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At least 451 records · Page 25Linked to original sources

PubMed2000

Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study.

OBJECTIVE: To assess the feasibility and reproducibility of laparoscopic microsurgical tubal anastomosis using a remote-controlled robot. DESIGN: Descriptive case study. SETTING: Academic medical center. PATIENT(S): Eight patients with previous laparoscopic tubal sterilization who requested tubal reanastomosis. INTERVENTION(S): Systematization of the operative steps for laparoscopic tubal reanastomosis using a remote-controlled robot. MAIN OUTCOME MEASURE(S): Primary outcome measures were feasibility and reproducibility; secondary measures were tubal patency, operative time, complications, and ergonomic qualities. RESULT(S): The 16 tubes were successfully reanastomosed and patency was confirmed. The mean time that the robotic system was in use was 140 minutes, and mean surgical time was 52 minutes per tube. CONCLUSION(S): Laparoscopic microsurgical tubal reanastomosis after tubal sterilization can be performed using a remote-controlled robotic system. The robot, which has three-dimensional vision, allows the surgeon to perform ultraprecise manipulations with intraabdominal articulated instruments while providing the necessary degrees of freedom. Systematization of the operative steps allowed performance of the operation at a speed that compares favorably with the time needed for open microsurgical techniques. Larger series are needed to assess postoperative pregnancy rates.

Adult↗

PubMed1999

Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.

OBJECTIVE: The development of endoscopic coronary artery bypass grafting has been limited because of poor visualization and increased technical difficulties in carrying out operations through ports. We investigated whether the use of robotic assisted instruments could minimize these difficulties. METHODS: After a period of technical development and training on cadavers (n = 8) with the Intuitive Surgical system (Intuitive Surgical, Inc, Mountain View, Calif), the first clinical application in coronary artery surgery was performed in 4 male patients (mean age 59 +/- 6 years) with the indication of grafting the left internal thoracic artery to the left anterior descending coronary artery. Robotic assisted 3-dimensional endoscopes and instruments were introduced into the left side of the chest through 3 intercostal ports. The Heartport system (Heartport, Inc, Redwood City, Calif) was used for arresting the heart during the anastomosis. RESULTS: In 2 patients, the harvesting of the left internal thoracic artery was completed endoscopically with robotic assisted instruments and the anastomosis to the left anterior descending artery was performed through a minithoracotomy with conventional instruments. In 2 other patients, the entire operation was completed endoscopically with robotic assisted instruments. Early postoperative coronary angiography demonstrated the patency of the grafts in all cases. At 6-month follow-up, all patients were free of symptoms. CONCLUSIONS: Robotic assisted instruments make endoscopic coronary bypass possible and open a new era in minimally invasive surgery.

Anastomosis, Surgical↗

PubMed2006

Robot assisted laparoscopic partial nephrectomy: initial experience.

PURPOSE: Advances in laparoscopy have made laparoscopic partial nephrectomy a technically feasible procedure but it remains challenging to even experienced laparoscopists. We hypothesized that robotic assisted laparoscopic partial nephrectomy may make this procedure more efficacious than the standard laparoscopic approach. MATERIALS AND METHODS: Ten patients with a mean age of 58 years and mean tumor size of 2.0 cm underwent robotic assisted laparoscopic partial nephrectomy and another 10 with a mean age of 61 years and mean tumor size of 2.18 cm underwent laparoscopic partial nephrectomy, as performed by a team of 2 surgeons (MS and ST) between May 2002 and January 2004. Demographic data, intraoperative parameters and postoperative data were compared between the 2 groups. RESULTS: There were no significant differences in patient demographics between the 2 groups. Intraoperative data and postoperative outcomes were statistically similar. In the 10 patients who underwent robotic assisted laparoscopic partial nephrectomy there were 2 intraoperative complications. There was 1 conversion in the laparoscopic partial nephrectomy group. CONCLUSIONS: Robotic assisted laparoscopic partial nephrectomy is a safe and feasible procedure in patients with small exophytic masses. The robotic approach to laparoscopic partial nephrectomy does not offer any clinical advantage over conventional laparoscopic nephrectomy.

