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At least 217 records · Page 12Linked to original sources

PubMed2006

da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up.

OBJECTIVE: Laparoscopic partial nephrectomy is gaining acceptance as an alternative to open surgery for small renal tumours, although technical difficulty of intracorporeal suturing and concerns over warm ischemia time are limitations. Previous work has demonstrated that suturing with the robotic system is easier compared with laparoscopy. We believe the robot has an application and we report our initial experience in 10 patients undergoing robotic partial nephrectomy. METHODS: Ten patients with small exophytic renal masses underwent intraperitoneal robotic partial nephrectomy. Principles of traditional open surgery were followed and intraoperative ultrasound was used to define resection margins. The renal artery was clamped with laparoscopic bulldog clamps and indigo carmine was administered intravenously to detect entry into collecting system. Suture closure and FLOSEAL were used for hemostasis. Frozen sections were obtained in all patients. RESULTS: Seven men and three women, mean age 59 yr, underwent robotic partial nephrectomy. Mean tumour size was 2 cm. Mean console and warm ischemia time were 158 min and 21 min, respectively. The median hospital stay was 1.5 d. Pathology revealed renal cell carcinoma in eight, oncocytoma in one, and lipoma in one. All resection margins were negative. Follow-up ranged from 6 to 28 mo. CONCLUSIONS: Robotic partial nephrectomy is a viable alternative to open or laparoscopic partial nephrectomy in carefully selected patients with small renal tumours. The advantages of the robotic system must be weighed against its cost. Further studies will determine if reduction in procedure complexity warrants the expense of such technology.

Adult↗

PubMed2005

Telemedicine and robotics: paving the way to the globalization of surgery.

The concept of delivering health services at a distance, or telemedicine is becoming an emerging tool for the field of surgery. For the surgical services, telepresence surgery through robotics is gradually being incorporated into health care practices. This article will provide a brief overview of the principles surrounding telemedicine and telepresence surgery as they specifically relate to robotics. Where limitations have been reached in laparoscopy, robotics has allowed further steps forward. The development of robotics in medicine has been a progression from passive to immersive technology. In gynecology, the utilization of robotics has evolved from the use of Aesop, a robotic arm for camera manipulation, to full robotic systems such as Zeus, and the daVinci surgical system. These systems have not only been used directly for a variety of procedures but have also become a useful tool for conferencing and the mentoring of surgeons from afar. As this mode of technology becomes assimilated into the culture of surgery and medicine globally, caution must be taken to carefully navigate the economic, legal and ethical implications of telemedicine. Despite the challenges faced, telepresence surgery holds promise for more widespread applications.

Gynecologic Surgical Procedures↗

PubMed2005

Totally minimally invasive robot-assisted unstented pyeloplasty using the Zeus Microwrist Surgical System: an animal study.

BACKGROUND: Minimally invasive pyeloplasty is a difficult procedure even for an expert laparoscopic surgeon. The major difficulty is associated with the limitations of intracorporeal suturing and knot tying. Surgical robots, which hold minimally invasive surgical instruments, have wrists and provide tremor filtration and motion scaling that might be expected to facilitate complex procedures in newborns. METHODS: Seven survival piglets (4.0-7.5 kg) underwent a totally minimally invasive robot-assisted unstented pyeloplasty employing the Zeus Robotic Microwrist System. The ureter was transected at the level of the ureteropelvic junction and 8 mm was resected. The unstented anastomosis was fashioned with running suture and intracorporeal knot tying. The animals were recovered and intravenous urography was performed at 1 month. After sacrifice, the anastomosis and the kidney were evaluated grossly and histologically for leak, caliber, and healing. RESULTS: All animals survived the procedure without postoperative complications. The mean robotic setup time was 19 minutes (range, 10-30 min), mean anastomosis time 51 minutes (range, 39-63 min), and mean total operation time 76 minutes (range, 57-87 min). The urography showed hydronephrosis in the first animal. The other 6 animals had no abnormalities. Histopathology demonstrated severe hydronephrosis in the first pig and moderate hydronephrosis in the sixth and seventh. All other animals had no sign of hydronephrosis. All anastomoses were well healed and intact. CONCLUSIONS: Robot-assisted laparoscopic pyeloplasty is a technically feasible procedure with acceptable morbidity in an animal model. The robotic technology enhances surgical dexterity and precision. Robotic assistance can increase the applicability of minimally invasive surgery to complex procedures in children.

