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At least 415 records · Page 23Linked to original sources

PubMed1999

Automated prostate recognition: a key process for clinically effective robotic prostatectomy.

Clinical trials of PROBOT, a robotic system for prostate surgery, have shown that robotic surgery of soft tissue can be successful. Monitoring of the progress of the resection has shown to be a necessary feature of an effective robotic system for prostate surgery. It should provide the surgeon with a reliable method of assessing the cavity during resection. An automatic system for intraoperative monitoring of the progress of the resection during robotic prostatectomy consists of two subsystems: real-time intraoperative imaging of the prostate and automatic identification of the contour of the gland on each image. The development of a fully automatic scheme for prostate recognition on transurethral ultrasound scans is reported. A genetic algorithm has been developed to automatically adjust a model of the prostate boundary until an optimum fit to the prostate in a given image is obtained. An analysis of its performance on 22 different ultrasound images showed an average error of 6.21 mm. Use of a genetic algorithm and a constrained prostate model have shown to be a robust way to automatically identify the prostate in ultrasound images. The scheme is able to produce approximate prostate boundaries, without any human intervention, on ultrasound scans of varying quality. In addition to soft tissue robotic surgery, the genetic algorithm technique is also applicable to a wide range of computer assisted surgical techniques.

Humans↗

PubMed1997

[Robotics in oral and maxillofacial surgery. Possibilities, chances, risks].

Robot systems are being tested in stereotactic neurosurgical interventions, orthopedic surgery of the hip or knee and advancal endoscopic systems for minimally invasive surgery. In contrast to most industrially manufactured products, objects for medical treatment are characterized by plasticity as well as by complex and individual forms. Thus, features of robots in this field have to be further developed in terms of advanced sensory and specific micromotoric systems. Safety and cooperation between surgeon and robot on the patient in the operating room have to be guaranteed. Extensive three-dimensional diagnosis, computer-aided planning and simulation of the intervention as well as sensory systems that monitor the actual performance of the operation are mandatory parts of this concept. In our interdisciplinary study, we aim to examine whether a robot-given a complete preoperative planning and simulation procedure-is able to perform certain surgical operations more precisely than the surgeon. Examples are drilling with depth control, shaping of bone surface by milling, sawing with defined depth in cranial osteotomies, defined preparation of implant sites and the positioning and insertion of dental and other surgical implants, whereby autonomous employment of the robot is not that which is aspired to in these interventions but rather the interactive support of the surgeon.

Humans↗

PubMed2003

Robotic assisted microsurgical vasal reconstruction in a model system.

Our objective was to determine whether or not male reproductive microsurgery is adaptable to current robotic technology. We devised a model vas deferens system using rat vasa deferentia and completed vasal anastomosis with full-thickness and mucosal robotically placed, Sharpoint 10-0 bicurve nylon sutures. Experienced and inexperienced microsurgeons performed separate anastomoses. Both groups of microsurgeons completed anastomoses with accuracy and enhanced comfort. The robotic graspers had the dexterity to delicately handle the 10-0 sutures and needles. We conclude that through our model vas deferens system, we demonstrated the feasibility of applying robotic technology to male reproductive microsurgery. This pilot study reveals some advantages of the robot and suggests future use of this system in a new urological application domain.

Anastomosis, Surgical↗

PubMed2006

The history of robotics in urology.

Despite being an ancient surgical specialty, modern urology is technology driven and has been quick to take up new minimally invasive surgical challenges. It is therefore no surprise that much of the early work in the development of surgical robotics was pioneered by urologists. We look at the relatively short history of robotic urology, from the origins of robotics and robotic surgery itself to the rapidly expanding experience with the master-slave devices. This article credits the vision of John Wickham who sowed the seeds of robotic surgery in urology.

England↗

PubMed2006

Current status of robotics in female urology and gynecology.

Currently, there has been limited reporting and research in the female urology and gynecological literature concerning the use of robotics. To date, robotics have been utilized only for the treatment of three benign gynecologic conditions: benign hysterectomy; repair of vesicovaginal fistula; and sacrocolpopexy which is a treatment for posthysterectomy vaginal vault prolapse. We describe a novel minimally invasive technique of vaginal vault prolapse repair and present our initial experience. The surgical technique involves placement of five laparoscopic ports: three for the daVinci robot and two for the assistant. A polypropylene mesh is then attached to the sacral promontory and to the vaginal apex using Gortex sutures. Thirty-one patients underwent a robotic-assisted laparoscopic sacrocolpopexy at our institution in the past 24 months for severe symptomatic vaginal vault prolapse. Complications were limited to mild port site infections in two patients, which resolved with oral antibiotic therapy. While our early experience utilizing robotic repairs in female urology and gynecology is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.

