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PubMed2001

[Applications for a robot in the lateral skull base. Evaluation of robot-assisted mastoidectomy in an anatomic specimen].

In the past decade, a great variety of robot systems have been applied in numerous areas of life. In the public health system, robots are increasingly used in the operating theater. The potential for reproducibility and predictability was one of the main arguments for the use of robots in orthopedic treatment of bones, especially the implantation of a cementless total hip replacement. In otorhinolaryngological surgery (ENT), different hearing aids were developed: the cochlea implant for the deaf or the totally implantable hearing aid for the hearing impaired. Their site of implantation is localized in the lateral skull base. Removal of the bone mass with the reamer requires both great precision and considerable physical effort on the part of the surgeon, which does not result in an ergonomic operating technique. The following project describes the evaluation of processing parameters for a robot-assisted mastoidectomy to expose an implantation bed. The goal was to establish different parameters for robot-controlled reaming in the calotte or mastoid. In addition, several parameters were tested for their influence on surface structure, procedure reliability, and quality as well as the ability of the Mayfield clip to stabilize the head during the operation.

Cochlear Implantation↗

PubMed1990

Development of a laboratory robotic system for automated bioanalytical methods--II. A robot computer program for guarding totally automated bioanalytical methods.

The application of fully automated, unattended sample preparation performed by a laboratory robot for the analysis of drugs in biological samples requires the prevention of system failures which may arise in the on-line coupled chromatographic system or in other components of the robotic system. A computer program has been developed which can help to detect such problems. The control program for the robotic sample preparation contains a number of safety measures to intercept robotic or human errors. A routine is implemented, guarding for chromatographic malfunctions and errors in dispensing liquids by the robot. After detection of trouble, sample preparation is interrupted.

Algorithms↗

PubMed2006

Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.

OBJECTIVES: Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy. METHODS: Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation. RESULTS: Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents' mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents (P <0.005). CONCLUSIONS: A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.

Humans↗

PubMed2003

Robotic bone preparation does not increase cement penetration into the proximal femur: a matched-pair cadaver study comparing hand-broaching versus robotic bone preparation.

In a cadaver study, we prepared 20 matched pairs of human femora using chipped-tooth broaches and robotic milling with the same geometry. For robotic bone preparation the CASPAR robotic system with a rotating milling head was used. Cancellous bone was irrigated with 1 liter of pulsed lavage and the specimens were embedded in specially-designed pots. After vacuum mixing, bone cement was introduced in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3,000 N. Radiographs were taken and horizontal sections were obtained at predefined levels, using a diamond saw. Microradiographs of the bone slices were taken, digitized and analyzed to assess cement penetration into cancellous bone. No femoral fractures or fissures occurred with either preparation technique. The microradiographic evaluation showed no morphometric differences between chipped-tooth broaches and robotic milling as regards cement penetration into cancellous bone. Therefore, in the presence of pulsed lavage, we conclude that robotic bone preparation does not increase cement penetration into cancellous bone of the proximal end of the femur.

Analysis of Variance↗

PubMed2000

New UWA robot--possible application to robotic surgery.

This research is motivated by the need to design a Nuclear Magnetic Resonance Image guided surgical robot. The achievement of this objective requires the solution of two problems: design and construction of a magnetic resonance compatible mechanical manipulator and development of the appropriate robot control system. It is beneficial to keep robot actuators outside the magnet. Therefore, the parallel architecture should be used for the mechanical manipulator. Newly developed University of Western Australia Robot satisfies this requirement. Moreover, it has substantially larger workspace and torsional stiffness when compared to existing parallel configurations such as the Delta. The plausible method of dealing with the delays in the robot control system caused by the image analysis is the prediction of the deformation based on the mathematical model of the organ mechanical and geometric properties. The hyper-viscoelastic constitutive models offer a good way of representing non-linear stress-strain and stress-strain rate relations of soft tissues such as the brain. The numerical values for material constants for brain tissue are given. Additional advantage of the proposed model is that it can be easily implemented in commercially available finite element codes and immediately applied to large-scale computer simulations.

