameters. Density plots utilizing area under the curve demonstrated cost overlap. Among 76 hospitals, 11,472 bypasses (223 open, 6885 laparoscopic, 4364 robotic) and 36,316 sleeves (26,596 laparoscopic, 9724 robotic) were included. Total cost for robotic was approximately 1.5-fold higher (p < 0.001) than laparoscopic for both procedures. For GB, laparoscopic had lower total ($15,520) and operative ($6497) average cost compared to open (total $17,779; operative $9273) and robotic (total $21,756; operative $10,896). For SG, laparoscopic total cost was significantly less than robotic ($10,691 vs. $16,393). Robotic GB cost-over-time increased until 2021, when there was a large decrease in cost (-$944, compared with 2020). Robotic SG total cost-over time fluctuated, but decreased significantly in 2021 (-$490 compared with 2020). While surgical costs rose significantly in 2020 for bariatric procedures, our study suggests a possible downward trend in robotic bariatric surgery as total and operative costs are decreasing at a higher rate than laparoscopic costs.
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Affiliation(s)
- Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Johnathan Torikashvili
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA.
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10
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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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11
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [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: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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12
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Baghdadi A, Guo E, Lama S, Singh R, Chow M, Sutherland GR. Force Profile as Surgeon-Specific Signature. ANNALS OF SURGERY OPEN 2023; 4:e326. [PMID: 37746608 PMCID: PMC10513276 DOI: 10.1097/as9.0000000000000326] [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: 01/27/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the notion that a surgeon's force profile can be the signature of their identity and performance. Summary background data Surgeon performance in the operating room is an understudied topic. The advent of deep learning methods paired with a sensorized surgical device presents an opportunity to incorporate quantitative insight into surgical performance and processes. Using a device called the SmartForceps System and through automated analytics, we have previously reported surgeon force profile, surgical skill, and task classification. However, an investigation of whether an individual surgeon can be identified by surgical technique has yet to be studied. Methods In this study, we investigate multiple neural network architectures to identify the surgeon associated with their time-series tool-tissue forces using bipolar forceps data. The surgeon associated with each 10-second window of force data was labeled, and the data were randomly split into 80% for model training and validation (10% validation) and 20% for testing. Data imbalance was mitigated through subsampling from more populated classes with a random size adjustment based on 0.1% of sample counts in the respective class. An exploratory analysis of force segments was performed to investigate underlying patterns differentiating individual surgical techniques. Results In a dataset of 2819 ten-second time segments from 89 neurosurgical cases, the best-performing model achieved a micro-average area under the curve of 0.97, a testing F1-score of 0.82, a sensitivity of 82%, and a precision of 82%. This model was a time-series ResNet model to extract features from the time-series data followed by a linearized output into the XGBoost algorithm. Furthermore, we found that convolutional neural networks outperformed long short-term memory networks in performance and speed. Using a weighted average approach, an ensemble model was able to identify an expert surgeon with 83.8% accuracy using a validation dataset. Conclusions Our results demonstrate that each surgeon has a unique force profile amenable to identification using deep learning methods. We anticipate our models will enable a quantitative framework to provide bespoke feedback to surgeons and to track their skill progression longitudinally. Furthermore, the ability to recognize individual surgeons introduces the mechanism of correlating outcome to surgeon performance.
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Affiliation(s)
- Amir Baghdadi
- From the Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute University of Calgary, Calgary, Alberta, Canada
| | - Eddie Guo
- From the Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute University of Calgary, Calgary, Alberta, Canada
| | - Sanju Lama
- From the Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute University of Calgary, Calgary, Alberta, Canada
| | - Rahul Singh
- From the Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute University of Calgary, Calgary, Alberta, Canada
| | - Michael Chow
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Garnette R. Sutherland
- From the Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute University of Calgary, Calgary, Alberta, Canada
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13
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Marchegiani F, Siragusa L, Zadoroznyj A, Laterza V, Mangana O, Schena CA, Ammendola M, Memeo R, Bianchi PP, Spinoglio G, Gavriilidis P, de'Angelis N. New Robotic Platforms in General Surgery: What's the Current Clinical Scenario? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1264. [PMID: 37512075 PMCID: PMC10386395 DOI: 10.3390/medicina59071264] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Orsalia Mangana
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, 88100 Catanzaro, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Giuseppe Spinoglio
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, Saint Helena STHL 1ZZ, South Atlantic Ocean, UK
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
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14
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Van Lewen D, Janke T, Austin R, Lee H, Billatos E, Russo S. A Millimeter-Scale Soft Robot for Tissue Biopsy Procedures. ADVANCED INTELLIGENT SYSTEMS (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 5:2200326. [PMID: 37637939 PMCID: PMC10456987 DOI: 10.1002/aisy.202200326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 08/29/2023]
Abstract
While interest in soft robotics as surgical tools has grown due to their inherently safe interactions with the body, their feasibility is limited in the amount of force that can be transmitted during procedures. This is especially apparent in minimally invasive procedures where millimeter-scale devices are necessary for reaching the desired surgical site, such as in interventional bronchoscopy. To leverage the benefits of soft robotics in minimally invasive surgery, a soft robot with integrated tip steering, stabilization, and needle deployment capabilities is proposed for lung tissue biopsy procedures. Design, fabrication, and modeling of the force transmission of this soft robotic platform allows for integration into a system with a diameter of 3.5 mm. Characterizations of the soft robot are performed to analyze bending angle, force transmission, and expansion during needle deployment. In-vitro experiments of both the needle deployment mechanism and fully integrated soft robot validate the proposed workflow and capabilities in a simulated surgical setting.
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Affiliation(s)
- Daniel Van Lewen
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215 USA
| | - Taylor Janke
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215 USA
| | - Ryan Austin
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215 USA
| | - Harin Lee
- Department of Biomedical Engineering, Boston University, Boston, MA 02215 USA
| | - Ehab Billatos
- Boston Medical Center, Boston University School of Medicine, Boston, MA 02118 USA
| | - Sheila Russo
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215 USA, Division of Materials Science and Engineering, Boston University, Boston, MA 02215 USA
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15
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Hamza H, Baez VM, Al-Ansari A, Becker AT, Navkar NV. User interfaces for actuated scope maneuvering in surgical systems: a scoping review. Surg Endosc 2023:10.1007/s00464-023-09981-0. [DOI: 10.1007/s00464-023-09981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
A variety of human computer interfaces are used by robotic surgical systems to control and actuate camera scopes during minimally invasive surgery. The purpose of this review is to examine the different user interfaces used in both commercial systems and research prototypes.
