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At least 595 records · Page 33Linked to original sources

PubMed2004

Placement of 125I implants with the da Vinci robotic system after video-assisted thoracoscopic wedge resection: a feasibility study.

PURPOSE: To evaluate the feasibility of using the da Vinci robotic system for radioactive seed placement in the wedge resection margin of pigs' lungs. METHODS AND MATERIALS: Video-assisted thoracoscopic wedge resection was performed in the upper and lower lobes in pigs. Dummy (125)I seeds embedded in absorbable sutures were sewn into the resection margin with the aid of the da Vinci robotic system without complications. In the "loop technique," the seeds were placed in a cylindrical pattern; in the "longitudinal," they were above and lateral to the resection margin. Orthogonal radiographs were taken in the operating room. For dose calculation, Variseed 66.7 (Build 11312) software was used. RESULTS: With looping seed placement, in the coronal view, the dose at 1 cm from the source was 97.0 Gy; in the lateral view it was 107.3 Gy. For longitudinal seed placement, the numbers were 89.5 Gy and 70.0 Gy, respectively. CONCLUSION: Robotic technology allows direct placement of radioactive seeds into the resection margin by endoscopic surgery. It overcomes the technical difficulties of manipulating in the narrow chest cavity. With the advent of robotic technology, new options in the treatment of lung cancer, as well as other malignant tumors, will become available.

Animals↗

PubMed2004

Reduction of femoral shaft fractures in vitro by a new developed reduction robot system 'RepoRobo'.

Closed reduction of the long bones is associated with the use of considerable force. This force must be maintained for the reduction maneuver and fixation process. At present, apart from the extension table or the large AO distractor, only rather inadequate reduction aids are available. A solution to this problem is being sought in the form of a robotic system with which precision can be improved and the holding effort reduced. In the research project presented here, a synthetic femur with integrated tensioned mainspring and a 32-A3 type fracture served as a bone reduction model. The fracture was stabilized with a standard AO fixator. A Stäubli robot (model RX130) was converted by appropriate modification so that it could be used for the reduction of femoral shaft fractures in vitro. The robot was equipped with a pneumatic 2-fingered gripper, on which the fingers have been modified so that they can grip the AO fixator clamp. A Force-Feedback-Sensor was inserted between the gripper and the robot to obtain online recordings of the forces and moments in all three axes. With this setup it is possible to achieve precise reduction of the fracture in all planes under visual control.

External Fixators↗

PubMedDate not supplied

Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes.

STUDY OBJECTIVE: To examine the operative variables and complications associated with robotic-assisted total laparoscopic hysterectomy. DESIGN: Canadian Task Force classification II-1. SETTING: Gynecology service affiliated with a major cancer center in Southern California. PATIENTS: Twenty women with a benign gynecologic condition. INTERVENTION: Robotic-assisted total laparoscopic hysterectomy. Patient status was evaluated in terms of operative morbidity, length of surgery, anesthesia time, estimated blood loss, and hospital stay. MEASUREMENTS AND MAIN RESULTS: Mean operative time was 3.2 hours, and anesthesia time was 4 hours. Mean estimated blood loss was 81 mL, and patient postoperative hospital stay was 2 days. The complication rate in this study was low. The surgical procedure was converted to a laparotomy and abdominal hysterectomy in two patients because of poor visualization during robotic-assisted surgery. CONCLUSIONS: While the number of patients and nonrandomized nature of this single-institution experience are insufficient to draw any definitive conclusions regarding potential treatment efficacy, the patient postoperative stay and low complication rates suggest that this procedure is feasible and promising. Additional study comparing the efficacy and cost of robotic laparoscopic hysterectomy with standard laparoscopic hysterectomy with a larger patient population is warranted.

Adult↗

PubMed2005

Real-time haptic-teleoperated robotic system for motor control analysis.

