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At least 55 records · Page 3Linked to original sources
PubMed2003

Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up.

OBJECTIVE: Laparoscopic radical prostatectomy is a complex procedure and has been standardized only during the last years. The remote controlled da Vinci Surgical System has opened up a new era in minimally invasive surgery. We here present our initial experience with the translation of open retropubic radical prostatectomy to laparoscopic technique using da Vinci and a one year follow-up. METHODS: After a period of technical development and training on cadavers, 40 consecutive patients eligible for radical prostatectomy were treated. After port placement, the urologist took control of the 3D 30 degrees laparoscope and the two instrument arms at the da Vinci remote console to perform bilateral pelvic lymph node dissection, radical prostatovesiculectomy and urethrovesical anastomosis. RESULTS: The procedure was completed laparoscopically in all but two patients. Mean procedure time was 8.3 hours and mean intra-operative blood loss 570 ml. Learning curves associated with the use of the da Vinci Surgical System show that there is a 22-minute decrease in time required to perform the radical prostatectomy and lymphadenectomy for each case (p<0.0001). Patients recovered rapidly after surgery with early oncological and functional results that were similar to those obtained with our standard radical prostatectomy technique. CONCLUSIONS: Remote controlled robotic surgical systems are useful to translate open retropubic radical prostatectomy to laparoscopy. This new technology has the potential to equip the urologist with the microsurgical precision needed to preserve the delicate structural integrity of the pelvic floor in order to improve functional results without compromising the oncological outcome.

Aged↗
PubMed2006

Robotics in plastic and reconstructive surgery: use of a telemanipulator slave robot to perform microvascular anastomoses.

Many methods for microvascular anastomoses exist, including use of magnifying loupes (x 2.5, x 3.5, x 4.5, x 6), but the operating microscope remains the gold standard. The authors present the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) as an alternative method for performing microvascular anastomoses. The da Vinci robot has fully articulating microinstruments with six degrees of freedom, the ability to filter tremor, the capability to perform telesurgery, and the advantage of 3-D visualization. It offers full and dynamic control over the operating camera, allowing variable positioning and the ability to scale down movements. Its drawbacks include initial high cost, lack of haptic feedback, decreased participation of the first assistant, and lack of widespread availability. In this feasibility study, multiple microanastomoses were performed in canine tarsal and superficial femoral vessels.

Anastomosis, Surgical↗
PubMed2006

Transfer of training in robotic-assisted microvascular surgery.

BACKGROUND: Transfer of training refers to the ability to transfer acquired skills from one discipline to another. This study aims to determine whether experience in traditional freehand microsurgery facilitates mastery of robotic microsurgery. METHODS: Microsurgical anastomoses of coronary arteries harvested from explanted pig models were used to demonstrate whether prior experience with microsurgery is required in learning robot-assisted microsuturing. Eighty microsurgical anastomoses were performed. Three fully trained vascular surgeons (n = 3) (Group A) and 5 midlevel surgical residents (n = 5) (Group B) performed the anastomoses. Each subject performed 5 freehand and 5 robotic-assisted (Zeus robotic system) anastomoses. Anastomosis time and integrity of anastomoses were recorded, including errors of management (EOM) (breaking suture, breaking knots, breaking or damaging needles). RESULTS: For fully trained surgeons, all anastomoses in the robotic-assisted group were mechanically intact. There was significantly increased anastomosis time with the robot (Robot: 14 minutes, versus freehand: 7.2 minutes, P < 0.01). The robotic-assisted anastomoses were associated with a higher EOM (Robot: 1.2, versus freehand: 0.3, P < 0.01). Surgical trainees had longer anastomosis times with robotic assistance (Robot: 14.8 minutes, versus freehand, 12.7 minutes; P < 0.01) and increased EOM (Robot: 1.6, versus freehand: 1.0; P < 0.05).Overall, surgical trainees and fully trained vascular surgeons had longer anastomotic times with robotic assistance [Robot: 14.0 versus 14.8 minutes; P = not significant (NS)], and EOM (Robot: 1.6, versus freehand: 1.2; P = NS) were not significantly different. CONCLUSION: The technical feasibility of performing a safe and efficient robotic-assisted microsurgical anastomosis in explanted vessels was repeatedly tested and demonstrated in this study within reasonable time required for the anastomosis. Compared with conventional microanastomosis, both fully trained surgeons and residents demonstrated an ability to master the robotically assisted procedure with similarly longer anastomosis times and EOM. This study indicates that robotically assisted microanastomosis can be mastered equally well by surgical trainees and fully trained vascular surgeons.

Anastomosis, Surgical↗
PubMed1991

Worker selection of safe speed and idle condition in simulated monitoring of two industrial robots.