Humans↗

PubMed2002

Robotic surgery: the computer-enhanced control of surgical instruments.

Robotic procedures are still in a developmental stage. Studies have shown that many operations can be performed safely with computer-enhanced telemanipulators, but distinct advantages of robotic procedures have not been established. Before third-party payors begin paying a premium for the use of a robot, costs will need to decrease or outcomes will need to be sufficiently better. Manufacturers of robotic surgery systems are marketing directly to consumers and promoting their systems to hospitals based on the number of patients that can be attracted by such programs. Only the acceptance of robotics into mainstream surgical practice, however, will prove it to be more than just a niche technology.

Endoscopy↗

PubMed2002

Use of robotics in assessing the adaptive capacity of the rat lumbar spinal cord.

We have developed a robotic device that can record the trajectory of the hindlimb movements in rats. The robotic device can also impose programmed forces on the limbs during stepping. In the present paper we describe experiments using this robotic device, i.e. the rat stepper, to determine whether step training improves the locomotor capacity of adult rats that received complete spinal cord transections as neonates. We also determined to what extent the locomotor patterns can be maintained when the step cycle is physically perturbed by the robotic device. The results of the present study demonstrate that a robotic device can be used effectively to quantify the improvements in the locomotor capacity of spinal transected rats that occurs over a period of step training. The present results also demonstrate that when an external force is imposed to disrupt the step cycle, the spinal cord has the neural control elements necessary to normalize the kinematics over a number of steps, in the face of the disrupted forces.

Animals↗

PubMed2001

Robotic laparoscopic surgery: a comparison of the DA Vinci and Zeus systems.

OBJECTIVES: To evaluate two currently available robotic surgical systems in performing various urologic laparoscopic procedures in an acute porcine model. METHODS: Robotic laparoscopic surgery was performed in 14 swine. Data were compared between the da Vinci Robotic System and the Zeus Robotic System. RESULTS: During laparoscopic nephrectomy, the da Vinci System (n = 6) had a significantly shorter total operating room time (51.3 versus 71.6 minutes; P = 0.02) and actual surgical time (42.1 versus 61.4 minutes; P = 0.03) compared with the Zeus System (n = 5). However, the blood loss and adequacy of surgical dissection were comparable between the two groups. For laparoscopic adrenalectomy, the da Vinci System (n = 5) had a shorter actual surgical time (12.2 versus 26.0 minutes; P = 0.006) than did the Zeus System (n = 5). For laparoscopic pyeloplasty, the da Vinci System had a shorter total operating room time (61.4 versus 83.4 minutes; P = 0.10) and anastomotic time (44.7 versus 66.4 minutes; P = 0.11). During pyeloplasty anastomosis, the total number of suture bites per ureter was 13.0 for the da Vinci System (n = 6) and 10.8 for the Zeus System (n = 6). The complications included an adrenal parenchymal tear each during a da Vinci System-based left adrenalectomy and a Zeus System-based right adrenalectomy. An inferior vena caval tear during a Zeus System-based right adrenalectomy occurred in 1 case, which was suture-repaired telerobotically. CONCLUSIONS: Robotic laparoscopic procedures can be performed effectively using either the da Vinci or Zeus System. In this limited study, the learning curve and operative times were shorter and the intraoperative technical movements appeared inherently more intuitive with the da Vinci System. Additional clinical experience is necessary.

Adrenalectomy↗

PubMed2002

Using robotics to teach the spinal cord to walk.

We have developed a robotic device (e.g. the rat stepper) that can be used to impose programmed forces on the hindlimbs of rats during stepping. In the present paper we describe initial experiments using this robotic device to determine the feasibility of robotically assisted locomotor training in complete spinally transected adult rats. The present results show that using the robots to increase the amount of load during stance by applying a downward force on the ankle improved lift during swing. The trajectory pattern during swing was also improved when the robot arms were programmed to move the ankle in a path that approximated the normal swing trajectory. These results suggest that critical elements for successful training of hindlimb stepping in spinal cord injured rats can be implemented rigorously and evaluated using the rat stepper.