Methods
A comprehensive scoping review of scientific literature was conducted using PubMed and IEEE Xplore databases to identify user interfaces used in commercial products and research prototypes of robotic surgical systems and robotic scope holders. Papers related to actuated scopes with human–computer interfaces were included. Several aspects of user interfaces for scope manipulation in commercial and research systems were reviewed.
Results
Scope assistance was classified into robotic surgical systems (for multiple port, single port, and natural orifice) and robotic scope holders (for rigid, articulated, and flexible endoscopes). Benefits and drawbacks of control by different user interfaces such as foot, hand, voice, head, eye, and tool tracking were outlined. In the review, it was observed that hand control, with its familiarity and intuitiveness, is the most used interface in commercially available systems. Control by foot, head tracking, and tool tracking are increasingly used to address limitations, such as interruptions to surgical workflow, caused by using a hand interface.
Conclusion
Integrating a combination of different user interfaces for scope manipulation may provide maximum benefit for the surgeons. However, smooth transition between interfaces might pose a challenge while combining controls.
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16
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Khajeh E, Aminizadeh E, Dooghaie Moghadam A, Nikbakhsh R, Goncalves G, Carvalho C, Parvaiz A, Kulu Y, Mehrabi A. Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery. Cancers (Basel) 2023; 15:cancers15030839. [PMID: 36765797 PMCID: PMC9913667 DOI: 10.3390/cancers15030839] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
With increasing trends for the adoption of robotic surgery, many centers are considering changing their practices from open or laparoscopic to robot-assisted surgery for rectal cancer. We compared the outcomes of robot-assisted rectal resection with those of open and laparoscopic surgery. We searched Medline, Web of Science, and CENTRAL databases until October 2022. All randomized controlled trials (RCTs) and prospective studies comparing robotic surgery with open or laparoscopic rectal resection were included. Fifteen RCTs and 11 prospective studies involving 6922 patients were included. The meta-analysis revealed that robotic surgery has lower blood loss, less surgical site infection, shorter hospital stays, and higher negative resection margins than open resection. Robotic surgery also has lower conversion rates, lower blood loss, lower rates of reoperation, and higher negative circumferential margins than laparoscopic surgery. Robotic surgery had longer operation times and higher costs than open and laparoscopic surgery. There were no differences in other complications, mortality, and survival between robotic surgery and the open or laparoscopic approach. However, heterogeneity between studies was moderate to high in some analyses. The robotic approach can be the method of choice for centers planning to change from open to minimally invasive rectal surgery. The higher costs of robotic surgery should be considered as a substitute for laparoscopic surgery (PROSPERO: CRD42022381468).
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Affiliation(s)
- Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Ehsan Aminizadeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Rajan Nikbakhsh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Gil Goncalves
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Department of Oncology, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Amjad Parvaiz
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-5636223
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Farnum A, Parnas M, Hoque Apu E, Cox E, Lefevre N, Contag CH, Saha D. Harnessing insect olfactory neural circuits for detecting and discriminating human cancers. Biosens Bioelectron 2023; 219:114814. [PMID: 36327558 DOI: 10.1016/j.bios.2022.114814] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
There is overwhelming evidence that presence of cancer alters cellular metabolic processes, and these changes are manifested in emitted volatile organic compound (VOC) compositions of cancer cells. Here, we take a novel forward engineering approach by developing an insect olfactory neural circuit-based VOC sensor for cancer detection. We obtained oral cancer cell culture VOC-evoked extracellular neural responses from in vivo insect (locust) antennal lobe neurons. We employed biological neural computations of the antennal lobe circuitry for generating spatiotemporal neuronal response templates corresponding to each cell culture VOC mixture, and employed these neuronal templates to distinguish oral cancer cell lines (SAS, Ca9-22, and HSC-3) vs. a non-cancer cell line (HaCaT). Our results demonstrate that three different human oral cancers can be robustly distinguished from each other and from a non-cancer oral cell line. By using high-dimensional population neuronal response analysis and leave-one-trial-out methodology, our approach yielded high classification success for each cell line tested. Our analyses achieved 76-100% success in identifying cell lines by using the population neural response (n = 194) collected for the entire duration of the cell culture study. We also demonstrate this cancer detection technique can distinguish between different types of oral cancers and non-cancer at different time-matched points of growth. This brain-based cancer detection approach is fast as it can differentiate between VOC mixtures within 250 ms of stimulus onset. Our brain-based cancer detection system comprises a novel VOC sensing methodology that incorporates entire biological chemosensory arrays, biological signal transduction, and neuronal computations in a form of a forward-engineered technology for cancer VOC detection.
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Affiliation(s)
- Alexander Farnum
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Michael Parnas
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Ehsanul Hoque Apu
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Elyssa Cox
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Noël Lefevre
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Christopher H Contag
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Debajit Saha
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA.
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18
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Lawrie L, Gillies K, Davies L, Torkington J, McGrath J, Kerr R, Immanuel A, Campbell M, Beard D. Current issues and future considerations for the wider implementation of robotic-assisted surgery: a qualitative study. BMJ Open 2022; 12:e067427. [PMID: 36368747 PMCID: PMC9660630 DOI: 10.1136/bmjopen-2022-067427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effective implementation of a fast-changing healthcare delivery innovation, such as robotic-assisted surgery (RAS), into a healthcare system, can be affected (both positively and negatively) by external contextual factors. As part of a wider project investigating ways to optimise the implementation of RAS, this qualitative study aimed to uncover current issues of RAS and predictions about the future of robotic surgery. We refer to 'current issues' as the topical and salient challenges and opportunities related to the introduction of RAS in the UK healthcare system, from the perspectives of key stakeholders involved in the delivery and implementation of RAS. DESIGN Semi-structured interviews and focus groups were conducted. A thematic analysis was conducted to summarise salient issues that were articulated by the participants. SETTING AND PARTICIPANTS The interview sample (n=35) comprised surgeons, wider theatre staff and other relevant personnel involved in the introduction and delivery of RAS services across the UK, including service managers and policymakers/commissioners. Two focus groups were also conducted with surgical trainees (n=7) and members of the public (n=8), respectively. RESULTS The results revealed a largely positive attitude towards the introduction of RAS technology and an expectation of continued rapid expansion. Areas perceived to be particularly pertinent and requiring ongoing attention were also highlighted, including the need to achieve improved quality control, expertise quantification and training issues and the need to educate the public. Issues of centralisation, service organisation and equity of access were also emphasised. CONCLUSIONS Our study has highlighted a range of issues perceived to be particularly pertinent to the current and future provision of RAS which should be addressed. The areas outlined can enable healthcare managers and surgeons to plan for the adoption and/or expansion of RAS services.
