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PubMedDate not supplied

Learning robot actions based on self-organising language memory.

In the MirrorBot project we examine perceptual processes using models of cortical assemblies and mirror neurons to explore the emergence of semantic representations of actions, percepts and concepts in a neural robot. The hypothesis under investigation is whether a neural model will produce a life-like perception system for actions. In this context we focus in this paper on how instructions for actions can be modeled in a self-organising memory. Current approaches for robot control often do not use language and ignore neural learning. However, our approach uses language instruction and draws from the concepts of regional distributed modularity, self-organisation and neural assemblies. We describe a self-organising model that clusters actions into different locations depending on the body part they are associated with. In particular, we use actual sensor readings from the MIRA robot to represent semantic features of the action verbs. Furthermore, we outline a hierarchical computational model for a self-organising robot action control system using language for instruction.

Language↗

PubMed2004

Preliminary experience with robot-assisted laparoscopic myomectomy.

The following retrospective case series evaluated the technique and feasibility of integrating robot-assisted technology in the performance of a laparoscopic myomectomy in order to overcome the limitations of conventional laparoscopy. We attempted 35 robot-assisted laparoscopic myomectomies in a university hospital setting with a conversion rate of 8.6%. There were a total of 48 myomas removed in 31 patients with completed robot-assisted laparoscopy. The mean number of myomas removed/patient was 1.6 (range 1-5). The mean diameter of myomas removed was 7.9 +/- 3.5 cm (95% CI 6.63-9.13), with the majority greater than 5 cm. The mean myoma weight was 223.2 +/- 244.1 g (95% CI 135.8-310.6). Mean operating time was 230.8 +/- 83 minutes (95% CI 201.6-260). The average estimated blood loss was 169 +/- 198.7 mL (95% CI 99.1-238.4). One patient experienced cardiogenic shock from vasopressin, two developed postoperative infections, and one was found to have adenomatous adenomyosis instead of a leiomyoma. The median length of hospital stay was 1 day. Overall, robot-assisted laparoscopic myomectomy is a promising new technique that may overcome many of the surgical limitations of conventional laparoscopy.

Adult↗

PubMed2002

System for robotically assisted prostate biopsy and therapy with intraoperative CT guidance.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the work-in-progress prototype of an image-guided, robotic system for accurate and consistent placement of transperineal needles into the prostate with intraoperative image guidance inside the gantry of a computed tomographic (CT) scanner. MATERIALS AND METHODS: The coach-mounted system consists of a seven-degrees-of-freedom, passive mounting arm: a remote-center-of-motion robot; and a motorized, radiolucent needle-insertion device to deliver 17-18-gauge implant and biopsy needles into the prostate with the transperineal route. The robot is registered to the image space with a stereotactic adapter. The surgeon plans and controls the intervention in the CT scanner room with a desktop computer that receives DICOM images from the CT scanner. The complete system fits in a carry-on suitcase, does not need calibration, and does not utilize vendor-specific features of the CT scanner. RESULTS: In open air, the average accuracy was better than 1 mm at a 5-8-cm depth. In various phantoms, the average orientation error was 1.3 degrees, and the average distance between the needle tip and the target was 2 mm. CONCLUSION: Results of preliminary experiments indicate that this robotic system may be suitable for transperineal needle placement into the prostate and shows potential in a variety of other percutaneous clinical applications.

Biopsy, Needle↗

PubMed1999

Hippocrate: a safe robot arm for medical applications with force feedback.

We have developed a robotic system to assist doctors when they are moving ultrasonic probes on a patient's skin while exerting a given effort. The probes are used to monitor arteries for cardiovascular disease prevention, namely to reconstruct the three-dimensional profile of arteries. A preliminary feasibility study making use of an industrial robot has been made to validate the force control scheme. It has proven the interest of the robotized approach for such medical applications where force control is needed. In order to comply with safety constraints, a dedicated robotic system 'Hippocrate' has been designed. This paper describes the arm and the controller architectures, with emphasis on design strategies selected to meet safety requirements. Preliminary in vivo results are presented as well as a possible new application of Hippocrate as a tool for reconstructive surgery.