Anastomosis, Surgical↗

PubMed2006

A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children.

BACKGROUND: It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children. METHODS: The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy. RESULTS: No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 +/- 7.5 vs 34.6 +/- 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 +/- 8.7 vs 20.2 +/- 5.3 minutes, P < .05). CONCLUSION: At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.

Adolescent↗

PubMed2005

Comparison of skill training with robotic systems and traditional endoscopy: implications on training and adoption.

BACKGROUND: Robotic systems are being used by an increasing number of surgeons. This environment is markedly different from that of traditional surgery and involves videoscopic guidance, remote surgical control, and the loss of haptic feedback. Defining how surgeons learn with these systems is necessary to establish training protocols for this technology. This study compared the learning curve for a robotic surgical system with that of traditional endoscopy in the performance of two standardized skill drills. MATERIALS AND METHODS: Twenty participants (average age 27 +/- 4 years, six females) repeated two standardized endoscopic dexterity and depth perception drills for 15 repetitions with the ZEUS robotic surgical system and manual endoscopic instruments (MAN). A score combining time and precision was given for each repetition. The learning curves and overall performance with and without robotic assistance were compared. RESULTS: For both MAN and ZEUS, improvements in performance were significantly greatest during the first five repetitions (P < 0.01, for both). Participants reached the training curve plateau faster with ZEUS than with conventional instruments (8th versus 10th for both drills). Using robotic assistance, dominant and non-dominant hand performance were statistically similar. The number of errors committed with ZEUS were significantly fewer for drill two (0.09 errors/repetition versus 0.24 errors/repetition, P = 0.002) compared to manual technique. CONCLUSIONS: This study demonstrated that training curves for conventional and robotic-assisted systems are remarkably similar. This should prove useful in the training and education of this new technology. This study further suggested that robotics may increase ambidexterity by improving non-dominant hand performance.

Adult↗

PubMed2004

Total laparoscopically and robotically assisted aortic aneurysm surgery: a critical evaluation.

BACKGROUND: Laparoscopically assisted aortic aneurysm resection requiring a minilaparotomy can be performed as a routine procedure. It was the purpose of our study to evaluate whether a total laparoscopic operation can be offered to aneurysm patients as a minimally invasive alternative. We also wanted to test whether a master-slave robot could facilitate the total laparoscopic procedure. METHODS: A prospective, consecutive number of 50 patients was evaluated. A transperitoneal left retrocolic access was used to expose the aorta. If possible, a tube graft repair was performed. The aortic anastomosis was sutured totally laparoscopically, with the surgeon standing on the right side of the operating table. In 10 consecutive patients, the anastomosis was sutured with the help of the Zeus robot. RESULTS: After excluding 3 cases that required suprarenal cross-clamping, 47 patients were operated using a total laparoscopic approach. A totally laparoscopic operation could be performed successfully in 39 patients with aneurysms. In 8 patients (17%), conversion to a laparoscopic hand-assisted operation with a 7-cm minilaparotomy was required. The robot was used to perform the aortic anastomosis in 10 patients. In 8 patients, a tube graft repair could successfully be performed totally laparoscopically. In the remaining patients, a bifurcated graft was implanted laparoscopically. The mean operating time was 227 minutes in the laparoscopy group and was 242 minutes in those patients in whom the anastomosis was sutured with the help of the Zeus Robot. Mean cross-clamping time, +/- SD, was 81.4 + 31 minutes. None of the patients died perioperatively. Major complications occurred in three patients (6.3%). The overall morbidity was 14.8%, including one patient who required temporary hemodialysis postoperatively. The time to suture the aortic anastomosis was significantly shorter in the robotic-assistance group (40.8 +/- 4 minutes), yet total operating time was longer in this group because of the technical complexity of the robotic device. Patients with a total laparoscopic procedure asked for significantly fewer analgesics and could regain full mobility earlier compared with those patients for whom a minilaparotomy after conversion to the laparoscopic hand-assist procedure was required. CONCLUSIONS: Total laparoscopic aneurysm resection can be offered to the majority of patients in our institution. The robot still requires further refinements to reduce operating times and the aortic cross-clamping period. We now have the technique and the instrumentation to offer laparoscopic aneurysm surgery as a minimally invasive alternative for patients whose conditions are unsuitable for endovascular aneurysm repair.

