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Abendstein B, Prugger M, Rab A, Siaulys R, Nausediene V, Karpiciute R, Willeke F, Samalavicius NE. Exploring robotic total hysterectomies: a multi-site experience with the Senhance Surgical System. J Robot Surg 2024; 18:268. [PMID: 38922454 PMCID: PMC11208233 DOI: 10.1007/s11701-024-01944-4] [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: 02/13/2024] [Accepted: 04/06/2024] [Indexed: 06/27/2024]
Abstract
Robotic-assisted surgery emerged as a technological advancement in the twentieth century, with gynaecology being a key adopter of this approach. The Senhance Surgical System has gained prominence for total hysterectomies from single-site experiences, but multi-site reporting are still lacking in present literature. This multi-site study, conducted at Klaipeda University Hospital and Academic Teaching Hospital Feldkirch, aimed to explore the safety and feasibility of total hysterectomies with the Senhance Surgical System. The study involved 295 cases, showcasing a well-established routine with minimal procedure times. The average age of the patients was 53.5 years (SD: 10.3 years), ranging from 18 to 80 years. The patients' BMI averaged 25.6 kg/m2 (SD: 6.2 kg/m2), ranging from a minimum of 17.7 kg/m2 to a maximum of 69.5 kg/m2. The duration of surgery varied between 30 and 215 min, with a median of 95 min (IQR: 81-116). The docking time was a median of 3 (IQR: 2-5) min and varied between 1.0 and 30.0 min, with a minimum to a maximum range of 1.0 to 122 min. Conversion (3 cases, 1%) and adverse events (6 cases, 2%) were infrequent. Additionally, robotic malfunctions were recorded minimally in 4,1% (12 cases) of the procedures, and pain on a 0-10 visual pain scale was reduced from mild [2.7 (± 1.2)] one day postoperative to minimal [0.9 (± 0.5)] at discharge. Overall, a great routine with the Senhance Surgical System proves good control and, thus, feasibility and safety. Therefore, the Senhance Surgical System is a viable option for total hysterectomy.
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Affiliation(s)
- Burghard Abendstein
- Department of Gynaecology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Michael Prugger
- Department of Gynaecology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Attila Rab
- Department of Gynaecology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Raimondas Siaulys
- Department of Gynaecology, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Vaida Nausediene
- Clinic of Abdominal and Thoracic Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Faculty of Health Sciences, Management of Human Health Activities, Klaipeda University, Klaipeda, Lithuania
| | - Rita Karpiciute
- Department of Day Surgery, National Cancer Institute, Santariskiu 1, Vilnius, Lithuania
| | - Frank Willeke
- Department of General and Visceral Surgery, Marien Hospital, Siegen, Germany
| | - Narimantas Evaldas Samalavicius
- Clinic of Abdominal and Thoracic Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
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Balch JA, Abbott KL, Loftus TJ. Critical appraisal of artificial intelligence in robotic surgery. Surgery 2024:S0039-6060(24)00187-9. [PMID: 38772774 DOI: 10.1016/j.surg.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Jeremy A Balch
- Department of Surgery, University of Florida, Gainesville, FL; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | | | - Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, FL; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL. https://twitter.com/_TylerLoftus
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Takács K, Lukács E, Levendovics R, Pekli D, Szijártó A, Haidegger T. Assessment of Surgeons' Stress Levels with Digital Sensors during Robot-Assisted Surgery: An Experimental Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2915. [PMID: 38733021 PMCID: PMC11086209 DOI: 10.3390/s24092915] [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: 03/04/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Robot-Assisted Minimally Invasive Surgery (RAMIS) marks a paradigm shift in surgical procedures, enhancing precision and ergonomics. Concurrently it introduces complex stress dynamics and ergonomic challenges regarding the human-robot interface and interaction. This study explores the stress-related aspects of RAMIS, using the da Vinci XI Surgical System and the Sea Spikes model as a standard skill training phantom to establish a link between technological advancement and human factors in RAMIS environments. By employing different physiological and kinematic sensors for heart rate variability, hand movement tracking, and posture analysis, this research aims to develop a framework for quantifying the stress and ergonomic loads applied to surgeons. Preliminary findings reveal significant correlations between stress levels and several of the skill-related metrics measured by external sensors or the SURG-TLX questionnaire. Furthermore, early analysis of this preliminary dataset suggests the potential benefits of applying machine learning for surgeon skill classification and stress analysis. This paper presents the initial findings, identified correlations, and the lessons learned from the clinical setup, aiming to lay down the cornerstones for wider studies in the fields of clinical situation awareness and attention computing.
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Affiliation(s)
- Kristóf Takács
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
| | - Eszter Lukács
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
| | - Renáta Levendovics
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
- John von Neumann Faculty of Informatics (NIK), Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology (ACMIT), 2700 Wiener Neustadt, Austria
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary; (D.P.); (A.S.)
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary; (D.P.); (A.S.)
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics (IROB), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary; (E.L.); (R.L.)
- Austrian Center for Medical Innovation and Technology (ACMIT), 2700 Wiener Neustadt, Austria
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Casas MA, Monrabal Lezama M, Schlottmann F. Medical and surgical treatment of acute appendicitis: Past, present and future. Curr Probl Surg 2024; 61:101458. [PMID: 38704174 DOI: 10.1016/j.cpsurg.2024.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Maria A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina; Department of Surgery, University of Illinois at Chicago, Chicago, IL.
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Tellez JC, Radi I, Alterio RE, Nagaraj MB, Baker HB, Scott DJ, Zeh HJ, Polanco PM. Proficiency Levels and Validity Evidence for Scoring Metrics for a Virtual Reality and Inanimate Robotic Surgery Simulation Curriculum. JOURNAL OF SURGICAL EDUCATION 2024; 81:589-596. [PMID: 38403503 DOI: 10.1016/j.jsurg.2024.01.004] [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: 07/23/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Our institution recently implemented a virtual reality (VR) skills curriculum for general surgery residents using the SimNow simulator. Based on a content alignment study, we revised the curriculum to include only 20 of 33 VR tasks and we added 3 previously validated inanimate tasks. The purpose of this study was to establish expert-derived proficiency levels for all tasks and to evaluate the validity of the scoring for the VR tasks. DESIGN Two expert robotic surgeons performed 5 repetitions of each VR and inanimate task. The trimmed mean (lowest scoring attempt and outliers [>2 standard deviations] were eliminated) was defined as the expert level for each task. For the VR tasks, expert levels were compared to resident performance to evaluate validity. SETTING This study was conducted at the University of Texas Southwestern Medical Center (Dallas, TX), a tertiary care academic teaching hospital. PARTICIPANTS Two expert robotic surgeons participated in this study. The data from 42 residents (PGY2-4) who completed the original curriculum was used to represent novice performance. RESULTS Comparison of expert levels and resident performance was statistically significant for 15 VR tasks (supporting validity) and approached significance (p = 0.06, 0.09) for 2 VR tasks; expert levels were designated as proficiency levels for these 17 tasks. Group comparisons were clearly not significant (p = 0.2-0.8) for 3 VR tasks; 2 of these 3 tasks were retained as introductory exercises (with 3 repetitions required) and 1 was excluded. For the 3 inanimate tasks, expert levels minus 2 standard deviations were designated as proficiency levels. CONCLUSIONS This analysis generated validity evidence for 15 VR tasks and established expert-derived proficiency levels for 17 VR tasks and 3 inanimate tasks. Our proposed curriculum now consists of 19 VR and 3 inanimate tasks using the selected proficiency levels. We anticipate that this design will maximize curriculum efficiency and effectiveness.
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Affiliation(s)
- Juan C Tellez
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imad Radi
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Rodrigo E Alterio
- Department of Surgery, Florida Atlantic University, Boca Raton, Florida
| | - Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haley B Baker
- Department of Otolaryngology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Tang D, Peng X, Wu S, Tang S. Autonomous Nanorobots as Miniaturized Surgeons for Intracellular Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:595. [PMID: 38607129 PMCID: PMC11013175 DOI: 10.3390/nano14070595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Artificial nanorobots have emerged as promising tools for a wide range of biomedical applications, including biosensing, detoxification, and drug delivery. Their unique ability to navigate confined spaces with precise control extends their operational scope to the cellular or subcellular level. By combining tailored surface functionality and propulsion mechanisms, nanorobots demonstrate rapid penetration of cell membranes and efficient internalization, enhancing intracellular delivery capabilities. Moreover, their robust motion within cells enables targeted interactions with intracellular components, such as proteins, molecules, and organelles, leading to superior performance in intracellular biosensing and organelle-targeted cargo delivery. Consequently, nanorobots hold significant potential as miniaturized surgeons capable of directly modulating cellular dynamics and combating metastasis, thereby maximizing therapeutic outcomes for precision therapy. In this review, we provide an overview of the propulsion modes of nanorobots and discuss essential factors to harness propulsive energy from the local environment or external power sources, including structure, material, and engine selection. We then discuss key advancements in nanorobot technology for various intracellular applications. Finally, we address important considerations for future nanorobot design to facilitate their translation into clinical practice and unlock their full potential in biomedical research and healthcare.
