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PubMed1995

Robots in operating theatres.

Robots designed for surgery have three main advantages over humans. They have greater three dimensional spatial accuracy, are more reliable, and can achieve much greater precision. Although few surgical robots are yet in clinical trials one or two have advanced to the stage of seeking approval from the UK's Medical Devices Agency and the US Federal Drug Administration. Safety is a key concern. A robotic device can be designed in an intrinsically safe way by restricting its range of movement to an area where it can do no damage. Furthermore, safety can be increased by making it passive, guided at all times by a surgeon. Nevertheless, some of the most promising developments may come from robots that are active (monitored rather than controlled by the surgeon) and not limited to intrinsically safe motion.

Humans↗

PubMed1995

Neural network based dynamic controllers for industrial robots.

The industrial robot's dynamic performance is frequently measured by positioning accuracy at high speeds and a good dynamic controller is essential that can accurately compute robot dynamics at a servo rate high enough to ensure system stability. A real-time dynamic controller for an industrial robot is developed here using neural networks. First, an efficient time-selectable hidden layer architecture has been developed based on system dynamics localized in time, which lends itself to real-time learning and control along with enhanced mapping accuracy. Second, the neural network architecture has also been specially tuned to accommodate servo dynamics. This not only facilitates the system design through reduced sensing requirements for the controller but also enhances the control performance over the control architecture neglecting servo dynamics. Experimental results demonstrate the controller's excellent learning and control performances compared with a conventional controller and thus has good potential for practical use in industrial robots.

Algorithms↗

PubMed2001

Robotically assisted laparoscopic radical prostatectomy: feasibility study in men.

PURPOSE: We report our early experience of robotically assisted laparoscopic radical prostatectomy. MATERIAL AND METHODS: Five consecutive patients, with an average age of 58 years, PSA 12, 1.6 positive biopsies, Gleason score 6, were operated in our institution over a period of 1 week by the same surgeon. A robotically assisted laparoscopic nerve sparing radical prostatectomy was performed according to the Montsouris technique with the Da Vinci robot (Intuitive Inc., Mountain View, Calif., USA). RESULTS: The mean installation time was 93 min (range 76-149). The mean operating time (starting at the dissection of the seminal vesicles until the final stitch of the anastomosis) was 222 min (range 150-381 min). The average blood loss was 800 cm(3) (range 700-1,600 cm(3)). No postoperative complications were seen. Bladder catheter time: 6.5 days, hospital stay 5.5 days, urine leak 1/5, continence 4/5, positive margin 1/5. CONCLUSION: After this short experience, we conclude that: The use of a tele manipulation system accompanied by a three-dimensional view of the operating field provides a real benefit for the surgeon, and the urethro-anastomosis is easier to perform. The benefit for the patient is presently not very clear in terms of operating time, postoperative course and functional results, our initial results show that the robotically assisted procedure is at least as safe and effective as the conventional laparoscopic procedure.

Equipment Design↗

PubMed2003

Totally endoscopic atrial septal defect repair with robotic assistance.

BACKGROUND: Computer (robotic) enhancement had emerged as a facilitator of minimally invasive cardiac surgery, and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the next step in this progression-the first U.S. application of robotic technology for totally endoscopic open heart surgery. METHODS AND RESULTS: Seventeen patients underwent repair of a secundum-type atrial septal defect (n=12) or patent foramen ovale (n=5) by a totally endoscopic approach, utilizing the Da Vinci robotic system. Cardiopulmonary bypass (CPB) was achieved peripherally. Cardioplegia was administered via the distal port of the arterial cannula after endo-balloon inflation. Via three port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, atrial septopexy, and atrial closure were performed by a surgeon seated at a computer console. A fourth 15-mm port was utilized for suction and suture passage by a patient-side assistant. The mean age of the patients was 47 years (range, 22 to 68). Aortic crossclamp time was 32 minutes (median), and CPB time was 122 minutes. In 16 patients, transesophageal echocardiography after 30 days confirmed successful repair. In one patient, a recurrent shunt was identified and repaired on postoperative day 5. Median length of stay (LOS) in the intensive care unit was 20 hours, and median hospital length of stay was 4 days. CONCLUSIONS: Robotic technology can be utilized to perform open heart procedures safely and effectively via totally endoscopic approaches. This technique represents an option for patients seeking a reliable ASD repair but wishing to avoid sternotomy or thoracotomy.