A versatile teleoperated robotic system was created as an assessment device for testing upper-extremity motor control adaptation using different control strategies. While many systems display output virtually on a computer monitor, this system was designed to output in three-dimensional physical space. The system accepts haptic force and torque input, and outputs robot end-effector displacements and rotations in three spatial dimensions. Benefits of this system include flexibility to conduct a variety of dissimilar tasks and reality of user feedback in physical space. Two separate experiments validated the teleoperated robotic system. The first experiment tested unimanual human motor control and the second tested bimanual motor control. This teleoperated robotic system can be used as an assessment device to study neuromuscular adaptability via a variety of control strategies providing a new and functional approach to human motor control analysis.

Arm↗

PubMed2004

Robotically assisted esophago-esophagostomy in newborn pigs.

PURPOSE: Repair of esophageal atresia and tracheoesophageal fistula (TEF) in the newborn is challenging when done as an open procedure but only a few surgeons have attempted this with minimally invasive surgery (MIS). Surgical robots that hold MIS instruments have wrists and provide tremor filtration and motion scaling, which might be expected to facilitate complex procedures in small spaces such as an esophageal anastomosis in a newborn. METHODS: Seven newborn pigs weighing 2 to 3 kg were used as a model. The authors performed an esophageal resection and end-to-end anastomosis using the Zeus Microwrist Robotic Surgical System. The authors monitored the following data-Zeus robotic set-up time, operating time, esophageal dissection time, and anastomosis time. After 1 month, the animals were anesthetized to perform esophagram and than were killed. RESULTS: In these very small animals the space available for performing an anastomosis is very limited, approximately 2 cm3. Two pigs each died 18 days postoperatively. One animal could not eat and died during esophageal dilation. The second pig died of unrelated enteritis. Neither had evidence of anastomotic leak at autopsy. The esophagram of the 5 pigs that survived for 30 days showed no narrowing or proximal dilation in 2. In 3 there was some stenosis requiring dilation. Histopathology was done on each operated animal. Two of the anastomoses were well healed, and 5 showed only focal small ulceration. CONCLUSIONS: Robotic assistance facilitates an MIS approach to the upper esophagus even in the limited space of the infant chest.

Anastomosis, Surgical↗

PubMed2005

An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity.

BACKGROUND: This study compares the mental and physical workload of laparoscopic and robotic technique while performing simulated surgical tasks in a laboratory setting. MATERIALS AND METHODS: Ten volunteer surgeons performed two tasks in a laparoscopic trainer using laparoscopic (LAP) and robotic (ROB) techniques. Outcome measures included: Task time, task-error, vertical/horizontal arm displacement, percent maximum electromyographic signal from the thenar, forearm flexor, and deltoid muscle compartments, skin conductance, and perceived difficulty and discomfort levels. A two-way repeated-measures ANOVA compared surgical technique and laparoscopic experience level (E = expert, N = novice). RESULTS: For the simple task, ROB technique was slower and had higher errors, and the surgeon's arm was more elevated. For the complex task, ROB electromyographic signal was lower. Stress was lower in both tasks for ROB, but the decrease was not statistically significant. CONCLUSIONS: Robotic technique appears slower and less precise than laparoscopic technique for simple tasks, but equally fast and possibly less stressful for complex tasks. Previous laparoscopic experience has a complex influence on the physical and mental adaptation to robotic surgery.

Adult↗

PubMed2005

Robotic mitral valve surgery: a United States multicenter trial.

