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At least 433 records · Page 24Linked to original sources

PubMed2004

Robotic skeletonizing of the internal thoracic artery: is it safe?

BACKGROUND: The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). METHODS: Nine dogs underwent bilateral robotic internal thoracic artery harvesting through three ports placed in the left chest. One internal thoracic artery was harvested as a pedicle in each dog, and the other was skeletonized. Internal thoracic artery blood flow was measured in each graft, and comparative endothelial histologic studies were performed. Data are mean +/- the standard error of the mean. RESULTS: All 18 internal thoracic arteries were harvested successfully. Skeletonized internal thoracic artery harvests required more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvests (39.0 minutes +/- 1.4; p < 0.05). Internal thoracic artery flows during the final intervals were similar (skeletonized = 30.0 mL/min +/- 2.4 vs pedicle = 31.5 mL/min +/- 1.8; p = 0.9). Free internal thoracic artery bleeding flow was similar in both groups (skeletonized = 162.0 mL/min +/- 3.0 vs pedicle = 189.0 mL/min +/- 2.4; p = 0.4). Histologically, both groups were similar with minimal endothelial damage. CONCLUSIONS: Robotically skeletonized harvesting is safe, but it requires more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvesting. Despite muted tactile feedback with robotics, neither technique was associated with histologic or functional damage. These encouraging results may represent an advantage for complete arterial revascularization in robotic coronary bypass patients.

Animals↗

PubMed2004

Minimally invasive mitral valve repair using the da Vinci robotic system.

BACKGROUND: Minimally invasive mitral valve repair with a shortened hospital stay and quick return to an active lifestyle is the ultimate goal for robotically assisted surgery. We evaluated our da Vinci robotically assisted mitral valve repair experience toward achieving this goal. METHODS: All procedures were performed with peripheral cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia. Two ports and a 4-cm intercostal incision in the right chest were used for access. All patients had a ring annuloplasty, and all but 1 had a posterior leaflet resection. The entire repair and all knot tying were performed robotically. RESULTS: Between October 2001 and October 2002, 25 patients (18 men) underwent robotic mitral valve repair. The mean age was 56 years (range, 37 to 81 years). There were no incisional conversions, deaths, strokes, or reoperations for bleeding. Twenty-one (84%) of 25 patients were extubated in the operating room. Overall mean study times were as follows: procedure, 199.7 minutes (range, 140 to 287 minutes); cardiopulmonary bypass, 126.6 minutes (range, 89 to 186 minutes); and cross-clamp, 87.7 minutes (range, 58 to 143 minutes). Eight (32%) patients were discharged home in less than 24 hours, with an average length of stay of 2.7 days. Comparing the first 10 patients to the last 15 there was a significant reduction of times: total operating room time, 318.5 versus 275.1 minutes; cross-clamp, 97.6 versus 81.1 minutes; leaflet resection or repair, 26.2 versus 15.6 minutes; annuloplasty ring, 31.9 versus 24.8 minutes; and length of stay, from 4.2 days to 1.67 days. Five patients had postoperative atrial fibrillation. Two (8%) patients ultimately required mitral valve replacement for recurrent mitral insufficiency. CONCLUSIONS: Mitral valve repair can be successfully performed with the da Vinci robotic system. Long-term follow-up is needed to determine the durability of the repair compared with a standard sternotomy approach.

Adult↗

PubMed2006

Robotic-assisted coronary artery bypass on a beating heart: initial experience and implications for the future.

BACKGROUND: Although totally endoscopic coronary artery bypass using facilitated anastomotic devices is still in development, practical less invasive surgical strategies using sophisticated robotic microsurgical systems have been applied to facilitate the journey to a completely endoscopic procedure. This report summarizes the initial clinical experience with off-pump coronary artery bypass grafting using the Intuitive da Vinci Surgical Robotic System. METHODS: Robotically-assisted coronary artery bypass grafting through a small thoracotomy on a beating heart without the use of cardiopulmonary bypass was performed on 70 patients from February 16, 2004 through September 20, 2005. Postoperative morbidity, mortality, and length of stay were recorded. RESULTS: Operative mortality was 0%. The average operative time per case for the entire series was 4 hours, 3 minutes. The average operative time per case for the first 10 cases was 5 hours, 56 minutes, which decreased to 3 hours, 52 minutes for the last 10 cases of the series. The incidents of postoperative complications were as follows: reoperations for bleeding (2 patients; 2.8%); transfusions (7 patients; 10%); atrial fibrillations (6 patients; 8.5%); infections (2 patients; 2.8%); neurologic (0%); renal failure (0%); and ventilation greater than 1 day (0%). The average postoperative length of stay was 5.7 days. CONCLUSIONS: Early results suggest robotic-assisted coronary artery bypass grafting is a safe and effective means of myocardial revascularization and its continued clinical use is justified. Operative time has decreased with experience. Robotic-assisted coronary artery bypass grafting performed through a small thoracotomy on a beating heart without the use of cardiopulmonary bypass may pave the way to a completely endoscopic, closed chest procedure for coronary artery bypass grafting.