Anastomosis, Surgical↗

PubMed2005

Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique.

INTRODUCTION: The da Vinci robot-assisted laparoscopic radical prostatectomy is a relatively new approach that is revolutionizing the surgical treatment of localized prostate cancer. Since its introduction, several improvements have been made in the robot design model, as well as in the surgical technique for prostatectomy. One of the more recent advances in this technology has been the introduction of a four-arm robot model. This modified system allows the operating surgeon to use the fourth arm for key steps and maneuvers during the operation, thereby decreasing the reliance on advanced assistant laparoscopic skills. In this report, we describe our modifications for the extraperitoneal approach for laparoscopic removal of the prostate using the four-arm da Vinci surgical system. TECHNICAL CONSIDERATIONS: During a 24-month period, 154 consecutive patients with clinically localized prostate cancer underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy using the four-arm da Vinci robot system. All cases were videotaped and subsequently reviewed. Important factors regarding extraperitoneal access, patient positioning, port placement, and assistant role with or without the fourth arm were defined. CONCLUSIONS: Our experience has revealed that the extraperitoneal approach allows for a more natural patient position during the operation and avoids intraperitoneal organ injury. The addition of the fourth arm to the da Vinci robot provides the operating surgeon with a great deal of independence, which facilitates all aspects of robot-assisted laparoscopic prostatectomy. It allows the operating surgeon to retract tissue during critical steps in this challenging operation and reduces the reliance on highly trained laparoscopic assistants.

Equipment Design↗

PubMed2005

Laparoscopic radical prostatectomy: conventional and robotic.

By 2015, prostate cancer will become the most commonly diagnosed cancer in men. Radical prostatectomy reduces disease-specific mortality in patients with localized prostate cancer; however, the invasiveness of surgery and its resultant side effects cause many men to seek other treatments. In 2000, laparoscopic radical prostatectomy emerged as a minimally invasive alternative to open surgery; it has been refined recently by the addition of robotic technology. To examine the outcomes of robotic radical prostatectomy and compare them with those from open and conventional laparoscopic radical prostatectomy, we prospectively collected baseline demographic data on all patients undergoing surgery for prostate cancer over a 4-year period at our center. Urinary function and sexual function were evaluated using standardized criteria as well as a questionnaire preoperatively and at 1, 3, 6, 12, and 18 months after their procedure. Operative and postoperative outcomes were compared using values for open radical prostatectomy as the reference standard. A total of 100 men underwent open radical prostatectomy with conventional laparoscopic radical prostatectomy (n = 50) and robotic radical prostatectomy (n = 500). The odds ratios for operative times, blood loss, postoperative pain, complications, and median times to urinary continence and resumption of sexual activity all were lower for robotic than for open or laparoscopic radical prostatectomy. It appears safe to conclude that conventional laparoscopic radical prostatectomy is a reasonable alternative to open radical prostatectomy in the surgical treatment of patients with clinically localized prostate cancer. The incorporation of robotics may result in even better surgical outcomes than conventional laparoscopy. However, the surgical robot is expensive; few centers have access to the technology and even fewer have expertise in the technique. For robotic radical prostatectomy to become the standard of care for the treatment of localized prostate cancer will require economies of cost, dissemination of surgical expertise, and data from randomized trials.

Humans↗

PubMed2006

Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children.