Industrial robots often operate at high speed, with unpredictable motion patterns and erratic idle times. Serious injuries and deaths have occurred due to operator misperception of these robot design and performance characteristics. The main objective of the research project was to study human perceptual aspects of hazardous robotics workstations. Two laboratory experiments were designed to investigate workers' perceptions of two industrial robots with different physical configurations and performance capabilities. Twenty-four subjects participated in the study. All subjects were chosen from local industries, and had had considerable exposure to robots and other automated equipment in their working experience. Experiment 1 investigated the maximum speed of robot arm motions that workers, who were experienced with operation of industrial robots, judged to be 'safe' for monitoring tasks. It was found that the selection of safe speed depends on the size of the robot and the speed with which the robot begins its operation. Speeds of less than 51 cm/s and 63 cm/s for large and small robots, respectively, were perceived as safe, i.e., ones that did not result in workers feeling uneasy or endangered when working in close proximity to the robot and monitoring its actions. Experiment 2 investigated the minimum value of robot idle time (inactivity) perceived by industrial workers as system malfunction, and an indication of the 'safe-to-approach' condition. It was found that idle times of 41 s and 28 s or less for the small and large robots, respectively, were perceived by workers to be a result of system malfunction. About 20% of the workers waited only 10 s or less before deciding that the robot had stopped because of system malfunction. The idle times were affected by the subjects' prior exposure to a simulated robot accident. Further interpretations of the results and suggestions for operational limitations of robot systems are discussed.

Accidents, Occupational↗
PubMed2004

Comparison of two techniques of robot-aided upper limb exercise training after stroke.

OBJECTIVE: This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke. DESIGN: A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol. Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry. Subjects capable of participating in resistance training were randomized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training. Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy. Those subjects capable of participating in resistance training at 3 wks were then randomized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training. RESULTS: One subject withdrew due to unrelated medical issues, and data for the remaining 46 subjects were analyzed. Subjects in all groups showed improvement in measures of motor control (mean increase in Fugl-Meyer of 3.3; 95% confidence interval, 2.2-4.4) and maximal force (mean increase in maximal force of 3.5 N, P = 0.027) over the course of robot-aided exercise training. No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups. Subjects' ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control. CONCLUSION: The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training, though interpretation of these results is limited by sample size. Individuals with better motor control at baseline experienced greater increases in motor control with robotic training.

Adult↗
PubMed1995

Complete robot-assisted laparoscopic urologic surgery: a preliminary report.

BACKGROUND: The feasibility and applicability of using surgeon-controlled robotic arms as a substitute for surgical assistants during urologic laparoscopic surgery was assessed. STUDY DESIGN: Seventeen laparoscopic procedures (nephrectomy, n = 4; retroperitoneal lymph node sampling, n = 2; varix ligation, n = 2; pyeloplasty, n = 3; Burch bladder suspension, n = 2; pelvic lymph node dissection, n = 1; orchiopexy, n = 1; ureterolysis, n = 1; and nephropexy, n = 1) were performed by a single laparoscopic surgeon assisted by one or two robotic arms directly controlled by the operating surgeon. One robotic arm controlled the laparoscope and was maneuvered by a foot pedal. The second robotic arm served as a retractor and was manipulated by a hand control. Assessment of robotic positioning, laparoscopic instrument port placement, time for setup and breakdown of the operative field, operative time, outcome, and operative complications were made for each procedure and compared with historical human-assisted laparoscopic procedures. RESULTS: Standard laparoscopic port placement was adequate for use of the robotic arms. All procedures were successfully completed with three minor surgical complications not related to the use of the robotic arm. Robotic arm positioning on the operating room table differed for each type of procedure, yet placement of the robotic arm controlling the laparoscope on the surgeon's side provided optimal surgical views. In three cases, intraoperative bleeding required human assistance for camera control. There was no increase in operating time when the robotic arms were used. There was no difference between the setup and breakdown time for this series of complete robot-assisted procedures when compared with either a nonrobot-assisted series (p > 0.05) or another robotic series completed prior to initiation of this study when no focus was made on setup and breakdown times and in which the robotic arm and human surgical assistant were compared (p < 0.05). CONCLUSIONS: We found that simultaneous use of remote controlled robotic arms as surgical assistants is feasible in genitourinary laparoscopic surgery. The potential long-term cost effectiveness of using robotic surgical assistants in laparoscopic surgery highlights the economic impact of this research and warrants further investigation.

Adult↗
PubMed2001

Robotic surgical training in an academic institution.

OBJECTIVE: To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. SUMMARY BACKGROUND DATA: Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. METHODS: Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors' two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. RESULTS: Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. CONCLUSION: Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely.

