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At least 721 records · Page 40Linked to original sources

PubMed1999

[Voice-directed robotic cystoscopy].

OBJECTIVE: In line with our previous studies in the field of robotics, a new application of our robotic arm is presented: voice-directed cystoscopy. METHODS: Cystoscopy was performed in a sow using a voice-directed robotic arm to which a cystoscope had been attached. The computer executes all the processes that enable interaction with the surgeon and communication with the robotic system. The surgeon directs the movements of the cystoscope by voice, using instructions easily recognizable by the voice identifier. RESULTS/CONCLUSIONS: This system is easy to operate and carries out the commands given by the surgeon with great precision and safety.

Computers↗

PubMed1999

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

Equipment Design↗

PubMed1999

The robotized workstation "MASTER" for users with tetraplegia: description and evaluation.

The rehabilitation robotics MASTER program was developed by the French Atomic Energy Commission (CEA) and evaluated by the APPROCHE Rehabilitation centers. The aim of this program is to increase the autonomy and quality of life of persons with tetraplegia in domestic and vocational environments. Taking advantage of its experience in nuclear robotics, the CEA has supported studies dealing with the use of such technical aids in the medical area since 1975 with the SPARTACUS project, followed by MASTER 10 years later, and its European extension in the framework of the TIDE/RAID program. The present system is composed of a fixed robotized workstation that includes a six-axis SCARA robot mounted on a rail to allow horizontal movement and is equipped with tools for various tasks. The Operator Interface (OI) has been carefully adapted to the most severe tetraplegia. Results are given following a 2-year evaluation in real-life situations.

Activities of Daily Living↗

PubMed2000

Computer assisted surgery with 3D robot models and visualisation of the telesurgical action.

This paper deals with the support of virtual reality computer action in the procedures of surgical robotics. Computer support gives a direct representation of the surgical theatre. The modelization of the procedure in course and in development gives a psychological reaction towards safety and reliability. Robots similar to the ones used by the manufacturing industry can be used with little modification as very effective surgical tools. They have high precision, repeatability and are versatile in integrating with the medical instrumentation. Now integrated surgical rooms, with computer and robot-assisted intervention, are operating. The computer is the element for a decision taking aid, and the robot works as a very effective tool.

Computer Simulation↗

PubMed2000

Totally endoscopic atrial septal defect closure using robotic techniques: report of two cases.

BACKGROUND: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. We report 2 cases of totally endoscopic atrial septal defect (ASD) closure using a robotic system. Open-heart closure of an ASD without opening the chest has never been previously reported. METHODS: Following percutaneous cannulation for cardiopulmonary bypass, aortic occlusion and delivery of cardioplegia, 2 patients with an ASD were successfully operated on using a robotic surgical device. After exclusion of the right lung, two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax. A fourth port was inserted for an accessory endoscopic instrument. The ASD closure was carried out with interrupted stitches in one case and with a continuous suture in the other. RESULTS: Cardiopulmonary bypass and cardioplegic arrest times were respectively 130 and 75 min in the first and 87 and 60 min in the second case. Extubation was carried out 3 and 5 hours postoperatively. Both patients resumed a totally normal lifestyle 1 week after the operation. CONCLUSIONS: Totally endoscopic open-heart ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and excellent cosmetic results. This modality of treatment can be considered an alternative to the transcatheter closure of ASD.

Female↗

PubMed2000

Robot-assisted computer enhanced closed-chest coronary surgery: preliminary experience using a Harmonic Scalpel and ZEUS.