Angiography↗

PubMed1997

Automated protein preparation techniques using a digest robot.

Since the introduction of fast analysis methods for peptide mixtures such as MALDI-MS, peptide micropreparation and digest methods have become an important bottleneck in the protein characterization process. We therefore developed and describe here a digest robot capable of processing 30 protein samples in parallel [Houthaeve et al. (1995), FEBS Lett. 376, 91-94]. Briefly, after gel pieces or blots are cut out, they are loaded in flowthrough reactors and these are loaded in a thermocontrolled reactor block. The proteins are then washed, reduced, and alkylated, proteolytically or chemically cleaved, and resulting peptides extracted. The system allows the parallel use of different reagents and enzymes during the same run, and is compatible with RP-HPLC peptide separation and Edman degradation, MALDI-MS, and NanoES-MS/MS. The digest robot is now also commercially available from ABIMED. In an ongoing project aimed at elucidating proteinaceous structures involved in the functional and structural maintenance of the Golgi apparatus, we illustrate the strength of the digest robot for the fast analysis of several proteins. We conclude that the performance of the digest robot is comparable to currently used manual digestion methods. The approach outlined makes sample preparation procedures faster, simpler, and less labor-intensive.

Chemistry Techniques, Analytical↗

PubMed2004

Technology Insight: surgical robots--expensive toys or the future of urologic surgery?

There is an increasing demand for minimally invasive surgery, despite any controversy over whether patients benefit from minimally invasive procedures rather than undergoing open surgery. In the field of urology, the performance of more complicated procedures is still a challenge even for experienced laparoscopic surgeons. Recently, robots have been introduced to enhance operative performance, increase applicability and precision of laparoscopy, and improve the learning curve for complicated minimally invasive procedures. With the introduction of master-slave systems where the surgeon is seated remotely from the robot and uses controls to maneuver the mechanical arms placed inside the patient, a new development in robot-assisted surgery has commenced. Several authors have suggested that surgical robots similar to the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA), which have three-dimensional (3D) vision and wristed instruments thus giving a greater degree of freedom than rigid laparoscopic instruments, will facilitate the outcome of these more challenging laparoscopic procedures. Whether these features will translate into better functional and oncological results remains to be evaluated. Data published so far clearly suggest that the patient will benefit from less postoperative pain, decreased bleeding and a shorter hospital stay compared with open surgery, and that the surgeon benefits from a faster learning curve than for conventional laparoscopy. For the benefit of our patients and for the development of urology it is vital that we understand both the limitations of telerobotics and when it is appropriate to incorporate these new techniques in day-to-day urologic surgery.

Costs and Cost Analysis↗

PubMed1999

Robotic selective sampling and total automation for anti-CMV screening.

The provision of anti-cytomegalovirus (CMV)-negative blood products causes the blood banking community considerable logistical problems. This is due firstly to the fact that only a select group of patients require anti-CMV-negative units, namely the immunocompromised. Secondly, the prevalence of CMV antibody in the blood donor population is high and, thirdly, the demand for anti-CMV-negative blood components continues to increase. To address this problem, a system of robotic selective sampling and total assay automation for anti-CMV screening has been developed. An in-house computer program generates a worklist from the donation database of samples requiring screening to meet clinical demand. Algorithms incorporated in the program ensure that the minimum number of samples possible are selected for provision of anti-CMV-negative products. This 'intelligent' selection of samples substantially reduces reagent cost. Robotic pipetting from the electronically derived worklist, masterplate to test plate robotic transfer and use of an automated assay processor maintains specific sample identification throughout. Results are read mechanically and transmitted directly to the main computer system. Robotic selective sampling and total assay automation produces an efficient, secure, auditable and completely traceable system for the provision of anti-CMV-negative units. The system produced a substantial reduction in labour costs with a 40% reduction in reagent usage. This system can be readily adapted for screening other markers on a selective basis.

