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PubMed2006

Methods and mechanisms for contact feedback in a robot-assisted minimally invasive environment.

Providing a surgeon with information regarding contacts made between instruments and tissue during robot-assisted interventions can improve task efficiency and reliability. In this report, different methods for feedback of such information to the surgeon are discussed. It is hypothesized that various methods of contact feedback have the potential to enhance performance in a robot-assisted minimally invasive environment. To verify the hypothesis, novel mechanisms needed for incorporating contact feedback were designed, including a surgeon-robot interface with full force feedback capabilities and a surgical end-effector with full force sensing capabilities, that are suitable for minimally invasive applications. These two mechanisms were used to form a robotic "master-slave" test bed for studying the effect of contact feedback on the system and user performance. Using the master-slave system, experiments for surgical tasks involving soft tissue palpation were conducted. The performance of the master-slave system was validated in terms of criteria that assess the accurate transmission of task-related information to the surgeon, which is critical in the context of soft tissue surgical applications. Moreover, using a set of experiments involving human subjects, the performance of several users in carrying out the task was compared among different methods of contact feedback.

Adult↗

PubMed2005

Robotic surgery training and performance: identifying objective variables for quantifying the extent of proficiency.

BACKGROUND: To understand the process of skill acquisition in robotic surgery and to allow useful real-time feedback to surgeons and trainees in future generations of robotic surgical systems, robotic surgical skills should be determined with objective variables. The aim of this study was to assess skill acquisition through a training protocol, and to identify variables for the quantification of proficiency. METHODS: Seven novice users of the da Vinci Surgical System engaged in 4 weeks of training that involved practicing three bimanual tasks with the system. Seven variables were determined for assessing speed of performance, bimanual coordination, and muscular activation. These values were compared before and after training. RESULTS: Significant improvements were observed through training in five variables. Bimanual coordination showed differences between the surgical tasks used, whereas muscular activation patterns showed better muscle use through training. The subjects also performed the surgical tasks considerably faster within the first two to three training sessions. CONCLUSIONS: The study objectively demonstrated that the novice users could learn to perform surgical tasks faster and with more consistency, better bimanual dexterity, and better muscular activity utilization. The variables examined showed great promise as objective indicators of proficiency and skill acquisition in robotic surgery.

Adult↗

PubMed2006

Computer-enhanced robotic surgery in gynecologic oncology.

BACKGROUND: This study aimed to report the computer-enhanced robotic surgery experience of the authors' gynecologic oncology division. METHODS: From January 2001 to August 2006, 41 patients underwent laparoscopic surgery by our gynecologic oncology service using a computer-enhanced surgical robot. This report describes a retrospective review of these patients. RESULTS: The patients ranged in age from 27 to 77 years (mean, 44.2 years), in weight from 44 to 131 kg (mean, 72.1 kg), in operative time from 1 h and 50 min to 9 h (mean, 5 h and 2 min), and in estimated blood loss from 50 to 1,500 ml (mean, 253 ml). Of the 20 patients with gynecologic malignancies, 14 had cervical cancer. A total of 21 patients had benign indications for surgery. Complications included shoulder palsy, robot failure, colotomy, bradycardia, and intraabdominal bleeding requiring minilaparotomy and ligation of a bleeding pedicle. CONCLUSION: This case series is one of the first to report the use of a computer-enhanced surgical robot in gynecologic oncology. This approach proved to be feasible and well tolerated in this series of patients and deserves further study for clarification of its indications, benefits, and safety.

Adult↗

PubMed2001

Bilateral internal thoracic artery harvesting under robotic video-assistance.

BACKGROUND: Following upon the recent development of minimally invasive coronary robotic surgery, we set out to evaluate the feasibility of bilateral internal mammary artery (IMA) harvesting using the voice-controlled AESOP 2000 video assisted robot. METHODS: The robot is placed on the right side of the patient. The left IMA is first totally video-harvested, with the arm of the robot crossing over the patient to reach the left chest. The voice-controlled movement of the arm allows the surgeon to obtain the best video image of the artery. After completion of the dissection, the arm is positioned on the right part of the chest. The right IMA is then harvested using the same technique. RESULTS: Two patients underwent harvest of a bilateral IMA using this technique. The time of dissection was 52 min and 86 min, respectively. CONCLUSION: This technique allows a more precise, faster, tremor-free dissection, as compared to a conventional thoracoscopic harvesting.

Adult↗

PubMed2005

The window sign: an aid in laparoscopic and robotic radical prostatectomy.