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Affiliation(s)
- Louisa Lawrie
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Loretta Davies
- RCS Surgical Interventional Trials Unit (SITU), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
| | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Richard Kerr
- Department of Neurosurgery, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Arul Immanuel
- Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Marion Campbell
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David Beard
- RCS Surgical Interventional Trials Unit (SITU), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
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19
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Bramhe S, Pathak SS. Robotic Surgery: A Narrative Review. Cureus 2022; 14:e29179. [PMID: 36258968 PMCID: PMC9573327 DOI: 10.7759/cureus.29179] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
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Pazhouhnia Z, Beheshtizadeh N, Namini MS, Lotfibakhshaiesh N. Portable hand-held bioprinters promote in situ tissue regeneration. Bioeng Transl Med 2022; 7:e10307. [PMID: 36176625 PMCID: PMC9472017 DOI: 10.1002/btm2.10307] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 12/17/2022] Open
Abstract
Three-dimensional bioprinting, as a novel technique of fabricating engineered tissues, is positively correlated with the ultimate goal of regenerative medicine, which is the restoration, reconstruction, and repair of lost and/or damaged tissue function. The progressive trend of this technology resulted in developing the portable hand-held bioprinters, which could be used quite easily by surgeons and physicians. With the advent of portable hand-held bioprinters, the obstacles and challenges of utilizing statistical bioprinters could be resolved. This review attempts to discuss the advantages and challenges of portable hand-held bioprinters via in situ tissue regeneration. All the tissues that have been investigated by this approach were reviewed, including skin, cartilage, bone, dental, and skeletal muscle regeneration, while the tissues that could be regenerated via this approach are targeted in the authors' perspective. The design and applications of hand-held bioprinters were discussed widely, and the marketed printers were introduced. It has been prospected that these facilities could ameliorate translating the regenerative medicine science from the bench to the bedside actively.
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Affiliation(s)
- Zahra Pazhouhnia
- Department of Tissue EngineeringSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehranIran
- Regenerative Medicine group (REMED)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Nima Beheshtizadeh
- Department of Tissue EngineeringSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehranIran
- Regenerative Medicine group (REMED)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Mojdeh Salehi Namini
- Department of Tissue EngineeringSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehranIran
- Regenerative Medicine group (REMED)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Nasrin Lotfibakhshaiesh
- Department of Tissue EngineeringSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehranIran
- Regenerative Medicine group (REMED)Universal Scientific Education and Research Network (USERN)TehranIran
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Barriers and enablers to the effective implementation of robotic assisted surgery. PLoS One 2022; 17:e0273696. [PMID: 36037179 PMCID: PMC9423619 DOI: 10.1371/journal.pone.0273696] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Implementation of Robotic Assisted Surgery (RAS) is complex as it requires adjustments to associated physical infrastructure, but also changes to processes and behaviours. With the global objective of optimising and improving RAS implementation, this study aimed to: 1) Explore the barriers and enablers to RAS service adoption, incorporating an assessment of behavioural influences; 2) Provide an optimised plan for effective RAS implementation, with the incorporation of theory-informed implementation strategies that have been adapted to address the barriers/enablers that affect RAS service adoption. Methods Semi-structured interviews were conducted with RAS personnel and stakeholders, including: surgeons, theatre staff, managers, industry representatives, and policy-makers/commissioners. The Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) was used to identify barriers and enablers that represent individual behaviours, capabilities, attitudes, beliefs, and external organisational factors that influence the implementation of RAS. Results Findings suggest that implementation planning has three separate phases–pre-, early, and late implementation. For pre-implementation, barriers and enablers identified included the cost of RAS equipment and issues of economic viability, weak outcome evidence for RAS, a preponderance of an eminence driven model, the clinician/manager relationship, and views around the uptake and expansion of RAS in the future. Early implementation findings revealed role changes for theatre personnel and an enhanced team approach, reliance on industry for training provision, and changes in skill sets and attentional processes. Late implementation factors included equipment maintenance costs, technological limitations, changes to cognition during RAS routine use, and benefits to institutions/healthcare professionals (such as ergonomic improvement). Conclusion Together, findings suggest the factors that affect RAS implementation are multi-faceted and change across the life-cycle of intervention adoption. Theory-informed strategies are suggested which can optimise implementation of RAS. Optimisation strategies need planning from the outset.
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Mo H, Li X, Ouyang B, Fang G, Jia Y. Task Autonomy of a Flexible Endoscopic System for Laser-Assisted Surgery. CYBORG AND BIONIC SYSTEMS 2022; 2022:9759504. [PMID: 38616915 PMCID: PMC11014730 DOI: 10.34133/2022/9759504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/01/2022] [Indexed: 04/16/2024] Open
Abstract
Laser beam steering has been widely studied for the automation of surgery. Currently, flexible instruments for laser surgery are operated entirely by surgeons, which keeps the automation of endoluminal surgery at the initial level. This paper introduces the design of a new workflow that enables the task autonomy of laser-assisted surgery in constrained environments such as the gastrointestinal (GI) tract with a flexible continuum robotic system. Unlike current, laser steering systems driven by piezoelectric require the use of high voltage and are risky. This paper describes a tendon-driven 2 mm diameter flexible manipulator integrated with an endoscope to steer the laser beam. By separating its motion from the total endoscopic system, the designed flexible manipulator can automatically manipulate the laser beam. After the surgical site is searched by the surgeon with a master/slave control, a population-based model-free control method is applied for the flexible manipulator to achieve accurate laser beam steering while overcoming the noise from the visual feedback and disturbances from environment during operation. Simulations and experiments are performed with the system and control methods to demonstrate the proposed framework in a simulated constrained environment.