Female↗

PubMed2006

Robotic radical prostatectomy: the Vattikuti Urology Institute training experience.

Robotic radical prostatectomy is increasingly becoming a popular surgical treatment modality for men with clinically localized prostate cancer. Establishing a robotic prostatectomy program is a tremendous undertaking for any institution requiring both financial support and a dedicated operating room team. A structured approach to learning robotics is paramount in order to successfully start a program while optimizing the learning curve to master the technique and minimize peri-operative complications. We describe our own experience in establishing a robotics program to accomplish a safe and effective operation. In addition, we describe the steps utilized in order to teach our structured approach to other practitioners and institutions around the world. Robotic surgery can be taught to experienced open, as well as, laparoscopic surgeons, and incorporated into residency and fellowship training using this structured approach to learning.

Clinical Competence↗

PubMed2006

Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy.

BACKGROUND AND AIMS: Laparoscopic surgery has become the treatment of choice for cholecystectomy. Many studies showed that while this approach benefits the patient, the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence. Robots have the potential to overcome these problems. To evaluate the efficiency and feasibility of robotically assisted surgery (RAC), we designed a prospective study to compare it with standard laparoscopic cholecystectomy (SLC). MATERIALS AND METHODS: Between 2001 and 2003, 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system. The feasibility, safety, and possible advantages were evaluated. To assess the efficacy, the total time in the operating room was divided into preoperative, operative, and postoperative time frames. RESULTS: For RAC in comparison with SLC, the preoperative phase including equipment setup was significantly longer. In the intraoperative phase, the cut-closure time and camera and trocar insertion times were significantly longer. It is interesting to note that the net dissection time for the cystic artery, duct, and the gall bladder was not different from SLC. CONCLUSIONS: The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity. There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore, presents no benefit in using the robot in laparoscopic cholecystectomy.

Adolescent↗

PubMed2006

Robotic-assisted transhiatal esophagectomy.

BACKGROUND: Despite its reduced aggressiveness and excellent results obtained in certain diseases, minimally invasive surgery did not manage to significantly lower the risks of esophageal resections. Further advances in technology led to the creation of robotic systems with their unique maneuverability of the instruments and exceptional view on the operative field, thus setting the prerequisites for performance in complex surgical procedures and offering new possibilities to a disease notorious for its dismal prognosis. MATERIALS AND METHODS: The robotic-assisted transhiatal esophagectomy technique was used in a patient with squamous cell carcinoma of the lower esophagus that had high medical risk for surgical therapy. RESULTS: Esophageal resection and reconstruction were possible through a robotic-assisted minimally invasive transhiatal approach. There were no intraoperative incidents, blood loss was minimal, and lymph node dissection and removal was possible during the procedure. Early ambulation and conservative treatment of the mild complications that occurred offered a favorable postoperative outcome. CONCLUSION: The robotic-assisted transhiatal esophagectomy technique is feasible and safe. Complex procedures become less technically demanding with the help of the robotic system and, thus, the minimally invasive approach can be offered for the benefit of selected patients. Further studies are required to confirm these observations and to establish the role of this procedure in the future.

Aged↗

PubMed2004

Dexterity enhancement with robotic surgery.

BACKGROUND: The aim of this study was to quantify the extent of dexterity enhancement in robotic surgery as compared to laparoscopic surgery. METHODS: Ten surgeons with varying laparoscopic suturing experience were asked to place three sutures on a suture pad. The sutures were placed laparoscopically, robotically with 2-D vision and robotically with 3-D vision. The da Vinci systems Application Programming Interface (API) was used for positional data. A validated motion analysis system was used for data retrieval for the laparoscopic task. Custom software was developed for data analysis. RESULTS: Compared to laparoscopic suturing, when the task was undertaken robotically with 2-D vision there was a 20% reduction in the time taken but this was not significant (p = 0.07). There was a 55% reduction in the path traveled by the right hand (p = 0.01) and a 45% reduction in the path traveled by the left hand (p = 0.008). When the task was undertaken robotically with 3-D vision, there was a 40% reduction in the time taken (p = 0.01). There was a 70% reduction in the path traveled by right hand (p = 0.008) and a 55% reduction by the left hand (p = 0.08). CONCLUSIONS: The presence of wristed instrumentation, tremor abolition, and motion scaling enhance dexterity by nearly 50% as compared to laparoscopic surgery. 3-D vision enhances dexterity by a further 10-15%. In addition, the presence of 3-D vision results in a 93% reduction in skills-based errors.

Clinical Competence↗

PubMed2006

Artificial consciousness, artificial emotions, and autonomous robots.