Antibodies, Viral↗

PubMed2003

A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution.

UNLABELLED: The authors from the Vattikuti Institute in the USA report a prospective comparison of radical prostatectomy and robot-assisted prostatectomy. They found that the robot-assisted procedure was safer, and yielded favourable oncological and functional results. They also present work in association with the Department of Urology in Mansoura into robot-assisted radical cystoprostatectomy and urinary diversion, and point out the advantages and disadvantages associated with performing the most complex types of urinary diversion. There is also an interesting paper relating to the association between sexual factors and prostate cancer, from authors in institutions in Australia, New Zealand and Italy. They found that in a case-control study of men aged <70 years, ejaculatory frequency was negatively associated with the risk of prostate cancer. Technology has made many contributions to the management of urological patients. The classic example is that of urinary stone management. Authors from the USA evaluated cyroablation of renal carcinoma in patients with solitary kidneys. They are encouraged by their results and suggest that there is merit in this treatment, but indicate the need for a longer follow-up. OBJECTIVE: To prospectively compare standard radical retropubic prostatectomy (RRP) and the robotically assisted Vattikuti Institute prostatectomy (VIP) in the management of localized prostate cancer. PATIENTS AND METHODS: The study was a single-institution, prospective, unrandomized comparison of histopathological, and functional outcomes, at baseline and during and after surgery, in 100 patients undergoing RRP and 200 undergoing VIP. RESULTS: While the variables before surgery, the operative duration (163 vs 160 min) and pathological stages were comparable, there were significant differences in the measured outcomes. The blood loss was 910 and 150 mL for RRP and VIP, respectively, and transfusion was greater after RRP (67% vs none; both P < 0.001). There were four times as many complications after RRP (20% vs 5%, P < 0.05), the haemoglobin level at discharge was lower (100 vs 130 g/L, P < 0.005) and the hospital stay longer (3.5 vs 1.2 days; P < 0.05). Most (93%) of VIP and none of the RRP patients were discharged within 24 h (P < 0.001); the duration of catheterization was twice as long after RRP (15.8 vs 7 days; P < 0.05). Positive margin was more frequent after RRP (23% vs 9%, P < 0.05). After VIP, patients achieved continence and return of erections more quickly than after RRP (160 vs 44, and 180 vs 440 days, both P < 0.5). The median return to intercourse was 340 days after VIP but after RRP half the patients have as yet not resumed intercourse at 700 days (P < 0.05). CONCLUSIONS: The VIP procedure appears to be safer, less bloody and requires shorter hospitalization and catheterization. The oncological and functional results were favourable in patients undergoing VIP.

Adult↗

PubMed2004

Robotic surgery in urology: fact or fantasy?

Advanced robotic surgery was first introduced into urology in 2000. The first studies showed the feasibility and safety of the daVinci (Intuitive Surgical Inc., Sunnyvale, CA) telemanipulator assistance in radical prostatectomy, pelvi-ureteric junction obstruction, and radical cystectomy and neobladder formation. The miniature endowristed tools offer a potential advantage over standard laparoscopy in the accuracy of preparation and suturing. Other features are a three-dimensional vision system and unimpaired hand-eye coordination. Complex laparoscopic tasks are learned faster by using the robot, which may also explain the shorter training required for radical prostatectomy than for manual laparoscopy. This new and expensive technology has spread rapidly over the last 4 years. By 2004, approximately 10% of radical prostatectomies in the USA will be robot-assisted. Data on the functional and oncological outcomes are accruing but not yet conclusive. There will be a further spread of robotic surgery, routine telesurgery, smaller and more affordable systems, the introduction of virtual reality, all developments which have the potential to urological surgeons to improve.

Costs and Cost Analysis↗

PubMed2004

[A comparison of the Arndt endobronchial blocker with a double lumen tube in robotic cardiac surgery].