Academic Medical Centers↗
PubMed1991

Laboratory systems integration: robotics and automation.

Robotic technology is going to have a profound impact on the clinical laboratory of the future. Faced with increased pressure to reduce health care spending yet increase services to patients, many laboratories are looking for alternatives to the inflexible or "fixed" automation found in many clinical analyzers. Robots are being examined by many clinical pathologists as an attractive technology which can adapt to the constant changes in laboratory testing. Already, laboratory designs are being altered to accommodate robotics and automated specimen processors. However, the use of robotics and computer intelligence in the clinical laboratory is still in its infancy. Successful examples of robotic automation exist in several laboratories. Investigators have used robots to automate endocrine testing, high performance liquid chromatography, and specimen transportation. Large commercial laboratories are investigating the use of specimen processors which combine the use of fixed automation and robotics. Robotics have also reduced the exposure of medical technologists to specimens infected with viral pathogens. The successful examples of clinical robotics applications were a result of the cooperation of clinical chemists, engineers, and medical technologists. At the University of Virginia we have designed and implemented a robotic critical care laboratory. Initial clinical experience suggests that robotic performance is reliable, however, staff acceptance and utilization requires continuing education. We are also developing a robotic cyclosporine which promises to greatly reduce the labor costs of this analysis. The future will bring lab wide automation that will fully integrate computer artificial intelligence and robotics. Specimens will be transported by mobile robots. Specimen processing, aliquotting, and scheduling will be automated.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗
PubMed2001

Robotically assisted laparoscopic cholecystectomy: a pilot study.

HYPOTHESIS: Since the advent of laparoscopic surgery in 1987 and the introduction of robotics into medicine in 1991, medical technology has advanced to robotic applications in performing surgery. In our study, we investigated the feasibility of performing simple laparoscopic maneuvers and laparoscopic cholecystectomy using a robotic surgical system. DESIGN: The study used a ZEUS robotic system (Computer Motion Inc, Goleta, Calif), consisting of 3 interactive robotic arms fixed at the operating table and remotely controlled by the surgeon. After initial training, using a bench model and 3 isolated porcine livers to perform cholecystectomy, 7 female pigs underwent robotically assisted laparoscopic cholecystectomy. The surgeon, seated at the console, manipulated the 3-mm laparoscopic instruments and performed the surgery. RESULTS: Robotically assisted laparoscopic cholecystectomy was accomplished in all 7 pigs, with a mean operative time of 46 minutes (range, 30-62 minutes). There were no complications. The mean time to setup of the robotic system decreased from 30 minutes to 14 minutes. All the robotic maneuvers were performed without any particular difficulties, and the movements were stable, accurate, and reliable, with good control. CONCLUSIONS: Our preliminary experimental study showed that robotically reproduced laparoscopic maneuvers, such as tying, suturing, dissection, clipping, and cautery, seemed to be as accurate and as fast as maneuvers made without robotics. We conclude that our initial experimental and animal study confirmed the feasibility of robotically assisted laparoscopic cholecystectomy. Further reports are needed to show that robotics can be used for clinical applications in surgery.

Animals↗
PubMed2006

Robotic cholecystectomy: learning curve, advantages, and limitations.

BACKGROUND: Robotic cholecystectomy is safe, feasible procedure. Initial studies showed significant set up time and operating time but no clear clinical advantage of the robotic involvement. We have investigated the learning curve, advantages and limitation of the procedure. MATERIAL AND METHODS: We reviewed all (n = 51) robotic cholecystectomies performed between July 2004 and December 2005. The surgery was performed using the da Vinci system. We recorded operative time, setup time of robotics instrumentation, conversion to laparoscopic or open cholecystectomy and complication of the procedure. RESULTS: Forty-eight of the 51 procedures (94%) were completed robotically. We did not experience any significant complications directly related to robotics surgery. The mean +/- SD operating time was 77 +/- 22.3 min. The mean setup time for robotics (from incision until robot was in place, including draping the robot) was 24 +/- 8.8 min. However, the setup time significantly improved as we gained more experience: from 30.6 +/- 10.7 min (first 16 cases) to 18.3 +/- 4.0 min (cases 33-48). The mean robotic time was 34 +/- 16.1 min. We observed no significant improvement in robotic procedure time. CONCLUSIONS: Robotic cholecystectomy offers significant advantages such as three-dimensional view, easier instrument manipulations and possibility of remote site surgery. We observed some shortcomings of robotic surgery such as need for larger and additional ports, and need for undocking the machine in case of cholangiography or change of patient position. Our data shows that the learning curve is between 16 to 32 procedures to significantly decrease the setup time and total operating time.

Adolescent↗