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PubMedDate not supplied

Increasing productivity and quality of care: robot-aided neuro-rehabilitation.

This paper presents an overview of our research in robot-aided stroke neuro-rehabilitation and recovery. At the onset of this research we had to confront squarely (and solve!) a critical question: If anatomy is destiny, can we influence it? Our efforts over the last five years have been focused on answering this question and we will present a few of our clinical results from over 2,000 hours of robot-aided therapy with 76 stroke patients. To determine if exercise therapy influences plasticity and recovery of the brain following a stroke, we needed the appropriate "microscope" that would allow us to concomitantly control the amount of therapy delivered to a patient, while objectively measuring patient's performance. Back-driveable robots are the key enabling technology. Our results to date using common clinical scales suggest that robot-aided sensorimotor training does have a genuinely positive effect on reduction of impairment and the reorganization of the adult brain. Yet while clinical scales can help us to examine the impact in the neuro-recovery process, their coarse nature requires extensive and time-consuming trials, and on top of that they fail to show us details important for optimizing therapy. Alternative, robot-based scales offer the potential benefit of new finer measurements-and deeper insight into the process of recovery from neurological injury. We also plan to use present technology to establish the practicality and economic feasibility of clinician-supervised, robot-administered therapy, including classroom therapy. We feel quite optimistic that the march of progress will accelerate substantially in the near future and allow us to transfer this technology from the research realm to the everyday treatment of stroke survivors.

Efficiency↗

PubMedDate not supplied

Robotics, telesurgery and telementoring--their position in modern urological laparoscopy.

OBJECTIVES: Laparoscopic surgery in general is handicapped by the reduction of the range of motion from six to four degrees of freedom. This has a major impact on technically difficult procedures such as laparoscopic radical prostatectomy. Solutions for this problems include the understanding of the geometry of laparoscopy with sophisticated training programs, but lie also in newly developed surgical robots, computer simulators and telementoring. This article evaluates the value of these alternatives based on own experiences and an analysis of the current literature. METHODS: Own experiences with robot-assisted surgery include 406 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as 6 telesurgical interventions with the Da Vinci-system. Additionally, substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and computer simulation. Moreover, the current literature of the last 10 years on telesurgery and telementoring has been reviewed. RESULTS: The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees; the angles between the instrument and the working plane that should not exceed 55 degrees; and the angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 to 110 degrees. 3-D-systems did not yet proved to be effective due to handling problems such as shutter glasses, video-helmets or reduced brightness. At the moment, there are only two robotic surgical systems (ZEUS, Da Vinci) in clinical use for telesurgery, of which only the Da Vinci provides stereovision and all six degrees of freedom (DOF). In the meantime, more than 200 laparoscopic radical prostatectomies have been performed with this system. Until now, however, there was no evidence of any advantages over the conventional laparoscopic approach. The ZEUS in combination with the telecommunication system SOKRATES is the only device enabling to realize telemanipulation and telementoring over long distances (i.e. transatlantic). CONCLUSION: Robotic surgery represents a turning point of surgical research. However, broad use of robotic systems is limited mainly because of the high investment and running costs. Whereas there will be a clear role of audio-visual telementoring in future training concepts, the need of telemanipulation/telesurgery has not yet been clarified. New technological concepts promote the development of hand-held mechanical manipulators (i.e. 6-DOF-needle-holder) used in combination with mono-tasking computerized robots (i.e. AESOP) resulting in a significant cost reduction.

Computer Simulation↗

PubMed2002

Robot-assisted navigated neuroendoscopy.

OBJECTIVE: Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definitive controlled movement of the endoscope within the brain depends on the experience and skill of the individual neurosurgeon. METHODS: With the Evolution 1 precision robot (Universal Robot Systems, Schwerin, Germany), a new neurosurgical tool has become available for the precise steering of instruments within the cranium. After preclinical anatomic and precision studies, the system was used for neuronavigated endoscopic procedures for three patients. RESULTS: All robot-assisted, navigated, endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 minutes for the first patient to 30 minutes for the third patient. The time for the surgical part of the endoscopic procedure ranged from 17 to 65 minutes. No complications occurred during any procedure. CONCLUSION: The use of robotic technology for neuroendoscopic procedures is a major advance for controlled movement of the endoscope within the cranium. The start-up procedure and calibration of the robot are still time-consuming, but the actual operation time is comparable to that of freehand neuroendoscopic procedures. Steering of the endoscope is facilitated, and the precision of the endoscopic movements is noteworthy.

Adolescent↗

PubMedDate not supplied

Applications of robotics in surgery.