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Affiliation(s)
- Hangjie Mo
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering, Hong KongChina
| | - Xiaojian Li
- School of Management, Hefei University of Technology, Hefei, China
| | - Bo Ouyang
- School of Management, Hefei University of Technology, Hefei, China
| | - Ge Fang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Yuanjun Jia
- Department of Automation, University of Science and Technology of China, Hefei, China
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Abstract
Abstract
Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.
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24
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Cepolina F, Razzoli RP. An introductory review of robotically assisted surgical systems. Int J Med Robot 2022; 18:e2409. [PMID: 35476899 PMCID: PMC9540802 DOI: 10.1002/rcs.2409] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 12/28/2022]
Abstract
Purpose The scope of the work is to present the state of the art of robotically assisted surgical systems and to give a general idea about how technology can help today and tomorrow robotic surgery. The road to innovation passes through research and on field trials; for this reason, not only commercial surgery robots, but also innovative prototype robots, proposed by the Academic world, are presented. Design/methodology/approach Following a short introduction, robotically assisted surgery systems are introduced discussing their architectures and main peculiarities. A further section is dedicated to the key enabling technologies that will make possible to improve current systems and that will lead to a new generation of surgical robotic systems able to meet the patient's needs and facilitate the surgeon's task. Finally, brief concluding comments are given. Findings The idea of using robots for surgery was born many years ago and in a short time a market demand was created. Today the market is very dynamic, and several new products are updated and created for the execution of both traditional and new procedures. The article provides a guide for the reader who has an interest in this area. Originality/value This paper provides an insight into the commercial robotic surgical systems and a look on research prototypes from academic and industrial worlds.
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Affiliation(s)
- Francesco Cepolina
- Department of Mechanical Engineering, Energy, Production, Transport and Mathematical Models (DIME) University of Genoa Genova Italy
| | - Roberto P. Razzoli
- Department of Mechanical Engineering, Energy, Production, Transport and Mathematical Models (DIME) University of Genoa Genova Italy
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Chung DG, Hwang M, Cheon B, Kong D, Kang D, Lee D, Kim C, Kim D, Han JM, Kim Y, Kwon D. Bed‐mounted laparoscopic surgical robot system with novel positioning arm mechanism. Int J Med Robot 2022; 18:e2402. [DOI: 10.1002/rcs.2402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022]
Affiliation(s)
| | - Minho Hwang
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu Republic of Korea
| | | | - Dukyoo Kong
- EasyEndo Surgical Inc Daejeon Republic of Korea
| | - DongHoon Kang
- Department of Mechanical Engineering Korea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea
| | - Dong‐Ho Lee
- EasyEndo Surgical Inc Daejeon Republic of Korea
| | | | - Duksang Kim
- EasyEndo Surgical Inc Daejeon Republic of Korea
| | | | | | - Dong‐Soo Kwon
- EasyEndo Surgical Inc Daejeon Republic of Korea
- Department of Mechanical Engineering Korea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea
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Design of a Magnetically Anchored Laparoscope Using Miniature Ultrasonic Motors. MICROMACHINES 2022; 13:mi13060855. [PMID: 35744469 PMCID: PMC9230738 DOI: 10.3390/mi13060855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023]
Abstract
Images taken by an endoscope in single-port-access surgery are the most important information for directing surgeons to operate, so acquiring images taken at better position and a more desired perspective has profound significance for improving the efficiency and safety of surgery. The magnetically anchored laparoscope can help to realize this goal compared with the traditional laparoscope used in single-port-access surgery. In this paper, we propose the concept of applying ultrasonic motors in the magnetically anchored laparoscope. Two types of ultrasonic motors used for driving the laparoscope, namely a miniature traveling wave-rotating ultrasonic motor and a miniature traveling wave-tilt ultrasonic motor, are designed. The prototype of the magnetically anchored laparoscope using these two types of ultrasonic motors is fabricated and evaluated by experiments. The results show that the maximum output torque of the miniature traveling wave-rotating ultrasonic motor is 1.2 mN·m, and that of the miniature traveling wave-tilt ultrasonic motor is 1.4 mN·m, which is enough to actuate the magnetically anchored laparoscope. Additionally, it is proven that the two designed ultrasonic motors can be applied successfully in the laparoscope.
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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.
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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
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Robot-assisted techniques in vascular and endovascular surgery. Langenbecks Arch Surg 2022; 407:1789-1795. [PMID: 35226179 PMCID: PMC8884093 DOI: 10.1007/s00423-022-02465-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023]
Abstract
For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.
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29
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Kang YH, Kang JS, Cho YS, Kim HS, Lee M, Han Y, Sohn HJ, Kim H, Kwon W, Jang JY, Lee HK. A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system. Int J Med Robot 2021; 18:e2345. [PMID: 34676970 DOI: 10.1002/rcs.2345] [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: 05/23/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Single-incision robotic cholecystectomy (SIRC) is widely performed with both the da Vinci Xi system (Xi) and the da Vinci SP system (SP). But there are limited numbers of studies comparing these platforms. METHODS Patients who underwent SIRC between 2019 and 2020 were enrolled. Patient demographics, intraoperative factors, postoperative complications, postoperative pain were compared using a one-to-one propensity score matching (PSM). RESULTS Overall, 258 patients underwent SIRC with Xi and 72 with SP. After PSM, there were significant differences between the Xi and SP in operation time at console and numeric rating scale for postoperative pain, but no difference in total operation time and postoperative complications. The SP group showed more estimated blood loss. CONCLUSIONS Despite the statistical difference, clinical benefit was not significant. Both platforms can be safe and feasible to perform SIRC, but further investigation including the surgeon's workload and ergonomics is needed as a prospective study.
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Affiliation(s)
- Yoon Hyung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yo Seok Cho
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Seok Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mirang Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Ju Sohn
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Adasonla K, Quraishi MK, Samateh A, Tregunna R, Calleja E, Rimington PD. Robotic-assisted laparoscopic retrieval of a migrated IUCD in the pelvis. J Surg Case Rep 2021; 2021:rjab268. [PMID: 34234942 PMCID: PMC8257259 DOI: 10.1093/jscr/rjab268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022] Open
Abstract
Intrauterine contraceptive devices (IUCDs) are a popular treatment choice for contraception. We report a case of a woman in her forties who presented to a urology clinic with visible haematuria. Flexible cystoscopy revealed a bladder lesion, suspicious for a tumour. However, subsequent imaging determined that this was in fact the arm of an IUCD, sited 7 years previously, which had migrated into the bladder. The patient underwent an uneventful robotic-assisted laparoscopic removal of the device. IUCD-related complications are infrequent and can present atypically, warranting a broad diagnostic approach. Robotic-assisted laparoscopic removal of devices migrating into pelvic structures offers all the advantages of minimally invasive surgery, with the added benefits of three-dimensional views and endowrist movement facilitating tasks such as intracorporeal suturing. We report the first documented case of utilizing the da Vinci robotic system in safely assisting the removal of a migrated IUCD.