Adult↗

PubMed2001

Three generations of automatically designed robots.

The difficulties associated with designing, building, and controlling robots have led their development to a stasis: Applications are limited mostly to repetitive tasks with predefined behavior. Over the last few years we have been trying to address this challenge through an alternative approach: Rather than trying to control an existing machine or create a general-purpose robot, we propose that both the morphology and the controller should evolve at the same time. This process can lead to the automatic design of special-purpose mechanisms and controllers for specific short-term objectives. Here we provide a brief review of three generations of our recent research, which underlies the robots shown on the cover of this issue: Automatically designed static structures, automatically designed and manufactured dynamic electromechanical systems, and modular robots automatically designed through a generative DNA-like encoding.

Computer-Aided Design↗

PubMedDate not supplied

Learning from and about others: towards using imitation to bootstrap the social understanding of others by robots.

We want to build robots capable of rich social interactions with humans, including natural communication and cooperation. This work explores how imitation as a social learning and teaching process may be applied to building socially intelligent robots, and summarizes our progress toward building a robot capable of learning how to imitate facial expressions from simple imitative games played with a human, using biologically inspired mechanisms. It is possible for the robot to bootstrap from this imitative ability to infer the affective reaction of the human with whom it interacts and then use this affective assessment to guide its subsequent behavior. Our approach is heavily influenced by the ways human infants learn to communicate with their caregivers and come to understand the actions and expressive behavior of others in intentional and motivational terms. Specifically, our approach is guided by the hypothesis that imitative interactions between infant and caregiver, starting with facial mimicry, are a significant stepping-stone to developing appropriate social behavior, to predicting others' actions, and ultimately to understanding people as social beings.

Comprehension↗

PubMedDate not supplied

New robotics: design principles for intelligent systems.

New robotics is an approach to robotics that, in contrast to traditional robotics, employs ideas and principles from biology. While in the traditional approach there are generally accepted methods (e. g., from control theory), designing agents in the new robotics approach is still largely considered an art. In recent years, we have been developing a set of heuristics, or design principles, that on the one hand capture theoretical insights about intelligent (adaptive) behavior, and on the other provide guidance in actually designing and building systems. In this article we provide an overview of all the principles but focus on the principles of ecological balance, which concerns the relation between environment, morphology, materials, and control, and sensory-motor coordination, which concerns self-generated sensory stimulation as the agent interacts with the environment and which is a key to the development of high-level intelligence. As we argue, artificial evolution together with morphogenesis is not only "nice to have" but is in fact a necessary tool for designing embodied agents.

Artificial Intelligence↗

PubMed1998

Online evolution for a self-adapting robotic navigation system using evolvable hardware.

Great interest has been shown in the application of the principles of artificial life to physically embedded systems such as mobile robots, computer networks, home devices able continuously and autonomously to adapt their behavior to changes of the environments. At the same time researchers have been working on the development of evolvable hardware, and new integrated circuits that are able to adapt their hardware autonomously and in real time in a changing environment. This article describes the navigation task for a real mobile robot and its implementation on evolvable hardware. The robot must track a colored ball, while avoiding obstacles in an environment that is unknown and dynamic. Although a model-free evolution method is not feasible for real-world applications due to the sheer number of possible interactions with the environment, we show that a model-based evolution can reduce these interactions by two orders of magnitude, even when some of the robot's sensors are blinded, thus allowing us to apply evolutionary processes online to obtain a self-adaptive tracking system in the real world, when the implementation is accelerated by the utilization of evolvable hardware.

