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At least 649 records · Page 36Linked to original sources

PubMed2003

Robotic resection of pancreatic neuroendocrine tumor.

Computer-assisted surgical devices, or "surgical robots," have recently been approved for general surgical use. The device allows the surgeon remote control of multi-articulated instrument arms with a three-dimensional view. Here we report the first known case of pancreatic resection with use of a computer-assisted, or robotic, surgical device. A 46-year old woman presented with back pain and a complex cystic mass in the tail of the pancreas. The daVinci surgical robot was used to remove the lesion en bloc with the tail of the pancreas and spleen. The patient did well and returned to full activity promptly. In summary, robotic technology may enhance advanced laparoscopic procedures. Pancreatic resection is feasible, and future experience will determine the true benefits of this technique.

Carcinoma, Neuroendocrine↗

PubMed2005

Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting?

BACKGROUND AND PURPOSE: Robotic surgery allows three-dimensional (3D) viewing of tissues. We compared two-dimensional (2D) and 3D suturing drills using the daVinci surgical system to determine if the latter is advantageous. MATERIALS AND METHODS: Twenty-eight anastomotic drills were completed by seven surgeons using the daVinci robot. Three surgeons had considerable (>6 months) robotic experience, and four had none. Drills were performed randomly in both dimensional modes in a blinded fashion. Drill 1 was an interrupted four stitch and drill 2 a running closure. All tasks were kept uniform. We recorded time to completion, difficulty, and accuracy. The drills were evaluated by two independent reviewers for accuracy and major errors (i.e., broken suture, torn graft). RESULTS: The average operative time per drill in two dimensions was 13.1 minutes (range 6.9-21.9 minutes) and in three dimensions was 8.5 minutes (range 4.7-12.8 minutes) (P<0.001). Drill 1 was 6.1 minutes faster in three dimensions (mean 9.2 minutes; P<0.01), and drill 2 was 2.9 minutes faster (mean 7.8 minutes; P=0.03). Both advanced and novice groups were faster in 3D (P<0.01). There were two major errors in the 3D performances and 5 in the 2D exercises (P<0.05). The participants correctly identified the dimensional mode 92.9% of the time (P<0.01). CONCLUSION: The anastomosis was completed 65% faster using 3D with equal, if not greater, accuracy. Drill 1 was improved to a greater degree than drill 2, suggesting most benefit of 3D views during knot tying. Use of three dimensions outperformed two dimensions in both groups. Surgeons can immediately benefit from 3D viewing during robotic surgery.

Anastomosis, Surgical↗

PubMed2006

Robotic computer-assisted pyeloplasty versus conventional laparoscopic pyeloplasty.

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty (LP) for the repair of ureteropelvic junction (UPJ) obstruction provides results similar to those of open pyeloplasty with less morbidity, but its use has been limited, as it requires advanced laparoscopic skills. Robotic computer-assisted pyeloplasty (RAP) has the potential to reduce the technical challenges of the reconstructive portion of the operation. We compare our RAP experience with our recent LP cases. PATIENTS AND METHODS: Fourteen patients underwent LP, and 31 underwent RAP. The demographics of the two groups were similar. Three patients in the RAP group had been treated previously for UPJ obstruction. All procedures were performed transperitoneally. For RAP, conventional laparoscopic dissection and exposure preceded robot-assisted reconstruction. A Double-J stent was placed cystoscopically in all patients. Patient demographics and operative, postoperative, and follow-up data were compared. Success was defined strictly as the unequivocal absence of both obstruction and postoperative pain. Also technical success was defined as no evidence of persistent high-grade obstruction, no loss of function, no symptomatic obstruction, and no necessity for further treatment. RESULTS: The diagnosis of UPJ obstruction was confirmed intraoperatively in all cases. No difference was found in operative and postoperative outcomes of the two procedures. Operative time, including cystoscopy, was 299 minutes in the LP group and 271 minutes in the RAP group. The median estimated blood loss was <100 mL in both groups. The median console time for RAP was 76 minutes (range 54-124 minutes) and consisted of preparation and completion of the anastomosis. The median robotic docking and undocking time was 16 minutes (range 5-30 minutes). The anastomotic times for LP were not recorded. There were no conversions to open surgery and no intraoperative complications. The mean length of stay (LOS) was 2 days in both groups. There were two postoperative complications in each group: In the LP group, one large retroperitoneal hematoma and one umbilical hernia; in the RAP group, one nonfebrile urinary-tract infection and one urine leak. The mean follow-up was 10 months (range 1-31 months) for LP and 6 months (range 1-21 months) for RAP. Strict success was seen in 64% of the LP patients and 66% of the RAP patients. There was one technical failure in the RAP group, resulting in a technical success rate of 100% for LP and 97% for RAP. Technical success was seen in two LP patients and five RAP patients with partial obstruction on early postoperative renography and three LP patients and four RAP patients with occasional postoperative pain. CONCLUSION: Robotic computer-assisted pyeloplasty provides short-term results similar to those of conventional laparoscopic pyeloplasty at our institution.