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Affiliation(s)
- Kelvin Adasonla
- Department of Urology, Eastbourne District General Hospital, Eastbourne, UK
| | | | - Abdoulai Samateh
- Department of Urology, Eastbourne District General Hospital, Eastbourne, UK
| | - Rebecca Tregunna
- Department of Urology, Eastbourne District General Hospital, Eastbourne, UK
| | - Edward Calleja
- Department of Urology, Eastbourne District General Hospital, Eastbourne, UK
| | - Peter D Rimington
- Department of Urology, Eastbourne District General Hospital, Eastbourne, UK
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Elnikety S, Badr E, Abdelaal A. Surgical training fit for the future: the need for a change. Postgrad Med J 2021; 98:820-823. [PMID: 33941663 PMCID: PMC9613864 DOI: 10.1136/postgradmedj-2021-139862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
Postgraduate training in surgical specialties is one of the longest training programmes in the medical field. Most of the surgical training programmes require 5–6 years of postgraduate training to become qualified. This is usually followed by 1–2 years of fellowship training in a subspecialised interest. This has been the case for the last 20–30 years with no significant change. The surgical practice is transforming quickly due to the advances in medical technology. This transformation is not matched in the postgraduate training, there is minimal exposure to the new technological advances in early years of postgraduate training. The current postgraduate training in surgical specialties is not fit for the future. Early exposure to robotic and artificial intelligence technologies is required. To achieve this, a significant transformation of surgical training is necessary, which requires a new vision and involves significant investment. We discuss the need for this transformation in the postgraduate surgical specialties training and analyse the threats and opportunities in relation to this transformation.
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Affiliation(s)
- Sherif Elnikety
- College of Medicine and Health Science, Department of Surgery, United Arab Emirates University, Al Ain, UAE
| | - Eman Badr
- Medical Education, University of Buckingham, Buckingham, UK
| | - Ahmed Abdelaal
- Trauma and Orthopaedics Department, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
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32
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Schreyer J, Koch A, Herlemann A, Becker A, Schlenker B, Catchpole K, Weigl M. RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings. Surg Endosc 2021; 36:1916-1926. [PMID: 33844085 PMCID: PMC8505574 DOI: 10.1007/s00464-021-08474-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08474-2.
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Affiliation(s)
- Julia Schreyer
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.
| | - Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Annika Herlemann
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,Institute for Patient Safety, University Hospital, Bonn University, Bonn, Germany
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Proposed training pathway with initial experience to set up robotic hepatobiliary and pancreatic service. J Robot Surg 2021; 16:65-71. [PMID: 33575862 DOI: 10.1007/s11701-021-01207-6] [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: 11/21/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
Although robot-assisted hepatobiliary and pancreatic (HPB) surgery has gained momentum over the last 2 decades, only a handful of units in the world perform major robotic resections. Adaptation of robotic surgery in the UK lags behind its European counterparts and this is mainly because of cost implications in a publicly funded National Health Service (NHS). We describe our experience of setting up a robotic HPB programme with clinical outcomes and propose a training pathway that would help prospective centres in setting up their own robotic HPB service with robust clinical governance oversight. After gaining colleagues' and departmental support, approval from the hospital clinical governance, finance department and new intervention procedure committee was sought. A team of two consultant surgeons, three assistants and three theatre staff went through a structured training programme sponsored mainly by the industry. Surgeon training consisted of online modules, simulation, wet lab, cadaveric training, case observations, proctored procedures followed by independent practice. All major cases were recorded and videos reviewed to improve performance. A total of 111 procedures were successfully completed with robotic assistance between April 2018 and March 2020. The programme started with robot-assisted cholecystectomy as index procedure and progressed on to more complex liver and pancreatic resections including major hepatectomy and Whipple's procedure. The training pathway followed by our team has been effective in setting up a safe robotic HPB programme and could be considered as a roadmap to start new Robotic HPB services.
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Devlin CM, Fowler S, Biyani CS, Forster JA. Changes in UK renal oncological surgical practice from 2008 to 2017: implications for cancer service provision and surgical training. BJU Int 2021; 128:206-217. [PMID: 33249738 DOI: 10.1111/bju.15310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine and analyse the temporal changes in oncological nephrectomy practice and training opportunities using data obtained from the UK British Association of Urological Surgeons nephrectomy register from 2008 to 2017. PATIENT AND METHODS All nephrectomies within the dataset for this time period were analysed (n = 54 251). Cases were divided into radical nephrectomy (RN), partial nephrectomy (PN) and nephroureterectomy (NU). Simple nephrectomy, donor nephrectomy and benign PN were excluded. The annual frequencies for each oncological nephrectomy method, surgical approach, grade of surgeon, hospital caseload numbers and short-term surgical outcomes were determined. RESULTS Reported annual nephrectomy numbers increased by 2.5-fold in the 9-year time period. The number of hospitals performing nephrectomies decreased by 22%, however, more than 40% of centres performed more than 70 cases a year. There was a trend towards a decrease in overall length of hospital stay (9 vs 5 days; P < 0.01) and decreased transfusion rates. The proportion of minimally invasive procedures increased from 57% to 75%, with nephron-sparing rates increasing from 8.9% overall to 24.8%. With regard to surgical technique, robot-assisted surgery saw a mean annual increase of 222%. Overall, there was a 10% decrease in the proportion of PNs performed by trainee surgeons. CONCLUSIONS Renal surgery has changed considerably with regard to volume and also surgical approach, with rates of nephron-sparing surgery and minimally invasive surgery significantly increasing. Increasing hospital centralization and institutional experience, and a shift to robot-assisted surgery appear to have contributed to the observed improved patient outcomes. The increasing utilization of robot-assisted surgery has potential implications and challenges for the training of future urology surgeons.
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Affiliation(s)
- Conor M Devlin
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James A Forster
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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Inoue T, Okada S, Hamamoto S, Fujisawa M. Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 2021; 62:121-135. [PMID: 33660439 PMCID: PMC7940851 DOI: 10.4111/icu.20200526] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan.,Department of Urology, Kobe University, Kobe, Hyogo, Japan.