Aged↗

PubMed2006

Robot control with biological cells.

At present there exists a large gap in size, performance, adaptability and robustness between natural and artificial information processors for performing coherent perception-action tasks under real-time constraints. Even the simplest organisms have an enviable capability of coping with an unknown dynamic environment. Robots, in contrast, are still clumsy if confronted with such complexity. This paper presents a bio-hybrid architecture developed for exploring an alternate approach to the control of autonomous robots. Circuits prepared from amoeboid plasmodia of the slime mold Physarum polycephalum are interfaced with an omnidirectional hexapod robot. Sensory signals from the macro-physical environment of the robot are transduced to cellular scale and processed using the unique micro-physical features of intracellular information processing. Conversely, the response form the cellular computation is amplified to yield a macroscopic output action in the environment mediated through the robot's actuators.

Animals↗

PubMedDate not supplied

Robotically assisted prostate brachytherapy with transrectal ultrasound guidance--Phantom experiments.

PURPOSE: To report the preliminary experimental results obtained with a robot-assisted transrectal ultrasound (TRUS)-guided prostate brachytherapy system. METHODS AND MATERIALS: The system consists of a TRUS unit, a spatially coregistered needle insertion robot, and an FDA-approved treatment planning and image-registered implant system. The robot receives each entry/target coordinate pair of the implant plan, inserts a preloaded needle, and then the seeds are deposited. The needles/sources are tracked in TRUS, thus allowing the plan to be updated as the procedure progresses. RESULTS: The first insertion attempt was recorded for each needle, without adjustment. All clinically relevant locations were reached in a prostate phantom. Nonparallel and parallel needle trajectories were demonstrated. Based on TRUS, the average transverse placement error was 2 mm (worst case 2.5 mm, 80% less than 2 mm), and the average sagittal error was 2.5 mm (worst case 5.0 mm, 70% less than 2.5 mm). CONCLUSIONS: The concept and technical viability of robot-assisted brachytherapy were demonstrated in phantoms. The kinematically decoupled robotic assistant device is inherently safe. Overall performance was promising, but further optimization is necessary to prove the possibility of improved dosimetry.

Brachytherapy↗

PubMed2006

Robot-assisted hindlimb extension increases the probability of swing initiation during treadmill walking by spinal cord contused rats.

Training and evaluation of locomotion in animals with spinal cord injury will likely be improved with the development of techniques that increase stepping activity. We hypothesized that robot-assisted extension of the hindlimbs of spinal cord injured rats during stance would increase the probability that the swing phase of gait would be initiated. Thirty-three adult, Sprague-Dawley rats received a contusion injury to the mid-thoracic spinal cord. The animals' hindlimbs were pulled into extension using small robotic arms to pull at the ankle, as the rat stepped on either a reciprocating, robotic paw platform or a conventional treadmill belt. The animals demonstrated an increase in the probability of swing initiation with spontaneous recovery during the first 4 weeks following injury (p < 0.0001). The probability of swing initiation was found to be greater with the use of robot-assisted extension versus no extension force at the ankle (75+/-16.9% versus 38.9+/-16.6%, p < 0.001). Swing initiation occurred most frequently at a particular distance of hindlimb extension (50 mm caudal from the neutral position at stance), but was broadly tuned about this distance. These results indicate that a greater amount of stepping activity can be elicited by robot-assisted extension, thereby providing possible benefits to evaluation and training of gait following SCI.

Algorithms↗

PubMed2004

Robot-enhanced fetoscopic surgery.