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Affiliation(s)
- Daitian Tang
- Luohu Clinical Institute, School of Medicine, Shantou University, Shantou 515000, China; (D.T.); (X.P.)
| | - Xiqi Peng
- Luohu Clinical Institute, School of Medicine, Shantou University, Shantou 515000, China; (D.T.); (X.P.)
| | - Song Wu
- Luohu Clinical Institute, School of Medicine, Shantou University, Shantou 515000, China; (D.T.); (X.P.)
| | - Songsong Tang
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024:01209203-990000000-00205. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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Checcucci E, Puliatti S, Pecoraro A, Piramide F, Campi R, Carrion DM, Esperto F, Afferi L, Veneziano D, Somani B, Vásquez JL, Fiori C, Mottrie A, Amato M, N'Dow J, Porpiglia F, Liatsikos E, Rivas JG, Cacciamani GE. ESRU-ESU-YAU_UROTECH Survey on Urology Residents Surgical Training: Are We Ready for Simulation and a Standardized Program? EUR UROL SUPPL 2024; 61:18-28. [PMID: 38384440 PMCID: PMC10879935 DOI: 10.1016/j.euros.2023.12.008] [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] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
Background Currently, the landscape of surgical training is undergoing rapid evolution, marked by the initial implementation of standardized surgical training programs, which are further facilitated by the emergence of new technologies. However, this proliferation is uneven across various countries and hospitals. Objective To offer a comprehensive overview of the existing surgical training programs throughout Europe, with a specific focus on the accessibility of simulation resources and standardized surgical programs. Design setting and participants A dedicated survey was designed and spread in May 2022 via the European Association of Urology (EAU) mail list, to Young Urologist Office (YUO), Junior membership, European Urology Residents Education Program participants between 2014 and 2022, and other urologists under 40 yr, and via the EAU Newsletter. Intervention A 64-item, online-based survey in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) using the platform of Survey Monkey (Portland, OR, USA) was realized. Outcome measurements and statistical analysis The study involved an assessment of the demographic characteristics. Additionally, it explored the type of center, availability of various surgical approaches, presence of training infrastructure, participation in courses, organization of training, and participants' satisfaction with the training program. The level of satisfaction was evaluated using a Likert-5 scale. The subsequent sections delved into surgical training within the realms of open, laparoscopic, robotic, and endoscopic surgery, each explored separately. Finally, the investigation encompassed the presence of a structured training course and the availability of a duly validated final evaluation process. Results and limitations There were 375 responders with a completion rate of 82%. Among them, 75% were identified as male, 50.6% were young urologists, 31.7% were senior residents, and 17.6% were junior residents. A significant majority of participants (69.6%) were affiliated with academic centers. Regarding the presence of dry lab training facilities, only 50.3% of respondents indicated its availability. Among these centers, 46.7% were primarily focused on laparoscopy training. The availability of virtual and wet lab training centers was even more limited, with rates of 31.5% and 16.2%, respectively. Direct patient involvement was reported in 80.5% of cases for open surgery, 58.8% for laparoscopy, 25.0% for robotics, and 78.6% for endourology. It is worth noting that in <25% of instances, training followed a well-defined standardized program comprising both preclinical and clinical modular phases. Finally, the analysis of participant feedback showed that 49.7% of respondents expressed a satisfaction rating of either 4 or 5 points with respect to the training program. The limitations of our study include the low response rate, predominance of participants from academic centers, and absence of responses from individuals not affiliated with the EAU network. Conclusions The current distribution of surgical training centers falls short of ensuring widespread access to standardized training programs. Although dry lab facilities are relatively well spread, the availability of wet lab resources remains restricted. Additionally, it appears that many trainees' initial exposure to surgery occurs directly with patients. There is a pressing need for continued endeavors to establish uniform training routes and assessment techniques across various surgical methodologies. Patient summary Nowadays, the surgical training landscape is heterogeneous across different countries. The implementation of a standardized training methodology to enhance the overall quality of surgical training and thereby improving patient outcomes is needed.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Federico Piramide
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M. Carrion
- Torrejon University Hospital, Madrid, Spain
- Universidad Francisco de Vitoria, Madrid, Spain
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Cristian Fiori
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Francesco Porpiglia
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | | | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
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Olsen RG, Hartwell D, Dalsgaard T, Madsen ME, Bjerrum F, Konge L, Røder A. First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:368-377. [PMID: 38031442 PMCID: PMC10823395 DOI: 10.1111/aogs.14727] [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: 09/08/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. MATERIAL AND METHODS Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. RESULTS The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. CONCLUSIONS In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Hartwell
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Torur Dalsgaard
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Mette Elkjær Madsen
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Department of Surgery, Herlev‐Gentofte HospitalHerlevDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Boal M, Di Girasole CG, Tesfai F, Morrison TEM, Higgs S, Ahmad J, Arezzo A, Francis N. Evaluation status of current and emerging minimally invasive robotic surgical platforms. Surg Endosc 2024; 38:554-585. [PMID: 38123746 PMCID: PMC10830826 DOI: 10.1007/s00464-023-10554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework. METHODS A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature. RESULTS 21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0. CONCLUSIONS The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
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Affiliation(s)
- M Boal
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | | | - F Tesfai
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - T E M Morrison
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - S Higgs
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - J Ahmad
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - N Francis
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK.
- Yeovil District Hospital, Somerset NHS Foundation Trust, Yeovil, UK.
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13
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Gorard J, Boal M, Swamynathan V, Ghamrawi W, Francis N. The application of objective clinical human reliability analysis (OCHRA) in the assessment of basic robotic surgical skills. Surg Endosc 2024; 38:116-128. [PMID: 37932602 PMCID: PMC10776495 DOI: 10.1007/s00464-023-10510-2] [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: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based assessment tool that provides in-depth analysis of individual technical errors. We conducted a feasibility study to assess the concurrent validity and reliability of OCHRA when applied to basic, generic robotic technical skills assessment. METHODS Selected basic robotic surgical skill tasks, in virtual reality (VR) and dry lab equivalent, were performed by novice robotic surgeons during an intensive 5-day robotic surgical skills course on da Vinci® X and Xi surgical systems. For each task, we described a hierarchical task analysis. Our developed robotic surgical-specific OCHRA methodology was applied to error events in recorded videos with a standardised definition. Statistical analysis to assess concurrent validity with existing tools and inter-rater reliability were performed. RESULTS OCHRA methodology was applied to 272 basic robotic surgical skills tasks performed by 20 novice robotic surgeons. Performance scores improved from the start of the course to the end using all three assessment tools; Global Evaluative Assessment of Robotic Skills (GEARS) [VR: t(19) = - 9.33, p < 0.001] [dry lab: t(19) = - 10.17, p < 0.001], OCHRA [VR: t(19) = 6.33, p < 0.001] [dry lab: t(19) = 10.69, p < 0.001] and automated VR [VR: t(19) = - 8.26, p < 0.001]. Correlation analysis, for OCHRA compared to GEARS and automated VR scores, shows a significant and strong inverse correlation in every VR and dry lab task; OCHRA vs GEARS [VR: mean r = - 0.78, p < 0.001] [dry lab: mean r = - 0.82, p < 0.001] and OCHRA vs automated VR [VR: mean r = - 0.77, p < 0.001]. There is very strong and significant inter-rater reliability between two independent reviewers (r = 0.926, p < 0.001). CONCLUSION OCHRA methodology provides a detailed error analysis tool in basic robotic surgical skills with high reliability and concurrent validity with existing tools. OCHRA requires further evaluation in more advanced robotic surgical procedures.
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Affiliation(s)
- Jack Gorard
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Matthew Boal
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, University College London, London, UK
| | - Vishaal Swamynathan
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Walaa Ghamrawi
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
| | - Nader Francis
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK.
