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At least 523 records · Page 29Linked to original sources

PubMed2003

Preserving the abductor mechanism in robotic THR: the influence of stem design and cutterpath.

OBJECTIVE: The tip of the greater trochanter is the attachment site for the abductor muscles of the hip joint. Its preservation in robotic and conventional THR is important for normal gait. The effect of different stem designs and robotic cutterpaths on the preservation of the trochanter tip is examined. MATERIALS AND METHODS: One anatomical stem, one straight stem, and one stem specifically designed for robotic THR were implanted virtually in CT scans of osteoarthrotic hip joints using the Torch preoperative planning unit (URS-ortho). In transverse sections of the trochanter tip, dimensions of the trochanter area removed by the milling tool were recorded for each stem design and different cutterpaths (3-axis versus 5-axis milling). RESULTS: Five-axis milling showed significantly better results than 3-axis milling. For straight stems, more bone was removed than for anatomic stems. The most favorable results were achieved with 5-axis milling and a curved stem specifically designed for robotic THR. CONCLUSIONS: The introduction of 5-axis milling in robotic THR is an improvement of the technique and makes preservation of the abductor mechanism at the tip of the greater trochanter easier for the surgeon.

Arthroplasty, Replacement, Hip↗

PubMed2003

An MRI-compatible surgical robot for precise radiological interventions.

OBJECTIVE: A variety of medical robots have been developed in recent years. MRI, including MR angiography and morphological imaging, with its excellent soft-tissue contrast is attractive for the development of interventional MRI-guided therapies and operations. This paper presents a telerobotic device for use in CT- and/or MR-guided radiological interventions. A robotic device for precise needle insertion during MR-guided therapy of spinal diseases will be briefly described. MATERIALS AND METHODS: Actuation of robots in an MRI environment is difficult due to the presence of strong magnetic fields. Therefore, the robot was constructed of nonmagnetic materials. The system frame was built from polyether ether ketone (PEEK) and fiber-reinforced epoxy, and actuated using ultrasonic and pneumatic motors. Completely MR-compatible sensors were developed for positioning control. RESULTS: Accuracy evaluation procedures and phantom tests were performed, with the required accuracy of approximately 1 mm being achieved and no significant artifacts being caused by the robotic device during MR image acquisition.

Animals↗

PubMed2003

Clinical application of robotic telemanipulation system in neurosurgery. Case report.

The NeuRobot is a telecontrolled microscopic micromanipulator system designed for neurosurgical procedures. The unit houses a three-dimensional endoscope and three robot arms that the surgeon operates without direct contact with the patient. The authors have successfully performed robotics-assisted neurosurgical procedures by using the NeuRobot in a 54-year-old man who had a recurrent atypical meningioma. Following the usual preparation of craniotomy and opening of the dura mater, a portion of the tumor was removed using the NeuRobot with the aid of microscopic observation. No complication related to the use of the NeuRobot was encountered and the patient's postoperative course was uneventful. Although various kinds of robots have been developed for use in neurosurgery in recent years, a robotic telemanipulation system capable of performing several surgical tasks has not previously been introduced to clinical neurosurgery. This is the first case report in which neurosurgical manipulation by a robotics system is described.

Humans↗

PubMed1999

[Nissen fundoplication done by remotely controlled robotic technique].

Two Nissen fundoplications were performed by a minimally invasive robotic technique on May 19, 1998. The Mona robot, was placed to the left of the patient. It held and activated surgical tools. The surgeon was placed some 3 meters from the patient and was seated at a console. He was not scrubbed. He commanded the 3 robotic arms by manipulating two handles, while observing a 3 dimensional picture recreated by a binocular system. Manipulations of the handles were translated into digital information by a computer. This information was modified by the computer with downscaling of the amplitude of motion by a factor 1 to 3 or 1 to 5. Physiologic tremor was eliminated. The computer delivered an impulse in command of the articulated robot arms via a 5 m long cable. Operating time was 4.30 hours, and 1.30 hours respectively. Blood loss was estimated at 20 and 30 ml. The two patients were discharged on the first postoperative day after a gastrograffin swallow had been performed in order to check the position of the wrap and its patency. Our experience with the Mona device may suggest that surgical robotics could have an increasingly important role in tomorrow's operating theatres. It should allow for more precise procedures, performed under better circumstances.

Adult↗

PubMed1999

[Networked robotics: its present status and future prospect].