OBJECTIVE: In a prospective phase II Food and Drug Administration trial, robotic mitral valve repairs were performed in 112 patients at 10 centers by using the da Vinci surgical system. The safety of performing valve repairs with computerized telemanipulation was studied. METHODS: After institutional review board approval, informed consent was obtained. Patients had moderate to severe mitral regurgitation. Operative technique included peripheral cardiopulmonary bypass, a 4- to 5-cm right minithoracotomy, a transthoracic aortic crossclamp, and antegrade cardioplegia. The successful study end point was grade 0 or 1 mitral regurgitation by transthoracic echocardiography at 1 month after surgery. RESULTS: Valve repairs included quadrangular resections, sliding plasties, edge-to-edge approximations, and both chordal transfers and replacements. The average age was 56.4 +/- 0.09 years (mean +/- SEM). There were 77 (68.8%) men and 35 (31.2%) women. Valve pathology was myxomatous degeneration in 105 (91.1%), and 103 (92.0%) had type II leaflet prolapse. Leaflet repair times averaged 36.7 +/- 0.2 minutes, with annuloplasty times of 39.6 +/- 0.1 minutes. Total robot, aortic crossclamp, and cardiopulmonary bypass times were 77.9 +/- 0.3 minutes, 2.1 +/- 0.1 hours, and 2.8 +/- 0.1 hours, respectively. On 1-month transthoracic echocardiography, 9 (8.0%) had grade 2 mitral regurgitation, and 6 (5.4%) of these had reoperations (5 replacements and 1 repair). There were no deaths, strokes, or device-related complications. CONCLUSIONS: Multiple surgical teams performed robotic mitral valve repairs safely early in development of this procedure, with a reoperation rate of 5.4%. Advancements in robotic design and adjunctive technologies may help in the evolution of this minimally invasive technique by decreasing operative times.

Adult↗

PubMed2006

Endoscopic robotic mitral valve surgery.

OBJECTIVE: To determine the safety and efficacy of endoscopic mitral valve surgery using robotic instruments through the lateral right chest. METHODS: We conducted a retrospective review of 127 patients taken to the operating room for endoscopic robotic mitral surgery from December 2002 through November 2005. Mean age was 54 +/- 13 years and 58% were male. Mitral regurgitation was 4+ in 121 patients, 3+ in 4 patients, and 2+ in 2 patients. Nineteen (15%) patients had a left ventricular ejection fraction of 0.50 or less. Surgical approach was through 4 right chest ports with femoral perfusion and endoaortic balloon occlusion. Mean follow-up was 13.7 +/- 8.9 months and was 100% complete. Echocardiographic follow-up was available on 98 patients with a mean of 8.4 +/- 8.1 months. RESULTS: The mitral procedure was completed endoscopically in 121 (95%) patients. Mitral valve repair was performed in 114 patients and mitral valve replacement in 7 patients. Two patients required reoperation on the mitral valve. There was 1 (0.8%) hospital death and 1 late death. Echocardiographic follow-up in 98 survivors of endoscopic mitral repair revealed 0-1+ regurgitation in 95 (96.9%) and 2+ in 3 (3.1%) patients. CONCLUSIONS: Totally endoscopic mitral surgery can be performed safely with robotic instrumentation. A right lateral configuration of the robotic system allows excellent visualization of the valve with minimal distortion and permits two surgical personnel to participate actively in valve instrumentation. In selected patients with mitral valve disease, this surgical approach might promote higher rates of valve repair.

Adult↗

PubMed2006

Human voluntary activity integration in the control of a standing-up rehabilitation robot: a simulation study.

The paper presents a novel control approach for the robot-assisted motion augmentation of disabled subjects during the standing-up manoeuvre. The main goal of the proposal is to integrate the voluntary activity of a person in the control scheme of the rehabilitation robot. The algorithm determines the supportive force to be tracked by a robot force controller. The basic idea behind the calculation of supportive force is to quantify the deficit in the dynamic equilibrium of the trunk. The proposed algorithm was implemented as a Kalman filter procedure and evaluated in a simulation environment. The simulation results proved the adequate and robust performance of "patient-driven" robot-assisted standing-up training. In addition, the possibility of varying the training conditions with different degrees of the subject's initiative is demonstrated.

Adult↗

PubMedDate not supplied

Application of neural network to humanoid robots-development of co-associative memory model.