The end of the 20th century brought an increased use of computerized technology in medicine and surgery. The development of robotic surgical systems opened new approaches in general and cardiac surgery. Two leading robotic companies, Computer Motion, Inc. and Intuitive Surgical, Inc. have developed the Zeus and Da Vinci respectively, as very effective tools for surgeons to use. Both of them consist of a surgeon console, located far from the operating table, and three robotic arms, which reproduce inside the patient's body the movements performed by the surgeon at the console. The advantages of robotic surgery over laparoscopy and open surgery include: better eye-hand coordination, tremor filtration, steadiness of camera, 3-D vision, motion scale, more degrees of freedom for instruments etc. Of course, there are also some disadvantages, like the lack of tactile feedback, long time of set up, long learning curve, high cost etc. However, the advantages seem to overcome the disadvantages and more and more operations are conducted using robots. The impact of robotics in surgery is therefore very promising and in the future it will probably open even more new ways in the surgical practice and education both in Romania and across the globe.

Forecasting↗

PubMed2003

Development of a tele-echography system by using an echographic diagnosis robot.

We have developed a tele-diagnosis system of echography (tele-echography system) using an Echographic Diagnosis Robot. The examiner moves the robot by using a control device at a distance from the patient and obtaining the echogram and the situation around the patient. The examiner and the patient locations are connected by a wireless local area network. Remote control is realized by the Object Request Broker (ORB) technique. We experimentally verified possibility of our system for clinical use. The robot was safe and stable even when there was slight movement of the patient and an adult patient never felt any discomfort due to the robot weight. Remote diagnosis of echograms was proved to be possible with sufficient image quality after a skilled examiner got used to controlling the robot. Since the required bandwidth of this system was at most 1Mbps, we confirmed the ability of this system for mobile robotic telemedicine.

Humans↗

PubMed2003

[Surgical robotics, short state of the art and prospects].

State-of-the-art robotized systems developed for surgery are either remotely controlled manipulators that duplicate gestures made by the surgeon (endoscopic surgery applications), or automated robots that execute trajectories defined relatively to pre-operative medical imaging (neurosurgery and orthopaedic surgery). This generation of systems primarily applies existing robotics technologies (the remote handling systems and the so-called "industrial robots") to current surgical practices. It has contributed to validate the huge potential of surgical robotics, but it suffers from several drawbacks, mainly high costs, excessive dimensions and some lack of user-friendliness. Nevertheless, technological progress let us anticipate the appearance in the near future of miniaturised surgical robots able to assist the gesture of the surgeon and to enhance his perception of the operation at hand. Due to many in-the-body articulated links, these systems will have the capability to perform complex minimally invasive gestures without obstructing the operating theatre. They will also combine the facility of manual piloting with the accuracy and increased safety of computer control, guiding the gestures of the human without offending to his freedom of action. Lastly, they will allow the surgeon to feel the mechanical properties of the tissues he is operating through a genuine "remote palpation" function. Most probably, such technological evolutions will lead the way to redesigned surgical procedures taking place inside new operating rooms featuring a better integration of all equipments and favouring cooperative work from multidisciplinary and sometimes geographically distributed medical staff.

Endoscopy↗

PubMed2004

[Laparoscopy and robotics].

Telerobotics is a wide term and include multiple directions and aspects in its development. When speaking of different aspects of its development, one should think of its functionality, construction aspects, communication aspects, implementation safety and acceptance by the environment. Robotics is a science dealing with possibilities of implementing different tasks, through mechanical instruments, controlled by humans. Telesurgery does not include only aspects of teleconference but assists in surgical procedures, i.e. enables for the part of surgical procedure to be performed through electronic commands on bigger distances. Currently, two robotic systems are employed in clinical practice. One is ZEUS system, constructed by the Computer Motion and manufactured by AESOP. Second one is Da Vinci surgical system. For laparoscopic robotic telesurgery, identical set of apparatus and instruments as the one used in a routine laparoscopic surgical procedures is needed. In all reports, authors refer to safe and successful surgical method. Recovery of the patient is identical as in classic laparoscopy. No statistically significant difference has been found in the duration of the surgery between robotic and classic laparoscopy. When counting used instruments, it was found that less instruments were used in the robotic laparoscopy. From presented studies related to the robotic laparoscopy, it can be seen that there is an intention to present this method as safe and usable. One thing is sure--this method is the first step toward new model of planning and performing surgical procedures with only one goal--to help the patient.

Humans↗

PubMed2005

Surgical robot setup simulation with consistent kinematics and haptics for abdominal surgery.