One of the most promising technologies today is the integration of virtual reality and robotics on a network. This is called network robotics in general and R-cubed (real-time remote robotics) in particular. R-cubed is a Japanese national R&D scheme to realize augmented telexistence (tele-existence) through various kinds of networks including the Internet. Telexistence is a concept named for the technology that enables people to have a real-time sensation of being present at a location other than the place where they actually exist, and to interact with a remote and/or virtual environment. They can thus "telexist" in a real environment that the robot is present or in a virtual environment that a computer has generated. It is also possible to telexist in a mixed environment of real and virtual which can be called augmented telexistence. The concept of telexistence, i.e., virtual existence in a remote or computer-generated environment, has developed into the national R-cubed R&D scheme to create an advanced and comfortable life for the network society of the 21st century. Based on the national R&D scheme of R-Cubed, the Humanoid Robotics Project (HRP) was launched in April 1998. This is an effort to integrate telerobotics, network technology, and virtual reality into networked telexistence, and significant results are expected.

Forecasting↗

PubMed1999

Development of a robotic navigation system for neurosurgery.

This paper presents a robotic navigation system for image-guided neurosurgery, which can be applied to the treatment of Parkinson's disease and biopsy of brain tumor. The system integrates a computer for real-time display of brain anatomy, a magnetic tracking device for measuring the positions and orientations of surgical instruments, and a robot manipulator for guiding surgical instruments to the preplanned positions and orientations. The computer display of brain anatomy offers a convenient tool for surgeons to diagnose brain disease and to plan safe surgical paths; while the tracking device assists the robot manipulator to automatically guide surgical instruments to the preplanned direction. The registrations among the tracking device, the image system, and the robot are completed on the base of coordination mappings of external markers. An experiment of using a skull model for simulating a robotic biopsy of brain tumor has been done to verify the performance of the navigation system. The result shows that the system can accomplish a positioning accuracy around 2 mm.

Biopsy↗

PubMedDate not supplied

Laparoscopic robot-assisted right adrenalectomy and left ovariectomy (case reports).

BACKGROUND: Laparoscopic robot-assisted surgery has been created to reduce the patient risk of inappropriate scope movements by an assistant and to perform operations quicker and with greater ease. The Authors report their experience in laparoscopic robot-assisted right adrenalectomy for Conn's syndrome and right ovariectomy for benign ovarian mass. MATERIAL AND METHODS: Case 1. CT scan: solid right adrenal mass (diam. 2 cm). An anterior transperitoneal approach was used to perform the right adrenalectomy. The surgeon was placed at the ventral side of the patient and robotic-device was placed at the backside. HISTOLOGY: adrenocortical adenoma (diam. 3 x 2.5 x 1.5 cm). Case 2. CT scan: left iliac mass (diam. 3.5 cm) with origin in the left ovary. The patient was positioned in the gynecological position. The surgeon was positioned on right side of the patient and robot-device on left side. Left ovariectomy was performed. HISTOLOGY: ovarian serous cyst. RESULTS: Operating time was 180 min. for the adrenalectomy and 25 min. for the ovariectomy. No blood loss or complications for both operations were encountered. Image was steady and lens cleaning was unnecessary. CONCLUSIONS: The robot device (AESOP 2000) facilitated the procedures by enhancing stability of the image and reducing the need for lens cleaning. We believe that this method is feasible and could be advantageous especially for cholecystectomy, Nissen funduplication or ovariectomy but at the moment there are no comparative studies to establish the real value of this device.

Adrenalectomy↗

PubMed2000

Modular robotic workcell for coagulation analysis.

BACKGROUND: Total laboratory automation (TLA) has been shown to increase laboratory efficiency and quality. However, modular automation is smaller, requires less initial capital, and requires less planning than TLA. We engineered and performed clinical trials on a modular robotic preanalytical workcell for coagulation analysis. METHODS: Timing studies were used to quantify the efficiency of the manual processes and to identify areas in the processing of coagulation specimens where bottlenecks and long waiting periods were encountered. We then designed our modular robotic system to eliminate these bottlenecks. Our robotic modular workcell was engineered to allow a choice of specimen introduction manually, by conveyor, or by mobile robot. Additional timing studies were performed during clinical trials of the robotic system. RESULTS: Prior to automation, the time required for preanalytical processing time was 18-107 min; after automation, it was 45-50 min. Additional improvements in workcell efficiency could be realized when high quality, prelabeled specimens were introduced into the system. CONCLUSION: Compared with manual methods, modular automation provides more predictable variation in specimen processing.