BACKGROUND: Fetoscopic surgery carries with it less maternal morbidity than open fetal surgery. Robotic surgery facilitates endoscopic surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. The goal of the authors was to explore using a robotic surgery platform in a fetal animal model. METHODS: Using the Zeus Robotic Surgery System (Computer Motion, Santa Barbara, CA), fetoscopic surgery in pregnant sheep was performed using a variety of techniques: uterus exteriorized or totally percutaneous and with liquid or gas insufflation. Using the percutaneous technique and gas insufflation, the authors created and sutured fetal skin and fascial defects. The ewes were recovered and killed 2 weeks postoperatively, and autopsies were performed on them and their fetuses. RESULTS: In the exteriorized uterus model, instrument movement was unpredictable and fluid leaked. In the fluid environment, clouding of the visual field and difficulty in immobilizing the fetus were major difficulties. In the survival model, 4 of the 6 fetuses survived to autopsy at 2 weeks and showed good healing grossly and histologically. CONCLUSIONS: The Zeus Robotic Surgery System can be used for fetoscopic surgery in a sheep model. The percutaneous approach with a nitrous oxide environment is the most effective. Advantages of robotic surgery may be applicable in fetoscopic surgery, but further work in a primate model is required.

Animals↗

PubMed2004

Robotic totally endoscopic coronary artery bypass: program development and learning curve issues.

BACKGROUND: The introduction of new procedures in heart surgery is a critical phase that includes learning curves and the risk of increased mortality or morbidity. Totally endoscopic coronary artery bypass grafting using robotic techniques represents such an innovative procedure. The aim of this report is to demonstrate the safe introduction of totally endoscopic coronary artery bypass grafting using a stepwise and modular approach. METHODS: From June 2001 until December 2002, 50 procedures were performed using the da Vinci telemanipulator system. After baseline training the following procedure modules were carried out in a stepwise manner: robotically assisted endoscopic left internal thoracic artery harvesting and completion of the procedure as conventional coronary artery bypass grafting, minimally invasive direct coronary artery bypass, or off-pump coronary artery bypass (n = 19), robotically assisted suturing of left internal thoracic artery to left anterior descending anastomoses during conventional coronary artery bypass grafting (n = 15), totally endoscopic coronary artery bypass grafting on the arrested heart using remote access perfusion and aortic endocclusion coronary bypass grafting (n = 15). One patient was excluded intraoperatively from a robotic procedure due to pleural adhesions. RESULTS: A significant learning curve was observed for left internal thoracic artery takedown time, y(min) = 181 - 39 x ln(x) (x = procedure number) (P <.001), and total operative time in totally endoscopic coronary artery bypass grafting, y(min) = 595 - 87 x ln(x) x = (procedure number) (P =.028). The conversion rate in totally endoscopic coronary artery bypass grafting was 2/15. Intensive care unit stay correlated significantly with total operative time (r =.427, P =.002). There was no hospital mortality. CONCLUSION: Totally endoscopic coronary artery bypass grafting can be safely implemented into a heart surgery program. Learning curves are steep for robotic left internal thoracic artery takedown and for performance of totally endoscopic coronary artery bypass grafting. Long operative times translate into prolonged intensive care unit stay in specific cases but not into increased mortality.

Adult↗

PubMed2004

Do robots need to sleep?

The present paper exposes algorithmic results providing a vision about sleep functions which complements biological theory and experiments. Derived from the algorithmic theory of information, the theory of adaptation aims at quantifying how an inherited or acquired piece of knowledge helps individuals to survive. It gives a scale of complexity for survival problems and proves that some of them can only be solved by a dynamical management of memory associating continuous learning and forgetting methods. In this paper we explain how a virtual robot "Picota" has been designed to simulate the behavior of a living hen. In order to survive in its synthetical environment, our robot must recognize good seeds from bad ones, and should take rest during night periods. Within this frame, and facing the rapid evolution of to-be-recognized forms, the best way to equilibrate the energetic needs of the robot and ensure survival is to use the nightly rest to reorganize the pieces of data acquired during the daily learning, and to trash the less useful ones. Thanks to this time sharing, the same circuits can be used for both daily learning and nightly forgetting and thus costs are lower; however, this also forces the system to "paralyse" the virtual robot, and therefore the night algorithm is reminiscent of paradoxical (REM) sleep. The algorithm of the robot takes advantage of the alternation between wakefulness or activity and the rest period. This diagram quite accurately recalls the REM period. In the future, the convergence between the neurophysiology of sleep and the theory of complexity may give us a new line of research in order to elucidate sleep functions.

Algorithms↗

PubMed2004

Chaotic dynamics of a behavior-based miniature mobile robot: effects of environment and control structure.