Animals↗

PubMed2006

Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has a reported learning curve of 100 cases. Robotic-assisted surgery decreases the learning curve in complex laparoscopic surgeries. We hypothesize that robotic-assisted, hand-sewn gastrojejunostomy during a LRYGB will improve results during the initial 100 cases when compared with the literature. METHODS: Our first 100 robotic-assisted gastrojejunostomies performed during LRYGB were reviewed from a prospective database. Patient demographics, operative times, length of stay, reoperations, anastomotic leak, pulmonary embolus, and death were all evaluated. RESULTS: The mean age and body mass index were 42 and 50, respectively. Operative times ranged from 148 minutes to 437 minutes (mean = 254). There were no leaks or deaths. Four patients had complications, including reoperation (1), incisional hernia (1), pulmonary embolus (1), and recurrent umbilical hernia (1). CONCLUSIONS: Robotic-assisted LRYGB is feasible and safe, as evidenced by the excellent outcomes from this series during the initial learning curve for LRYGB.

Adult↗

PubMed2004

Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system.

OBJECTIVES: To develop and assess the feasibility of laparoscopic partial nephrectomy performed using the daVinci robotic system. METHODS: Between November 2002 and August 2003, 13 patients with solid or suspicious cystic renal masses underwent robotic-assisted laparoscopic partial nephrectomy. In 8 cases, an intra-arterial catheter was inserted for renal cooling before occlusion of the renal artery. The remaining 5 patients underwent partial nephrectomy after the renal hilum had been clamped. Tumor excision and intracorporeal suturing were performed entirely with telerobotics. The perioperative data and pathologic results were retrospectively reviewed. RESULTS: The mean lesion diameter was 3.5 cm (range 2.0 to 6.0). The mean operative time was 215 minutes (range 130 to 262), and the mean blood loss was 170 mL (range 50 to 300). The mean warm ischemia was 22 minutes (range 15 to 29), and the mean cold ischemia time was 33 minutes (range 18 to 43). The length of hospital stay averaged 4.3 days (range 2 to 7). The resected lesions included renal cell carcinoma in 10, oncocytoma in 2, and a complex renal cyst in 1. In 1 case, a positive margin occurred despite negative frozen sections; laparoscopic nephrectomy was performed and showed no residual tumor. One patient experienced postoperative ileus. At 2 to 11 months of follow-up, no recurrence had been observed. CONCLUSIONS: Robotic-assisted partial nephrectomy is feasible. Robotic partial nephrectomy can be safely performed using a transperitoneal or retroperitoneal approach. A second scrubbed assistant is mandatory to provide assistance using conventional laparoscopic instruments with this technique.

Adenoma, Oxyphilic↗

PubMed2002

Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies.

Laparoscopic surgery offers patients distinct benefits but is not without its disadvantages to surgeons in terms of maneuverability and visualization. Robotic telemanipulation systems were introduced with the objective of providing a solution to the problems in this field of surgery. The feasibility of robot-assisted surgery was assessed by performing 35 laparoscopic cholecystectomies with the da Vinci robotic system. Time necessary for system setup and operation was recorded, as were complications, technical problems, postoperative hospital stay, morbidity, and mortality. Thirty-four of 35 cholecystectomy procedures were completed laparoscopically with the da Vinci system. Technical problems occurred in three cases, resulting in one intraoperative complication (a minilaparotomy caused by the loss of an instrument part). Median hospitalization was 2 days. There were no postoperative deaths or morbidity within 30 days after surgery. System setup time decreased as the experience of the operating team increased. Operating times were comparable with those reported for standard laparoscopic cholecystectomy. Robot-assisted surgery was repeatedly proven as a safe and feasible approach to laparoscopic cholecystectomy.

Adult↗

PubMed2005

Robotics in microsurgery: use of a surgical robot to perform a free flap in a pig.