BACKGROUND: Successful endoscopic harvesting of arterial conduits is critical to the performance of totally endoscopic bypass grafting. Recent success with computer-enhanced robotic systems in the performance of endoscopic single vessel coronary artery bypass (ENDOCAB) has paved the way for developing techniques for multivessel ENDOCAB. The Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) has previously demonstrated versatility and efficacy in manual endoscopic internal thoracic artery (ITA) harvesting. This study was undertaken to determine the feasibility of adapting this technology to a robotic telemanipulation system and its safety and efficacy in telerobotic ITA harvesting. METHODS: The Harmonic Scalpel was adapted to the ZEUS robotic surgical system (Computer Motion, Goleta, CA) and used to harvest the ITA in 19 patients undergoing multivessel off-pump coronary artery bypass (OPCAB) surgery. With the left lung collapsed, the ITA was harvested in all patients with CO2 insufflation through three 5 mm ports in the left chest. Postoperative angiography and transthoracic Doppler studies were performed in all patients. RESULTS: There were no ITA injuries and patients tolerated insufflation without hemodynamic compromise. Side branches were controlled easily without bleeding. Average ITA harvest time was 65 +/- 21 minutes. All vessels were patent after harvesting and demonstrated no angiographic evidence of injury. CONCLUSIONS: This paper demonstrates a technique by which the Harmonic Scalpel can be readily adapted to the ZEUS robotic telemanipulation system. Using this system, ITA's can be safely harvested totally endoscopically within a reasonable time frame for patients undergoing ENDOCAB.

Coronary Angiography↗

PubMed2001

RAVECAB: improving outcome in off-pump minimal access surgery with robotic assistance and video enhancement.

OBJECTIVE: To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA). DESIGN: A case series. SETTING: London Health Sciences Centre, University of Western Ontario, London, Ont. PATIENTS AND METHODS: Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting. INTERVENTION: Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant. MAIN OUTCOME MEASURES: Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization. RESULTS: RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days. CONCLUSIONS: RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.

Coronary Artery Bypass↗

PubMed2001

Robot assisted laparoscopic nephrectomy.

PURPOSE: The feasibility and safety of remote laparoscopic surgery using a surgical telemanipulator have been demonstrated in laboratory experience and recently in clinical practice. To our knowledge we report the first robot assisted, laparoscopic nephrectomy in a human. MATERIALS AND METHODS: A 77-year-old woman was diagnosed with a nonfunctioning hydronephrotic right kidney due to ureteropelvic junction obstruction. Robot assisted, transperitoneal right laparoscopic nephrectomy was performed. RESULTS: Complete dissection was successfully performed with the robot. The renal pedicle was dissected without any problem, and the artery and vein were individually ligated. Operative time was 200 minutes, anesthesia time was 245 minutes and blood loss was less than 100 ml. Convalescence was uneventful. Histological examination confirmed the preoperative diagnosis. CONCLUSIONS: We report the technical feasibility of robot assisted laparoscopic nephrectomy in humans. Current technology needs further improvement and its actual usefulness for patient treatment must be established by large clinical trials. Technological improvements and future telecommunication networks should open new avenues in surgery, namely remote telesurgery.

Aged↗

PubMed2001

[Forensic aspects of a trainee in robotic surgery of the heart].

The grounds for liability with robotic surgery include damage to patients, causality, illegality and guilt. The patient must receive very comprehensive information on the treatment under consideration, his/her risk and what will be done in the case of technical failure. The surgeon operating the robotic device is obliged to provide normal conscientious care and state-of-the-art treatment. In addition, there is possible neglect of supervisory duties vis-à-vis other hospital personnel to be considered. A special problem is posed by a forensic physician who lacks experience in robotic surgery. There should be a surgeon at the operating table who is at least equally skilled as the surgeon operating the monitor. Robotic surgery must ultimately be at least as effective as conventional surgery, if not better. It must, however, be borne in mind that in cases involving this new technology, it is that patient who is the pioneer.

Education, Medical, Graduate↗

PubMedDate not supplied

[Robotic techniques in laparoscopic surgery].

Robotic technology is being increasingly used in surgery. The authors assess the usefulness, effectiveness and safety of the AESOP 2000 robotic device (Automated Endoscopic System for Optimal Positioning) in videolaparoscopic surgery. Two laparoscopic cholecystectomies were performed with the aid of the AESOP 2000 robot. A short increase in operative time was observed and there were no complications. Voice understanding was accurate and flawless and no inadvertent smearing of the lens occurred. The use of the AESOP 2000 robotic device is safe, improves the quality of vision and reduces the number of surgeons needed in the team. Nevertheless, a learning curve and simultaneous training in the use of the device are required.

Cholecystectomy, Laparoscopic↗

PubMed2002

[Future aspect of robotic surgery].