To study the regularity and complexity of autonomous behavior, the flow of sensory information obtained in autonomous mobile robots under various conditions was analyzed as a complex system. Sensory information time series Xn was collected from a miniature mobile robot during free navigation, and plotted on the return map, the graph of X(n+tau) vs. Xn. The plot exhibited a characteristic trajectory, representing the regularity of the time series. Correlation integral and Lyapunov exponent analysis also showed properties of deterministic chaos; the presence of fractal dimension and positive Lyapunov exponent. Analysis of sensory information obtained in the robot with three different neural controllers revealed that the autonomous robot behaves in such a way that the flow of sensory information is governed by a deterministic rule, and this pattern is unique to each controller. Furthermore, the analysis in various environments exhibited that transitions from one trajectory to another on the return map occur during the course of autonomous behavior. The fractal and Lyapunov dimensions calculated in various conditions indicate that these dimension could be utilized to quantify the complexity of autonomous behavior and the relative difficulty of tasks. Analyses at different evolutionary stage revealed that behavioral performance correlates with fractal dimension. These studies using a miniature mobile robot that allowed to idealize the experimental conditions demonstrated firmly that the complex analysis could be utilized in evaluation and optimization of autonomous systems and the behavior.

Behavior↗

PubMed2004

Laparoscopic robotic gynecologic surgery.

The first gynecologic procedure performed with a robot was a tubal anastomosis. This was performed in 1998 with the Zeus robot. Over the past several years other gynecologic procedures have been performed with other robots. Current robotic technology may not be universally applicable to many gynecologists' clinical practice. The field of surgical robotics is evolving at an ever increasing pace, however, and gynecologists need to participate in its development.

Female↗

PubMed2004

Robotic nanolitre protein crystallisation at the MRC Laboratory of Molecular Biology.

We have set up high-throughput robotic systems to screen and optimise crystallisation conditions of biological macromolecules with the aim to make difficult structural biology projects easier. The initial screening involves two robots. A Tecan Genesis liquid handler is used to transfer commercially available crystallisation reagents from 15 ml test tubes into the reservoirs of 96-well crystallisation plates. This step is fully automated and includes a carousel for intermediate plate storage, a Beckman plate sealer and a robotic arm, which transfers plates in between steps. For adding the sample, we use a second robot, a 17-tip Cartesian Technologies PixSys 4200 SynQuad liquid handler, which uses a syringe/solenoid valve combination to dispense small quantities of liquid (typically 100 nl) without touching the surface of the plate. Sixteen of the tips are used to transfer the reservoir solution to the crystallisation wells, while the 17th tip is used to dispense the protein. The screening of our standard set of 1440 conditions takes about 3 h and requires 300 microl of protein solution. Once crystallisation conditions have been found, they are optimised using a second Tecan Genesis liquid handler, which is programmed to pipette gradients from four different corner solutions into a wide range of crystallisation plate formats. For 96-well plates, the Cartesian robot can be used to add the sample. The methods described are now used almost exclusively for obtaining diffraction quality crystals in our laboratory with a throughput of several thousand plates per year. Our set-up has been copied in many institutions worldwide.

Combinatorial Chemistry Techniques↗

PubMed2006

Robotics in colorectal surgery: telemonitoring and telerobotics.

Surgery has just passed through the laparoscopic surgery revolution, with validation of the advantages for the patient evaluated painstakingly; however, laparoscopy is a transition phase to fully information-based surgery, which only can be accomplished when hand motions are converted to information through robotic surgery systems. The main advantage is using such systems to integrate the entire surgical process. The components that will allow such a transition exist in other industries that use robotics, so it is more a matter of applying these engineering principles to surgery, rather than inventing new technologies. Robotics cannot only improve the performance of surgery, but is providing access to surgical expertise in remote and underserved areas through telementoring, teleconsultation, and telesurgery. Colorectal surgeons should seize the opportunity to begin to use surgical robotic systems in those niche areas and procedures that have proven to be of significant benefit to the patient and are cost-effective. Over time, with the development of even more advanced systems it will become more advantageous to use robotics on a routine basis.

Colon↗

PubMed2005

Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy.