We present the concept that a surgical robot may be used to successfully perform a free flap. To study different microsurgical techniques, a porcine free flap model was developed in our laboratory. Dissection of the free flap model and isolation of the vessels were completed under traditional loupe magnification. The da Vinci robot was then used to perform vessel adventitiectomy and microanastomoses. The model was observed for 4 h postoperatively, noting flap color, temperature, capillary refill, and Doppler signal. At the end of this period, the flap was noted to be viable; anastomoses were evaluated and found to be grossly and microscopically patent. Advantages conferred by the da Vinci robot include elimination of tremor, scalable movements, fully articulating instruments with six degrees of spatial freedom, and a dynamic three-dimensional visualization system. Drawbacks include the cost and the absence of true microsurgical instruments.

Anastomosis, Surgical↗

PubMed1997

Electromagnetic compatibility aspects of active robotic systems for surgery: the robotic prostatectomy experience.

The paper discusses the susceptibility to electromagnetic interference (EMI) of active robots for surgery, which are safety-critical systems. The high EMI environment of an operating room in the presence of an electrosurgical generator is considered. Experience of a surgeon assistant robot for prostatectomies in improving the immunity to EMI is described. It has been found that effective isolation of the robotic system hardware from grounded metal objects provides significant improvements to safety by its immunity to EMI, in minimising the flow of high-frequency current to ground through the system hardware.

Electromagnetic Fields↗

PubMed2001

[The importance to generate robot-assisted milled cavities for total hip replacement. A comparative experimental study: manual versus robotic preparation].

We present an experimental study to determine the effectiveness of computer assisted robotic bone preparation with regard to primary rotational stability in comparison to hand broaching. 5 different cementless stems were standardized implanted in synthetic femora and measured in a specially designed apparatus (displacement in 6 degrees of freedom). In addition the contact areas of the stems and the bone were visualized. The S-ROM- and ABG-stems were more stable in hand broached femora. The Osteolock-, G2- and Vision-2000-stems were more stable in the robot group. The mode of fixation of each implant could be characterized in relation to its position and its stiffness (primary rotational stability). The contact areas differed in some prosthesis in the way of preparation. The findings highlight the current difficulties in creating a perfect match of robotically milled cavity and stem geometry to achieve enhanced stability.

Arthroplasty, Replacement, Hip↗

PubMed2006

Virtual reality simulator training equals mechanical robotic training in improving robot-assisted basic suturing skills.

BACKGROUND: This study aimed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills. METHODS: Two randomized groups of students underwent a controlled training program. Both groups completed an identical test before and after training. The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect. To evaluate the subjective feeling of understanding and mastering, the students indicated this on a visual analog scale. RESULTS: Both groups showed a significant increase in the number of stitches placed during the posttest, and an increase in subjective feeling of understanding and mastering. The increase did not differ between the groups, indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique. CONCLUSIONS: Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator.

Computer Simulation↗

PubMed2006

Robotic surgery and training: electromyographic correlates of robotic laparoscopic training.

BACKGROUND: Robotic laparoscopic surgery has been shown to decrease task completion time, reduce errors, and decrease training time, as compared with manual laparoscopic surgery. However, current literature has not addressed the physiologic effects, in particular muscle responses, to training with a robotic surgical system. The authors seek to determine the frequency response of electromyographic (EMG) signals of specific arm and hand muscles with training using the da Vinci Surgical System. METHODS: Seven right-handed medical students were trained in three tasks with the da Vinci Surgical System over 4 weeks. These subjects, along with eight control subjects, were tested before and after training. Electromyographic (EMG) signals were collected from four arm and hand muscles during the testing sessions, and the median EMG frequency and bandwidth were computed. RESULTS: The median frequency and frequency bandwidth both were increased after training for two of the three tasks. CONCLUSION: The results suggest that training reduces muscle fatigue as a result of faster and more deliberate movements. These changes occurred predominantly in muscles that were the dominant muscles for each task, whereas the more demanding task recruited more diverse motor units. An evaluation of the physiologic demands of robotic laparoscopic surgery using electromyography can provide us with a meaningful quantitative way to examine performance and skill acquisition.

Adult↗

PubMed2000

Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Advanced Robotic Telemanipulator for Minimally Invasive Surgery.