Preoperative simulation and planning of surgical robot setup should accompany advanced robotic surgery if their advantages are to be further pursued. Feedback from the planning system will plays an essential role in computer-aided robotic surgery in addition to preoperative detailed geometric information from patient CT/MRI images. Surgical robot setup simulation systems for appropriate trocar site placement have been developed especially for abdominal surgery. The motion of the surgical robot can be simulated and rehearsed with kinematic constraints at the trocar site, and the inverse-kinematics of the robot. Results from simulation using clinical patient data verify the effectiveness of the proposed system.

Biomechanical Phenomena↗

PubMed2004

Computer-assisted robotic antireflux surgery.

Robotic surgical systems are relatively new technical devices designed to address several of the limitations inherent to standard laparoscopy. Since the 1(st) report of a computer-assisted fundoplication in 1997, numerous authors have reported their experiences with these devices in antireflux surgery. While there are several advantages to robotic when compared to standard laparoscopic antireflux surgery, there are also some distinct drawbacks. Robotic surgical systems allow the surgeon to perform more complex maneuvers with increased precision and accuracy, and without tremor. The image is high-definition and the surgeon operates in a more ergonomic position. These systems are also costly to purchase and maintain, they are large and may limit access to the patient during surgery, they provide a narrower field of view of the operative site, and they provide the surgeon with essentially no tactile feedback. Clinical outcomes of robotic fundoplication seem to be very similar to those of standard laparoscopic fundoplication, although the operating times in many series are increased when using the robot. The role of computer-assisted fundoplication in general practice, at least at the current level of robotic technology, remains to be defined.

Gastroesophageal Reflux↗

PubMedDate not supplied

Total laparoscopic hysterectomy utilizing a robotic surgical system.

OBJECTIVES: To describe the use of a robotic surgical system for total laparoscopic hysterectomy. METHODS: We report a series of laparoscopic hysterectomies performed using the da Vinci Robotic Surgical System. Participants were women eligible for hysterectomy by standard laparoscopy. Operative times and complications are reported. RESULTS: We completed 10 total laparoscopic hysterectomies between November 2001 and December 2002 with the use of the da Vinci Robotic Surgical System. Operative results were similar to those of standard laparoscopic hysterectomy. Operative time varied from 2 hours 28 minutes to 4 hours 37 minutes. Blood loss varied from 25 mL to 350 mL. Uterine weights varied from 49 g to 227 g. A cystotomy occurred in a patient with a history of a prior cystotomy unrelated to the robotic system. CONCLUSION: Total laparoscopic hysterectomy is a complex surgical procedure requiring advanced laparoscopic skills. Tasks like lysis of adhesions, suturing, and knot tying were enhanced with the robotic surgical system, thus providing unique advantages over existing standard laparoscopy. Total laparoscopic hysterectomy can be performed using robotic surgical systems.

Adult↗

PubMed2005

A new era in laparoscopic surgery. Evaluation of robot-assisted laparoscopic procedures.

OBJECTIVE: To present the experience with the advanced technology of robot-assisted laparoscopic surgery at our institute. METHODS: We reviewed and present patients who had robot-assisted laparoscopic surgical procedures, between April 2003 and March 2004, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. All procedures were carried out using the da Vinci system (Intuitive Surgical, Mountain View, Ca, USA). We recorded the time for system setup, operating time, morbidity and postoperative hospital stay. RESULTS: We performed 42 robot-assisted laparoscopic operations. The most frequently performed operations were robot-assisted cardiac procedures (n=25), laparoscopic cholecystectomy (n=9) other operations were: thymectomy (4), apical bullectomy (2), and one for each adrenalectomy, and lung volume reduction. The median time to install and drape the robotic system was 15 minutes. In 2 patients (4.7%) we converted the procedures to conventional laparoscopy or open. There was postoperative wound infection at the site of the port in one patient. The average postoperative hospital stay was similar to conventional laparoscopic procedures. CONCLUSION: Robot-assisted minimally invasive surgery is feasible, safe and may become the surgical procedure of the future.

Adult↗

PubMed2005

Gastrointestinal robot-assisted surgery. A current perspective.

Minimally invasive techniques have revolutionized operative surgery. Computer aided surgery and robotic surgical systems strive to improve further on currently available minimally invasive surgery and open new horizons. Only several centers are currently using surgical robots and publishing data. In gastrointestinal surgery, robotic surgery is applied to a wide range of procedures, but is still in its infancy. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed operations. The ZEUS (Computer Motion, Goleta, CA) and the da Vinci (Intuitive Surgical, Mountain View, CA) surgical systems are today the most advanced robotic systems used in gastrointestinal surgery. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery. Its main drawbacks are the absence of force feedback and extremely high costs. At this moment there are no reports to clearly demonstrate the superiority of robotics over conventional laparoscopic surgery. Further research and more prospective randomized trials are needed to better define the optimal application of this new technology in gastrointestinal surgery.