Nowadays for robots, the notion of behavior is reduced to a simple factual concept at the level of the movements. On another hand, consciousness is a very cultural concept, founding the main property of human beings, according to themselves. We propose to develop a computable transposition of the consciousness concepts into artificial brains, able to express emotions and consciousness facts. The production of such artificial brains allows the intentional and really adaptive behavior for the autonomous robots. Such a system managing the robot's behavior will be made of two parts: the first one computes and generates, in a constructivist manner, a representation for the robot moving in its environment, and using symbols and concepts. The other part achieves the representation of the previous one using morphologies in a dynamic geometrical way. The robot's body will be seen for itself as the morphologic apprehension of its material substrata. The model goes strictly by the notion of massive multi-agent's organizations with a morphologic control.

Adaptation, Psychological↗

PubMed2003

Preparedness in robotically assisted interventions.

For many years, robots have been used in manufacturing to perform a variety of delicate tasks. Their use is now being generalized to other fields, such as biology, domestic applications, and especially medicine, in which they are poised to make a significant contribution. This evolution comes from the progress made in the field of robotics and from recent changes in medical and surgical techniques, namely, developments in medical imaging and a new desire for minimally invasive interventions. This emerging combination of high-precision robotic manipulators, new medical diagnostic techniques, and efficient minimally invasive surgery has not yet been perfected. After a brief discussion of state-of-the-art robotic systems used in urology, this article discusses new challenges presented by robotic minimally invasive surgery. A computer-integrated approach aimed at increasing the efficiency of such interventions through better preparedness is presented. This approach is illustrated by a case study in human nephrectomy and a cardiac animal experiment.

Humans↗

PubMed1991

Current capabilities of rehabilitation robots.

Predictions are often made of intelligent and independently mobile robots for the disabled, and researchers are continually improving laboratory systems. Reductions in the cost of the technology involved may lead to affordable devices by the end of the decade. Less ambitious goals must be adopted by those projects wishing to distribute robotic aids to the disabled in the next few years. A modest selling price dictates the use of existing components. Even with the advent of more advanced robots, cost considerations may still make simpler devices on attractive alternative. Excessive optimism of future capabilities should be avoided, lest unrealistic expectations of current robotic aids hamper their development. Progress at all levels of rehabilitation robotics is complementary.

Humans↗

PubMed1991

Clinical experience in rehabilitation robotics.

A robotic workstation system for the disabled, based on a commercially available arm, was tested with six patients at the Spinal Injuries Unit, Odstock Hospital, Salisbury. A questionnaire was administered to those who used the system. Users evaluated the usefulness and performance of the system and commented on their reactions to the use of robots in rehabilitation. The users were generally favourable as regards the ease of use of the system using a two-switch input, operating a scanning menu. All users wanted the robot to be able to replay previously created routines, and the majority also wanted to be able to directly control the robot as well. The users were unsure about the potential usefulness of the system. Because a robot is by definition a flexible device, the context in which it is introduced will effect the way it is received by potential users. Tests in a hospital environment are useful because there is a high concentration of users in their own home situations will give a better idea of the usefulness of such devices. The system was not ideal from the point of visibility and layout, and was too large for use in a domestic environment. The layout was largely dictated by the geometry of the manipulator. Therefore a new workstation system has been constructed using a purpose built manipulator. This new system particularly aims to overcome the poor layout of the earlier workstation and benefits from feedback from users.

Adult↗

PubMed1992

Evaluation of a robotic workstation for the disabled.

Experience with potential users is vital at all stages of the design of equipment for the disabled, not least in the field of rehabilitation robotics. The development of a robotic workstation for the disabled has progressed, over a period of 6 years, from the use of a cheap educational arm, to a specially engineered robot arm and workstation. The design and specification has been refined through constant evaluation by disabled users. Trials at a spinal injuries unit have given approval to the design and appearance of the latest robot arm and workstation, and have led to modifications to the user interface and software. Further trials have taken place in a user's home to investigate in greater depth the usefulness of a robotic workstation in a practical situation. The results of these trials are presented. It is proposed to refine the design of the arm for low-volume production, easy maintenance in the field and improved appearance.

Adult↗

PubMed1988

Automated production of several positron-emitting radiopharmaceuticals using a single laboratory robot.