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan
| | - Shuzo Hamamoto
- Department of Urology, Medical School, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Crippa J, Carvello M, Kotze PG, Spinelli A. Robotic Surgery in Inflammatory Bowel Disease. Curr Drug Targets 2020; 22:112-116. [PMID: 33109059 DOI: 10.2174/1389450121999200820125918] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/06/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgery is considered a cornerstone of inflammatory bowel disease (IBD) treatment. In the last years, robotic surgery has seen an increase in adoption rates for both benign and malignant diseases. OBJECTIVE This work aims to review the current applications of robotic surgery in IBD. DISCUSSION AND CONCLUSION Minimally-invasive techniques have been applied to the treatment of IBD for more than 20 years. Investments in surgical digital and robotic platforms are increasingly arising, with an estimate of getting doubled within the next 5 years. Robotic surgery represents the newest technology available to reduce the impact of surgery on patients affected by IBD, and may theoretically be even more effective than other minimally-invasive techniques given the lower rate of conversion to open surgery as compared to laparoscopy according to many large retrospective series. Data on robotic surgery applied to IBD are still scarce and initial experiences in high-volume centers from retrospective series suggested that robotic surgery may achieve similar results when compared to laparoscopy. A new wave of robotics incorporating artificial intelligence is awaited to empower the capability of IBD surgeon in terms of intraoperative decision-making beyond technical skill enhancement.
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Affiliation(s)
- Jacopo Crippa
- General surgery residency program, University of Milan, Milan, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Paulo Gustavo Kotze
- IBD outpatient clinics, Colorectal Surgery Unit, Catholic University of Parana (PUCPR), Curitiba, Brazil
| | - Antonino Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
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Omil-Lima DO, Gupta K, Calaway AC, Zell MA. Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy. Urol Clin North Am 2020; 48:35-44. [PMID: 33218592 DOI: 10.1016/j.ucl.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.
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Affiliation(s)
- Danly O Omil-Lima
- Urology Institute, University Hospitals-Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Karishma Gupta
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam C Calaway
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael A Zell
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Hangai S, Nozaki T, Soma T, Miyashita H, Asoda S, Yazawa M, Sato K, Kawana H, Ohnishi K, Kobayashi E. Development of a microsurgery-assisted robot for high-precision thread traction and tension control, and confirmation of its applicability. Int J Med Robot 2020; 17:e2205. [PMID: 33207394 PMCID: PMC7988610 DOI: 10.1002/rcs.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
Background Microsurgery requires high skills for suturing using fragile threads, often within narrow surgical fields. Precise tension is required for good healing and to avoid the risk of thread breakage. Methods To meet the demands, we developed a novel assist robot utilizing high‐precision sensorless haptic technology. The robot adopts a cable‐driven mechanism to maintain a distance from the surgical area and enhances compatibility with surgical equipment such as microscopes. The robot performance was verified through in vitro and in vivo experiments using a rat model. Results The realization of precise tension control was confirmed in both experiments. In particular, in the in vivo experiments, the developed robot succeeded to produce a knot with an accurate tension of 0.66% error. Conclusions The developed robot can realize to control traction force precisely. This technology might open up the window for a full assist robot for microsurgery with haptic feeling.
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Affiliation(s)
- Satoshi Hangai
- Department of System Design Engineering, Keio University, Minato, Tokyo, Japan
| | - Takahiro Nozaki
- Department of System Design Engineering, Keio University, Minato, Tokyo, Japan.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Tomoya Soma
- Department of Dentistry and Oral Surgery, Keio University, Minato, Tokyo, Japan
| | - Hidetaka Miyashita
- Department of Dentistry and Oral Surgery, Keio University, Minato, Tokyo, Japan
| | - Seiji Asoda
- Department of Dentistry and Oral Surgery, Keio University, Minato, Tokyo, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, Keio University, Minato, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiromasa Kawana
- Department of Dentistry and Oral Surgery, Keio University, Minato, Tokyo, Japan.,Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Kouhei Ohnishi
- Haptics Research Center, Keio University, Yokohama, Japan
| | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Jang JH, Kim CN. Robotic Total Mesorectal Excision for Rectal Cancer: Current Evidences and Future Perspectives. Ann Coloproctol 2020; 36:293-303. [PMID: 33207112 PMCID: PMC7714377 DOI: 10.3393/ac.2020.06.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
Despite the technical limitations of minimally invasive surgery, laparoscopic total mesorectal excision (LTME) for rectal cancer has short-term advantages over open surgery, but the pathological outcomes reported in randomized clinical trials are still in controversy. Minimally invasive robotic total mesorectal excision (RTME) has recently been gaining popularity as robotic surgical systems potentially provide greater benefits than LTME. Compared to LTME, RTME is associated with lower conversion rates and similar or better genitourinary functions, but its long-term oncological outcomes have not been established. Although the operating time of RTME is longer than that of LTME, RTME has a shorter learning curve, is more convenient for surgeons, and is better for sphincter-preserving operations than LTME. The robotic surgical system is a good technical tool for minimally invasive surgery for rectal cancer, especially in male patients with narrow deep pelvises. Robotic systems and robotic surgical techniques are still improving, and the contribution of RTME to the treatment of rectal cancer will continue to increase in the future.
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Affiliation(s)
- Je-Ho Jang
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Chang-Nam Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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Tunca F, Dural AC, Sahbaz NA, Akarsu C, Sormaz IC, Saygi Emir N, Guzey D, Giles Senyurek Y. Pure transoral robotic thyroidectomy; institutional adaptation and early results from a tertiary endocrine surgery centre. Int J Med Robot 2020; 16:1-8. [PMID: 32835431 DOI: 10.1002/rcs.2151] [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: 05/06/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Novel thyroidectomy techniques have been described to minimize the visible scar. Hereby, we aim to present our experience with transoral robotic thyroidectomy (TORT) without axillary access. MATERIAL AND METHODS Between August 2018 and March 2019, six eligible patients were enrolled to undergo TORT. Procedures were performed by using the Da Vinci Xi platform under intermittent intraoperative nerve monitoring. RESULTS All patients were female, and the mean age was 40.0 ± 14.4 years. Three patients underwent total thyroidectomy, and lobectomy was performed for the remaining three patients. In one patient, the procedure was converted to conventional open thyroidectomy due to bleeding. The mean docking time, console time and total operative time were 22.8 ± 5.2 min, 118.5 ± 48.7 min and 218.29 ± 50.6 min for total thyroidectomy and 21.8 ± 4.1 min, 68.6 ± 6.1 min and 177.6 ± 15.1 min for lobectomy, respectively. All patients were discharged uneventfully. CONCLUSIONS Pure TORT is a safe procedure, when performed in carefully selected patients by experienced surgeons, but further prospective studies with larger number of patients are required.