OBJECTIVES: To compare the initial results of robotic-assisted laparoscopic versus open pyeloplasty in children with ureteropelvic junction obstruction. METHODS: From June 2002 to July 2004, 8 pediatric patients underwent robotic-assisted laparoscopic pyeloplasty and were matched by age group with patients undergoing conventional open pyeloplasty. The mean age was 11.5 years (range 6.4 to 16.5) in the robotic-assisted group and 9.8 years (range 6.0 to 15.6) in the open group. A four-port transperitoneal technique was used to perform the Anderson-Hynes pyeloplasty with the da Vinci Surgical System. RESULTS: The mean operative time and estimated blood loss was 363 minutes (range 255 to 522) and 13.1 mL (range 5 to 25) in the robotic-assisted group versus 248 minutes (range 144 to 375) and 53.8 mL (range 5 to 200) in the open group, respectively. The mean length of hospitalization and pain medication use was 2.4 days (range 1 to 5) and 7.4 mg morphine (range 0 to 23) in the robotic-assisted group compared with 3.3 days (range 1 to 8) and 22.0 mg morphine (range 0 to 100) in the open group, respectively. At a mean follow-up of 14.7 months (range 2 to 24), all robotic procedures were successful as determined by subjective data using pain scales and radiologic data. CONCLUSIONS: Robotic-assisted laparoscopic pyeloplasty appears to decrease the length of hospitalization and use of pain medication, but has a longer operative time. Additional clinical experience is required to determine the long-term efficacy of this method.

Adolescent↗

PubMed2006

Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist and AESOP: a pilot study.

OBJECTIVES: Robotic camera holders provide steady camera movement and view during laparoscopic surgery. We compared two such robots, EndoAssist and AESOP, by evaluating timed setup and surgical performance during laparoscopic radical prostatectomy (LRP). METHODS: We prospectively collected data for 20 patients undergoing LRP using either the EndoAssist or AESOP. AESOP was mounted to the surgical bed and controlled by an experienced assistant using a hand-held remote control. The EndoAssist device was placed over the patient's right shoulder. Its movements were executed by the surgeon using a head-mounted optical emitter with brief head movements detected by a sensor mounted atop the surgeon's video monitor. The robot setup time and LRP operative steps were timed and compared between the two cohorts. RESULTS: The time for robot setup favored AESOP over the EndoAssist (2.0 minutes versus 5.3 minutes, P = 0.001). The time for accomplishing vas deferens and seminal vesicle dissection favored the EndoAssist (23 minutes versus 33 minutes, P = 0.04). However, no statistically significant difference was found in the efficiency of task performance between the two robots in any of the other 11 steps measured. CONCLUSIONS: The EndoAssist appears to be equally efficient to the assistant-controlled AESOP robot with respect to surgical performance during LRP. The advantages of the EndoAssist include its accurate response and ability to provide the surgeon with complete control of the desired operative view without relying on an assistant. Its disadvantages include its large profile, lack of a table-mounted design, and the need for pedal activation. Additional modifications are needed to improve the efficiency and design of this novel robotic device further.

Humans↗

PubMed2003

Robotic mitral valve surgery.

A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for placement of an atrial retractor, as well as needle, tissue, and suture retrieval. With the development of specialized retractors and a delivery/retrieval port, a truly endoscopic approach will be consistently reproducible. New navigation systems and image guided surgery portend an improving future for robotic cardiac surgery. Recently, we have combined robotically guided microwave catheters for ablation of atrial fibrillation with robotic mitral valve repairs (Fig. 8). Thus, we are beginning to achieve the ideal operation, with a native valve repair and a return to normal sinus rhythm. Robotic cardiac surgery is an evolutionary process, and even the greatest skeptics must concede that progress has been made toward endoscopic cardiac valve operations. Surgical scientists must continue to critically evaluate this technology in this new era of cardiac surgery. Despite enthusiasm, caution cannot be overemphasized. Surgeons must be careful because indices of operative safety, speed of recovery, level of discomfort, procedural cost, and long-term operative quality have yet to be defined. Traditional valve operations still enjoy long-term success with ever-decreasing morbidity and mortality, and remain our measure for comparison. Surgeons must remember that we are seeking the most durable operation with the least human trauma and quickest return to normalcy, all done at the lowest cost with the least risks. Although we have moved more asymptotically to these goals, surgeons alone must map the path for the final ascent.

Cardiac Surgical Procedures↗

PubMed2002

Robotic-assisted laparoscopic adrenalectomy.