Animals↗

PubMed2002

A comparison of laparoscopic pyeloplasty performed with the daVinci robotic system versus standard laparoscopic techniques: initial clinical results.

PURPOSE: Laparoscopic pyeloplasty is an accepted therapy for primary ureteropelvic junction obstruction (UPJO), however difficulty associated with intracorporeal suturing has limited widespread clinical application. We report our initial experience of laparoscopic pyeloplasty performed with the daVinci robotic system matched to procedures performed with standard laparoscopic techniques. PATIENTS AND METHODS: From June 2001 until August 2001, six patients underwent definitive management of primary UPJO using the daVinci robotic system. In four patients an Anderson-Hynes pyeloplasty was performed, while in two patients Fengerplasty was performed. Using demographic and preoperative information, each patient in the daVinci-assisted group was matched to a corresponding patient with primary UPJO undergoing laparoscopic pyeloplasty with standard techniques between November 1999 and June 2001. Perioperative results and follow-up data were subsequently compared. RESULTS: Treatment groups were identical with regard to surgical procedure, gender, and side of UPJO. The length of hospitalization was 4 days for all patients, regardless of treatment group. Estimated blood loss was <50 cc in all cases. For Anderson-Hynes pyeloplasty, the mean overall operative and suturing times were 140 and 70 min using the daVinci system and 235 and 120 min using standard techniques, respectively. For the Fengerplasty, the mean overall operative and suturing times were 78 and 13 minutes using the daVinci system and 100 and 28 minutes using standard techniques, respectively. No complications were observed and there were no open conversions. CONCLUSION: Anderson-Hynes pyeloplasty and Fengerplasty are feasible using either conventional laparoscopic techniques or the daVinci robotic system. In this initial pilot study, procedures performed with the daVinci robotic system resulted in overall decreased operative time, however factors responsible for the decreased operative time remain to be defined. Long-term prospective follow-up of procedures performed with or without the daVinci robotic system for surgeons with limited experience in laparoscopic management of UPJO is warranted to delineate the true efficacy of the device.

Humans↗

PubMed2003

An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy.

OBJECTIVE: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis. AIM AND HYPOTHESIS: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies. METHODS: A team of urologists and an anatomist performed anatomic dissections of 12 male cadavers using a combination of laparoscopic equipment, magnification, and open surgical dissection. Each step involved in laparoscopic prostatectomy was reviewed in relation to the possible impact the step could have on the neurovascular bundles. RESULTS: Dissections were performed systematically to mimic various steps of laparoscopic and robotic prostatectomy. The neurovascular bundles were identified and correlated with video images of actual surgery. This enabled us to construct computer simulations and show the actual nerves on the operative pictures. We specially unraveled the relationship between neurovascular bundles and lateral pelvic and Denonvillier's fascias, both of which enclose and hide these important structures. The course of the bundles was traced from its origin at pelvic plexus to its distal course along the urethra. We also showed the important relationship between pelvic plexus ganglions and seminal vesicles to illustrate the vulnerability of these nerves to thermal, electrical and/or crush injury during seminal vesicle and prostatic pedicle dissections. The importance of additional fine neural plexus along the posterior and antero-lateral surface of the prostate was shown by both gross anatomical and microscopic images. The distal precarious location of the bundles was illustrated by dissections showing anteriorly lifted prostate.These anatomico-operative correlations have not been published for laparoscopic and robotic prostatectomies, which differ significantly in its visual angles, magnifications and sometimes three-dimensional (3D) visualization from its open counter part. CONCLUSION: Laparoscopic and robotic radical prostatectomy provides exposure and visualization of male pelvis not previously appreciated. It is only through a careful reexamination of the anatomy of the male pelvis, in the context of this new procedure, that the improvements in visualization and exposure benefit the surgeon. Our work provides a detailed map relating to operative steps to aid the surgeon in the performance of a nerve sparing robotic and laparoscopic radical prostatectomy.