Adolescent↗

PubMed1998

Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study.

As with standard microsurgical procedures performed at laparotomy, laparoscopic tubal anastomosis requires great dexterity. Handling fine suture materials under magnification to anastomose tubal segments with lumens less than 3 mm in diameter while working with your hands at a distance from the tissue makes these fine movements even more difficult. This is exacerbated by the tremor induced by the fatigue caused by a prolonged laparoscopic procedure and the need for precise control. We conducted a pilot study to evaluate the feasibility of performing laparoscopic tubal anastomosis with robotic assistance in a live porcine model. Two anastomoses were performed on one uterine horn via each of the following techniques: laparoscopy, laparoscopy with robotic assistance, and open microsurgery. Immediate necropsy demonstrated all the anastomoses to be patent. There were no intraoperative complications. Laparoscopic tubal anastomosis was associated with surgeon fatigue and neck, shoulder, and back pain. The surgeons were more comfortable performing the procedure with robotic assistance. The device functioned well and without incident. This acute animal study suggests that robotic assistance in laparoscopic tubal anastomoses is safe and feasible. It enhances surgeons' dexterity and precision while reducing fatigue. It is promising for future use in chronic experimental studies.

Anastomosis, Surgical↗

PubMed1999

Full robotic assistance for laparoscopic tubal anastomosis: a case report.

Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans.

Adult↗

PubMed2005

Laparoscopic splenectomy with the da Vinci robot.

BACKGROUND: We report our first series of minimally invasive splenectomies with a robotic surgical system. METHODS: From August 2001 to October 2003, laparoscopic splenectomies with the da Vinci operating robot were performed in 7 patients (five females and two males, ages 20 to 74 years). RESULTS: Indications for splenectomy were hematologic disorders in four patients and hypersplenism in three patients. Median dimensions of the resected spleens were 140 +/- 34 mm x 80 +/- 11 mm x 50 +/- 17 mm and median weight was 307 +/- 193 g. Median total operative time was 147 +/- 58 minutes including 107 +/- 49 minutes for the robotic act. There were no intraoperative complications and no conversions to open surgery. The median postoperative hospital stay was 7 days. CONCLUSION: This first series suggests that robotic splenectomy with the da Vinci surgical system is technically feasible and safe. It provides an alternative to the conventional laparoscopic procedure. Nevertheless, justification for this new technique will require a larger prospective series and longer follow-up.

Adult↗

PubMed2006

Robot-assisted laparoscopic resection of a type I choledochal cyst in a child.

Although the laparoscopic approach to the treatment of complex biliary disease is possible, it is technically challenging. In an attempt to overcome these difficulties, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California) was used to facilitate the minimally invasive treatment of a type I choledochal cyst in a 5-year-old, 22 kg, girl. Complete resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy were performed using the robotic surgical system. Total robotic setup time (preparation, port placement, docking) was 40 minutes. Total procedure time was 440 minutes. Total robotic operative time was 390 minutes. No intraoperative complications or technical problems were encountered. At 6-month follow-up, the child is doing well with no episodes of cholangitis. Robot-assisted laparoscopic type I choledochal cyst resection appears safe and feasible. The three-dimensional visualization and wristed instrumentation greatly aids in the dissection of the cyst and in the biliary reconstruction.

Anastomosis, Roux-en-Y↗

PubMed2004

Design evolution of an interactive robot for therapy.

This paper describes a project using telecommunication and robotics to develop a system that addresses developmental goals for children with disabilities. A user-centered design was employed to meet the needs of the end users: children with disabilities, therapists, educators, and parents. The design team developed the prototype robot system for therapy, education, and play. The robot system is an adaptable, programmable robot, designed to address a wide range of disabilities, interests, and developmental goals. The production design will include data collection and remote monitoring capabilities. The steps leading to the prototype and its evaluation are described, including identification of user needs and system requirements to satisfy these needs.

Child↗

PubMed2005

Robot-assisted epicardial ablation of the pulmonary veins: is a completed isolation necessary?