INTRODUCTION: Remote robotic telemanipulators have been recently used in performing laparoscopic urologic procedures, both in the laboratory and in clinical practice. We present, to our knowledge, the initial 2 cases of robotic-assisted laparoscopic adrenalectomy in humans. TECHNICAL CONSIDERATIONS: Robotic-assisted laparoscopic adrenalectomy (one right, one left) was performed in 2 patients with an adrenal tumor (one nonfunctional, one pheochromocytoma). Patient age was 81 and 47 years, and tumor size was 4.5 and 3 cm, respectively. Both cases were performed transperitoneally using the da Vinci Robotic Surgical System. Robotic-assisted laparoscopic adrenalectomy was successful in both cases without conversion to conventional laparoscopy or open surgery. The operative time was 110 and 165 minutes, the blood loss was 50 and 100 mL, and the hospital stay was 2 and 3 days. No intraoperative or postoperative complications occurred. CONCLUSIONS: Robotic-assisted laparoscopic adrenalectomy is technically feasible. With increasing experience and refinement in the technology, the role of robotics in urologic laparoscopy is likely to expand.

Adrenal Gland Neoplasms↗

PubMed2002

Early experience with robotic technology for thoracoscopic surgery.

OBJECTIVE: Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. The purpose of this study was to develop a technique to perform thoracoscopic lung resection using a telemanipulation system. METHODS: We have used a robotic system to perform thoracoscopic surgery in 12 cases: five lobectomies, three tumor enucleations, three excisions and one bulla stitching completed with fibrin glue for spontaneous pneumothorax. The operations were performed using the Intuitive Microsurgical system (Da Vinci System) through three ports and, a fourth space 'service entrance' incision, in the major lung resection. RESULTS: Three procedures begun with the robotic technique were completed by a minimal thoracotomy. No technical operative mishaps were associated with the manoeuvres of robotic arms. In all manoeuvres (up, down, insertion, extraction, etc.), the robotic arms moved appropriately in the favorable operative fields. All patients tolerated the procedure well and the post-operative course was satisfactory, requiring few analgesics. CONCLUSIONS: Although further studies on robotically assisted procedures are needed to clarify the clinical feasibility of this procedure, the results in our cases are encouraging. We believe that thoracoscopic procedures using a robotic manipulation system may be technically feasible in selected cases and in the hands of experienced thoracic surgeons.

Adolescent↗

PubMed2003

Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology.

OBJECTIVE: Computer (robotic) enhancement has been used to facilitate simple thoracoscopic procedures such as internal mammary artery (IMA) mobilization. This report describes the use of robotic technology in advanced thoracoscopic procedures. METHODS: Ten patients underwent advanced thoracoscopic procedures utilizing the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) at our institution. RESULTS: Patients 1-6 underwent endoscopic phrenic nerve mobilization with insertion of phrenic nerve pacemakers. The indications were quadriplegia (n=2), central hypoventilation syndrome (n=2), and intractable hiccups (n=2). Three 1-cm incisions were made to access each hemithorax. Patients 7 and 8 underwent robotically assisted resection of posterior mediastinal masses. Patient 9 underwent robotically assisted thoracoscopic left lower lobectomy for a lung mass. Patient 10 underwent robotically assisted left ventricular lead placement for biventricular pacing for heart failure. CONCLUSIONS: Robotic technology can be used to perform advanced intrathoracic maneuvers thoracoscopically. The increased visualization and instrument dexterity afforded by this technology may facilitate the development of minimally invasive thoracic approaches that were previously not feasible.

Adolescent↗

PubMed2002

Robotic-assisted esophagoesophagostomy.