Fascia↗

PubMed2002

Anesthetic implications of the addition of an operative robot for endoscopic surgery: a case report.

Laparoscopic surgery has become increasingly popular over the last decade. However, this surgical technique has a number of limitations. It is difficult to work in a three-dimensional space while viewing a two-dimensional monitor, long instruments amplify natural tremor, and traditional instruments have limited mobility due to few degrees of freedom. Robot-assisted surgery has been developed in response to these limitations. A three-dimensional viewer allows the surgeon to operate in a realistic environment, natural tremor is eliminated by translating the surgeon's hand motions to robotic movements, and the robotic surgical instruments are designed to have the same dexterity as a human wrist. We describe a case of robot-assisted laparoscopic Nissen fundoplication and discuss the anesthetic issues associated with this new surgical technique. In addition to the anesthetic issues associated with traditional laparoscopic surgery, robot-assisted laparoscopic surgery presents some unique challenges.

Adult↗

PubMed2002

Technique and first clinical results of robot-assisted total knee replacement.

Total knee replacement (TKR) is a common procedure for treatment of severe gonarthrosis, but the outcome may be unsatisfactory due to primary malalignment of the prosthetic components. In order to improve precision and accuracy of this surgical procedure, a commercial robotic surgical system (CASPAR) has been adapted to assist the surgeon in the preoperative planning and intraoperative execution of TKR. So far, 70 patients with idiopathic gonarthrosis were successfully treated with a robot-assisted technique in our institution. No major adverse events related to the use of the robotic system have been observed. The mean difference between preoperatively planned and postoperatively achieved tibiofemoral alignment was 0.8 degrees (0-4.1 degrees ) in the robotic group vs. 2.6 degrees (0-7 degrees ) in a manually operated historical control group of 50 patients. A clear advantage of robot-assisted TKR seems to be the ability to execute a highly precise preoperative plan based on computed tomography (CT) scans. Due to better alignment of the prosthetic components and improved bone-implant fit, implant loosening is anticipated to be diminished which may be most evident in non-cemented prostheses. Current disadvantages such as the need for placement of fiducial markers, increased operating times and higher overall costs have to be resolved in the future.

Aged↗

PubMedDate not supplied

First steps in robot automation of sampling and sample management during cultivation of mammalian cells in pilot scale.

The robot automation of sampling and the subsequent treatment and storage of aliquots during mammalian cell cultivations was investigated. The complete setup, the development and testing of the sampling device, the robot arm, and the cell imaging system are described. The developed sampling device is directly coupled to a pilot bioreactor. It allows the computerized sterile filling of cell broth into 50 mL sample tubes. After each sampling the whole tubing system is steam sterilized. For further off-line treatment a robot takes the sample to the different devices. This robot is equipped with a camera and a force/torque sensor. A color-based object recognition guides the arm in a complex surrounding with different illumination situations, enabling the robot to load the sampling device with tubes and take the sample to further devices. For necessary pipetting and refilling we developed a computerized device. Cells are automatically stained and counted using an imaging system. The cell number and viability is automatically saved in a process control system together with the on-line parameters. During several cultivations in 20 and 100 L scale these main components of the automation strategy were successfully tested.

Animals↗

PubMed2003

Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion.

