Biomedical subjects

Philippe Cinquin

Publications and source records attributed to Philippe Cinquin.

8 recordsLinked to original sources

PubMed2006

Accessing the influence of repositioning on the pelvis' 3-D orientation in wheelchair users.

This study aimed at evaluating the effects of mechanical repositioning, obtained by the increase in seat-to-back (STB) and system tilt angles, on the position of the pelvis with spinal-cord injured subjects seated in a wheelchair. The noninvasive method used combined magnetic resonance imaging (MRI) images of the whole pelvis obtained in a supine posture and ultrasound images of the pelvic iliac crests obtained in four seating positions. The matching of the two image data sets enabled the location of fourteen pelvic landmarks in the seated positions. From these landmarks, the pelvic tilt, obliquity, and transverse rotation, and the three-dimensional (3-D) motion of the pelvis were calculated. Results showed that the increase in STB angle is not equal to the calculated increase in pelvic tilt and that the pelvis rotated posteriorly, moved forward and downwards. An increase in the system tilt moved the pelvis rearwards and downwards, which counter-balanced the movement seen with the increase in STB. At the return to the first position, no significant changes were observed in the pelvis' position and orientation compared to the initial posture. Results also demonstrated the importance in calculating the total 3-D rotations and translations to characterize adequately the pelvic movement.

Adult↗

PubMed2006

[Use of robotics in laparoscopic urological surgery: state of the art].

OBJECTIVE: To evaluate the current place of robotics in laparoscopic urological surgery. MATERIAL AND METHODS: A review of the international literature was conducted to evaluate the various available endoscope robot systems and telemanipulator robots and to establish their practical limitations and their contribution to surgery. RESULTS: Robotic systems are based on various structures, which each present specific disadvantages. Two types of systems can be distinguished: endoscope robots and telemanipulator robots (complete robotic systems) with different degrees of complexity, dimensions and costs. Each system is different in terms of service rendered. Endoscope robot systems (EndoAssist, AESOP, LapMan) are reliable and eliminate the need for an assistant to hold the camera. Man-machine interfaces can be manual, by pedal or by voice recognition. They are relatively large and expensive, limiting their diffusion at the present time. Complete instrument-handling robots (master-slave manipulators) are currently represented by 2 robots (Zeus and Da Vinci) which have demonstrated their efficacy in many difficult operations. Their very high cost and their large dimensions also constitute limitations to their diffusion, making them inaccessible to the majority of centres. The urological community has largely contributed to the evaluation of robots in laparoscopic operations, as reflected by the large number of publications. CONCLUSION: Considerable technological progress has been made over recent years to make laparoscopic surgery more accessible. Current robotized tools are still imperfect systems, but, in the future, may possibly facilitate difficult laparoscopic operations, particularly in urology.

Equipment Design↗

PubMed2006

[Preclinical development of the TIMC LER (light endoscope robot)].

INTRODUCTION: The authors participated in the development of an innovative endoscope robot in laparoscopic surgery designed by TIMC-GMCAO, providing a solution to the disadvantages of currently available systems, i.e. their cost and large dimensions. MATERIAL AND METHODS: A compact robot (LER) placed on the patient's skin that can be used in the lateral and dorsal supine position was tested on cadavres and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The amplitude of vision is 360 degrees with an angle of 160 degrees. Twenty three procedures were performed (2 radical prostatectomies, 4 pelvic lymph node dissections, 6 nephrectomies, 2 adrenalectomies, 3 cholecystectomies, 1 small bowel resection-anastomosis, 1 cystectomy, 1 splenectomy, and 3 appendicectomies). RESULTS: Among the various control systems tested, we adopted voice recognition on the basis of its intuitive nature and the fact that it leaves one hand free. In the light of these studies, several aspects of the prototype were modified: reliability, fixation, ergonomy and dimensions. The ease of installation, which takes only 5 minutes, and the easy handling of the robot allowed 21 out of 23 laparoscopic procedures to be performed without the need for an assistant. CONCLUSION: The LER robot is an endoscope robot guided by the surgeon's voice that can eliminate the need for an assistant to hold the camera during laparoscopic surgery in the lateral and dorsal supine positions. The ease of installation and manufacture should make this an effective and inexpensive system. The gain in operating time was not evaluated during these trials on cadavres and pigs, as various prototypes were tested and several problems of reliability were successively resolved. Ongoing randomized, prospective clinical trials should soon validate this robot prior to marketing.

Animals↗

PubMed2005

Development and testing of a compact endoscope manipulator for minimally invasive surgery.