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Fontalis A, Hansjee S, Giebaly DE, Mancino F, Plastow R, Haddad FS. Troubleshooting Robotics During Total Hip and Knee Arthroplasty. Orthop Clin North Am 2024; 55:33-48. [PMID: 37980102 DOI: 10.1016/j.ocl.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
The introduction of new surgical technology highlights appreciable concerns; robotic arthroplasty is no exception. Acquiring comprehensive understanding of the robotic technology to avoid complications during surgery and devising troubleshooting strategies to overcome potential difficulties is of paramount importance. Troubleshooting algorithms depend on the stage of the procedure and problem encountered, such as loosening of the pins or array, registration or verification problems, or malfunctioning of the device, which is rare. This article aims to outline reproducible workflows and solutions for troubleshooting during robotic-arm assisted total hip arthroplasty and total knee arthroplasty.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK.
| | - Shanil Hansjee
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
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Vinit N, Vatta F, Broch A, Hidalgo M, Kohaut J, Querciagrossa S, Couloigner V, Khen-Dunlop N, Botto N, Capito C, Sarnacki S, Blanc T. Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study. Ann Surg 2023; 278:e932-e938. [PMID: 36692109 DOI: 10.1097/sla.0000000000005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To report one-year morbidity of robotic-assisted laparoscopic surgery (RALS) in a dedicated, multidisciplinary, pediatric robotic surgery program. Summary Background Data. RALS in pediatric surgery is expanding, but data on morbidity in children is limited. METHODS All children who underwent RALS (Da Vinci Xi, Intuitive Surgical, USA) were prospectively included (October 2016 to May 2020; follow-up ≥1 year). Analyzed data: patient characteristics, surgical indication/procedure, intraoperative adverse events (ClassIntra classification), blood transfusion, hospital stay, postoperative complications (Clavien-Dindo). RESULTS Three hundred consecutive surgeries were included: urology/gynecology (n=105), digestive surgery (n=83), oncology (n=66), ENT surgery (n=28), thoracic surgery (n=18). Median age and weight at surgery were 9.5 [interquartile range (IQR)=8.8] years and 31 [IQR=29.3] kg, respectively. Over one year, 65 (22%) children presented with ≥1 complication, with Clavien-Dindo ≥III in 14/300 (5%) children at ≤30 days, 7/300 (2%) at 30-90 days, and 12/300 (4%) at >90 days. Perioperative transfusion was necessary in 15 (5%) children, mostly oncological (n=8). Eight (3%) robotic malfunctions were noted, one leading to conversion (laparotomy). Overall conversion rate was 4%. ASA ≥3, weight ≤15 kg, and surgical oncology did not significantly increase the conversion rate, complications, or intraoperative adverse events (ClassIntra ≥2). ASA score was significantly higher in children with complications (Clavien-Dindo ≥III) than without (p=0.01). Median hospital stay was 2 [IQR=3] days. Three children died after a median follow-up of 20 [IQR=16] months. CONCLUSIONS RALS is safe, even in the most vulnerable children with a wide scope of indications, age, and weight. Robot-specific complications or malfunctions are scarce.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Mary Hidalgo
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Stefania Querciagrossa
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
- Department of Pediatric ENT, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
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16
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Di Fabrizio D, Alizai NK, Najmaldin AS. Early and Long-term Complications of Robotic Assisted Laparoscopy in Infants and Children. J Pediatr Surg 2023; 58:1832-1837. [PMID: 36997389 DOI: 10.1016/j.jpedsurg.2023.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/14/2023] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Robotic-assisted laparoscopy still lacks wide acceptance in infants and children. We developed the service and report the largest single institution experience of complications over a period of 11 years. METHODS Between March 2006 and May 2017, consecutive infants and children who underwent robotic assisted laparoscopy under the care of two laparoscopic surgeons were studied. Data for patients, surgeons, year of surgery, operation, and timing, nature, grades of complications were assessed. RESULTS A total of 601 robotic procedures (45 different types) were carried out in 539 patients. Of these 31 (5.8%) were converted, none for operative complications. These and another 4 with complicated co-morbidity were excluded, leaving 504 patients for further analysis. There were 60 (11.9%) complications in 57 (11.3%) patients. Mean (SD) age was 7.7 years -/+5.1 with the youngest being 4 weeks. Concomitant or bilateral robotic and non-robotic procedures took place in 8.1% and 13.3% of patients respectively. Significant medical co-morbidity and abdominal scarring were present in 29% and 14.9% of patients respectively. Complications occurred in theatre 1.6%, hospital 5.6%, 28 days 1.2%, and late 3.6%. Mean follow up was 7.6 years -/+ 3.1 SD. Over-all postoperative complication rate was 10.3%: CD grade I 6.5% (33), II 0.6% (3), and IIIa/b 3.2% (16) which included 1.4% (7) re-do surgery. Most (11/16) grade III occurred late. There were no bleeding, grade IV or V complications, surgical mortality, or technology related complications. CONCLUSIONS Complications are low even during the learning phase and while developing the new technique. Most complications occurred early and were minor. Most high-grade complications presented late. LEVELS OF EVIDENCE 2B.
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Affiliation(s)
- Donatella Di Fabrizio
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK
| | - Naved K Alizai
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK
| | - Azad S Najmaldin
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK.
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17
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Li S, Zhong X, Yang Y, Qi X, Hu Y, Yang X. Force-Position Hybrid Compensation Control for Path Deviation in Robot-Assisted Bone Drilling. SENSORS (BASEL, SWITZERLAND) 2023; 23:7307. [PMID: 37631841 PMCID: PMC10458884 DOI: 10.3390/s23167307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Bone drilling is a common procedure in orthopedic surgery and is frequently attempted using robot-assisted techniques. However, drilling on rigid, slippery, and steep cortical surfaces, which are frequently encountered in robot-assisted operations due to limited workspace, can lead to tool path deviation. Path deviation can have significant impacts on positioning accuracy, hole quality, and surgical safety. In this paper, we consider the deformation of the tool and the robot as the main factors contributing to path deviation. To address this issue, we establish a multi-stage mechanistic model of tool-bone interaction and develop a stiffness model of the robot. Additionally, a joint stiffness identification method is proposed. To compensate for path deviation in robot-assisted bone drilling, a force-position hybrid compensation control framework is proposed based on the derived models and a compensation strategy of path prediction. Our experimental results validate the effectiveness of the proposed compensation control method. Specifically, the path deviation is significantly reduced by 56.6%, the force of the tool is reduced by 38.5%, and the hole quality is substantially improved. The proposed compensation control method based on a multi-stage mechanistic model and joint stiffness identification method can significantly improve the accuracy and safety of robot-assisted bone drilling.
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Affiliation(s)
- Shibo Li
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (S.L.); (X.Z.); (Y.Y.); (X.Q.); (Y.H.)
| | - Xin Zhong
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (S.L.); (X.Z.); (Y.Y.); (X.Q.); (Y.H.)
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen 518055, China
| | - Yuanyuan Yang
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (S.L.); (X.Z.); (Y.Y.); (X.Q.); (Y.H.)
| | - Xiaozhi Qi
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (S.L.); (X.Z.); (Y.Y.); (X.Q.); (Y.H.)
| | - Ying Hu
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (S.L.); (X.Z.); (Y.Y.); (X.Q.); (Y.H.)
| | - Xiaojun Yang
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen 518055, China
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18
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Planells H, Parmar V, Marcus HJ, Pandit AS. From theory to practice: what is the potential of artificial intelligence in the future of neurosurgery? Expert Rev Neurother 2023; 23:1041-1046. [PMID: 37997765 DOI: 10.1080/14737175.2023.2285432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Hannah Planells
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Viraj Parmar
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Anand S Pandit
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- High-dimensional Neurology, Institute of Neurology, London, UK
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19
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Shafiei SB, Shadpour S, Mohler JL, Attwood K, Liu Q, Gutierrez C, Toussi MS. Developing surgical skill level classification model using visual metrics and a gradient boosting algorithm. ANNALS OF SURGERY OPEN 2023; 4:e292. [PMID: 37305561 PMCID: PMC10249659 DOI: 10.1097/as9.0000000000000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Assessment of surgical skills is crucial for improving training standards and ensuring the quality of primary care. This study aimed to develop a gradient boosting classification model (GBM) to classify surgical expertise into inexperienced, competent, and experienced levels in robot-assisted surgery (RAS) using visual metrics. Methods Eye gaze data were recorded from 11 participants performing four subtasks; blunt dissection, retraction, cold dissection, and hot dissection using live pigs and the da Vinci robot. Eye gaze data were used to extract the visual metrics. One expert RAS surgeon evaluated each participant's performance and expertise level using the modified Global Evaluative Assessment of Robotic Skills (GEARS) assessment tool. The extracted visual metrics were used to classify surgical skill levels and to evaluate individual GEARS metrics. Analysis of Variance (ANOVA) was used to test the differences for each feature across skill levels. Results Classification accuracies for blunt dissection, retraction, cold dissection, and burn dissection were 95%, 96%, 96%, and 96%, respectively. The time to complete only the retraction was significantly different among the 3 skill levels (p-value = 0.04). Performance was significantly different for 3 categories of surgical skill level for all subtasks (p-values<0.01). The extracted visual metrics were strongly associated with GEARS metrics (R2>0.7 for GEARS metrics evaluation models). Conclusions Machine learning (ML) algorithms trained by visual metrics of RAS surgeons can classify surgical skill levels and evaluate GEARS measures. The time to complete a surgical subtask may not be considered a stand-alone factor for skill level assessment.