AIM: Certain steps of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP), such as identification of seminal vesicles, bladder neck and retroprostatic dissections are technically challenging specially during initial experience. We describe an important land mark -- "Window sign", which helps significantly during the procedure. METHODS: The seminal vesicles can be dissected either through the transperitoneal, subperitoneal or extraperitoneal approach. In transperitoneal approach the vas deferens, seminal vesicles and Denonvillier's fascia are dissected posteriorly, and this plane is re-entered after division of the prostate from the posterior bladder neck, and with division of the Denonvillier's fascia. The communication between the anteriorly and posteriorly dissected planes in the retrovesical and retroprostatic space is termed "the window." Alternatively, in the RRP technique, bladder neck is divided anteriorly and posteriorly and vas deferens and seminal vesicle pulled out through this window. We have found that this window in transperitoneal, subperitoneal or extraperitoneal approach whether done during laparoscopic or robotic radical prostatectomy, allows to retract the vas deferens and seminal vesicles to elevate the prostate, facilitates control of the prostatic pedicles, helps in dissection of the prostate and assists in the identification and careful avoidance of the neurovascular bundles. RESULTS: This window sign was identified on the basis of our experience of over 450 cases of laparoscopic and robotic anatomical radical prostatectomies. We have followed this step in all of the cases by either technique. CONCLUSION: The "window sign" is an important aid while performing laparoscopic and robotic radical prostatectomy. This technique helps the surgeon to achieve both the anatomic and oncologic goals of the nerve sparing, during anatomic radical prostatectomy.

Humans↗

PubMed2003

Principles and advantages of robotics in urologic surgery.

Although the available minimally invasive surgical techniques (ie, laparoscopy) have clear advantages, these procedures continue to cause problems for patients. Surgical tools are limited by set axes of movement, restricting the degree of freedom available to the surgeon. In addition, depth perception is lost with the use of two-dimensional viewing systems. As surgeons view a "virtual" target on a television screen, they are hampered by decreased sensory input and a concurrent loss of dexterity. The development of robotic assistance systems in recent years could be the key to overcoming these difficulties. Using robotic systems, surgeons can experience a more natural and ergonomic surgical "feel." Surgical assistance, dexterity and precision enhancement, systems networking, and image-guided therapy are among the benefits offered by surgical robots. In return, the surgeon gains a shorter learning curve, reduced fatigue, and the opportunity to perform complex procedures that would be difficult using conventional laparoscopy. With the development of image-guided technology, robotic systems will become useful tools for surgical training and simulation. Remote surgery is not a routine procedure, but several teams are working on this and experiencing good results. However, economic concerns are the major drawbacks of these systems; before remote surgery becomes routinely feasible, the clinical benefits must be balanced with high investment and running costs.

Humans↗

PubMed1993

Enhanced robotic dissolution system with concurrent off-line analysis.

A Zymate II robotic dissolution system was modified by addition of a liquid chromatography (LC) system equipped with an Isco ISIS autosampler. Using the Concurrent EasyLab programming language, operation of this LC system was integrated into the main robotic dissolution procedure. This enabled simultaneous dissolution sampling and LC analysis of standard and pre-pulled sample solutions. The resulting dual-tasking system effects considerable efficiency of operation and results in significant time savings. Comparison of the robotic and non-robotic data indicate good correlation and statistically insignificant differences at the 95% confidence level. Validation studies confirm linearity and precision of the quantitative LC method, accuracy and precision of volume and temperature measurements and negligible vessel-to-vessel carryover.

Capsules↗

PubMed2004

Robots and humans: synergy in planetary exploration.

How will humans and robots cooperate in future planetary exploration? Are humans and robots fundamentally separate modes of exploration, or can humans and robots work together to synergistically explore the solar system? It is proposed that humans and robots can work together in exploring the planets by use of telerobotic operation to expand the function and usefulness of human explorers, and to extend the range of human exploration to hostile environments.

Extraterrestrial Environment↗

PubMed2004

Robotic assisted rectopexy.

BACKGROUND: During the last 3 years, robotic surgery has had a considerable impact on minimally invasive surgery in a wide range of specialties. This study describes the surgical technique and preliminary results of our first 6 cases of robotic assisted suture rectopexy. METHODS: During a period of 13 months 6 patients with full thickness rectal prolapse were operated on with the da Vinci surgical system. All patients were considered suitable for a suture rectopexy. Setting-up time, procedure time, patient recovery, and hospital stay were recorded and compared with the current literature. RESULTS: All operations were completed successfully using the robotic system. There were no major complications and no deaths. Mean setting-up time was 28 minutes, mean operation time was 127 minutes, and mean hospital stay was 6 days. At 3 to 6 months of follow-up all patients are in good health, with no signs of recurrence and no reports of constipation. CONCLUSIONS: Robotic assisted suture rectopexy is feasible and safe and apparently meets accepted standards of laparoscopic surgery.

Adult↗

PubMed2006

Robot-assisted laparoscopic hysterectomy: technique and initial experience.