OBJECTIVE: To develop a technique of nerve-sparing robot-assisted radical cystoprostatectomy (RRCP) for patients with bladder cancer. PATIENTS AND METHODS: Robotic assistance should enhance the ability to preserve the neurovascular bundles during laparoscopic radical cystectomy. Thus we undertook RRCP and urinary diversion using a three-step technique. First, using a six-port approach and the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), one surgeon carried out a complete pelvic lymphadenectomy and cystoprostatectomy using a technique developed specifically for robotic surgery. The neurovascular bundles were easily identified and dissected away, the specimen entrapped in a bag and removed through a 5-6 cm suprapubic incision. Second, a different surgical team exteriorized the bowel through this incision and created a neobladder extracorporeally. Third, the neobladder was internalized, the incision closed and the primary surgeon completed the urethro-neovesical anastomosis with robotic assistance. RESULTS: RRCP was carried out in 14 men and three women by the primary surgeon (M.M.). The form of urinary reconstruction was ileal conduit in three, a W-pouch with a serosal-lined tunnel in 10, a double-chimney or a T-pouch with a serosal-lined tunnel in two each. The mean operative duration for robotic radical cystectomy, ileal conduit and orthotopic neobladder were 140, 120 and 168 min, respectively. The mean blood loss was < 150 mL. The number of lymph nodes removed was 4-27, with one patient having N1 disease. The margins of resection were free of tumour in all patients. CONCLUSIONS: We developed a technique for nerve-sparing RRCP using the da Vinci system which allows precise and rapid removal of the bladder with minimal blood loss. The bowel segment can be exteriorized and the most complex form of orthotopic bladder can be created through the incision used to deliver the cystectomy specimen. Performing this part of the operation extracorporeally reduced the operative duration.

Blood Loss, Surgical↗

PubMedDate not supplied

Accuracy of anterior cruciate ligament tunnel placement with an active robotic system: a cadaveric study.

PURPOSE: The objective of this study was to evaluate the accuracy of tunnel placement for ACL reconstruction performed with an active robotic system. TYPE OF STUDY: Cadaveric analysis. METHODS: A reference screw containing 4 fiducials was placed in the femur and tibia of 13 fresh-frozen cadaveric knees. A preoperative plan was developed using images from 3-dimensional computed tomography reconstructions of the knee. The active robotic system then drilled the tunnels. The location and direction of each planned tunnel in the femur and tibia were determined from the preoperative plan. To compare these parameters postoperatively, a mechanical digitizer and a tunnel plug were used. The deviation in location and direction between the planned and drilled tunnel was determined. RESULTS: In preliminary trials, the tibial tunnel was located inaccurately because slippage of the drill bit occurred on the bone at the start of tunnel drilling. This was minimized by decreasing the feed rate of the robot by 75%. For the remaining 10 knees, deviations with respect to the preoperative plan were found of 2.0 +/- 1.2 mm and 1.1 degrees +/- 0.7 degrees for the intra- articular tibial tunnel location and direction, respectively. For the femur, the deviations were 1.3 +/- 0.9 mm for the tunnel location (intra-articular) and 1.0 degrees +/- 0.6 degrees for the tunnel direction. CONCLUSIONS: The active robotic system is highly accurate for tunnel placement during ACL reconstruction, meaning that the robot drills the tunnels very close to the surgeon's plan. Comparison to a control group of surgeons could not be made because no preoperative plan is usually created in traditional surgery. However, accuracy values in this study were found to be below the values for precision of repeated tunnel placements reported in the literature.

Aged↗

PubMed2006

Analysis of surgical management of calvarial tumours and first results of a newly designed robotic trepanation system.

This study was performed to evaluate the surgical strategy in patients with calvarial tumours, in order to design and modify a robot-assisted trepanation system. A total of 75 patients underwent craniectomy for the treatment of calvarial tumours during the 10-year period from 1993 to 2002. The patients' complaints, the size, location and histology of the tumour, and the various cranioplasty techniques used were analysed retrospectively. In a second procedure several craniectomies at typical locations according to the study's results were performed in a laboratory setting using a hexapod robotic tool, constructed at the Helmholtz-Institute, RWTH Aachen University, and plastic model heads. The workflow was documented and the reproducibility and the accuracy of the procedure were registered. A total of 83 surgical procedures were performed on 75 patients. The majority (87 %) of lesions treated surgically were located in the frontal, temporal and anterior parts of the parietal region. Histological examination revealed benign lesions in 66 % of the patients and dural involvement in 46 %. According to these results craniectomies were performed using the robotic system. Mean positioning accuracy of the robotic system while milling was 0.24 mm, with a standard deviation of 0.04 mm, and maximum error under 1 mm. Craniectomies leaving a 1-mm layer of the tabula interna intact to ensure a healthy dura were performed in several regions successfully. The majority of calvarial tumours, requiring surgical treatment in our patients, were located in cosmetically relevant areas in which drilling can be carried out with the robotic trepanation system. Consequently, the surgical approach had to be planned carefully in order to achieve a good cosmetic outcome.