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Affiliation(s)
- Somayeh B. Shafiei
- From the Department of Urology, Roswell Park Comprehensive Cancer Center in Buffalo, NY
| | - Saeed Shadpour
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
| | - James L. Mohler
- From the Department of Urology, Roswell Park Comprehensive Cancer Center in Buffalo, NY
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Qian Liu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Camille Gutierrez
- Obstetrics and Gynecology Residency Program, Sisters of Charity Health System, Buffalo, NY
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Sühn T, Esmaeili N, Mattepu SY, Spiller M, Boese A, Urrutia R, Poblete V, Hansen C, Lohmann CH, Illanes A, Friebe M. Vibro-Acoustic Sensing of Instrument Interactions as a Potential Source of Texture-Related Information in Robotic Palpation. SENSORS (BASEL, SWITZERLAND) 2023; 23:3141. [PMID: 36991854 PMCID: PMC10056323 DOI: 10.3390/s23063141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
The direct tactile assessment of surface textures during palpation is an essential component of open surgery that is impeded in minimally invasive and robot-assisted surgery. When indirectly palpating with a surgical instrument, the structural vibrations from this interaction contain tactile information that can be extracted and analysed. This study investigates the influence of the parameters contact angle α and velocity v→ on the vibro-acoustic signals from this indirect palpation. A 7-DOF robotic arm, a standard surgical instrument, and a vibration measurement system were used to palpate three different materials with varying α and v→. The signals were processed based on continuous wavelet transformation. They showed material-specific signatures in the time-frequency domain that retained their general characteristic for varying α and v→. Energy-related and statistical features were extracted, and supervised classification was performed, where the testing data comprised only signals acquired with different palpation parameters than for training data. The classifiers support vector machine and k-nearest neighbours provided 99.67% and 96.00% accuracy for the differentiation of the materials. The results indicate the robustness of the features against variations in the palpation parameters. This is a prerequisite for an application in minimally invasive surgery but needs to be confirmed in realistic experiments with biological tissues.
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Affiliation(s)
- Thomas Sühn
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- SURAG Medical GmbH, 39118 Magdeburg, Germany
| | | | - Sandeep Y. Mattepu
- INKA Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | | | - Axel Boese
- INKA Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Robin Urrutia
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile
| | - Victor Poblete
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile
| | - Christian Hansen
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
| | - Christoph H. Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | | | - Michael Friebe
- INKA Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Department of Measurement and Electronics, AGH University of Science and Technology, 30-059 Kraków, Poland
- CIB—Center of Innovation and Business Development, FOM University of Applied Sciences, 45127 Essen, Germany
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21
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Boissonneau S, Dufour H, Pann A. Neurosurgery 3.0? Neurosurg Rev 2023; 46:65. [PMID: 36897511 DOI: 10.1007/s10143-023-01974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Affiliation(s)
- S Boissonneau
- Neurosurgical Department, Hospital La Timone - APHM, Aix-Marseille University, Marseille, France.
| | - H Dufour
- Neurosurgical Department, Hospital La Timone - APHM, Aix-Marseille University, Marseille, France
| | - A Pann
- Neurosurgical Department, Hospital La Timone - APHM, Aix-Marseille University, Marseille, France
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22
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Alterio RE, Nagaraj MB, Scott DJ, Tellez J, Radi I, Baker HB, Zeh HJ, Polanco PM. Developing a Robotic Surgery Curriculum: Selection of Virtual Reality Drills for Content Alignment. J Surg Res 2023; 283:726-732. [PMID: 36463811 DOI: 10.1016/j.jss.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Despite the importance of simulation-based training for robotic surgery, there is no consensus about its training curricula. Recently, a virtual reality (VR) platform (SimNow, Intuitive, Inc) was introduced with 33 VR drills but without evidence of their validity. As part of our creating a new robotic VR curriculum, we assessed the drills' validity through content mapping and the alignment between learning goals and drill content. METHODS Three robotically trained surgeons content-mapped all 33 drills for how well the drills incorporated 15 surgery skills and also rated the drills' difficulty, usefulness, relevance, and uniqueness. Drills were added to the new curriculum based on consensus about ratings and historic learner data. The drills were grouped according to similar skill sets and arranged in order of complexity. RESULTS The 33 drills were judged to have 12/15 surgery skills as primary goals and 13/15 as secondary goals. Twenty of the 33 drills were selected for inclusion in the new curriculum; these had 11/15 skills as primary goals and 11/15 as secondary goals. However, skills regarding energy sources, atraumatic handling, blunt dissection, fine dissection, and running suturing were poorly represented in the drills. Three previously validated inanimate drills were added to the curriculum to address lacking skill domains. CONCLUSIONS We identified 20 of the 33 SimNow drills as a foundation for a robotic surgery curriculum based on content-oriented evidence. We added 3 other drills to address identified gaps in drill content.
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Affiliation(s)
- Rodrigo E Alterio
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern, Dallas, Texas; Simulation Center, University of Texas Southwestern, Dallas, Texas
| | - Juan Tellez
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Imad Radi
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Hayley B Baker
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
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Zhang J, Zhang ZM. Ethics and governance of trustworthy medical artificial intelligence. BMC Med Inform Decis Mak 2023; 23:7. [PMID: 36639799 PMCID: PMC9840286 DOI: 10.1186/s12911-023-02103-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The growing application of artificial intelligence (AI) in healthcare has brought technological breakthroughs to traditional diagnosis and treatment, but it is accompanied by many risks and challenges. These adverse effects are also seen as ethical issues and affect trustworthiness in medical AI and need to be managed through identification, prognosis and monitoring. METHODS We adopted a multidisciplinary approach and summarized five subjects that influence the trustworthiness of medical AI: data quality, algorithmic bias, opacity, safety and security, and responsibility attribution, and discussed these factors from the perspectives of technology, law, and healthcare stakeholders and institutions. The ethical framework of ethical values-ethical principles-ethical norms is used to propose corresponding ethical governance countermeasures for trustworthy medical AI from the ethical, legal, and regulatory aspects. RESULTS Medical data are primarily unstructured, lacking uniform and standardized annotation, and data quality will directly affect the quality of medical AI algorithm models. Algorithmic bias can affect AI clinical predictions and exacerbate health disparities. The opacity of algorithms affects patients' and doctors' trust in medical AI, and algorithmic errors or security vulnerabilities can pose significant risks and harm to patients. The involvement of medical AI in clinical practices may threaten doctors 'and patients' autonomy and dignity. When accidents occur with medical AI, the responsibility attribution is not clear. All these factors affect people's trust in medical AI. CONCLUSIONS In order to make medical AI trustworthy, at the ethical level, the ethical value orientation of promoting human health should first and foremost be considered as the top-level design. At the legal level, current medical AI does not have moral status and humans remain the duty bearers. At the regulatory level, strengthening data quality management, improving algorithm transparency and traceability to reduce algorithm bias, and regulating and reviewing the whole process of the AI industry to control risks are proposed. It is also necessary to encourage multiple parties to discuss and assess AI risks and social impacts, and to strengthen international cooperation and communication.
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Affiliation(s)
- Jie Zhang
- grid.410745.30000 0004 1765 1045Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China ,grid.260483.b0000 0000 9530 8833Nantong University Xinglin College, Nantong, 226236 China
| | - Zong-ming Zhang
- grid.410745.30000 0004 1765 1045Research Center of Chinese Medicine Culture, Nanjing University of Chinese Medicine, Nanjing, 210023 China
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24
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Li Y. Deep causal learning for robotic intelligence. Front Neurorobot 2023; 17:1128591. [PMID: 36910267 PMCID: PMC9992986 DOI: 10.3389/fnbot.2023.1128591] [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: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
This invited Review discusses causal learning in the context of robotic intelligence. The Review introduces the psychological findings on causal learning in human cognition, as well as the traditional statistical solutions for causal discovery and causal inference. Additionally, we examine recent deep causal learning algorithms, with a focus on their architectures and the benefits of using deep nets, and discuss the gap between deep causal learning and the needs of robotic intelligence.
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Affiliation(s)
- Yangming Li
- RoCAL, Rochester Institute of Technology, Rochester, NY, United States
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25
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Robič B, Petrovič R, Djordjević A, Železnik J, Intihar U, Jurič P, Gregorcič F, Antonič M. Surgeon-Guided Robotic Arm Facilitates LIMA Takedown in MIDCAB Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:80-83. [PMID: 36744731 DOI: 10.1177/15569845221149969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass has been scientifically proven to have the best patency and long-term results in myocardial revascularization. The latest guidelines suggest minimally invasive LIMA to LAD is the optimal therapy for isolated proximal LAD lesions. The start of a minimally invasive direct coronary artery bypass (MIDCAB) program can be quite challenging as robotic surgery demands high starting costs, while normal thoracoscopic techniques have a longer surgeon learning curve. In this article, we describe to the best of our knowledge the first use of surgeon-guided wristed instruments in LIMA harvesting for MIDCAB surgery. It allows for a facilitated LIMA harvest like in robotic surgery with the comfort of a surgeon constantly standing by the patient, allowing for a faster response time in case of an emergency or the need for instrument exchange. These features result in shorter operating times, lower costs compared with robotic surgery, and faster adoption of this technique for centers just starting MIDCAB surgery.