OBJECTIVE: In this prospective, randomised study a double lumen tube (DLT) or an Arndt bronchial blocker (BB) was used for one lung ventilation (OLV). Intraoperative oxygenation, ventilation, haemodynamics, and ease of placement were compared. METHODS: In 32 patients undergoing robotic harvesting of the left internal thoracic artery (ITA) a left-sided DLT or a BB controlled by bronchoscopy was used for OLV of the right lung. In 2 patients randomised for DLT, a single lumen tube and BB was used for difficult visualisation of the larynx. These 2 patients were excluded from the study. RESULTS: Correct placement of DLT (8.8 +/- 5.4 min, 87.5 % of the patients) as well as BB (6.5 +/- 4.0 min; n. s.; 100 % of the patients) was achieved rapidly. The Cormack-Lehane score for visualisation of the larynx was 2, 1 - 3 (median, range) in group DLT and 3, 1 - 4 (median, range) in group BB (p < 0.05). OLV lasted for 93 +/- 29 min in group DLT and 88 +/- 34 min in group BB (n. s.). Satisfactory conditions for harvesting ITA were achieved in all patients of both groups. There was no difference in any haemodynamic parameter at any time between the two groups. Mean pulmonary arterial pressure and pulmonary vascular resistance were increased without significant differences between the two groups during thoracoscopy for robotic preparation of left ITA. During OLV, index of paO (2)/FiO (2) was significantly (p < 0.05) lower in DLT patients compared to BB patients. Time to extubation did not differ between the two groups (DLT 14.3 +/- 4.6 h; BB 11.8 +/- 3.8 h). CONCLUSION: OLV in patients undergoing robotic cardiac surgery was safely achieved either by BB or by left-sided DLT. Positioning of the BB was easier than that of a DLT when intubation was difficult and tube exchange at the end of surgery is avoided. Therefore, we prefer a BB in patients undergoing robotic harvesting of left ITA.

Aged↗

PubMedDate not supplied

[Clinical outcome following robotic assisted versus conventional total hip arthroplasty: a controlled and prospective study of seventy-one patients].

AIM: Robotic assisted total hip arthroplasty remains controversial, since wider exposure of the proximal femur and placement of the leg in maximal hip adduction and external rotation using a rigid leg-holder apparatus may impair significantly the hip abductors. Consequently, it is the purpose of this study to analyse and report both clinical outcome and hip abductor function following robotic assisted versus conventional total hip arthroplasty. MATERIAL AND METHODS: 36 robotic-assisted (CASPAR, Orto-Maquet, Rastatt, Germany) and 35 conventional cementless total hip arthroplasties were followed on average for 18 months regarding incidence of complications, Harris hip score, the scoring system according to Merle d'Aubigné and Postel, hip abductor function (using a spring-balance), and incidence of Trendelenburg's sign (according to the Kuhfuss-classification). Statistical analysis was performed in case of continuous data using the t test and the Mann-Whitney test, respectively, and in case of categorical data using Fisher's exact test and the chi-squared test, respectively. The level of significance was set as p < 0.05. RESULTS: Average duration of surgery (CASPAR: 100.6 min; conventional: 51.5 min; p < 0.0001) as well as average loss of haemoglobin (CASPAR: 4.5 mg/dL; conventional: 3.3 mg/dL; p = 0.0002) differed significantly, whereas the incidence of complications (CASPAR: two dislocations, one sciatic paresis, one deep infection; conventional: one dislocation, two fissures), revision rate (CASPAR: 5.6 %; conventional: 2.9 %), and incidence of heterotopic ossifications (CASPAR: 30.6 %; conventional: 17.1 %) was comparable following both procedures (p > 0.05). Improvement of the Harris hip score also was comparable in both groups (CASPAR: 40.9 to 86.1 points; conventional: 39.5 to 88.0 points; p = 0.21), whereas improvement of the score according to Merle d'Aubigné and Postel was significantly greater following the manual procedure (CASPAR: 10.1 to 16.0 points; conventional: 8.3 to 16.6 points; p < 0.0001). Differences between the two groups were also significant regarding hip abductor function (CASPAR: 76.1 %; conventional: 93.8 % of the contralateral hip; p < 0.0001) and incidence of Trendelenburg's sign (CASPAR: 61.1 %; conventional: 25.7 %; p = 0.0014). CONCLUSION: The significant functional impairment following robotic assisted THA should be taken critically into consideration prior to initiating such procedure.