AIMS: To study the feasibility and electrophysiological efficacy of minimally invasive beating heart ablation of the pulmonary veins (PVs) via a robot-assisted single-sided approach. BACKGROUND: PV isolation by minimally invasive epicardial ablation may offer a new treatment for patients with lone atrial fibrillation (AF). However, complete PV isolation has been shown to be difficult to obtain. METHODS AND RESULTS: In 14 mongrel dogs, robot-assisted epicardial microwave ablation was performed on the beating heart by a single-sided right chest approach. Isolation of all PVs was performed in two steps to study the effect of an incomplete and a complete isolation on AF. AF was studied by random and burst pacing. Incremental pacing was performed to study conduction characteristics across the lesions. Opening of the pericardial reflections, introduction of the catheter and ablation were robotically feasible by a single-sided approach in 11 dogs. The AF duration decreased from 6.6+/-4.1 to 1.3+/-0.8 s (P=0.03) and 1.6+/-1.6 s (P=0.04 compared with control) after incomplete and completed isolation of the PVs. The AF cycle length increased from 134+/-5 to 141+/-5 and 145+/-8 ms (P=0.03) after incomplete and complete isolation, respectively. Several incomplete lesions showed 2:1 exit and/or entrance block during incremental pacing. After complete isolation, AF was no longer inducible from the PVs. CONCLUSION: Epicardial PV isolation can be successfully performed by a single-sided robot-assisted approach. The effect of PV ablation on AF is not an all or none phenomenon. Incomplete isolation already decreases AF duration and lengthens the AF cycle length. However, complete isolation is necessary to prevent AF induction by triggering from the isolated area.

Animals↗

PubMed1998

One year of experience working with the aid of a robotic assistant (the voice-controlled optic holder AESOP) in gynaecological endoscopic surgery.

The aim of the study was a comparison of robotic versus human laparoscopic camera control. Utilizing robotic technology a robot has been designed specifically for the purpose of holding and manoeuvring the laparoscope under the direct control of the surgeon. We tested AESOP (automated endoscopic system for optimal positioning) in 50 patients undergoing routine gynaecological endoscopic surgical procedures. The elimination of the camera holder allows two doctors to perform complex laparoscopic surgery faster than without the robotic arm. The timing of surgical procedures performed by surgeons using the voice control was compared to the timing of similar operations using the foot or hand control. The voice-controlled AESOP works more efficiently and faster than the hand or foot control.

Endoscopes↗

PubMed1991

A new challenge--robotics in the rehabilitation of the neurologically motor impaired.

Rehabilitation robotics is a research area, originating in engineering, that has emerged in the last decade. Its broad aim is to use robot technology to assist people with movement dysfunction. The neurologically impaired population might gain considerably from the provision of robots as "assistants" or "therapy aides," but the interface with the machine must match both the physical and intellectual abilities of the user. We therefore consider a multidisciplinary approach, encompassing both behavioral and engineering perspectives, to be essential in achieving this aim. However, to date, published reports have been largely restricted to engineering journals or conference reports, and relatively little has appeared in the therapy literature. This article seeks to introduce physical therapists to robotics, describe possible applications to the rehabilitation of neurologically impaired patients, and suggest issues deserving further investigation.

Evaluation Studies as Topic↗

PubMed2004

Robotics in valvular surgery: 2003 and beyond.

PURPOSE OF REVIEW: Currently, cardiac surgery is an evolving field. Not only has there been a technologic explosion, but there is also a strong interest in minimally invasive operations. Mitral valve surgery can now be performed with the use of sophisticated robotic systems through small incisions, and a review of recent advances is warranted. RECENT FINDINGS: Various groups have now documented that robotic valve surgery is feasible and safe. Despite an initial learning curve, facility with the procedure is gained with increasing experience. SUMMARY: Robotic mitral valve surgery is a procedure that is gaining widespread popularity. The patient of today and the future will demand minimally invasive operations. Initial clinical experience with robotic systems will allow further developments. Ultimately, this may result in completely endoscopic heart surgery.

Heart Valve Diseases↗

PubMedDate not supplied

Robotic heart surgery.

Advances in computer and robotic technology are transforming cardiac surgery, overcoming the limitations of conventional endoscopic tools. Using minimal access through 5 millimeter ports, computer-enhanced instruments provide superhuman dexterity through tremor filtration and motion scaling, and are capable of precise manipulation in confined body cavities. Using these technologies, endoscopic beating heart coronary bypass surgery as well as complex mitral valve repairs have been performed in the last few years. However, the current world experience with robotic heart surgery is mostly anecdotal, retrospective, and noncontrolled. Results of rigorous prospective randomized studies in the United States under Food and Drug Administration approved protocols, are awaited. The use of robotic telemanipulation technology for heart surgery is restricted in the United States to patients enrolled in clinical studies in a few elite centers. Further refinement in robotic and image-guided technology for cardiac surgery may further expand the use of computer enhanced instrumentation in the near future.