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Affiliation(s)
- Boris Robič
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Slovenia
| | - Rene Petrovič
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Slovenia
| | - Anže Djordjević
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Slovenia
| | - Jernej Železnik
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Slovenia
| | - Urška Intihar
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia
| | - Peter Jurič
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia
| | - Franc Gregorcič
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia
| | - Miha Antonič
- Department of Cardiac Surgery, University Clinical Centre Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Slovenia
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Kelkar DS, Kurlekar U, Stevens L, Wagholikar GD, Slack M. An Early Prospective Clinical Study to Evaluate the Safety and Performance of the Versius Surgical System in Robot-Assisted Cholecystectomy. Ann Surg 2023; 277:9-17. [PMID: 35170538 PMCID: PMC9762713 DOI: 10.1097/sla.0000000000005410] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the ability of the Versius Surgical System to successfully and safely complete cholecystectomy. BACKGROUND The system has been developed in-line with surgeon feedback to overcome limitations of conventional laparoscopy to enhance surgeon experience and patient outcomes. Here we present results from the cholecystectomy cohort from a completed early clinical trial, which was designed to broadly align with Stage 2b of the Idea, Development, Exploration, Assessment, Long-term follow-up framework for surgical innovation. METHODS Procedures were performed between March 2019 and September 2020 by surgical teams consisting of a lead surgeon and operating room (OR) assistants. Male or female patients aged 18 years and over and requiring cholecystectomy were enrolled. The primary endpoint was the rate of unplanned conversion from robot-assisted surgery to conventional laparoscopic or open surgery. Adverse events (AEs) and serious AEs were adjudicated by video review of the surgery and patient study reports by an independent Clinical Expert Committee. RESULTS Overall, 134/143 (93.7%) cholecystectomies were successfully completed using the device. Of the 9 (6.3%) conversions to another surgical modality, 7 were deemed to be related to the device. A total of 6 serious AEs and 3 AEs occurred in 8 patients (5.6%), resulting in 4 (2.8%) readmissions to hospital within 30 days of surgery and 1 death. CONCLUSIONS This study demonstrates cholecystectomy performed using the device is as safe and effective as conventional laparoscopy and supports the implementation of the device on a wider scale, pending instrument modifications, in alignment with Idea, Development, Exploration, Assessment, Long-term follow-up Stage 3 (Assessment).
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Affiliation(s)
- Dhananjay S Kelkar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Utkrant Kurlekar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Lewis Stevens
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University London, London, UK; and
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Duan Y, Shen C, Zhang Y, Luo Y. Advanced diagnostic and therapeutic strategies in nanotechnology for lung cancer. Front Oncol 2022; 12:1031000. [PMID: 36568152 PMCID: PMC9767962 DOI: 10.3389/fonc.2022.1031000] [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: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
As a highly invasive thoracic malignancy with increasing prevalence, lung cancer is also the most lethal cancer worldwide due to the failure of effective early detection and the limitations of conventional therapeutic strategies for advanced-stage patients. Over the past few decades, nanotechnology has emerged as an important technique to obtain desired features by modifying and manipulating different objects on a molecular level and gained a lot of attention in many fields of medical applications. Studies have shown that in lung cancer, nanotechnology may be more effective and specific than traditional methods for detecting extracellular cancer biomarkers and cancer cells in vitro, as well as imaging cancer in vivo; Nanoscale drug delivery systems have developed rapidly to overcome various forms of multi-drug resistance and reduce detrimental side effects to normal tissues by targeting cancerous tissue precisely. There is no doubt that nanotechnology has the potential to enhance healthcare systems by simplifying and improving cancer diagnostics and treatment. Throughout this review, we summarize and highlight recent developments in nanotechnology applications for lung cancer in diagnosis and therapy. Moreover, the prospects and challenges in the translation of nanotechnology-based diagnostic and therapeutic methods into clinical applications are also discussed.
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Affiliation(s)
- Yujuan Duan
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China,School of Chemical Science and Engineering, Tongji University, Shanghai, China,Department of Laboratory Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Shen
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinan Zhang
- School of Chemical Science and Engineering, Tongji University, Shanghai, China,*Correspondence: Yao Luo, ; Yinan Zhang,
| | - Yao Luo
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Yao Luo, ; Yinan Zhang,
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Theisgen L, Strauch F, de la Fuente Klein M, Radermacher K. Safe design of surgical robots - a systematic approach to comprehensive hazard identification. BIOMED ENG-BIOMED TE 2022; 68:117-123. [PMID: 36226833 DOI: 10.1515/bmt-2022-0202] [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: 05/19/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Since the 1980s, robotic arms have been transferred from industrial applications to orthopaedic surgical robotics. Adverse events are frequent and often associated with the adopted powerful and oversized anthropomorphic arms. The FDA's 510(k) pathway encourages building on such systems, leading to the adoption of hazards, which is known as "predicate creep". Additionally, the methodology of hazard identification for medical device development needs improvement. METHODS We present an approach to enhance general hazard identification and prevent hazards of predicate creep by using the integrative, scenario-based and multi-perspective Point-of-View (PoV) approach. We also present the Catalogue of Hazards (CoH) as an approach for collecting and systematising hazards for future risk analysis and robot development. RESULTS We applied seven predefined PoVs to the use case of robotic laminectomy and identified 133 hazards, mainly coming from HMI analysis and literature. By analysing the MAUDE and recalls databases of the FDA, we were able to classify historical hazards and adopt them into the use case. CONCLUSIONS The combination of PoV approach and CoH is suitable for integrating multiple established hazard identification methods, increasing comprehensiveness, and supporting the systematic and hazard-based development of surgical robots.
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Affiliation(s)
- Lukas Theisgen
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Florian Strauch
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | | | - Klaus Radermacher
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
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29
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Puliatti S, Amato M, Mazzone E, Rosiello G, De Groote R, Berquin C, Piazza P, Farinha R, Mottrie A, Gallagher AG. Development and Validation of the Metric-Based Assessment of a Robotic Dissection Task on an Avian Model. J Surg Res 2022; 277:224-234. [DOI: 10.1016/j.jss.2022.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 01/16/2023]
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30
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Zhang ZY, Wang YF, Kang JT, Qiu XH, Wang CG. Helical micro-swimmer: hierarchical tail design and propulsive motility. SOFT MATTER 2022; 18:6148-6156. [PMID: 35968815 DOI: 10.1039/d2sm00823h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Helical micro-swimmers have markedly extended the reach of human beings in numerous fields, ranging from in vitro tasks in lab-on-a-chip to in vivo applications for minimally invasive medicine. The previous studies on the propulsive motility optimization of the micro-swimmers mainly focused on the distinct actuation principles (e.g., chemically powered, magnetic- or ultrasound energy-driven) and paid little attention to the structural design of these swimming machines themselves. The improvements of the structures can assist the externally powered motors in providing propulsion in a tiny scale and satisfy the agile locomotion demands. This paper presents the design, mechanics modeling and available experiments of a novel type of hierarchical helical swimming robot that significantly enhances the motility of the helix-based swimmers. Validated by the resistive force theory, our numerical model can well analyze the mechanical properties with a variety of geometric parameters. The motion performance of the hierarchical and conventional helical structures in low Reynolds regimes is presented, highlighting the advantages of hierarchical swimmers over the existing typical swimmers. In addition, the stability and resilience of the hierarchical swimmers can be maintained at a decent level. Moreover, the variable forward velocity resulting from the combined hierarchical structures is investigated here, which can thereby serve as a reliable design strategy. The proposed hierarchical helical design enables enticing opportunities for various device systems of medical robots and bio-integrated electronics.
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Affiliation(s)
- Z Y Zhang
- National Key Laboratory of Science and Technology for National Defence on Advanced Composites in Special Environments, Harbin Institute of Technology, Harbin 150001, P. R. China.
- Institute of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland
| | - Y F Wang
- Department of Aeronautics and Astronautics, Fudan University, Shanghai 200433, P. R. China
| | - J T Kang
- College of Sciences, Northeastern University, Shenyang 110819, P. R. China
| | - X H Qiu
- National Key Laboratory of Science and Technology for National Defence on Advanced Composites in Special Environments, Harbin Institute of Technology, Harbin 150001, P. R. China.
| | - C G Wang
- National Key Laboratory of Science and Technology for National Defence on Advanced Composites in Special Environments, Harbin Institute of Technology, Harbin 150001, P. R. China.