BACKGROUND: Our study objective was to develop a technique for robot-assisted laparoscopic hysterectomy and to evaluate feasibility of the technology to address the technical limitations of conventional laparoscopy. METHODS: The study design was a case series analysis in a university hospital. Sixteen consecutive patients underwent robot-assisted laparoscopic hysterectomy and were assessed for outcomes. Robot-assisted hysterectomy technique was refined and is described. RESULTS: There were no conversions to laparotomy. The mean uterine weight was 131.5 g (range 30 to 327 g). Median operating time was 242 minutes (range 170 to 432). Average estimated blood loss was 96 mL (range 50 to 300 mL). One patient experienced a delayed thermal bowel injury, 2 developed postoperative infections, and 1 developed a vaginal cuff hematoma that was managed expectantly. The median length of hospital stay was 1.5 days. CONCLUSIONS: Robot-assisted laparoscopic hysterectomy is a feasible and promising new technique that may overcome surgical limitations seen with conventional laparoscopy.

Adult↗

PubMed2006

Comparison between hand rasping and robotic milling for stem implantation in cementless total hip arthroplasty.

We evaluated the effects of conventional hand rasping and robotic milling on the clinical and radiographic results of cementless total hip arthroplasty, with the same computed tomography (CT)-based 3-dimensional preoperative planning using a ROBODOC workstation (Integrated Surgical Systems, Davis, Calif). The robotic milling group consisted of 78 hips, and the hand-rasping group 78 hips. The radiographic findings from the preoperative planning and postoperative CT data were evaluated using the most accurate CT images reconstructed by the ROBODOC workstation. The robotic milling group showed significant superior Merle D'Aubigne hip score at 2 years. In the robotic milling group, there were no intraoperative femoral fractures, and a radiographically superior implant fit was obtained. Hand rasping had the potential to cause intraoperative femoral fractures, undersizing of the stem, unexpectedly higher vertical seating, and unexpected femoral anteversion causing inferior implant fit.

Adult↗

PubMed2004

Robotic techniques improve quality of life in patients undergoing atrial septal defect repair.

BACKGROUND: Minimally invasive cardiac surgery has emerged as an alternative to conventional, open surgery. Although most studies of robotically assisted cardiac surgery have reported morbidity and mortality, few have addressed outcome measures, such as pain and quality of life, which was the aim of this study. METHODS: Eleven patients with atrial septal defects (ASD), and five patients with patent foramen ovale, underwent repair using the Da Vinci system (Intuitive Surgical, Mountain View, CA). The Medical Outcomes Study Short Form Survey (SF-36), along with two additional questions, were administered to these patients on postoperative day 30, along with a similar number of patients who underwent ASD repair by mini-thoracotomy or sternotomy. Quality of life endpoints included bodily pain, vitality, mental health, general health, physical function, and social function. RESULTS: Robotic patients demonstrated significantly higher scores in 6 of the eight variables (p < 0.05). There was no significant difference in intensive care unit or overall hospital stay among the groups (p = NS). Robotic patients returned to work after 40.2 +/- 30.2 days, mini-thoracotomy patients after 45.6 +/- 27.9 days, and sternotomy patients after 51.7 +/- 40.2 days (p = 0.767). There were no significant differences in SF-36 scores between patients who underwent mini-thoracotomy and sternotomy approaches. CONCLUSIONS: Closure of an ASD can be performed safely and effectively via an endoscopic approach. Robotic technology minimized the degree of invasiveness, hastened postoperative recovery, and improved quality of life, although length of hospital stay was unchanged.

Adult↗

PubMed2004

Early experience with robot-assisted surgery for mediastinal masses.

BACKGROUND: We report the experience of a single institution with the minimally invasive resection of mediastinal masses using the da Vinci robotic surgical system. METHODS: From August 2001 to June 2003, 14 patients (5 men and 9 women aged from 21 to 77 years) with mediastinal masses were operated on minimally invasively with the da Vinci robotic system. This consisted of 9 thymectomies (6 thymomas, 2 nonatrophic thymic glands, 1 thymic cyst), 3 resections of paravertebral neurinomas, 1 ectopic mediastinal parathyroidectomy, and 1 resection of a lymphangioma. RESULTS: Complete, extended thymectomy was accomplished in all 9 cases, proven by examination of the thymic bed and resected specimen. In 1 patient with an hourglass-shaped neurinoma, conversion to an open procedure was necessary because the excessive size of the tumor limited vision. The median overall operation time was 166 minutes (range, 61 to 182) including 110 minutes (range, 46 to 142) for the robotic act. There were no intraoperative complications or surgical mortality. CONCLUSIONS: These preliminary results of our series suggest that application of the da Vinci robotic surgical system for resection of selected mediastinal masses is technically feasible and safe. It provides an alternative to open approaches and "conventional" thoracoscopy. Nevertheless, this new technique requires further investigation in larger series and longer follow-up.