Cardiac Surgical Procedures↗

PubMed2002

Surgical robotics: the early chronicles: a personal historical perspective.

The use of robotics has been emerging for approximately 75 years, but only during the past 5 years has the potential of robotics been recognized by the surgical community as a whole. This personal perspective chronicles the development of robotics for the general surgical community, the role of the military medical research effort, and many of the major programs that contributed to the current success of robotics.

Equipment Design↗

PubMed2004

The da Vinci robot in right adrenalectomy: considerations on technique.

The da Vinci Robotic System (Intuitive Surgical, Mountain View, CA) became available at the General Surgery Department of Camposampiero Hospital in May 2001. From May 2001 to October 2002, 139 robotic operations were performed, one of which was a right adrenalectomy for a right adrenal mass. The progressive growth of the mass was the indication for surgical excision. Surgical adrenalectomy was successfully completed with da Vinci Robotic System using 5 ports (3 for the robotic system, 2 as service trocars). The wrist-like movements of the instrument's tip easily enabled the detachment of the right hepatic lobe from the gland and vessel isolation, while the 3-dimensional vision facilitated dissection of the veins from the vena cava.

Adrenal Gland Neoplasms↗

PubMed2005

Local cost structures and the economics of robot assisted radical prostatectomy.

PURPOSE: Robot assisted prostatectomy (RAP) is more costly than traditional radical retropubic prostatectomy (RRP) under the cost structures at certain hospitals. However, this finding may not be the case in all care settings. We investigated the sensitivity of RAP and RRP inpatient costs to variations in length of stay (LOS), local hospitalization costs and robotic case volume in the specialist and generalist settings. MATERIALS AND METHODS: We developed a model of RAP vs RRP costs in the specialist and generalist settings using published data on operative time and LOS, and cost data from our academic medical center. All inpatient cost centers were included, namely surgery costs, professional fees, postoperative care, robotic equipment and service. Extensive 1 and 2-way sensitivity analyses were performed. RESULTS: Our base case model demonstrated a cost premium for RAP vs RRP of USD $783 and $195 in the specialist and generalist settings, respectively. Sensitivity analysis of our model assumptions demonstrated that RAP could achieve cost equivalence with RRP at a surgical volume of 10 cases weekly. If case volume increased to 14 cases weekly, RAP would be less expensive than RRP in some practice settings in which RAP LOS was less than 1.5 days. CONCLUSIONS: The inpatient costs of robotic assisted prostatectomy are volume dependent and cost equivalence with generalist radical retropubic prostatectomy is possible at higher volume RAP specialty centers. While RAP may be cost competitive with RRP at high cost hospitals or high volume RAP specialist centers, this procedure would exist at a cost premium to RRP in other practice settings.

Health Care Costs↗

PubMed2005

Robot-assisted biopsy using computed tomography-guidance: initial results from in vitro tests.

PURPOSE: We sought to develop a robotic system for computed tomography (CT)-guided biopsy to validate the feasibility, accuracy, and efficacy of the system using phantom tests. MATERIALS AND METHODS: Ten peas (mean diameter 9.9+/-0.4 mm) embedded within a gel phantom were selected for biopsy. Once the best access was defined on CT images, the position of the phantom was recorded by an optical tracking system. Positional data about the phantom and the corresponding CT image was transferred to the robot planning system (Linux-based industrial PC equipped with video capture card). Once the appropriate position, angulation, and pitch were calculated, the robotic arm moved automatically with 7 degrees-of-freedom to the planned insertion path, aiming the needle-trajectory at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured and short cut pieces of a guidewire were pushed into the target to evaluate the deviation of the actual needle track from the target. RESULTS: In all targets, biopsy specimens (mean length 5.6+/-1.4 mm) were harvested with only 1 needle pass required. The mean deviation of the needle tip from the center of the target in the x and z axes was 1.2+/-0.9 mm and 0.6+/-0.4 mm, respectively. CONCLUSIONS: Robotic-assisted biopsies in vitro, using CT guidance, were feasible and provided high accuracy.

Biopsy↗

PubMed2003

Developmental robotics: manifesto and application.

We argue that all embodied organisms, whether robots or animals, face the same challenge: of adapting to bodies, brains and environments that undergo constant and inevitable change. After highlighting the evidence for the universal role of a class of molecular factors called neurotrophic factors in the response of animals to this challenge, we suggest that implementing models of neurotrophic interactions on robots may confer on them the adaptability and robustness exhibited by animals. We briefly review a mathematical model of neurotrophic interactions and then discuss its application in a robotic context. Finally, we examine the potential, or otherwise, of our approach to developmental robotics.

Adaptation, Physiological↗