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Cundy TP, Fabrizio DD, Alizai NK, Najmaldin AS. Conversions in pediatric robot-assisted laparoscopic surgery. J Pediatr Surg 2022; 57:1637-1641. [PMID: 34924187 DOI: 10.1016/j.jpedsurg.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND New technology attracts necessary concerns regarding safety and effectiveness, including the risk and circumstances of conversions. This study analyses our 11-year experience of conversions from a dedicated pediatric robot-assisted laparoscopic surgery service. METHODS Consecutive patients were evaluated from a prospective database for the period March 2006 to May 2017. Descriptive and quantitative data for conversions were analysed. Variables were investigated including year of surgery, patient age, operation type, surgeon, and experience. RESULTS A total of 539 children underwent 601 procedures. There were 45 different types of procedures. Mean (± SD) age was 7.0 ± 5.2 years, and youngest 4 weeks old. There were 31 conversions (5.8%). Conversion rates were significantly higher in younger children, with rates of 10.0%, 6.1% and 4.2% for age groups 0-2, 2-6, and 6-18 years respectively (p = 0.01). There was a significant difference in conversion rates amongst procedures (p<0.001). Intravesical (9/26, 34.6%), liver cyst (2/8, 25.0%) and choledochal cyst (8/60, 13.3%) procedures were the highest. The most frequent reason for conversion was anesthetic related issues caused by dilated intestine and/or inadequate muscle relaxation (16/31, 52%). Three conversions were attributable to mechanical failures, none attributed to intraoperative complication. CONCLUSIONS Conversion rates are low even in the learning phase and comparable favourably to conventional laparoscopy, supporting the safety and effectiveness of robot-assisted technology for advanced laparoscopy in children. The importance of optimization of surgical conditions cannot be overemphasised.
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Affiliation(s)
- Thomas P Cundy
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK
| | | | - Naved K Alizai
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK
| | - Azad S Najmaldin
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK.
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Reporting and grading of complications for intracorporeal robot-assisted radical cystectomy: an in-depth short-term morbidity assessment using the novel Comprehensive Complication Index ®. World J Urol 2022; 40:1679-1688. [PMID: 35670880 DOI: 10.1007/s00345-022-04051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess suitability of Comprehensive Complication Index (CCI®) vs. Clavien-Dindo classification (CDC) to capture 30-day morbidity after robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS A total of 128 patients with bladder cancer (BCa) undergoing intracorporeal RARC with pelvic lymph node dissection between 2015 and 2021 were included in a retrospective bi-institutional study, which adhered to standardized reporting criteria. Thirty-day complications were captured according to a procedure-specific catalog. Each complication was graded by the CDC and the CCI®. Multivariable linear regression (MVA) was used to identify predictors of higher morbidity. RESULTS 381 complications were identified in 118 patients (92%). 55 (43%), 43 (34%), and 20 (16%) suffered from CDC grade I-II, IIIa, and ≥ IIIb complications, respectively. 16 (13%), 27 (21%), and 2 patients (1.6%) were reoperated, readmitted, and died within 30 days, respectively. 31 patients (24%) were upgraded to most severe complication (CCI® ≥ 33.7) when calculating morbidity burden compared to corresponding CDC grade accounting only for the highest complication. In MVA, only age was a positive estimate (0.44; 95% CI = 0.03-0.86; p = 0.04) for increased cumulative morbidity. CONCLUSION The CCI® estimates of 30-day morbidity after RARC were substantially higher compared to CDC alone. These measurements are a prerequisite to tailor patient counseling regarding surgical approach, urinary diversion, and comparability of results between institutions.
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Nechay TV, Panin SI, Sazhin AV, Bykov AV, Kuznetsov AA, Tyagunov AE, Melnikov-Makarchuk KY. [Comparison of robot-assisted and conventional endoscopic surgeries in the Russian Federation. (A systematic review and meta-analysis)]. Khirurgiia (Mosk) 2022:88-101. [PMID: 35658141 DOI: 10.17116/hirurgia202206188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation. MATERIAL AND METHODS Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis. RESULTS We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors. CONCLUSION Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.
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Affiliation(s)
- T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Bykov
- Volgograd State Medical University, Volgograd, Russia
| | - A A Kuznetsov
- Volgograd State Medical University, Volgograd, Russia
| | - A E Tyagunov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Hutchinson K, Li Z, Cantrell LA, Schenkman NS, Alemzadeh H. Analysis of executional and procedural errors in dry‐lab robotic surgery experiments. Int J Med Robot 2022; 18:e2375. [PMID: 35114732 PMCID: PMC9285717 DOI: 10.1002/rcs.2375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/10/2022]
Abstract
Background Analysing kinematic and video data can help identify potentially erroneous motions that lead to sub‐optimal surgeon performance and safety‐critical events in robot‐assisted surgery. Methods We develop a rubric for identifying task and gesture‐specific executional and procedural errors and evaluate dry‐lab demonstrations of suturing and needle passing tasks from the JIGSAWS dataset. We characterise erroneous parts of demonstrations by labelling video data, and use distribution similarity analysis and trajectory averaging on kinematic data to identify parameters that distinguish erroneous gestures. Results Executional error frequency varies by task and gesture, and correlates with skill level. Some predominant error modes in each gesture are distinguishable by analysing error‐specific kinematic parameters. Procedural errors could lead to lower performance scores and increased demonstration times but also depend on surgical style. Conclusions This study provides insights into context‐dependent errors that can be used to design automated error detection mechanisms and improve training and skill assessment.
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Affiliation(s)
- Kay Hutchinson
- Department of Electrical and Computer Engineering University of Virginia Charlottesville Virginia USA
| | - Zongyu Li
- Department of Electrical and Computer Engineering University of Virginia Charlottesville Virginia USA
| | - Leigh A. Cantrell
- Department of Obstetrics and Gynecology University of Virginia Charlottesville Virginia USA
| | - Noah S. Schenkman
- Department of Urology University of Virginia Charlottesville Virginia USA
| | - Homa Alemzadeh
- Department of Electrical and Computer Engineering University of Virginia Charlottesville Virginia USA
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik TJ, Schulman A. Device-related complications during renal cryoablation: insights from the Manufacturer and User Facility Device Experience (MAUDE) database. Urol Oncol 2022; 40:199.e9-199.e14. [DOI: 10.1016/j.urolonc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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Fosch-Villaronga E, Khanna P, Drukarch H, Custers B. The Role of Humans in Surgery Automation. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractInnovation in healthcare promises unparalleled potential in optimizing the production, distribution, and use of the health workforce and infrastructure, allocating system resources more efficiently, and streamline care pathways and supply chains. A recent innovation contributing to this is robot-assisted surgeries (RAS). RAS causes less damage to the patient's body, less pain and discomfort, shorter hospital stays, quicker recovery times, smaller scars, and less risk of complications. However, introducing a robot in traditional surgeries is not straightforward and brings about new risks that conventional medical instruments did not pose before. For instance, since robots are sophisticated machines capable of acting autonomously, the surgical procedure's outcome is no longer limited to the surgeon but may also extend to the robot manufacturer and the hospital. This article explores the influence of automation on stakeholder responsibility in surgery robotization. To this end, we map how the role of different stakeholders in highly autonomous robotic surgeries is transforming, explore some of the challenges that robot manufacturers and hospital management will increasingly face as surgical procedures become more and more automated, and bring forward potential solutions to ascertain clarity in the role of stakeholders before, during, and after robot-enabled surgeries (i.e. a Robot Impact Assessment (ROBIA), a Robo-Terms framework inspired by the international trade system 'Incoterms', and a standardized adverse event reporting mechanism). In particular, we argue that with progressive robot autonomy, performance, oversight, and support will increasingly be shared between the human surgeon, the support staff, and the robot (and, by extent, the robot manufacturer), blurring the lines of who is responsible if something goes wrong. Understanding the exact role of humans in highly autonomous robotic surgeries is essential to map liability and bring certainty concerning the ascription of responsibility. We conclude that the full benefits the use of robotic innovations and solutions in surgery could bring to healthcare providers and receivers cannot be realized until there is more clarity on the division of responsibilities channeling robot autonomy and human performance, support, and oversight; a transformation on the education and training of medical staff, and betterment on the complex interplay between manufacturers, healthcare providers, and patients.
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Cormi C, Parpex G, Julio C, Ecarnot F, Laplanche D, Vannieuwenhuyse G, Duclos A, Sanchez S. Understanding the surgeon's behaviour during robot-assisted surgery: protocol for the qualitative Behav'Robot study. BMJ Open 2022; 12:e056002. [PMID: 35393313 PMCID: PMC8991054 DOI: 10.1136/bmjopen-2021-056002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assisted surgery and the change in their behaviour with increasing experience in using the robot. METHODS AND ANALYSIS This is a qualitative study using semistructured interviews with surgeons who perform robot-assisted surgery. An interview guide comprising open questions will be used to ensure that the points to be discussed are systematically addressed during each interview (ie, (1) difference in behaviour and preparation of the surgeon between a standard procedure and a robot-assisted procedure; (2) the influence of proprioceptive modifications, gain in stability and cognitive biases, inherent in the use of a surgical robot and (3) the intrinsic effect of the learning curve on the behaviour of the surgeons. After transcription, interviews will be analysed with the help of NVivo software, using thematic analysis. ETHICS AND DISSEMINATION Since this project examines professional practices in the field of social and human sciences, ethics committee was not required in accordance with current French legislation (Decree no 2017-884, 9 May 2017). Consent from the surgeons is implied by the fact that the interviews are voluntary. Surgeons will nonetheless be informed that they are free to interrupt the interview at any time.Results will be presented in peer-reviewed national and international congresses and submitted to peer-reviewed journals for publication. The communication and publication of the results will be placed under the responsibility of the principal investigator and publications will be prepared in compliance with the ICMJE uniform requirements for manuscripts. TRIAL REGISTRATION NUMBER NCT04869995.