Adult↗

PubMedDate not supplied

What have we learnt after two years working with the da Vinci robot system in digestive surgery?

Robotic- assisted surgery has been introduced recently in order to overcome some of the difficulties surgeons encounter during advanced laparoscopic surgery. Due to the 3D vision equipment, higher number of degrees of freedom in manipulating instruments and better ergonomics it is hoped that by using robot techniques the indications of minimally invasive surgery in the field of digestive surgery can be broadened or that difficult procedures will be easier to perform. Since the introduction of the system in our hospital now almost two years ago 70 procedures have been performed with the aid of the da Vinci system covering the whole spectrum of GI surgery. Conversion took place in 2.5% and peroperative morbidity related to the use of robotic techniques was 10%. Although we had the subjective feeling that the procedures were indeed easier to perform and more relaxing for the surgeon, some major problems still exist as the complete lack of tactile feedback and the cost effectiveness of these procedures. Before robotics can be introduced in the every day clinical practice of the surgeon, its true benefit still needs to be established. This can only be done by well randomised prospective studies comparing one technique with the other.

Digestive System Surgical Procedures↗

PubMed2004

Robotic total knee arthroplasty: the accuracy of CT-based component placement.

BACKGROUND: Accurate alignment of the components in total knee arthroplasty is important. By use of postoperative CT controls, we studied the ability of a robotic effector to accurately place and align total knee arthroplasty (TKA) components according to a purely CT-based preoperative plan. PATIENTS AND METHODS: Robotic TKA was performed in 13 patients (6 men) with primary gonarthrosis. Locator screws were placed into femur and tibia under spinal anesthesia. A CT-scan including the femoral head, knee and ankle was performed. In the preoperative planning software, virtual components were positioned into the CT volume. In a second operation, the robot milled femur and tibia with a high-speed milling tool according to the preoperative plan. On the 10th day, CT controls were performed following the same protocol as preoperatively. RESULTS: The mean deviation of the postoperative from the preoperatively planned mechanical axis was 0.2 degrees (95% CI: -0.1 degrees to 0.5 degrees ). The accuracy of angular component placement in frontal, sagittal and transverse planes was within +/-1.2 degrees , and the accuracy of linear component placement in mediolateral, dorsoventral and caudocranial directions was within +/-1.1 mm. INTERPRETATION: Robotic TKA allows placement of components with unparalleled accuracy, but further development is mandatory to integrate soft-tissue balancing into the procedure and make it faster, easier and cheaper.

Arthritis↗

PubMed2002

Robotics in laparoscopic surgery: current status and future perspectives.

BACKGROUND: Laparoscopic surgery has been introduced to limit the burden of surgical damage to the abdominal wall and peritoneum. METHODS: Description of procedure and results of robotic laparoscopic surgery. RESULTS: Laparoscopic surgery has resulted in reduction of postoperative pain, surgery-related complications and scarring. Laparoscopic techniques, however, are challenging for the surgeon owing to the disadvantages of inverted and restricted manipulation and the indirect two-dimensional view. In order to solve these problems, robotic telemanipulation systems were developed and introduced to the market at the end of the past decade. This article describes and discusses the current status and future perspectives of robotic systems in endoscopic surgery. CONCLUSION: Robotic laparoscopic surgery overcomes some of the disadvantages of conventional laparoscopic surgery.

Humans↗

PubMed2006

Postoperative urinary continence after robot-assisted laparoscopic radical prostatectomy.