BACKGROUND/PURPOSE: Minimally invasive repair of esophageal atresia has been described but remains technically challenging. Robotic surgical systems address many of these technical challenges. The purpose of this study was to develop the procedure for and evaluate the technical feasibility of performing a robotic-assisted esophagoesophagostomy using the Zeus Robotic Surgical System. METHODS: Esophagoesophagostomy was performed in 10 piglets using thoracoscopic (control, n = 5) and robotic-assisted (Zeus, experimental, n = 5) approaches. An interrupted esophageal anastomosis using intracorporeal knot tying techniques was performed and evaluated for leak, narrowing, caliber, and mucosal approximation. Anesthesia, operative, anastomotic, and robotic set-up times were recorded as was the number of stitches used. RESULTS: All 10 anastomoses were patent with no narrowing and with excellent mucosal approximation. One anastomosis in the control group had a small leak. There was no statistically significant difference between the groups for the parameters measured. Weight (kg): control (C), 6.4 +/- 0.8; experimental (E), 6.3 +/- 1.0, P =.08. Times (min): anesthesia, C-124 +/- 25, E-151 +/- 20, P =.09; operative, C-97 +/- 21, E-131 +/- 27, P =.06; anastomotic, C-89 +/- 20, E-125 +/- 34, P =.08; robotic set-up, C-6.4 +/- 9.3, E-15.6 +/- 20, P = 0.13. Stitches (No.): C-11.8 +/- 0.8, E-12.0 +/- 1.2, P =.7. Caliber (French):C-18F-5; E-18F-4, 14F-1. CONCLUSION: Robotic-assisted esophagoesophagostomy is technically feasible and offers an alternative approach to thoracoscopic repair of esophageal atresia.

Anastomosis, Surgical↗

PubMed2003

Application of robotics in congenital cardiac surgery.

Over the past 5 years, robotic systems that combine advanced endoscopic imaging with computer-enhanced instrument control have been used for both coronary revascularization and intracardiac procedures in adults. In addition, endoscope positioning systems and articulated instruments with a robotic wrist mechanism have further expanded the potential applications for robotics in cardiac surgery. In pediatric cardiac surgery, potential applications can be divided into simple scope manipulation versus the use of 3-dimensional imaging and a robotic wrist for dissection and reconstruction. A voice-controlled robotic arm for scope manipulation can facilitate current pediatric thoracoscopic procedures such as ligation of patent ductus arteriosus and division of vascular rings. By using an advanced imaging system along with a robotic wrist, more complex extracardiac and even intracardiac procedures can be performed in children. Examples include coarctation repair, septal defect repair, and mitral or tricuspid valvuloplasty. Furthermore, with adequate intracardiac imaging, a robot-assisted off-pump approach to intracardiac pathology is conceivable. New real-time 3-dimensional echocardiography now offers sufficient resolution to enable such procedures, while the addition of instrument tracking, haptic feedback, and novel tissue fixation devices can facilitate safe and reliable intracardiac repair without extracorporeal circulation.

Cardiac Surgical Procedures↗

PubMed2002

[Mobile autonomous robots-Possibilities and limits].

Besides industrial robots, which today are firmly established in production processes, service robots are becoming more and more important. They shall provide services for humans in different areas of their professional and everyday environment including medicine. Most of these service robots are mobile which requires an intelligent autonomous behaviour. After characterising the different kinds of robots the relevant paradigms of intelligent autonomous behaviour for mobile robots are critically discussed in this paper and illustrated by three concrete examples of robots realized in Lübeck. In addition a short survey of actual kinds of surgical robots as well as an outlook to future developments is given.

Artificial Intelligence↗

PubMed2004

Adaptation of a hexapod-based robotic system for extended endoscope-assisted transsphenoidal skull base surgery.

OBJECTIVE: To adapt a hexapod-based robotic system for use in extended endoscope-assisted transsphenoidal skull base surgery. METHODS: A robotic system (Evolution 1, Universal Robot Systems, Schwerin, Germany) based on a hexapod design with an attached seventh axis is used as instrument holder. The instrument interface is operated via a joystick control. An endoscope is applied to the instrument interface, which is tracked by a navigation system (Stealth, Medtronic, USA). RESULTS: The instrument holder was modified so that it could be applied in transsphenoidal surgery. Furthermore, translation and pivoting movements of the system were implemented, also a quick change between microscope and robotic-controlled endoscope was made possible. After extensive phantom testing two patients with large invasive pituitary adenomas were operated on using the robotic endoscope assistance during transsphenoidal surgery. The robotic assistance allowed the use of two additional instruments under endoscopic view. For example, drilling, suctioning, application of punches, as well as microsurgical tumor removal could be performed under endoscopic view. CONCLUSION: A robotic system could be adapted for use in endoscope-assisted transsphenoidal skull base surgery allowing simultaneous use of two instruments under endoscopic view. This opens new possibilities to extend transsphenoidal skull base surgery.

Adenoma↗