Minimally invasive surgery has become a standard options of surgery. We have introduced a master-slave manipulator "da Vinci" to the clinical situation in July 2000, and developed new operative techniques, which are safer and more tender for patients than before. Up to now, a total of 45 patients underwent a robot-assisted endoscopic surgery using "da Vinci" system. Several procedures including laparoscopic splenectomy and thoracoscopic mediastinal tumor extirpation were first performed in the world. This system provided surgeons with motion scaling, physiological tremor elimination, and high-resolution 3-dimensional vision. Thanks to those sophisticated functions, all surgical procedures, which have been limited due to endoscopic circumstances, were performed much easily and safely than before. Every effort to develop a new type of robotic has been made in collaboration with other fields of scientists. A next-generation robotic surgery is required to equip new functions including tactile sensation system, a real-time navigation system and tele-operation system. Robotic surgery is believed to be one of the most promising and important fields of surgery in the near future.

Forecasting↗

PubMed2002

Robotically-assisted coronary artery surgery with and without cardiopulmonary bypass - from first clinical use to endoscopic operation.

BACKGROUND: Recently, the ZEUS(tm) Robotic Surgical System has been introduced to increase the precision of endoscopic cardiac surgery. This study investigated its clinical use for endoscopic coronary artery bypass grafting. MATERIAL/METHODS: Between 1998 and 2001, 41 patients with single and multivessel disease were operated on using the ZEUS(tm) system. The robotic system was introduced step by step into clinical practice. Initially, the system was used only for endoscopic internal mammary artery (IMA) harvest (n=12), later for coronary anastomoses on the arrested (n=13) or beating heart after median sternotomy (n=6), and finally for endoscopic coronary bypass grafting on either the arrested (n=2) or beating heart (n=8). RESULTS: Endoscopic IMA harvest ranged from 48 to 110 min and was completed in all cases. In the sternotomy group, the robotic anastomosis time averaged 21 min on the arrested and 25 min on the beating heart, respectively (n.s.). In the endoscopic cases, the average time for endoscopic anastomosis was 41 min on the arrested and 36.5 min on the beating heart (n.s.), with an overall duration of surgery between 4.0 and 8.0 hours. One endoscopic case was intraoperatively converted to a MIDCAB procedure with manual anastomosis. The total patency rate of all graft anastomoses, confirmed by early postoperative angiographic control, was 97%. One patient underwent reoperation with an uneventful postoperative course. CONCLUSIONS: The present study demonstrates the feasibility of endoscopic coronary revascularization using a computer-assisted surgical robotic system on the arrested and beating heart in selected patients.

Adult↗

PubMed2002

Totally endoscopic atrial septal defect closure with a robotic system: experience with seven cases.

BACKGROUND: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. The introduction of the robotic systems can further reduce the surgical trauma and improve the surgical dexterity. We report seven cases of complete closed chest atrial septal defect closure using the "da Vinci" Surgical System (Intuitive Surgical, Mountain View, CA). METHODS: Following peripheral cannulation for cardiopulmonary bypass (CPB), aortic occlusion and cardioplegia delivery, five patients with atrial septal defect (ASD) and two patients with patent forame ovale (PFO) with atrial septal aneurysm (ASA) were successfully treated using the robotic system. Two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax and an accessory port was placed for blood suction and ancillary instruments insertion. The defect closure was carried out with interrupted stitches in one patient and with a continuous suture in the others. RESULTS: Mean cardiopulmonary bypass and cross clamp time were 101.8 +/- 39.6 and 63.4 +/- 21.9 minutes respectively. Extubation was carried out within the seventh postoperative hour. All patients returned to normal lifestyle in one week. CONCLUSION: Complete closed chest ASD closure can be carried out using robotic technique with rapid postoperative recovery and excellent cosmetic result.

Adult↗

PubMed2002

Totally endoscopic atrial septal defect repair with robotic assistance.