Biological Evolution↗

PubMed1997

A robot trace maker: modeling the fossil evidence of early invertebrate behavior.

The study of trace fossils, the fossilized remains of animal behavior, reveals interesting parallels with recent research in behavior-based robotics. This article reports robot simulations of the meandering foraging trails left by early invertebrates that demonstrate that such trails can be generated by mechanisms similar to those used for robot wall-following. We conclude with the suggestion that the capacity for intelligent behavior shown by many behavior-based robots is similar to that of animals of the late Precambrian and early Cambrian periods approximately 530 to 565 million years ago.

Animals↗

PubMed2001

Analysis and experiments with an elephant's trunk robot.

The area of tentacle and trunk type biological manipulation is not new, but there has been little progress in the development and application of a physical device to simulate these types of manipulation. Our research in this area is based on using an 'elephant trunk' robot. In this paper, we review the construction of the robot and how it compares to biological manipulators. We then apply our previously designed kinematic model to describe the kinematics of the robot. We finish by providing some examples of motion planning and intelligent manipulation using the robot.

Algorithms↗

PubMed2003

Minimally invasive mitral valve surgery: from Port Access to fully robotic-assisted surgery.

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve operations through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.

Cardiac Catheterization↗

PubMed2004

Surgical application of a new robotic system for paranasal sinus surgery.

The applicability of a robotic system for fully automated surgical procedures approaching the sphenoid sinus is evaluated. An integrated robotic system, A73, for computer navigation-guided, fully automated, and telemanipulation robotic performance is described. Details of the system comprising newly designed surgical instruments for robotic operations and preoperative planning protocols are provided. Experiments with an operational accuracy of less than 1 mm were followed by surgical tests, in which the results of fully automated and telemanipulation performances on 5 cadaveric heads are seen. The A73 system has been successfully used for a reproducible and accurate resection of the anterior wall of the sphenoid sinus. Therefore, we conclude that this system is suited for further testing toward approaching fully automated and more complex procedures of paranasal surgery.

Cadaver↗

PubMed2004

Robot-assisted cardiac surgery.

The use of robotics is evolving in cardiac surgery. Robots allow minimally invasive techniques to be applied to ischemic heart and valve disease. Notably, this frees the patient from sternotomy, allowing a quick recovery while preserving the most critical aspects of the surgical procedure. The increasing use of stents for revascularization is significant. For best results to the patient, the graft of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) is a mainstay of symptom-free survival. Stenting and robotic LIMA-to-LAD grafting in a one-staged or two-staged approach may be an attractive combined specialty treatment. This would offer best practices to the patient, along with the best technologies available. In this chapter, the most common techniques in cardiac robotic surgery are outlined. Procedural steps are described, and their expanding indications for use discussed. Additionally, a focus on combining technologies for new treatments is considered.

Cardiac Surgical Procedures↗

PubMed2004

Robot-assisted urologic procedures.

Surgical robotics, the result of the combined efforts of engineers, computer scientists, entrepreneurs, and surgeons, has enabled the surgeon to execute precise technical maneuvers while seated at a remote console. The capability to perform sophisticated surgical operations by means of a robot is today's reality. The combination of laparoscopy and robotics has the potential to enhance operative performance and the outcomes of laparoscopy, and expand the clinical application of laparoscopy while reducing patient morbidity. In this article, we review initial pioneering and laboratory research, early clinical investigations, and current clinical applications of robotics in urologic surgery.

Humans↗

PubMed2006

High-throughput isolation of ultra-pure plasmid DNA by a robotic system.