OBJECTIVE: Laparoscopic radical prostatectomy has shown excellent results concerning patient morbidity, with less blood loss compared to conventional surgery. Robot-assisted laparoscopy offers several additional important technical improvements and therefore it might be suggested that robotic radical prostatectomy would also offer surgical advantages. The objective of this study was to evaluate urinary continence for the first 72 cases of robot-assisted radical prostatectomy performed by a single surgical team. MATERIAL AND METHODS: We analysed the outcomes of the first 72 consecutive patients to undergo robot-assisted prostatectomy for localized prostate cancer at our hospital between January 2002 and May 2004. A self-administered questionnaire concerning urinary status was mailed to the patients 3 and 6 months after surgery. Pre- and peroperative characteristics were obtained from patient medical records. The mean age was 61.2 years (range 36-71 years) and the mean preoperative prostate-specific antigen level was 6.3 ng/ml (range 2.3-10.7 ng/ml). The preoperative clinical stage was T1c, 67%, T2, 28% and T3, 5% and the mean Gleason sum was 6 (range 5-9). RESULTS: Sixty-one of the 68 patients (90%) reported no use of pads and 6 (9%) used a maximum of 1 pad/day 3-6 months after surgery. One patient reported use of >1 pad/day 6 months after surgery. Three significant complications were noted: ureter injury, haemorrhage and femoral nerve injury. CONCLUSIONS: In this series, which represents the learning curve for one surgical team, only a tenth of the patients still required pads 3-6 months after surgery. Considering the short follow-up period, the results in this series will probably improve over time.

Adult↗

PubMed2002

Robotically assisted gynaecological surgery.

Industry has used robots successfully for fine, delicate, repetitive tasks for decades. Recently, robots have been introduced into clinical medicine and specifically into the surgical suite. Voice algorithms have been developed that allow voice activation of some types of equipment in the operating room, such as the laparoscope or the light source. Advances in computer software have allowed a computer controller to translate a surgeon's movements from the handles located in a console to the robotic arms that hold the surgical instruments. This console is placed away from the surgical table. Clinical experience is limited and there are few published clinical trials. The initial trials have focused on laparoscopic microsuturing such as that performed during coronary bypass surgery or tubal anastomosis. Preliminary results have demonstrated that laparoscopic coronary bypass surgery with the internal mammary artery can be achieved. In gynaecological surgery, laparoscopic tubal reanastomosis can be performed using the same technique that has been used traditionally at laparotomy. Future clinical trials will assess whether other gynaecological procedures can be performed with robotic assistance.

Animals↗

PubMed2000

Conformal intensity-modulated radiotherapy (IMRT) delivered by robotic linac--conformality versus efficiency of dose delivery.

Intensity-modulated radiotherapy (IMRT) may be delivered with a high-energy-photon linac mounted on a robotic gantry and executing a complex trajectory. In a previous paper an inverse-planning technique was developed for such an application. Here the work is extended to demonstrate the dependence of conformality on the size of the elemental pencil beam, on the complexity of the trajectory and on the sampling of azimuth and elevation of the collimated source. The improved conformality of complex trajectories is demonstrated and benchmarked relative to simpler trajectories, more representative of existing non-robotic IMRT techniques. Specifically, by choosing a very fine pencil beam, exquisitely conformal dose distributions have been obtained. Important sampling considerations have been determined. Expressions have been derived for the dosimetry and monitor-unit efficiency of robotic IMRT. Equivalent trajectories were computed for executing the complex robotic trajectories instead by using a conventional linac. The work benchmarks an ideal in IMRT against which more practical and more common techniques may be measured.

Humans↗

PubMed2002

Computer-assisted laparoscopic splenectomy with the da Vinci surgical robot.

Laparoscopic splenectomy has become the standard of care for the surgical treatment of idiopathic thrombocytopenic purpura (ITP). The minimally invasive approach to splenic disorders such as ITP clearly results in the same benefits to the patients as have been demonstrated with the laparoscopic cholecystectomy techniques. New technologies in minimally invasive surgery have resulted in the development of robotic devises that assist the surgeon during the procedures. Robotic surgery is in its infancy at this point in time. Herein, we report a splenectomy performed with the assistance of the da Vinci surgical robot. With advancement of technology, robotic systems will play an integral role in future minimally invasive surgery.

Aged↗