We have been studying a system of many harmonic oscillators (neurons) interacting via a chaotic force since 2002. Each harmonic oscillator is driven by chaotic force whose bifurcation parameter is modulated by the position of the harmonic oscillator. Moreover, a system of mutually coupled chaotic neural networks was investigated. Different patterns were stored in each network and the associative memory problem was discussed in these networks. Each network can retrieve the pattern stored in the other network. On the other hand, we have been developing new mechanisms and functions for a humanoid robot with the ability to express emotions and communicate with humans in a human-like manner. We introduced a mental model which consisted of the mental space, the mood, the equations of emotion, the robot personality, the need model, the consciousness model and the behavior model. This type of mental model was implemented in Emotion Expression Humanoid Robot WE-4RII (Waseda Eye No.4 Refined II). In this paper, an associative memory model using mutually coupled chaotic neural networks is proposed for retrieving optimum memory (recognition) in response to a stimulus. We implemented this model in Emotion Expression Humanoid Robot WE-4RII (Waseda Eye No.4 Refined II).

Affect↗

PubMed2004

Robotic adrenalectomy.

The use of robotics in surgery is an emerging field. Robot-assisted laparoscopic adrenalectomy has been performed in small numbers worldwide. Advantages of robotic assistance over conventional laparoscopy are not acknowledged. Improvement in robotic technology, including addition of tactile feedback, miniaturization of end-effectors, reduced cost, and advances in remote surgery telecommunication technology are awaited.

Adrenalectomy↗

PubMed2004

Robotic pyeloplasty: technique and results.

The da Vinci robotic system can be used to perform dismembered and nondismembered pyeloplasty techniques effectively. Robotics not only seems to improve dexterity and surgical precision but also provides an ergonomic surgical environment for a surgeon performing complex reconstructive procedures such as pyeloplasty. Although performance-enhancing features of the da Vinci robot seem to decrease the difficulty of intracorporeal suturing, a learning curve also exists for telerobotic procedures. This learning curve may decrease as experience with telerobotics increases and as advances in technology are introduced. Presently, the interaction between the primary and assistant surgeon seems crucial to the success of the procedure. Although the early clinical experience with robotic pyeloplasty is favorable, continuing clinical evaluation and careful follow-up are required to determine if the procedure is as efficacious in the long run as open pyeloplasty and laparoscopic pyeloplasty.

Follow-Up Studies↗

PubMed2004

Robotic radical cystectomy and urinary diversion in the management of bladder cancer.

The authors have explored the versatility of the da Vinci robot for pelvic surgery to develop the technique of robotic radical cystectomy in conjunction with the Urology and Nephrology Center in Mansoura, Egypt, a world leader in conventional (open) cystectomy. This approach, which is designed to minimize the time required for surgery, is a sandwich technique in which the cystectomy and the neobladder-urethral anastomosis are performed with robotic assistance and the urinary diversion is performed extracorporeally. This article reviews the published literature and details the authors' current technique of robotic radical cystectomy and urinary diversion.

Cystectomy↗

PubMed2004

Robotic renal surgery.

Robotic technology is an expansion of laparoscopic surgery. Robots can be conceived of as specialized laparoscopic tools; their aim is to improve dexterity of the operating surgeon, and therefore they correspond to computer-enhanced telemanipulator devices. For the patient, the advantage of robotic surgery is essentially the advantage of the laparoscopic approach. It gives surgeons tremendous benefits, however, with its intuitive Endowrist and dexterity. From the patient perspective, the biggest difference is between an open operation and one that uses minimally invasive techniques. The contribution of robotics to the evolution of surgery will be obvious if these new systems increase the number of conventionally trained surgeons performing more complex operations using minimally invasive surgical techniques, or if the outcome data from different centers worldwide suggest that the use of advanced technology permits surgeons to have augmented technical performance.

Forecasting↗

PubMed2005

Laparoscopic vesicovaginal fistula repair with robotic reconstruction.