Digestive System Surgical Procedures↗

PubMedDate not supplied

[Robotics in general surgery: personal experience, critical analysis and prospectives].

Today mini invasive surgery has the chance to be enhanced with sophisticated informative systems (Computer Assisted Surgery, CAS) like robotics, tele-mentoring and tele-presence. ZEUS and da Vinci, present in more than 120 Centres in the world, have been used in many fields of surgery and have been tested in some general surgical procedures. Since the end of 2003, we have performed 70 experimental procedures and 24 operations of general surgery with ZEUS robotic system, after having properly trained 3 surgeons and the operating room staff. Apart from the robot set-up, the mean operative time of the robotic operations was similar to the laparoscopic ones; no complications due to robotic technique occurred. The Authors report benefits and disadvantages related to robots' utilization, problems still to be solved and the possibility to make use of them with tele-surgery, training and virtual surgery.

Digestive System Diseases↗

PubMed2006

Mobile in vivo biopsy and camera robot.

A mobile in vivo biopsy robot has been developed to perform a biopsy from within the abdominal cavity while being remotely controlled. This robot provides a platform for effectively sampling tissue. The robot has been used in vivo in a porcine model to biopsy portions of the liver and mucosa layer of the bowel. After reaching the specified location, the grasper was actuated to biopsy the tissue of interest. The biopsy specimens were gathered from the grasper after robot retraction from the abdominal cavity. This paper outlines the steps towards the successful design of an in vivo biopsy robot. The clamping forces required for successful biopsy are presented and in vivo performance of this robot is addressed.

Animals↗

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↗

PubMed1990

Robotics in the medical laboratory.

Robotic systems specifically designed for the automation of laboratory tasks are now available commercially. Equipped with computer, analytical hardware, and supporting software, these devices may soon revolutionize the concept of the clinical laboratory and usher in a new era in laboratory testing. We review the types of robots and motion-control software currently available and discuss examples of their applications that extend across many analytical areas. Several ongoing projects are concerned with the systematic integration of robotic devices with other laboratory automation. The integrated robotic laboratories emerging from this work portend a bright future for robotic automation. Many challenges remain, however, in training the individuals needed to develop and manage robotic laboratories, and in making this new technology cost-efficient.

Laboratories, Hospital↗

PubMed1990

A fully robotic assay for human hormone analysis.

To create a more convenient analytical system for the determination of hormones in human serum, we attempted to make a robotic system by combining robotic equipment and the DELFIA system (time-resolved fluoroimmunoassay; Pharmacia Co.). To combine the two systems, we constructed various peripheral instruments, created software for the computer, and introduced these to the robot at our laboratory. We developed this system to operate more exactly and smoothly than manual procedures during analytical movement steps such as taking samples, adding reagents, mixing samples in kit strips, and measuring the results of the fluoroimmunoassay. With this system the robot can measure in random sequence eight hormones--thyrotropin, triiodothyronine, thyroxin, prolactin, lutropin, follitropin, choriogonadotropin, and cortisol--according to physicians' orders placed through the computer. Consequently, this robotic system can operate fully automatically, from delivering the samples into the robotic system to printing out graph reports for physicians. The technologist merely puts the sample rack on the conveyor belt.

Fluoroimmunoassay↗

PubMed1995

Comparison of robotic versus human laparoscopic camera control .

PURPOSE: We investigated the accuracy and use of a robotic surgical arm compared to a human surgical assistant during urological laparoscopic surgery. MATERIALS AND METHODS: A total of 11 patients undergoing pelvic laparoscopic procedures that required identical bilateral surgical manipulations was evaluated. On 1 side a robotic surgical arm was used to manipulate the laparoscopic camera, while on the contralateral side the camera was positioned by a human surgical assistant. The side (left versus right) on which the robot was used was alternated with each case. Parameters assessed included operative time, erroneous camera motions, complications and outcome. RESULTS: All procedures were successfully completed without complications. Laparoscopic camera positioning was significantly steadier with less inadvertent movements when under robotic control (p < 0.0005). Operative times during dissections using the robot or human assistant were not statistically different. CONCLUSIONS: A robotic device can more effectively manipulate and accurately control the video endoscope than a human assistant during laparoscopic procedures.

Female↗