BACKGROUND: Laparoscopic Heller myotomy has emerged as the treatment of choice for achalasia. However, intraoperative esophageal perforation remains a significant complication. Computer-enhanced operative techniques have the potential to improve outcomes for certain operative procedures. Robotic, computer-enhanced laparoscopic telemanipulators using 3-dimensional magnified imaging and motion scaling are designed uniquely to facilitate certain operations requiring fine-tissue manipulation. We hypothesized that computer-enhanced robotic Heller myotomy would reduce intraoperative complications compared with laparoscopic techniques. METHODS: All patients undergoing an operation for achalasia at 3 institutions with a robotic surgery system (DaVinci; Intuitive Surgical Corporation, Sunnyvale, Calif) were followed-up prospectively. Demographics, perioperative course, complications, and hospital stay were recorded. Follow-up evaluation was obtained via a standardized symptom survey, office visits, and medical records. Data were compared with preoperative symptoms using a Mann-Whitney U test, and operating times were compared using the ANOVA test. RESULTS: Between August 2000 and August 2004 there were 104 patients who underwent a robotic Heller myotomy with partial fundoplicaton. There were 53 women and 51 men. All patients were symptomatic. The operative time was 140.55 minutes overall, but improved from 162.63 minutes to 113.50 minutes from 2000-2002 to 2003-2004 (P = .0001). There were no esophageal perforations. There were 8 minor complications and 1 patient required conversion to an open operation. Sixty-six (62.3%) patients were discharged on the first postoperative day and the average hospital stay was 1.5 days. A symptom survey was completed in 79 of 104 patients (76%) at follow-up evaluation. Symptoms improved in all patients with an average follow-up symptom score of 0.48 compared with 5.0 before the operation (P = .0001). Forty-three of the 79 patients from whom follow-up data were collected had a minimum follow-up period of 1 year. The follow-up period averaged 16 months. No patients required reoperation. CONCLUSIONS: Computer-enhanced robotic laparoscopic techniques provide a clear advantage over standard laparoscopy for the operative treatment of achalasia. We have shown in this large series that Heller myotomy can be completed using this technology without esophageal perforation. The application of computer-enhanced operative techniques appears to provide superior outcomes in selected procedures.

Adult↗

PubMed2004

The evolution of robotic urologic surgery.

The incorporation of robotics into surgical technology is a relatively recent development. Robotic surgical systems can be classified as master-slave systems, precise-path systems, or intern-replacement systems. Master-slave systems, the most familiar type, were developed from initial experiments in "telepresence" surgery funded by the US Department of Defense. Urology has embraced the use of commercial robotic surgical systems in a growing number of clinical applications. Although drawbacks and limitations exist for the use of surgical robotics, the systems are developing rapidly and an expanded role for this technology in the future of urology is inevitable. This article reviews the history of the use of robotics in surgery, focusing on its specific application to urology.

Equipment Design↗

PubMed2004

Robot-assisted vasovasostomy.

Robot-assisted vasovasostomy is an attractive alternative to traditional microscopic techniques for several reasons. The normal physiologic tremor is removed and greater ease and precision of suture placement is possible. The training period or learning curve for robot-assisted vasovasostomy is shorter than traditional microscopic techniques. This will allow more surgeons to provide quality technical surgical care for their patients. Additional costs are only a few hundred dollars. As surgical robots become increasingly available and used for a wider variety of procedures, the feasibility of robotic vasovasostomy becomes more realistic and vasoepididymostomy is likely. Although robotic surgery has improved prostate surgery, its contribution to microsurgical technique has the potential for a more profound impact.

Humans↗

PubMed1998

Comparison of position repeatability of a human operator and an industrial manipulating robot.

Robot performance criteria of position repeatability are studied. Weight-to-payload ratio is in manipulating robots significantly higher than in human operators. Bracing strategy improving the robot performances is introduced in the paper. The strategy copies human behavior during fine motion operations. A comparison is made between the robot and the human operator performing approximately the same manipulating task. Contactless measurements of position repeatability were accomplished with the OPTOTRAK motion analysis system. The results of tests demonstrate considerable improvement of robot and human operator's position repeatability when using bracing.

Braces↗

PubMed2000

Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study.

OBJECTIVE: To evaluate the feasibility and safety of a robotic device to perform a laparoscopic tubal anastomosis. DESIGN: Prospective pilot study. SETTING: Tertiary care medical center. PATIENT(S): Ten patients with previous tubal ligations underwent laparoscopic tubal ligation reversal using a robotic suturing device. INTERVENTION(S): Tubal surgery was performed with a robotic system. A two-layered closure was used for all tubes. Four stitches of 8-0 polygalactin sutures were used for each layer. MAIN OUTCOME MEASURE(S): Tubal patency; secondary measures were pregnancy rates, complications, and operative time. RESULT(S): The procedure was completed successfully in all 10 patients. No patient required conversion to an open procedure. The mean time (+/-SD) required to complete the anastomosis of both tubes was 159 +/- 33.8 minutes. Chromotubation at the end of the procedure showed patency in all tubes anastomosed. A postoperative hysterosalpingogram 6 weeks after surgery demonstrated patency in 17 of the 19 (89%) tubes anastomosed. There have been five pregnancies so far. There were no complications. CONCLUSION(S): Robotic technology can be used safely to create laparoscopic microsurgical anastomoses with adequate patency rates. Robotic technology has the potential to make laparoscopic microsuturing easier.

Adult↗