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Affiliation(s)
- Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cevher Akarsu
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Cem Sormaz
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nalan Saygi Emir
- Department of Anesthesiology, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Deniz Guzey
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Miller J, Braun M, Bilz J, Matich S, Neupert C, Kunert W, Kirschniak A. Impact of haptic feedback on applied intracorporeal forces using a novel surgical robotic system-a randomized cross-over study with novices in an experimental setup. Surg Endosc 2020; 35:3554-3563. [PMID: 32700151 PMCID: PMC8195941 DOI: 10.1007/s00464-020-07818-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/10/2020] [Indexed: 12/31/2022]
Abstract
Background Most currently used surgical robots have no force feedback; the next generation displays forces visually. A novel single-port robotic surgical system called FLEXMIN has been developed. Through an outer diameter of 38 mm, two instruments are teleoperated from a surgeon’s control console including true haptic force feedback. One additional channel incorporates a telescope, another is free for special instrument functions. Methods This randomized cross-over study analyzed the effect of haptic feedback on the application of intracorporeal forces. In a standardized experiment setup, the subjects had to draw circles with the surgical robot as gently as possible. The applied forces, the required time spans, and predefined error rates were measured. Results Without haptic feedback, the maximum forces (median/IQR) were 6.43 N/2.96 N. With haptic feedback, the maximum forces were lower (3.57 N/1.94 N, p < 0.001). Also, the arithmetic means of the force progression (p < 0.001) and their standard deviations (p < 0.001) were lower. Not significant were the shorter durations and lower error rates. No sequence effect of force or duration was detected. No characteristic learning or fatigue curve was observed. Conclusions In the experiment setup, the true haptic force feedback can reduce the applied intracorporeal robotic force to one-half when considering the aspects maximum, means, and standard deviation. Other test tasks are needed to validate the influence of force feedback on surgical efficiency and safety.
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Affiliation(s)
- Johanna Miller
- Clinic of General, Visceral and Transplant Surgery, Working Group Surgical Technology and Training, Tübingen University Hospital, Waldhörnlestrasse 22, 72072, Tübingen, Germany
| | - Manuel Braun
- Clinic for Orthopaedics, Tübingen University Hospital, Waldhörnlestrasse 22, 72072, Tübingen, Germany
| | - Johannes Bilz
- Department of Electromechanical Design, Darmstadt Technical University, Merckstrasse 25, 64283, Darmstadt, Germany
| | - Sebastian Matich
- Department of Electromechanical Design, Darmstadt Technical University, Merckstrasse 25, 64283, Darmstadt, Germany
| | - Carsten Neupert
- Department of Electromechanical Design, Darmstadt Technical University, Merckstrasse 25, 64283, Darmstadt, Germany
| | - Wolfgang Kunert
- Clinic of General, Visceral and Transplant Surgery, Working Group Surgical Technology and Training, Tübingen University Hospital, Waldhörnlestrasse 22, 72072, Tübingen, Germany.
| | - Andreas Kirschniak
- Clinic of General, Visceral and Transplant Surgery, Working Group Surgical Technology and Training, Tübingen University Hospital, Waldhörnlestrasse 22, 72072, Tübingen, Germany
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Abstract
Just as laparoscopic surgery provided a giant leap in safety and recovery for patients over open surgery methods, robotic-assisted surgery (RAS) is doing the same to laparoscopic surgery. The first laparoscopic-RAS systems to be commercialized were the Intuitive Surgical, Inc. (Sunnyvale, CA, USA) da Vinci and the Computer Motion Zeus. These systems were similar in many aspects, which led to a patent dispute between the two companies. Before the dispute was settled in court, Intuitive Surgical bought Computer Motion, and thus owned critical patents for laparoscopic-RAS. Recently, the patents held by Intuitive Surgical have begun to expire, leading to many new laparoscopic-RAS systems being developed and entering the market. In this study, we review the newly commercialized and prototype laparoscopic-RAS systems. We compare the features of the imaging and display technology, surgeons console and patient cart of the reviewed RAS systems. We also briefly discuss the future directions of laparoscopic-RAS surgery. With new laparoscopic-RAS systems now commercially available we should see RAS being adopted more widely in surgical interventions and costs of procedures using RAS to decrease in the near future.
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43
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Wang Y, Wang J. Current and Future Robotic Surgery Platforms: Introduction of keynote speech at 2019 Mayo Clinic-SRRSH Global Robotic & Endoscopic Surgery Summit. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mazzei M, Abbas AE. Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections. J Thorac Dis 2020; 12:70-81. [PMID: 32190356 DOI: 10.21037/jtd.2020.01.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Minimally invasive thoracoscopic surgical techniques have grown increasingly popular due to improved outcome measures compared to conventional rib-spreading thoracotomy. However, video-assisted thoracoscopic surgery (VATS) presents with unique technical challenges that have limited its role in certain cases. Here, we discuss our perspectives on the implementation of a successful robotic thoracic program. We will then present the case for how the adoption of robotic assisted thoracic surgery (RATS) provides the benefits of minimally invasive VATS while still retaining the technical finesse of bimanual articulating instruments and 3-dimensional imaging that is a universal component of any open surgery. We will also discuss how to overcome some of the perceived disadvantages to RATS in regard to the higher cost, lack of tactile feedback and potential safety concerns.