OBJECTIVE: This report describes the design, development, and testing of a novel compact surgical assistant robot to control the orientation and insertion depth of a laparoscopic endoscope during minimally invasive abdominal surgery. In contrast to typical endoscope manipulators, the described robot is particularly compact and lightweight, is simple to set up and use, occupies no floor or operating table space, and does not limit access to the patient in any way. MATERIALS AND METHODS: The sterilizable endoscope manipulator is sufficiently small and lightweight at 625 g and 110 mm in diameter that it can be placed directly on the abdomen of the patient without interfering with other handheld instruments during minimally invasive surgery. It consists of an annular base, a clamp to hold an endoscope trocar, and two joints which enable azimuth rotation and inclination of the endoscope about a pivot point at the incision. The endoscope insertion depth is controlled by a cable winding acting against a compression spring on the endoscope shaft. Voice recognition and miniature keypad user command interfaces are provided, and the manipulator motors are backdriveable for manual repositioning. RESULTS: Endoscope camera trajectory-following accuracy and response-time results were measured using an optical localizer. Experimental results are given comparing the current prototype with the previous cable-driven prototype. The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of minimally invasive surgical training procedures on cadavers and animals. CONCLUSIONS: The endoscope manipulator described has been shown to be a viable, practical device with performance and functionality equivalent to those of commercially available models, yet with greatly reduced size, weight, and cost.

Animals↗

PubMed2004

A virtual reality based navigation system for endovascular surgery.

Endovascular surgery provides a minimally invasive solution for the treatment of aortic aneurysms. Fluoroscopic guidance involves X-rays exposure and loss of space information. We have developed a navigation system allowing real-time visualisation of the endovascular tools in a 3D model of the vessels without any radiation exposure. A modified endoprosthesis is equipped with a magnetic sensor tracked by the Aurora magnetic localizer. The registration step uses 2.5D ultrasonography to replace pre-operative CT data in the Operating Room referential. The Virtual Reality based navigation system shows the location of the endoprosthesis inside a 3D CT model of the aorta. Endovascular procedure benefits from a reduced radiation exposure.

France↗

PubMed2003

Robot-based tele-echography: the TER system.

This paper presents a master-slave robotized system enabling a remote echographic diagnosis. The expert holds a virtual probe placed on a haptic device; he moves this virtual probe in order to control the motion of the real probe positioned on the body of the patient located remotely. The real probe is placed on a lightweight and user-friendly slave robot and moved by it. The contact force between the probe and the patient is fed back to the operator allowing him to have a haptic virtual environment. The aim of this haptic control is to preserve the medical expert proprioception in order to the facilitate hand-eye coordination necessary to echographic examination. In this paper we present the architecture of the system and experimental results.

France↗

PubMed2002

Computer-assisted orthognathic surgery: clinical evaluation of a mandibular condyle repositioning system.

PURPOSE: The purpose of this study was to evaluate a new method for positioning the mandibular condyle during orthognathic surgery based on 3-dimensional optical localization of infrared emitting diodes. PATIENTS AND METHODS: Eleven patients ("empirical group") underwent condylar repositioning using the empirical repositioning method (standard technique) and were considered controls. In 10 patients ("active group"), the computer-assisted system was used to replace the condyle-bearing fragment in its sagittal preoperative position. In these patients, the condylar torque was not controlled. In the third group of 10 patients ("graft group"), the computer-assisted system was used to replace the condyle in all 3 directions. Very often it was necessary in this group to fill the osteotomy gap with a bone graft. The clinical evaluation was based on 4 major criteria: the quality of the postoperative occlusion, the stability of skeletal position on successive cephalometric radiographs, the occurrence of temporomandibular dysfunction (TMD), and the preservation of mandibular motion. Clinical assessment was made at 1, 3, 6, and 12 months follow-up. RESULTS: Forty-five percent of the "empirical group" did not have the expected postoperative occlusion, 5 patients showed evidence of clinical relapse at 1 year, 45% had worsened TMD status, and only 63.37% of mandibular motion had been recovered at 6 months. All the patients in the "active group" had the expected occlusion and only 1 patient exhibited a mild relapse and TMD symptoms; however the average mandibular motion recovery was only 62.65% at 6 months. All the patients in the "graft group" had a good occlusion and no relapse or TMD. Their percentage of mandibular motion recovery was 77.58%. CONCLUSION: The quality of sagittal repositioning is the main factor contributing to a good occlusion and bone stability. Functional results (in particular, recovery of mandibular motion) are more related to limiting condylar torque.

Adolescent↗

PubMed2002

A haptic virtual environment for tele-echography.

Having a haptic virtual environment for tele-echography will enable the medical expert with faster adaptation and especially facilitated immersion in what we could call a "virtual echographic examination cabinet". The innovation of this haptic control is to preserve medical expert proprioception and gesture feelings, which provide the users with indications that are synchronized with the echographic images. In this paper, we will focus on the telegesture module: we will detail several issues and solutions related to this particular problem of tele-robotic scan examination.

Communication↗