Blood Chemical Analysis↗

PubMedDate not supplied

Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience.

For over 25 years, personal assistant robots for severely disabled individuals have been in development. More recently, using robots to deliver rehabilitation therapy has been proposed. This paper summarizes the development and clinical testing of three mechatronic systems for post-stroke therapy conducted at the VA Palo Alto in collaboration with Stanford University. We describe the philosophy and experiences that guided their evolution. Unique to the Palo Alto approach is provision for bimanual, mirror-image, patient-controlled therapeutic exercise. Proof-of-concept was established with a 2-degree-of-freedom (DOF) elbow/forearm manipulator. Tests of a second-generation therapy robot producing planar forearm movements in 19 hemiplegic and control subjects confirmed the validity and reliability of interaction forces during mechanically assisted upper-limb movements. Clinical trials comparing 3-D robot-assisted therapy to traditional therapy in 21 chronic stroke subjects showed significant improvement in the Fugl-Meyer (FM) measure of motor recovery in the robot group, which exceeded improvements in the control group.

Adult↗

PubMed2001

[Thoracoscopic lung resection for a peripheral lung cancer by a single surgeon with a voice-controlled robot].

Thirty patients with a peripheral lung cancer underwent consecutive thoracoscopic lung resections with a voice-controlled robot between October 1998 and February 2001. The patients with a high risk such as cardio-pulmonary dysfunction or the patients aged 80 years or older were included. Patients with stage I cancer of the right lung in which lobectomy with lymph node dissection was anticipated were also included. Thirty thoracoscopic procedures were performed by a single surgeon using a voice-controlled robot. Thoracoscopic lung resection by a single surgeon with a voice-controlled robot was achieved in 27 patients. The postoperative follow-up period ranged from 3 months to 42 months. In all patients, thoracoscopic procedures without no need for a human assistant were achieved. There were no survival differences between the wedge resection group and lobectomy group, in the patients having adenocarcinoma and patients having squamous cell carcinoma, and elderly patients and young group patients. Complications related or unrelated to the maneuvers of a voice-controlled robot were not noted. Postoperative complications occurred in 4 patients (atelectasis 2, postoperative dementia 2). All of the events resolved within one week. Thoracoscopic lung resection such as wedge resection or lobectomy by a single surgeon with a voice-controlled robot may be feasible in selected patients with lung cancers. Its application must be confirmed by further studies.

Aged↗

PubMed2002

Robotic surgery: is it for you?

Robotic surgery has indeed arrived. The approved device in the United States, the Intuitive Surgical System's daVinci System, is installed in about 80 hospitals worldwide. That number is rising rapidly. Once other companies, Computer Motion for example, receive Food and Drug Administration approval for their systems, the number of robotic-equipped operating rooms will begin to increase enormously. The current outcry regarding the expense of these systems is certainly not without merit. However, I would urge surgeons interested or even just curious about these systems to try one in a laboratory setting. The ease of accomplishing difficult tasks and the vividness of the 3-dimensional imaging create an experience that is both extremely impressive and enjoyable. There are currently no data to justify the expense of these systems in terms of patient outcomes or reduced complications. Such data will take a great deal of time and effort to accumulate. However, having become accustomed to the robotic system, this surgeon would have difficult moving back to standard laparoscopic instrumentation. Imagine during a standard open operation that your scrub assistant rubbed grease on your glasses and took away your favorite forceps and needle holder and gave you clumsy instruments 18 inches too long with less-than-reliable action at the tips. With enough struggling you would be able to accomplish the operation, and perhaps over time, even become facile with subpar instruments. However, you would certainly rather see well and have the instruments that you know work best in your hands. It would be very difficult to design a study to prove that your patients are better off when you use your normal instruments and clean glasses as opposed to fogging glasses and difficult-to-use instruments. But, you would know that there is a difference. That in large part is the feeling of surgeons who have had the good fortune of becoming accustomed to the current robotic systems for minimally invasive surgery. They can see much better and can manipulate tissue much better. Most of them are also convinced that when they can see better and manipulate tissue better, the outcomes for their patients are better. Is robotic surgery right for you? The answer is complex and has a myriad of elements. This author would suggest that a great start in determining the answer would be to try the current systems and keep track of both the literature and the technical evolution regarding these systems as time progresses.

Humans↗

PubMed2003

Sutureless robot-assisted mitral valve repair: an animal model.