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Affiliation(s)
- Michael Mazzei
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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45
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El Haj AJ. The Grand Challenges of Medical Technology. FRONTIERS IN MEDICAL TECHNOLOGY 2020; 2:1. [PMID: 35047873 PMCID: PMC8757731 DOI: 10.3389/fmedt.2020.00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/29/2020] [Indexed: 12/04/2022] Open
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46
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Veilleux E, Ponce J, Lutfi R. A Review of the Role of Robotics in Bariatric Surgery: Finding Our Future? J Laparoendosc Adv Surg Tech A 2020; 30:36-39. [DOI: 10.1089/lap.2019.0419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Eric Veilleux
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Jaime Ponce
- Chattanooga Bariatrics, Chatanooga, Tennessee
| | - Rami Lutfi
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
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47
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Nwosu AC, Sturgeon B, McGlinchey T, Goodwin CD, Behera A, Mason S, Stanley S, Payne TR. Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats. Palliat Med 2019; 33:1106-1113. [PMID: 31250734 PMCID: PMC6691596 DOI: 10.1177/0269216319857628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Medical robots are increasingly used for a variety of applications in healthcare. Robots have mainly been used to support surgical procedures, and for a variety of assistive uses in dementia and elderly care. To date, there has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care. AIM The objective of this article is to examine the possible future impact of medical robotics on palliative, supportive care and end-of-life care. Specifically, we will discuss the strengths, weaknesses, opportunities and threats (SWOT) of this technology. METHODS A SWOT analysis to understand the strengths, weaknesses, opportunities and threats of robotic technology in palliative and supportive care. RESULTS The opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. However, there are a number of technical, societal, economic and ethical factors which need to be considered to ensure meaningful use of this technology in palliative care. CONCLUSION Robotics could have a number of potential applications in palliative, supportive and end-of-life care. Future work should evaluate the health-related, economic, societal and ethical implications of using this technology. There is a need for collaborative research to establish use-cases and inform policy, to ensure the appropriate use (or non-use) of robots for people with serious illness.
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Affiliation(s)
- Amara Callistus Nwosu
- 1 Academic Palliative & End of Life Care Department, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK.,2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK.,3 Marie Curie Hospice Liverpool, Liverpool, UK
| | - Bethany Sturgeon
- 4 Bristol Robotics Laboratory, University of Bristol, Bristol, UK
| | - Tamsin McGlinchey
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK
| | - Christian Dg Goodwin
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK.,5 US-UK Fulbright Commission, London, UK
| | - Ardhendu Behera
- 6 Department of Computer Science, Edge Hill University, Ormskirk, UK
| | - Stephen Mason
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK
| | | | - Terry R Payne
- 7 Department of Computer Science, University of Liverpool, Liverpool, UK
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Carey BM, Jones CN, Fawcett WJ. Anaesthesia for minimally invasive abdominal and pelvic surgery. BJA Educ 2019; 19:254-260. [PMID: 33456899 DOI: 10.1016/j.bjae.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- B M Carey
- St Vincent's Hospital, Melbourne, Australia
| | - C N Jones
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - W J Fawcett
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Gafford JB, Webster S, Dillon N, Blum E, Hendrick R, Maldonado F, Gillaspie EA, Rickman OB, Herrell SD, Webster RJ. A Concentric Tube Robot System for Rigid Bronchoscopy: A Feasibility Study on Central Airway Obstruction Removal. Ann Biomed Eng 2019; 48:181-191. [PMID: 31342337 DOI: 10.1007/s10439-019-02325-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/13/2019] [Indexed: 12/19/2022]
Abstract
New robotic systems have recently emerged to assist with peripheral lung access, but a robotic system for rigid bronchoscopy has yet to be developed. We describe a new robotic system that can deliver thin robotic manipulators through the ports of standard rigid bronchoscopes. The manipulators bend and elongate to provide maneuverability of surgical tools at the endoscope tip, without endoscope motion. We describe an initial feasibility study on the use of this system to bronchoscopically treat a central airway obstruction (CAO). CAO is prevalent and can be life-threatening in patients with large tumors, and conventional rigid bronchoscopic treatments place patients at risk of complications including broken teeth, neck trauma and damage to oropharyngeal structures due to significant forces induced by bronchoscope tilting and manipulation. In this study, we used an ex vivo ovine airway model to demonstrate the ability of a physician using the robotic system to efficiently remove tissue and restore the airway. Pre- and post-operative CT scans showed that the robot was able to reduce the degree of airway obstruction stenosis from 75 to 14% on average for five CAO resections performed in an ex vivo animal model. Using cadaver experiments, we demonstrated the potential of the robotic system to substantially reduce the intraoperative forces applied to the patient's head and neck (from 80.6 to 4.1 N). These preliminary results illustrate that CAO removal is feasible with our new rigid bronchoscopy robot system, and that this approach has the potential to reduce forces applied to the patient due to bronchoscope angulation, and thereby reduce the risk of complications encountered during CAO surgery.
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Affiliation(s)
- Joshua B Gafford
- Mechanical Engineering Department, Vanderbilt University, Nashville, TN, USA. .,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA.
| | | | | | - Evan Blum
- Virtuoso Surgical, Inc., Nashville, TN, USA
| | | | - Fabien Maldonado
- Mechanical Engineering Department, Vanderbilt University, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Erin A Gillaspie
- Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Otis B Rickman
- Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - S Duke Herrell
- Mechanical Engineering Department, Vanderbilt University, Nashville, TN, USA.,Virtuoso Surgical, Inc., Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert J Webster
- Mechanical Engineering Department, Vanderbilt University, Nashville, TN, USA.,Virtuoso Surgical, Inc., Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
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50
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Wu CZ, Klebanoff JS, Tyan P, Moawad GN. Review of strategies and factors to maximize cost-effectiveness of robotic hysterectomies and myomectomies in benign gynecological disease. J Robot Surg 2019; 13:635-642. [PMID: 30919259 DOI: 10.1007/s11701-019-00948-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
Common benign gynecologic procedures include hysterectomies and myomectomies, with hysterectomy being the most common gynecologic procedure in the United States [1]. While historically performed via laparotomy, the field of gynecologic surgery was revolutionized with the advent of laparoscopic techniques, with the most recent advancement being the introduction of robotic-assisted surgery in 2005. Robotic surgery has all the benefits of laparoscopic surgery such as decreased blood loss, quicker return to activities, and shorter length of hospital stay. Additional robotic-specific advantages include but are not limited to improved ergonomics, 3D visualization, and intuitive surgical movements. Despite these advantages, one of the most commonly cited drawbacks of robotic surgery is the associated cost. While the initial cost to purchase the robotic console and its associated maintenance costs are relatively high, robotic surgery can be cost-effective when utilized correctly.This article reviews application strategies and factors that can offset traditional costs and maximize the benefits of robotic surgery.
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Affiliation(s)
- Catherine Z Wu
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
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