BACKGROUND: With the availability of complete genomes, a systematic inventory of cellular processes becomes achievable. This requires assessing the function of all individual genes. Transfection of plasmid DNA into cell culture cells is an essential technique for this aim as it allows functional overexpression or downregulation of genes. While many robotic systems isolate plasmids for sequencing purposes, for more demanding applications such as transfections there is a shortage of robots for the high-throughput isolation of plasmid DNA. RESULTS: Here we describe a custom-made, automated device, which uses a special protocol to isolate plasmid DNAs with a purity sufficient for efficient transfections into mammalian cells. Approximately 1,600 ultra pure plasmids can be isolated in a 96-well plate format within 12 hours. As a unique feature the robot comprises the integration of a centrifuge instead of expensive columns, the use of a custom-made pipetting head with a movable gripper, especially designed shaking platforms and an acetone wash facility. CONCLUSION: Using this robot we demonstrate how centrifugation steps with multiple precipitations, most notably through a precipitation step of SDS in isopropanol, lead to high purity plasmid DNA and make possible high-throughput transfections into mammalian cells for functional gene annotations.

Chemical Fractionation↗

PubMed2003

Peripheral cardiopulmonary bypass with modified assisted venous drainage and transthoracic aortic crossclamp: optimal management for robotic mitral valve repair.

The purpose of this study was to evaluate peripheral cardiopulmonary bypass (CPB) with modified assisted venous drainage (MAVD) and transthoracic aortic cross-clamping to maintain a bloodless surgical field, adequate myocardial protection, systemic flow and pressure during robotic surgical repair of the mitral valve. Peripheral CPB was established with a standard Duraflo-coated closed circuit with femoral arterial and venous cannulation. An additional 17 Fr wire-bound cannula was inserted into the right internal jugular vein and drainage rates of 200-400 mL/min were regulated using a separate roller-head pump. A transthoracic aortic crossclamp with antegrade cardioplegia was used for myocardial protection. Mitral valve (MV) repair was then performed through two 1-cm ports for the robotic arms and a 4-cm intercostal incision for the camera and passing suture. From October 2001 to October 2002, 25 patients underwent robotic MV repair. Average surgical times include leaflet resection and repair, 20 min, and insertion of annuloplasty ring, 28 min; average perfusion times, crossclamp 88 min and total bypass time of 126 min. There were no incisional conversions, no reoperations for bleeding and no deaths, strokes or perioperative myocardial infarctions. Twenty-one (84%) patients were extubated in the operating room. Average LOS was 2.7 days with eight (32%) patients discharged home in less than 24 hours. In conclusion, peripheral CPB with gravity drainage of the lower body and MAVD of the upper body allow safe and effective support during robotically assisted minimally invasive MV repair. This approach may be applied to other forms of minimally invasive cardiac surgery that requires CPB.

Adult↗

PubMed2006

Robotic virtual endoscopy: development of a multidirectional rigid endoscope.

INTRODUCTION: The use of neuroendoscopy has increased in the past 20 years. Despite an increase in the number of indications for use, novel adjuncts and modifications to existing endoscopes remain all but nonexistent. We introduce a robotic virtual endoscope with applications for neurosurgery that could serve as a novel step in the evolution of future endoscopic technologies. METHODS: Over the past 8 years, we have worked on the construction of a prototype endoscope with three degrees of freedom that was designed to allow for enhanced safety while maximizing the benefits of virtual field rendition and robotic control. We have developed a prototype to examine a cerebral ventricular model in vitro that functions via either a direct video- or computer-based interface. RESULTS: Assessment of viewing angulation with robotic feedback has verified the accuracy of the prototype. Models support the ability of the endoscope to localize regions identified via a software interface. CONCLUSION: The endoscope is a rigid virtual robotic endoscope that provides complete visual coverage of a three-dimensional space by controlling an adjustable viewing direction with three degrees of freedom.

Endoscopes↗

PubMed2000

A review of robotics in surgery.

A brief introduction is given to the definitions and history of surgical robotics. The capabilities and merits of surgical robots are then contrasted with the related field of computer assisted surgery. A classification is then given of the various types of robot system currently being investigated internationally, together with a number of examples of different applications in both soft-tissue and orthopaedic surgery. The paper finishes with a discussion of the main difficulties facing robotic surgery and a prediction of future progress.

Equipment Safety↗