Adult↗

PubMed2005

Robotic mitral valve annuloplasty with double-arm nitinol U-clips.

PURPOSE: Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times. DESCRIPTION: A 67-year-old female was approached through a right mini-thoracotomy with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Using 12 nitinol U-clips (Coalescent Surgical, Sunnyvale, CA) an annuloplasty band was placed under robotic guidance. Clip placement and deployment times were recorded and statistical comparisons were assessed to prior suture annuloplasties. EVALUATION: Clip placement time was 1.3 +/- 0.9 (minutes +/- standard deviation), statistical comparison with first, most recent, and all prior suture annuloplasties proving no significance. Clip deployment time was 0.5 +/- 0.2, whereas knot-tying times and respective statistical comparison for first, most recent, and all prior suture annuloplasties were 2.0 +/- 0.7 (p = 0.003), 1.2 +/- 0.4 (p = 0.0004), and 1.6 +/- 0.6 (p < 0.00001). Follow-up echocardiography performed postoperatively, at 3 months, and at 9 months revealed valvular structural integrity with only minimal mitral regurgitation. CONCLUSIONS: U-clips considerably reduce time for annuloplasty over conventional suture and may help reduce operative times as well.

Aged↗

PubMed2005

Current status of endoscopic and robotic mitral valve surgery.

Doctor C. Walton Lillehei and his colleagues set a standard for innovation and new technology development in cardiac surgery. Robotic mitral valve surgery has taken a similar translational course proffered by Lillehei. We evaluated 341 video-assisted and 100 da Vinci robotic mitral repairs done at East Carolina University between 1996 and 2004. The 30-day mortality was 2.2% and 1% for the video-assisted and robotic series, respectively. Complex anterior and posterior leaflet repairs were performed in both cohorts. Repair results were excellent. For the da Vinci group there was a clear learning curve, with repair, perfusion, and aortic cross-clamp times falling significantly (p < 0.05). This reports suggests that robotic and endoscopic minimally invasive mitral surgery could evolve to become the standard of care.

Aged↗

PubMed2004

Social behaviour of dogs encountering AIBO, an animal-like robot in a neutral and in a feeding situation.

The use of animal-like autonomous robots might offer new possibilities in the study of animal interactions, if the subject recognises it as a social partner. In this paper we investigate whether AIBO, a dog-like robot of the Sony Corp. can be used for this purpose. Twenty-four adult and sixteen 4-5 months old pet dogs were tested in two situations where subjects encountered one of four different test-partners: (1) a remote controlled car; (2) an AIBO robot; (3) AIBO with a puppy-scented furry cover; and (4) a 2-month-old puppy. In the neutral situation the dog could interact freely with one of the partners for 1 min in a closed arena in the presence of its owner. In the feeding situation the encounters were started while the dog was eating food. Our results show that age and context influence the social behaviour of dogs. Further, we have found that although both age groups differentiated the living and non-living test-partners for some extent, the furry AIBO evoked significantly increased responses in comparison to the car. These experiments show the first steps towards the application of robots in behavioural studies, notwithstanding that at present AIBO's limited ability to move constrains its effectiveness as social partner for dogs.

Animals↗

PubMed2005

Early experience with robotic aortic valve replacement.

We report our initial experience with aortic valve replacement using robotic assistance. All procedures were performed with peripheral cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cold crystalloid cardioplegia. One or two ports and a 5-cm intercostal incision in the right chest were used for access. All patients had aortic valve replacement performed robotically. Between February and September 2004, five patients underwent robotic aortic valve replacement. The mean age was 59 years (range 35-82 years). There were no incisional conversions, death, stokes, or reoperations for bleeding. Overall mean study times were as follows: procedure, 231.2 min (range 180-315 min); cardiopulmonary bypass, 121.5 min (range 83-173 min), and cross-clamp, 98.2 min (range 67-140 min). One patient developed postoperative pneumonia. Aortic valve replacement can be successfully performed with the da Vinci robotic system.

Adult↗

PubMed2004

Robots in the operating theatre--chances and challenges.

The use of surgical robots and manipulators is still being frequently discussed in the mass media as well as in the scientific community. Although it was already noted in 1985 that the first patient was treated by a joint team of robot and surgeon, today such systems are not routinely used. This can be explained by the high complexity of such systems and the often limited usability, but also, that it is difficult for surgeons to accept "automatic" machines. In this paper the possibilities and chances of robots and manipulators will be explained and it will be shown that robots will never work alone in the operating theatre as it is common in industry today. On the other hand, also limitations and challenges will be outlined. Therefore first a review on today's systems is given in different disciplines including oral- and cranio-maxillofacial surgery, then advantages and disadvantages are shown.

Equipment Design↗