BACKGROUND: Robotic mitral valve repair with the da Vinci robotic surgical system has been performed in more than 70 patients at our institution. This procedure reduces the need for blood transfusions, shortens hospital stay, and hastens return to normal activities. However, the robot-assisted repair also requires longer cardiopulmonary bypass and arrested-heart times than conventional open repairs. Because of increased risk of myocardial damage, arrhythmia, and other significant morbidities associated with longer arrested-heart time, a more efficient tissue approximation and adherence technique was evaluated to reduce operating time. METHODS: Twelve Dorset sheep were divided equally into 2 groups. In the control group Cosgrove-Edwards annuloplasty bands were secured to the posterior annulus with conventional 2-0 Ticron mattress sutures placed with robotic assistance. In the experimental group, the band was secured with double-armed nitinol U-clips placed with robotic assistance. Postoperative echocardiography was used to assess mitral valve function, and the animals were sacrificed at 3 or 6 months for histological evaluation. RESULTS: Total U-clip placement time was significantly decreased at 2.6 +/- 0.2 (mean +/- SEM) minutes versus total suture placement time at 4.9 +/- 0.4 minutes (P =.001). The main difference in time occurred between clip deployment at 0.75 +/- 0.1 minutes and suture tying at 2.78 +/- 0.2 minutes (P =.000003). Pathologic review showed excellent band incorporation at 3 and 6 months. Echocardiographic imaging showed no discernible mitral valve stenosis or regurgitation. CONCLUSIONS: With more cardiac procedures progressing toward minimally invasive approaches, novel technology to improve existing techniques must be evaluated. Nitinol U-clips help to reduce arrested-heart time and may improve outcome by decreasing morbidity. U-clip placement is intuitive, easily learned, and effective in securing the annuloplasty band to the mitral annulus.

Animals↗

PubMedDate not supplied

Robot-assisted placement of craniofacial implants.

PURPOSE: The purpose of this study was to improve and accelerate the rehabilitation process for patients with severe ear microtia with an implant-anchored auricular prosthesis. A medically approved robot system was used to place the craniofacial implants and a new process was developed for preoperative fabrication of the prosthesis using a rapid prototyping technique. MATERIALS AND METHODS: Preoperatively, after computerized tomography, the implant positions were determined in a planning tool according to bone availability and esthetic considerations. Intraoperatively, the robot showed the surgeon the planned implant positions and guided the placement procedure. RESULTS: The accuracy measurements showed that with this robot system, absolute implant position accuracy of approximately -0.5 +/- 0.4 mm, a relative accuracy between the implants of approximately 0.2 +/- 0.5 mm, and a deviation from the parallel position of approximately 0.6 +/- 0.5 degrees were achieved. Thirty implants were placed in 13 patients with robot assistance with no intraoperative injuries. DISCUSSION: This technique made it possible to apply the preoperatively fabricated auricular prosthesis directly after surgery. CONCLUSION: From this experience it can be concluded that the robot system and the new manufacturing concept for anaplastology can be applied advantageously in other areas of the head as well.

Adolescent↗

PubMed2003

Endoscopic computer-enhanced mediastinal mass resection using robotic technology.

BACKGROUND: Robotic technology can be used to facilitate the performance of a variety of cardiac surgical procedures, including internal mammary artery mobilization, atrial septal defect repair, mitral valve repair, and coronary artery bypass grafting. This report describes t h e use of robotic technology for resection of mediastinal masses. METHODS: Two patients underwent mediastinal mass resection performed using the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA, USA). The first patient had a 3 x 4-cm mass located in the left superiorposterior mediastinum, abutting the left subclavian artery. The second patient had a 2.7 x 1.9-cm mass located in the left chest wall. RESULTS: Both mediastinal masses were successfully excised using a totally endoscopic robotic approach with three 1-cm incisions. Neither case was converted to a thoracotomy or sternotomy. There were no postoperative complications. Both patients were discharged on postoperative day 2. CONCLUSIONS: Resection of a mediastinal mass ca n be performed safely and effectively using robotic technology. By minimizing surgical trauma, this approach is likely to yield a hastened postoperative recovery and improved quality of life.

Female↗

PubMed2004

[Application of robots in the upper limb physiotherapy of patients with hemiparesis].