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Affiliation(s)
- Clément Cormi
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
- LIST3N/Tech-CICO, Université de Technologie de Troyes, Troyes, France
| | - Guillaume Parpex
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpital Cochin, Paris, France
| | - Camille Julio
- Department of Digestive Surgery, Hôpital Saint-Louis, Paris, France
| | - Fiona Ecarnot
- EA3920, Burgundy Franche-Comté University, Besancon, France
| | - David Laplanche
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
| | - Geoffrey Vannieuwenhuyse
- Département de chirurgie gynécologique, mammaire et carcinologique, Centre Hospitalier de Troyes, Troyes, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
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Melnyk R, Saba P, Holler T, Cameron K, Mithal P, Rappold P, Wu G, Cubillos J, Rashid H, Joseph JV, Ghazi AE. Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery. Simul Healthc 2022; 17:78-87. [PMID: 34387245 DOI: 10.1097/sih.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated. METHODS Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months. RESULTS Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38⇾17, -40 seconds, and -500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (-4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1). CONCLUSIONS This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
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Affiliation(s)
- Rachel Melnyk
- From the Simulation Innovation Lab (R.M., P.S., T.H., K.C., A.E.G.) and Department of Urology (P.M., P.R., G.W., J.C., H.R., J.V.J., A.E.G.), University of Rochester Medical Center (URMC), Rochester, NY
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Micha JP, Rettenmaier MA, Bohart RD, Goldstein BH. Robotic-Assisted Surgery for the Treatment of Breast and Cervical Cancers. JSLS 2022; 26:JSLS.2022.00014. [PMID: 35815331 PMCID: PMC9215693 DOI: 10.4293/jsls.2022.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Robotic-assisted surgery facilitates the performance of numerous, complex procedures, namely conferring precision, flexibility, and control that is otherwise unavailable with conventional laparoscopy; and compared to open surgery, robotic-assisted surgery is ostensibly associated with fewer complications, reduced intraoperative complications, and shorter hospital stay duration. Nevertheless, the American College of Obstetricians and Gynecologists and the Food and Drug Administration have criticized the pervasive acceptance of robotic-assisted surgery, given the absence of randomized clinical trial data compared to traditional laparoscopy and open procedures, not to mention the increased surgical cost. Conclusions: While the research data continue to be borne out, surgeons should exercise considerable discretion in selecting the surgical approach from which their patients would derive the greatest clinical benefit.
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Affiliation(s)
- John P Micha
- Women's Cancer Research Foundation, Newport Beach, CA
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Nguyen M, Nabhani J, Hamilton A, Lee S, Katz J, Samakar K, Ghlandian A, Hua H. Surgeon Assessment of a Novel Multi-Resolution Foveated Laparoscope. Surg Innov 2022; 29:769-780. [PMID: 35331068 DOI: 10.1177/15533506221081100] [Citation(s) in RCA: 1] [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
BACKGROUND We developed a multi-resolution foveated laparoscope (MRFL) to improve situational awareness in laparoscopic surgery. We assessed surgeon objective task performance and subjective attitudes with MRFL when used for box trainer tasks and porcine surgery. METHODS The MRFL simultaneously obtains a wide-angle view and a magnified view. The 2 images are displayed simultaneously. 6 urologists and 2 general surgeons performed box trainer and porcine surgery tasks with the MRFL and a standard laparoscope. Task time, use of display options, and subjective assessments were obtained. RESULTS Subjectively, surgeons rated situational awareness, depth perception, and instrument interference as comparable between the prototype MRFL and laparoscope for trainer tasks. For porcine surgery, the MRFL was rated as having less interference than the standard laparoscope. The image quality of the MRFL was rated interior to the standard laparoscope. Participants found the different viewing modes useful for different roles and reported that they would likely use the MRFL for conventional laparoscopic and robotic surgery. Objectively, box trainer task time was comparable for 2 of 3 tasks with the remaining task shorter for the standard laparoscope. Porcine nephrectomy and oophorectomy were feasible with the prototype MRFL, although nephrectomy task time was significantly longer than traditional laparoscopy. CONCLUSIONS The MRFL demonstrated feasibility for performing complex surgery. Surgeons had favorable attitudes toward its features and likelihood to use the device if available. Users utilized different view types for different tasks. Longer MRFL task times were attributed to poorer image quality of the prototype.
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Affiliation(s)
- Mike Nguyen
- Department of Urology, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jamal Nabhani
- Department of Urology, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Allan Hamilton
- Department of Surgery, 242726University of Arizona, Tucson, AZ, USA
| | - Sangyoon Lee
- College of Optical Sciences, 242726University of Arizona, Tucson, AZ, USA
| | - Jeremy Katz
- College of Optical Sciences, 242726University of Arizona, Tucson, AZ, USA
| | - Kamran Samakar
- Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Allan Ghlandian
- Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Hong Hua
- College of Optical Sciences, 242726University of Arizona, Tucson, AZ, USA
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Ghandour Z, Siciliani L, Straume OR. Investment and quality competition in healthcare markets. JOURNAL OF HEALTH ECONOMICS 2022; 82:102588. [PMID: 35065851 DOI: 10.1016/j.jhealeco.2022.102588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
We study the strategic relationship between hospital investment and provision of service quality. We use a spatial competition framework and allow investment and quality to be complements or substitutes in patient benefit and provider cost. We assume that each hospital commits to a certain investment before deciding on service quality, and that investment is observable and contractible while quality is observable but not contractible. We show that, under a fixed DRG-pricing system, providers' lack of ability to commit to quality leads to under- or overinvestment, relative to the first-best solution. Underinvestment arises when the price-cost margin is positive, and quality and investments are strategic complements, which has implications for optimal contracting. Differently from the simultaneous-move case, the regulator must complement the payment with one more instrument to address under/overinvestment. We also analyse the welfare effects of different policy options (separate payment for investment, higher per-treatment prices, or DRG-refinement policies).
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Affiliation(s)
- Ziad Ghandour
- Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK.
| | - Odd Rune Straume
- Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Department of Economics, University of Bergen Norway.
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Stokkel LE, van de Kamp MW, Schaake EE, Boellaard TN, Hendricksen K, van Rhijn BWG, Mertens LS. Robot-Assisted Partial Cystectomy versus Open Partial Cystectomy for Patients with Urachal Cancer. Urol Int 2022; 106:840-847. [PMID: 35134799 DOI: 10.1159/000521605] [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: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC. METHODS We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification. RESULTS Median follow-up was 40 months (IQR 21-95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56-89 months) and 60% (95% CI; 42-78 months), respectively, versus 90% (95% CI; 85-95 months) and 66% (95% CI; 59-73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27). CONCLUSION Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.
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Affiliation(s)
- Laura E Stokkel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maaike W van de Kamp
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Vilanilam GC, Venkat EH. Editorial. Ethical nuances and medicolegal vulnerabilities in robotic neurosurgery. Neurosurg Focus 2022; 52:E2. [DOI: 10.3171/2021.10.focus21533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- George Chandy Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Easwer Hariharan Venkat
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Lagrange F, Fiard G, Larose C, Eschwege P, Hubert J. Role and Training of the Bedside Surgeon in Robotic Surgery: A Survey Among French Urologists-in-Training. Res Rep Urol 2022; 14:17-22. [PMID: 35083180 PMCID: PMC8785127 DOI: 10.2147/rru.s344369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Due to the development of robotic surgery, surgeons operating at the console are physically separated from the patient. They must rely on help from an assistant, also called bedside surgeon. This study aimed to investigate the habits and practices of French urologic residents when performing this role and to determine whether they expected specific training to qualify as bedside surgeons. Materials and Methods A web-based survey was sent to French urology residents and fellows using the mailing-list of the French Association of Urologists in Training (AFUF). Results Over a 3-month period, 86 residents and fellows responded to the survey. Seventy-five (87.2%) thought that an experience as bedside surgeon was useful to acquire console surgeon status and, more specifically, 48.2% of them indicated that this former experience was vital. Nearly 64% considered that learning robotic surgery was essential during residency and fellowship. Overall, 91.9% believed that bedside surgeons should receive a formal training. They were 69.7% to need 5 to 10 procedures to feel confident as bedside surgeon. Almost 75% underwent laparoscopic training on simulators. Having access to a surgery school significantly increased the probability of receiving laparoscopic training on simulators (p = 0.0033). Conclusion French urology residents and fellows expect a specific training program for bedside surgeons to increase their level of confidence and to get familiar with the device during their first robotic procedures. For them, a bedside surgeon program on a regional/national level would be required.
