The history of robotic surgery and its evolution: when illusion becomes reality

The term "robot" was concepted in the beginning of last century, coming originally from the Czech word "robota", meaning "labor". More recently, computer assistance and robotics based in the telepresence and virtual reality concept have been applied to surgical procedures. The application of robots in surgery dates approximately 35 years, experiencing significant growth in the last two decades fueled by the advent of advanced technologies. Despite its recent and brief status in surgery history, robotic technology has already proven its enhanced visualization, superior dexterity and precision during minimally invasive procedures. Currently, the worldwide diffused and predominant robot system used in surgery is Da Vinci by Intuitive Surgical, however robotic surgery evolution is far from over, with multiple potential competitors on the horizon pushing forward its paradigms. We aim to describe the history and evolution of robotic surgery in the last years as well as present its future perspectives.

Virtual Reality as a distraction therapy during cystoscopy: a clinical trial

OBJECTIVES

to investigate whether virtual reality (VR) experience is associated with decreased pain sensation among patients who undergo rigid cystoscopy under local anesthesia.

METHODS

we performed a prospective, randomized, controlled study of 159 patients who were aleatorily enrolled into two groups: VR and control. VR experience intervention consisted of using a headset with a smartphone adapted to a virtual reality glasses where an app-video was played during the procedure. Main outcomes analyzed were pain, discomfort, heart rate variability, difficulty and duration of the cystoscopy. Statistical analyses were performed using a Student's t test, Mann-Whitney test and Chi-square test. A P<0.05 was considered to be statistically significant.

RESULTS

among 159 patients studied (VR group=80 patients; control group=79 patients), the mean age was 63,6 years and 107 (67,3%) were male. There was no statistically significant difference in baseline characteristics between the 2 groups. VR was significantly associated to decreased heart rate variability (6,29 vs 11,09 bpm, P<0,001) and lower duration of the procedure (5,33 vs 8,65 min, P<0,001). Also, when cystoscopies due to double-J extraction were excluded, VR experience was associated with reduced pain on the visual analog score of pain (3,26 vs 4,33 cm, P=0,023).

CONCLUSIONS

the use of VR as a distraction therapy while performing outpatient cystoscopies is safe, has no side effects, is associated with less pain and discomfort, and reduces length of procedure.

VIDA-Nursing v1.0: immersive virtual reality in vacuum blood collection among adults

OBJECTIVE

to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0.

METHOD

methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects.

RESULTS

the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions.

CONCLUSION

the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.

Applicability of an immersive virtual reality system to assess egocentric orientation of older adults

BACKGROUND

Spatial orientation is a cognitive domain frequently compromised in patients with Alzheimer disease (AD) and may be one of its first clinical manifestations. Some studies have shown that allocentric integration with egocentric spatial information seems to be impaired in this pathology. There is no consensus on how best to assess spatial orientation and traditional tests lack ecological validity, but, recently, virtual reality (VR) has provided new opportunities for this assessment.

OBJECTIVES

To analyze the applicability and stability of an immersive virtual task developed to assess spatial orientation, the Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) in older adults with and without mild cognitive impairment.

METHODS

Forty-three older adults were included in the study, 24 without cognitive impairment and 19 with mild cognitive impairment. Applicability was assessed by the Witmer and Singer Sense of Presence Questionnaire and a questionnaire for adverse events of cybersickness. To assess stability, participants were assessed twice with an interval of 7 to 14 days, and the intraclass correlation coefficient was calculated between visits. The t test or the Mann-Whitney test was used to compare applicability and stability between groups.

RESULTS

There was no significant difference between the groups regarding applicability. A strong correlation between the first and second day of testing was found in the mild cognitive impairment group.

CONCLUSION

The SOIVET-Maze task showed excellent applicability and good stability, favoring its clinical application for the evaluation of spatial orientation in older adults.

Use of virtual reality equipment to assess the manual dexterity of applicants for ophthalmology residency

PURPOSE

To assess the microsurgery dexterity outcomes of two sequential training evaluations using virtual reality technology.

METHODS

This was a multicenter cross-sectional study of all candidates who were accepted as first-year residents at one of six ophthalmology teaching institutions. Residents were subjected to two identical series of standardized, reproducible dexterity tests using virtual reality equipment (Eyesi®): "sequence 1" and "sequence 2." Each sequence consisted of five difficulty levels that were assessed using a proprietary scoring system. The data were tested for normality using the Shapiro-Wilk test. The differences between tests in sequences 1 and 2 were evaluated using the Wilcoxon signed-rank test.

RESULTS

The data did not follow a normal distribution. There were improvements from sequence 1 in all the tests (all p values<0.05). The sum of all scores (total score) improved from sequence 1 (median= 152.50) to sequence 2 (median 256.00; p<0.001). There was no correlation between the delta sequence values and the average scores.

CONCLUSION

Two sequential training evaluations using virtual reality technology showed relevant improvement in quantifications of microsurgery dexterity. This information should be considered if virtual reality approaches are used for testing purposes, as previous experience may lead to improved test results.

Assisted technology in Parkinson's disease gait: what's up?

BACKGROUND

 Gait disturbances are prevalent and debilitating symptoms, diminishing mobility and quality of life for Parkinson's disease (PD) individuals. While traditional treatments offer partial relief, there is a growing interest in alternative interventions to address this challenge. Recently, a remarkable surge in assisted technology (AT) development was witnessed to aid individuals with PD.

OBJECTIVE

 To explore the burgeoning landscape of AT interventions tailored to alleviate PD-related gait impairments and describe current research related to such aim.

METHODS

 In this review, we searched on PubMed for papers published in English (2018-2023). Additionally, the abstract of each study was read to ensure inclusion. Four researchers searched independently, including studies according to our inclusion and exclusion criteria.

RESULTS

 We included studies that met all inclusion criteria. We identified key trends in assistive technology of gait parameters analysis in PD. These encompass wearable sensors, gait analysis, real-time feedback and cueing techniques, virtual reality, and robotics.

CONCLUSION

 This review provides a resource for guiding future research, informing clinical decisions, and fostering collaboration among researchers, clinicians, and policymakers. By delineating this rapidly evolving field's contours, it aims to inspire further innovation, ultimately improving the lives of PD patients through more effective and personalized interventions.

The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review

OBJECTIVE

To identify in national and international literature the use of virtual reality to develop manual skills of children with cerebral palsy.

METHODS

This is a systematic review carried out in the PubMed database, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and the Online System for Search and Analysis of Medical Literature (Ovid Medline) using the keywords "cerebral palsy", "virtual reality", "occupational therapy", "child", "daily activities/activities of daily living", in English and in Portuguese. The selected articles had their methodological quality evaluated through the Physiotherapy Evidence Database (PEDro scale).

RESULTS

228 studies were selected, as they included children with cerebral palsy undergoing treatment with exposure to virtual reality to improve manual function in daily activities. Studies on other themes, incomplete, and duplicated reviews were excluded. Three evaluators conducted the study selection process and included 14 articles in the analysis.

CONCLUSIONS

The findings suggest that virtual reality therapy has contributed to an improvement in the manual function of children with cerebral palsy, constituting a useful resource for a supporting intervention to enhance traditional therapies.