OBJECTIVE: Authors describe the robotic physiotherapy system developed in the scope of Reharob project belonging to the 5th Framework Programme of the European Union. The system is able to execute robot mediated physiotherapy of the shoulder and the elbow of patients with spastic hemiparesis. Due to the fact, that spasticity is velocity dependent, it is important to execute the exercises with a relatively slow and constant velocity. In such cases a robot can support the work of the physiotherapist first of all when delivering exercises with high repetition number. The objective of the first clinical trial was to gain experiences with the system, to prove its functionality and security. METHOD: 4 healthy subjects and 8 patients with spastic hemiparesis were given 30 minutes long robot mediated physiotherapy on 20 consecutive days. RESULTS: During 240 therapeutic events the robots executed the exercises according to the programme established by the physiotherapist, without any significant mechanical problem or dangerous situation. CONCLUSIONS: The clinical trial confirmed the functionality of the Reharob Therapeutic System. The development of the system will be continued according to the experiences gained during the trial.

Adult↗

PubMedDate not supplied

Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy.

INTRODUCTION: This study evaluates the feasibility and safety of using robotically assisted laparoscopy to perform a Roux-en-Y hepaticojejunostomy. This new method was compared with the open and standard laparoscopic approaches. METHODS: Eighteen pigs underwent a needlescopic common bile duct ligation to create a jaundice model. Three to 5 days later, transabdominal ultrasound was performed, and the common bile duct diameter was documented. For the Roux-en-Y hepaticojejunostomy, the pigs were randomly assigned to the open group (n=6), standard laparoscopy group (n=6), or robotically assisted laparoscopy group (Zeus) (n=6). One surgeon performed all 3 approaches with 1 assistant. Operative times, techniques, and complication rates were documented. RESULTS: The open approach was faster in all instances. At the hepaticojejunostomy, no difference was noted between the groups with the total number of stitches used. The robot required fewer stitches and less time in the posterior wall of the hepaticojejunostomy (P=-0.0083 and P=0.02049, respectively). The hepaticojejunostomy time was similar for the laparoscopy and robotically assisted groups. CONCLUSION: Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy is a feasible procedure. When compared with standard laparoscopy, operating time is similar.

Anastomosis, Roux-en-Y↗

PubMed2003

Wireless virtual instrument measurement of surgeons' physical and mental workloads for robotic versus manual minimally invasive surgery.

The human-technology interface in traditional minimally invasive surgery (MIS) is difficult for the surgeon. Efforts to improve this interface include the use of robotic surgery systems. Ergonomics studies are required to help understand and improve the MIS user interface. We have developed a tetherless virtual instrument (VI) ergonomics workstation for measuring the physical workloads and stress levels of surgeons performing MIS. The workstation records physiological measures of workload and stress and audio and multiple channels of video. The workstation frees up the subject so that studies can be performed in complex and realistic settings, including the operating room. We illustrate the use of the tetherless ergonomics workstation in a study to compare performance and workload for manual and robotically-assisted MIS. The surgeon volunteers were experienced with manual MIS but had no previous experience with the robotic system. The study results showed that the robotic system reduced the workload and stress levels for these subjects but somewhat degraded their performance. Additional studies are needed to determine the relative effects on performance of user inexperience and the robotic interface.

Ergonomics↗

PubMed2004

Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System.

We present the initial clinical experience using a robot to perform a laparoscopic dismembered pyeloplasty at a Canadian centre. Five patients were confirmed to have ureteropelvic junction obstructions through nuclear renography, cross sectional imaging and intravenous pyelography. After performing a retrograde ureteropyelography and double J stent placement, laparoscopic dismembered pyeloplasty was performed by a single surgeon at a remote workstation using the ZeusTM Telepresence Surgery System (Intuitive Surgicala). The mean total operative time was 225+/-48 minutes, anastomotic time was 71+/-16 minutes, and the mean time required to set-up the robot was 30+/-17 minutes. The estimated blood loss was less than 100 ml in each case. A mean total of 22+/-10 mg of morphine sulfate equivalents were used for analgesia, and the patients were discharged home after a mean of 58+/-10 hrs. There were no robotic failures, and all evaluable patients are free of pain and demonstrable obstruction. One patient developed a delayed urine leak, which resolved with percutaneous drainage. The robot provides the ability to perform complicated operations with precision through elimination of tremor, scaling of motion, and through the use of 'wristed' instruments that enhance the freedom of movement normally limited by straight-shafted laparoscopic needle drivers. The development of robotic telesurgery is still in its infancy, and the significance of its role in urologic surgery continues to be evaluated.

Adult↗