A Zymate Laboratory Automation System (Zymark Corp.), previously set up for the automated synthesis of 16 alpha-[18F]fluoroestradiol-17 beta [Brodack et al. (1986a) J. Nucl. Med. 27, 714] has been modified for the production of several short-lived radiopharmaceuticals in a single hot cell. All manipulations and apparatus normally used in the syntheses of carbon-11 and fluorine-18-labeled radiopharmaceuticals have been incorporated into the robot system. This achievement permits facile modifications of existing procedures used by the robot in addition to the incorporation of new routines in a minimal amount of time. Currently, the Zymate robot is programmed for the routine production of 16 alpha-[18F]fluoroestradiol-17 beta (7-11% EOS in 80 min), N-(3-[18F]fluoropropyl)spiperone (15-18% EOS in 70 min), and [1-11C]butanol (11-15% EOS in 25 min). A fourth compound, 2-deoxy-2-[18F]fluoro-D-glucose, is also synthesized by the robot. The yields and synthesis times of the robot-produced compounds are comparable to those obtained during manual syntheses. This method of automation represents a flexible and versatile alternative for the routine production of radiopharmaceuticals used in PET studies.

Fluorine Radioisotopes↗

PubMed1995

Plasma input function determination for PET using a commercial laboratory robot.

A commercial laboratory robot system (Zymate PyTechnology II Laboratory Automation System) was interfaced to standard and custom laboratory equipment and programmed to perform rapid radiochemical assays necessary for plasma input function determination in quantitative PET studies in humans and baboons. A Zymark XP robot arm was used to carry out two assays: (1) the determination of total plasma radioactivity concentrations in a series of small-volume whole blood samples and (2) the determination of unchanged (parent) radiotracer in plasma using only solid phase extraction methods. Steady state robotic throughput for determination of total plasma radioactivity in whole blood samples (0.350 mL) is 14.3 samples/h, which includes automated centrifugation, pipetting, weighing and radioactivity counting. Robotic throughput for the assay of parent radiotracer in plasma is 4-6 samples/h depending on the radiotracer. Percents of total radioactivities present as parent radiotracers at 60 min, postinjection of 25 +/- 5.0 (N = 25), 26 +/- 6.8 (N = 68), 13 +/- 4.4 (N = 30), 32 +/- 7.2 (N = 18), 16 +/- 4.9 (N = 20), were obtained for carbon-11 labeled benztropine, raclopride, methylphenidate, SR 46349B (trans, 4-[(3Z)3-(2-dimethylamino-ethyl) oxyimino-3 (2-fluorophenyl)propen-1-yl]phenol), and cocaine respectively in baboon plasma and 84 +/- 6.4 (N = 9), 18 +/- 11 (N = 10), 74 +/- 5.7 (N = 118) and 16 +/- 3.7 (N = 18) for carbon-11 labeled benztropine, deprenyl, raclopride, and methylphenidate respectively in human plasma. The automated system has been used for more than 4 years for all plasma analyses for 7 different C-11 labeled compounds used routinely in our laboratory. The robotic radiotracer assay runs unattended and includes automated cleanup procedures that eliminates all human contact with plasma-contaminated containers.

Animals↗

PubMed2004

Robot-assisted pediatric surgery.

Computer-enhanced robotic surgical systems have been increasingly used to facilitate complex minimal access surgical procedures. In adult patients, such systems have been used to perform a wide variety of operations including coronary artery bypass grafting, mitral valve repair, Roux-en-Y gastric bypass, colon resection, nephrectomy, and radical prostatectomy. In the field of pediatric surgery, the experience with robotic surgical systems has been more limited. However, with improvements in robotic technology, interest and experience with robotic pediatric surgery have grown rapidly. The purpose of this article is to review the current experimental and clinical literature regarding the use of robotic surgical systems in the pediatric patient population.

Adult↗

PubMed2004

Robotically assisted bariatric surgery.

Obesity is a serious health problem in the United States today, and surgical treatment is recognized as long-term effective therapy. Minimally invasive techniques are becoming the "gold standard" approach to the treatment of disease, and robotic surgery has the potential to advance the use and development of minimally invasive procedures. In this article, we report our experience using robotically assisted technology to perform bariatric surgery. From mid 2002 to early 2004, 110 robotically assisted Roux-en-Y gastric bypass and 32 robotically assisted gastric banding procedures were performed at our institution. The mean preoperative body mass index was 46 for the patients receiving Roux-en-Y gastric bypass and 49 for the patients receiving gastric banding. The mean length of stay was 2.1 days and 1 day for patients in the 2 respective groups. There were 3 strictures in the Roux-en-Y group and 1 marginal ulcer in the gastric banding group; no leaks were observed in any patients in either group. There was 1 conversion to a laparoscopic procedure in the Roux-en-Y gastric bypass group. We conclude that robotically assisted bariatric surgery will allow more surgeons to offer patients the same safety and successful outcomes currently available through open techniques but without the significant morbidities of large surgical wounds.

Anastomosis, Roux-en-Y↗