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Affiliation(s)
- Francois Lagrange
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
- Correspondence: Francois Lagrange, Tel +33 83 15 31 52, Email
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, 38043, France
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, 38043, France
| | - Clement Larose
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
| | - Pascal Eschwege
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
| | - Jacques Hubert
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
- IADI-UL-INSERM (U1254), University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
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Harnessing robot experimentation to optimize the regulatory framing of emerging robot technologies. DATA & POLICY 2022. [DOI: 10.1017/dap.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
From exoskeletons to lightweight robotic suits, wearable robots are changing dynamically and rapidly, challenging the timeliness of laws and regulatory standards that were not prepared for robots that would help wheelchair users walk again. In this context, equipping regulators with technical knowledge on technologies could solve information asymmetries among developers and policymakers and avoid the problem of regulatory disconnection. This article introduces pushing robot development for lawmaking (PROPELLING), an financial support to third parties from the Horizon 2020 EUROBENCH project that explores how robot testing facilities could generate policy-relevant knowledge and support optimized regulations for robot technologies. With ISO 13482:2014 as a case study, PROPELLING investigates how robot testbeds could be used as data generators to improve the regulation for lower-limb exoskeletons. Specifically, the article discusses how robot testbeds could help regulators tackle hazards like fear of falling, instability in collisions, or define the safe scenarios for avoiding any adverse consequences generated by abrupt protective stops. The article’s central point is that testbeds offer a promising setting to bring policymakers closer to research and development to make policies more attuned to societal needs. In this way, these approximations can be harnessed to unravel an optimal regulatory framework for emerging technologies, such as robots and artificial intelligence, based on science and evidence.
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Yaacoub JPA, Noura HN, Salman O, Chehab A. Robotics cyber security: vulnerabilities, attacks, countermeasures, and recommendations. INTERNATIONAL JOURNAL OF INFORMATION SECURITY 2022; 21:115-158. [PMID: 33776611 PMCID: PMC7978470 DOI: 10.1007/s10207-021-00545-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The recent digital revolution led robots to become integrated more than ever into different domains such as agricultural, medical, industrial, military, police (law enforcement), and logistics. Robots are devoted to serve, facilitate, and enhance the human life. However, many incidents have been occurring, leading to serious injuries and devastating impacts such as the unnecessary loss of human lives. Unintended accidents will always take place, but the ones caused by malicious attacks represent a very challenging issue. This includes maliciously hijacking and controlling robots and causing serious economic and financial losses. This paper reviews the main security vulnerabilities, threats, risks, and their impacts, and the main security attacks within the robotics domain. In this context, different approaches and recommendations are presented in order to enhance and improve the security level of robotic systems such as multi-factor device/user authentication schemes, in addition to multi-factor cryptographic algorithms. We also review the recently presented security solutions for robotic systems.
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Affiliation(s)
- Jean-Paul A. Yaacoub
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Hassan N. Noura
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté (UBFC), Besançon, France
| | - Ola Salman
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Ali Chehab
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, 1107 2020 Lebanon
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Mao J, Sedrakyan A, Sun T, Guiahi M, Chudnoff S, Kinard M, Johnson SB. Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing. Pharmacoepidemiol Drug Saf 2021; 31:442-451. [PMID: 34919294 DOI: 10.1002/pds.5402] [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: 03/16/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop an annotation model to apply natural language processing (NLP) to device adverse event reports and implement the model to evaluate the most frequently experienced events among women reporting a sterilization device removal. METHODS We included adverse event reports from the Manufacturer and User Facility Device Experience database from January 2005 to June 2018 related to device removal following hysteroscopic sterilization. We used an iterative process to develop an annotation model that extracts six categories of desired information and applied the annotation model to train an NLP algorithm. We assessed the model performance using positive predictive value (PPV, also known as precision), sensitivity (also known as recall), and F1 score (a combined measure of PPV and sensitivity). Using extracted variables, we summarized the reporting source, the presence of prespecified and other patient and device events, additional sterilizations and other procedures performed, and time from implantation to removal. RESULTS The overall F1 score was 91.5% for labeled items and 93.9% for distinct events after excluding duplicates. A total of 16 535 reports of device removal were analyzed. The most frequently reported patient and device events were abdominal/pelvic/genital pain (N = 13 166, 79.6%) and device dislocation/migration (N = 3180, 19.2%), respectively. Of those reporting an additional sterilization procedure, the majority had a hysterectomy or salpingectomy (N = 7932). One-fifth of the cases that had device removal timing specified reported a removal after 7 years following implantation (N = 2444/11 293). CONCLUSIONS We present a roadmap to develop an annotation model for NLP to analyze device adverse event reports. The extracted information is informative and complements findings from previous research using administrative data.
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Affiliation(s)
- Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Tianyi Sun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Maryam Guiahi
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott Chudnoff
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut, USA
| | | | - Stephen B Johnson
- Department of Population Health, New York University Langone Health, New York, New York, USA
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He B, de Smet MD, Sodhi M, Etminan M, Maberley D. A review of robotic surgical training: establishing a curriculum and credentialing process in ophthalmology. Eye (Lond) 2021; 35:3192-3201. [PMID: 34117390 PMCID: PMC8602368 DOI: 10.1038/s41433-021-01599-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Ophthalmic surgery requires a highly dexterous and precise surgical approach to work within the small confines of the eye, and the use of robotics offers numerous potential advantages to current surgical techniques. However, there is a lag in the development of a comprehensive training and credentialing system for robotic eye surgery, and certification of robotic skills proficiency relies heavily on industry leadership. We conducted a literature review on the curricular elements of established robotics training programs as well as privileging guidelines from various institutions to outline key components in training and credentialing robotic surgeons for ophthalmic surgeries. Based on our literature review and informal discussions between the authors and other robotic ophthalmic experts, we recommend that the overall training framework for robotic ophthalmic trainees proceeds in a stepwise, competency-based manner from didactic learning, to simulation exercises, to finally operative experiences. Nontechnical skills such as device troubleshooting and interprofessional teamwork should also be formally taught and evaluated. In addition, we have developed an assessment tool based on validated global rating scales for surgical skills that may be used to monitor the progress of trainees. Finally, we propose a graduating model for granting privileges to robotic surgeons. Further work will need to be undertaken to assess the feasibility, efficacy and integrity of the training curriculum and credentialing practices for robotic ophthalmic surgery.
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Affiliation(s)
- Bonnie He
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc D de Smet
- Department of Ophthalmology, University of Leiden, Leiden, Netherlands
| | - Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Maberley
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Kelkar D, Borse MA, Godbole GP, Kurlekar U, Slack M. Interim safety analysis of the first-in-human clinical trial of the Versius surgical system, a new robot-assisted device for use in minimal access surgery. Surg Endosc 2021; 35:5193-5202. [PMID: 32989548 PMCID: PMC8346419 DOI: 10.1007/s00464-020-08014-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to provide an interim safety analysis of the first 30 surgical procedures performed using the Versius Surgical System. BACKGROUND Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is currently undergoing a first-in-human prospective clinical trial to confirm the safety and effectiveness of the device when performing minimal access surgery (MAS). METHODS Procedures were performed using Versius by a lead surgeon supported by an operating room (OR) team. Male or female patients aged between 18 and 65 years old and requiring elective minor or intermediate gynaecological or general surgical procedures were enrolled. The primary endpoint was the rate of unplanned conversion of procedures to other MAS or open surgery. RESULTS The procedures included nine cholecystectomies, six robot-assisted total laparoscopic hysterectomies, four appendectomies, five diagnostic laparoscopy cases, two oophorectomies, two fallopian tube recanalisation procedures, an ovarian cystectomy and a salpingo-oophorectomy procedure. All procedures were completed successfully without the need for conversion to MAS or open surgery. No patient returned to the OR within 24 h of surgery and readmittance rate at 30 and 90 days post-surgery was 1/30 (3.3%) and 2/30 (6.7%), respectively. CONCLUSIONS This first-in-human interim safety analysis demonstrates that the Versius Surgical System is safe and can be used to successfully perform minor or intermediate gynaecological and general surgery procedures. The cases presented here provide evidence that the Versius clinical trial can continue to extend recruitment and begin to include major procedures, in alignment with the IDEAL-D Framework Stage 2b: Exploration.
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Affiliation(s)
- Dhananjay Kelkar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Mahindra A Borse
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Girish P Godbole
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Utkrant Kurlekar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Mark Slack
- CMR Surgical Ltd, 1 Evolution Business Park, Milton Road, Cambridge, CB24 9NG, UK.
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [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: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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