Adolescent↗

PubMed2002

Interruption of patent ductus arteriosus in children: robotically assisted versus videothoracoscopic surgery.

OBJECTIVES: If robotic surgery is to be widely used, the risks must be equivalent to those of standard techniques. This study analyzes the feasibility, safety, and efficiency of a robotically assisted technique for patent ductus arteriosus closure and compares the results with those of the videothoracoscopic technique. METHODS: During 2000, 56 children weighing 2.3 to 57 kg (mean, 12 kg) underwent surgical closure of a patent ductus arteriosus. They were distributed into 2 groups: 28 patients (group 1) underwent the videothoracoscopic technique, and 28 (group 2) underwent a robotically assisted (Zeus; Computer Motion, Inc, Goleta, Calif) approach. Operative and postoperative surgical data were studied. RESULTS: Operative time was significantly higher in the robotically assisted group. One conversion in videothoracoscopy was necessary, but no thoracotomy was required. Three persistent shunts were detected at postoperative echocardiography and were treated by means of application of a new clip with videothoracoscopy (1 in group 1 and 2 in group 2). No permanent laryngeal nerve injury and no hemorrhage were noted. The mean hospital stay was 3 days in both groups. CONCLUSIONS: Robotically assisted closure of a patent ductus arteriosus is comparable with closure by means of the videothoracoscopic technique. However, it requires a longer operative time because of the increment in complexity.

Adolescent↗

PubMed2003

Robotic surgery: urologic implications.

Current medical robots have nothing in common with the anthropomorphic robots in science fiction classics. They are in fact, manipulators, working on a master-slave principle. Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more spaces." The success of robots in surgery is based on their precision, lack of fatigue, and speed of action. This review describes the theory, advantages, disadvantages, and clinical utilization of mechanical and robotic arm systems to replace the second assistant and provide camera direction and stability during laparoscopic surgery. The Robotrac system (Aesculap, Burlingame, CA), the First Assistant (Leonard Medical Inc, Huntingdon Valley, PA), AESOP (Computer Motion, Goleta, CA), ZEUS (Computer Motion), and the da Vinci (Intuitive Surgical, Mountain View, CA) system are reviewed, as are simple mechanical-assist systems such as Omnitract (Minnesota Scientific, St. Paul, MN), Iron Intern (Automated Medical Products Corp., New York, NY), the Bookwalter retraction system (Codman , Somerville, NJ), the Surgassistant trade mark (Solos Endoscopy, Irvine, CA), the Trocar Sleeve Stabilizer (Richard Wolf Medical Instruments Corp., Rosemont, IL), and the Endoholder (Codman, Somerville, NJ).

Equipment Design↗

PubMed2001

Robotically assisted laparoscopic hysterectomy and adnexal surgery.

BACKGROUND: In this pilot study, we tested the feasibility and safety of using a robotic device to perform complex gynecologic surgery. METHODS: Ten female pigs underwent adnexal surgery (n = 5) or hysterectomy (n = 5) using the "Zeus" robotic device. The surgeon operates while sitting at the console away from the surgical table on which the robotic arms are fixed. Both procedures were performed solely with the robotic arms. After 1 week of observation the animals were sacrificed and the surgical site was explored. RESULTS: The procedure was completed successfully in all cases. No animal required conversion to laparotomy or nonrobotic laparoscopic assistance. The mean operative time (+/- SD) was 170 +/- 44 min for adnexal surgery and 200 +/- 57 min for hysterectomy. No complications occurred. No ureteral injuries were found on necropsy. CONCLUSION: Although designed for laparoscopic microsuturing, this robotic technology has the potential to be used for more complex gynecologic procedures.

Adnexa Uteri↗