BACKGROUND: The development of minimally invasive cardiac surgery has been characterized by the performance of increasingly complex operations through progressively smaller incisions. Computer (robotic) enhancement has emerged as a potential facilitator of these procedures, initially by providing enhanced endoscopic camera control and, more recently, by allowing the manipulation of surgical instruments through limited thoracic incisions. This report describes the next step in this progression, namely the performance of an atrial septal defect (ASD) repair entirely through thoracoscopic port incisions. This represents the first U.S. application of robotic technology for totally endoscopic open-heart surgery. MATERIALS AND METHODS: A 33-year-old woman with a secundum atrial septal defect underwent totally endoscopic repair through four port incisions by means of the Da Vinci (Intuitive Surgical, Mountain View, CA) robotic surgical system. Cardiopulmonary bypass was achieved peripherally (femoral Estech endoaortic balloon cannula; femoral and right internal jugular venous Bio-medicus cannulae). The myocardium was protected with antegrade cold blood cardioplegia delivered through the distal port of the arterial cannula. After port insertion, the entire operation, including pericardiotomy, bicaval occlusion, atriotomy, atrial septopexy, and atrial closure, was performed by computer-aided control of a camera and two instrument arms manipulated by a surgeon seated 15 feet away. The fourth port was used for suction and suture passage by the patient-side assistant. The aortic cross-clamp time was 43 minutes, and the postoperative transesophageal echocardiogram demonstrated normal ventricular function and the absence of interatrial shunting. The patient was extubated on the night of surgery, was ambulatory within 15 hours, and was discharged on the morning of postoperative day 3, 63 hours after the procedure. At 30-day follow-up, the patient was well and without complaints, and transthoracic echocardiogram confirmed the continued absence of interatrial shunting. CONCLUSIONS: Computer-aided robotic surgical technology can be used to perform open-heart procedures with a totally endoscopic approach. The benefits of this approach may include decreased perioperative pain, decreased recovery times, and improved cosmesis and patient acceptance. Clinical trials currently in progress will demonstrate whether this technology will be of reproducible value in the management of patients with intracardiac disease on a larger scale.

Adult↗

PubMed2003

Robot-aided sensorimotor training in stroke rehabilitation.

The first groups to use robotic devices to enhance the sensorimotor experience of patients recovering from upper limb paralysis after stroke have generated encouraging information. Patient acceptance and staff enthusiasm for robot training at Burke--MIT is consistently high. Robot training data are consistent with other controlled studies showing that more activity leads to more motor improvement and decreased impairment. Therapists equipped with a robotic device can increase the amount and intensity of movement of the paralyzed limb without sacrificing time spent training complex functionally appropriate kinematics.

Arm↗

PubMed2003

A porcine beating heart model for robotic coronary artery surgery.

BACKGROUND: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis. METHODS: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test. RESULTS: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049). CONCLUSIONS: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

Animals↗

PubMed2003

[A robot measurement system for spacesuit joint torque].

OBJECTIVE: To measure the joint torque of spacesuit so as to evaluate its dynamic force/torque performance. METHOD: A method for measuring the spacesuit joint torque by use of robot technology was proposed in this paper. The design of the measuring strategy and measuring robot was put forward and a mathematical model of the system was given. Then the working space of the robot was analyzed. RESULT: The robot designed is light, compact, easy to operate, and has a large working space. Experimental results demonstrated the effectiveness of the measuring principle and the reliability of the measuring system. CONCLUSION: The system can satisfy the requirements of the spacesuit joint torque measurement.

Biomechanical Phenomena↗

PubMed2003

Thoracoscopic lobectomy using robotic technology.

BACKGROUND: While robotic technology is gaining popularity in cardiac surgery, it also is being used to facilitate thoracoscopic procedures, such as insertion of phrenic pacemakers and resection of mediastinal masses. This report describes the use of robotic technology in performing thoracoscopic lobectomy. METHODS: One patient underwent a left lower lobectomy with the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA, USA). With 3 1-cm port incisions and a 4-cm minithoracotomy in the left chest, visualization of the pertinent anatomy was excellent. Standard lymph node dissection was performed. The specimen was removed through the 4-cm minithoracotomy incision. RESULTS: Pathologic examination revealed mucinous adenocarcinoma. The margins of the specimen were negative, and there was no vascular or bronchial invasion. The patient's postoperative course was uneventful, and he was discharged to home on postoperative day 5. CONCLUSION: Robotic technology enhances visualization and instrument dexterity during thoracoscopic intrathoracic procedures. This technology can be used to facilitate development of minimally invasive thoracic approaches.

Adenocarcinoma, Mucinous↗