In endoscopic surgery, the ability to guide the instrument is significantly decreased compared with open surgery. Rigid laparoscopic instruments offer only four of the six degrees of freedom required for the free handling of objects in space. Robotics technology can be used to restore full mobility of the endoscopic instrument. Therefore, we designed a master-slave manipulator system (ARTEMIS) for laparoscopic surgery as a prototype. The system consists of two robotic arms holding two steerable laparoscopic instruments. These two work units are controlled from a console equipped with two master arms operated by the surgeon. The systems and its components were evaluated experimentally. Laparoscopic manipulations were feasible with the ARTEMIS system. The placement of ligatures and sutures and the handling of catheters were possible in phantom models. The surgical practicability of the system was demonstrated in animal experiments. We conclude that robotic manipulators are feasible for experimental endoscopic surgery. Their clinical application requires further technical development.

Animals↗

PubMed2005

A rehabilitation robot with force-position hybrid fuzzy controller: hybrid fuzzy control of rehabilitation robot.

The goal of this study was to design a robot system for assisting in the rehabilitation of patients with neuromuscular disorders by performing various facilitation movements. The robot should be able to guide patient's wrist to move along planned linear or circular trajectories. A hybrid position/force controller incorporating fuzzy logic was developed to constrain the movement in the desired direction and to maintain a constant force along the moving direction. The controller was stable in the application range of movements and forces. Offline analyses of data were used to quantitatively assess the progress of rehabilitation. The results show that the robot could guide the upper limbs of subjects in linear and circular movements under predefined external force levels and apply a desired force along the tangential direction of the movements.

Computer-Aided Design↗

PubMed1993

Workstation robotics: a pilot study of a Desktop Vocational Assistant Robot.

Rehabilitation robots are increasingly being viewed as an appropriate assistive technology interface for persons with disabilities. The Desktop Vocational Assistant Robot (DeVAR) system is a voice-controlled robotic workstation designed to enable persons with severe mobility impairments to function independently in a work environment. This study examined the overall efficacy of the DeVAR system, the level of expertise required for therapist and support personnel, routine maintenance requirements, and the readiness of the device for a multicenter evaluation. Two precommercial DeVAR workstations were installed at selected sites. The pilot study spanned 8 months in which staff members and four subjects with high-level quadriplegia evaluated the systems extensively. Responses were generally favorable regarding ease of use and overall training process. Subjects recommended modifications, including incorporation of a noise cancellation microphone, more effective use of workstation space, and addition of vocational tasks. All respondents thought that if the recommended changes were implemented, DeVAR would have potential as a vocational assistant. The small number of subjects was due to the limited subject pool available for the study. On the basis of pilot results, the Veterans Administration Rehabilitation Research and Development Service, Baltimore, Maryland, is conducting a national multicenter evaluation to determine the overall utility and commercial readiness of the DeVAR system.

Activities of Daily Living↗

PubMed1997

Robots hooked on drugs. Robotic automation expands pharmacy services.

Hospitals are not known for automating labor-intensive tasks but robots are just beginning to make inroads in health-care. The first--and still only--robot grew from a class assignment to use an established technology in a new growth industry. The established technology was bar coding; the industry health-care; and the result a robotic device for the hospital pharmacy.

Electronic Data Processing↗

PubMed1999

Robots with a gentle touch: advances in assistive robotics and prosthetics.

As healthcare costs rise and an aging population makes an increased demand on services, so new techniques must be introduced to promote an individuals independence and provide these services. Robots can now be designed so they can alter their dynamic properties changing from stiff to flaccid, or from giving no resistance to movement, to damping any large and sudden movements. This has some strong implications in health care in particular for rehabilitation where a robot must work in conjunction with an individual, and might guiding or assist a persons arm movements, or might be commanded to perform some set of autonomous actions. This paper presents the state-of-the-art of rehabilitation robots with examples from prosthetics, aids for daily living and physiotherapy. In all these situations there is the potential for the interaction to be non-passive with a resulting potential for the human/machine/environment combination to become unstable. To understand this instability we must develop better models of the human motor system and fit these models with realistic parameters. This paper concludes with a discussion of this problem and overviews some human models that can be used to facilitate the design of the human/machine interfaces.

Biomechanical Phenomena↗