INTRODUCTION: To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time. A vesicovaginal fistula developed several weeks later, and she was referred for repair. The location of the fistula was deemed amenable to repair using a robot-assisted laparoscopic approach. TECHNICAL CONSIDERATIONS: The total operative time was 280 minutes, including placement of ureteral catheters and repositioning. The estimated blood loss was 50 mL. The fistula was repaired using robot-assisted laparoscopic techniques without complications, and the patient went home on the second postoperative day. The Foley catheter was removed 2 weeks postoperatively. The patient continued to void normally without recurrence at 16 weeks of follow-up. CONCLUSIONS: Laparoscopic repair of vesicovaginal fistulas has not gained widespread acceptance owing to its technical difficulty. We describe a minimally invasive laparoscopic approach using the DaVinci robotic system to repair a vesicovaginal fistula.

Adult↗

PubMed2005

Robotic-assisted vasovasostomy: a two-layer technique in an animal model.

OBJECTIVES: To assess the feasibility of a multilayered robotic-assisted vasovasostomy (RAVV) in a rabbit model. Microscope-assisted vasovasostomy (MAVV) is a technically challenging procedure. Robotics may be a surgical adjunct that helps overcome the microsurgical challenges, which include fine suture, delicate instruments, and tremor. A recent survey revealed that most urologists use a multilayered technique for vasovasostomies. METHODS: A surgeon performed eight vasovasostomies with 10-0 suture and a two-layer technique using an in vivo rabbit model-four were MAVV using conventional microsurgical instrumentation and four were RAVV using the da Vinci robot. Performance measures and adverse haptic events were recorded. Patency was evaluated by passing a 2-0 Prolene suture through the anastomoses. RESULTS: The mean operating time for the total procedure and for the mucosal layer only was longer for RAVV than for MAVV (75 versus 42 minutes, P = 0.03 and 38 versus 23 minutes, P = 0.03, respectively). The needle passes required for the mucosal layer and the number of mucosal and muscularis sutures were similar in both groups (9.5 versus 8.8 passes, P = 0.34; 4 versus 4, P >0.99; and 7 versus 6.3, P = 0.2, respectively). Unlike MAVV, no tremor was appreciated during RAVV. No adverse haptic events were observed in either group. All anastomoses were patent, and all rabbits were free of any crush injury. CONCLUSIONS: A multilayered RAVV can be performed in an in vivo rabbit model. Although it was associated with increased operative times, the absence of adverse haptic events and comparable patency rates continue to suggest a role for robotics in microsurgery.

Animals↗

PubMed2005

Robotic-assisted laparoscopic dismembered pyeloplasty.

OBJECTIVES: To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. METHODS: A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. RESULTS: Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 mL. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. CONCLUSIONS: Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results.

Adolescent↗

PubMed2005

Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation.

INTRODUCTION: We present our technique for clipless antegrade neurovascular bundle preservation during robotic laparoscopic radical prostatectomy, along with short-term follow-up of our patients' sexual function. TECHNICAL CONSIDERATIONS: Using the da Vinci three-arm robotic system, we performed robotic laparoscopic radical prostatectomy using a transperitoneal approach in an antegrade fashion. After division of the bladder neck, the posterior plane of the prostate was developed distally toward the apex of the prostate in the midline. This plane was then developed completely, releasing the vascular pedicles and neurovascular bundles in a medial to lateral direction, with occasional use of bipolar cautery and without the use of clips or monopolar cautery. Patients with a minimal follow-up of 3 months who did not require open conversion were included in this study. A total of 56 patients met these inclusion criteria between February 2003 and May 2004, with a mean follow-up of 6 months. Patients were given the validated Rand Medical Outcomes Study 36-Item Health Survey, version 2, with the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. The overall score for both unilateral and bilateral nerve-sparing groups was 35.0, 39.7, 49.4, and 49.6 at 1, 3, 6, and 12 months postoperatively, respectively. These coincided with a return to baseline potency rate of 47%, 54%, 66%, and 69% at 1, 3, 6, and 12 months, respectively. CONCLUSIONS: Antegrade dissection of the neurovascular bundle, avoiding the use of clips or monopolar cautery during robotic laparoscopic radical prostatectomy, may result in early return of sexual function and overall outcome similar to that after radical retropubic prostatectomy.

Adult↗