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At least 739 records · Page 41Linked to original sources

PubMed2004

Image-guided robotic surgery.

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.

Humans↗

PubMed2004

First Italian robot-enhanced coronary bypass.

This case report presents the first totally endoscopic coronary artery bypass performed with a robotic system in Italy at the Department of Cardiovascular Surgery of Padua University in December 2001. A 66-year-old male, with an indication to a single bypass of the left anterior descending coronary artery using the left mammary artery, was considered eligible for a robot-assisted myocardial revascularization using the da Vinci robotic system. The left internal mammary artery takedown was performed through three 1 cm ports on the thoracic wall. The "end-to-side" anastomosis between the mammary artery and the target coronary artery was totally performed endoscopically on a beating heart by means of a stabilizing device introduced through an additional subxiphoid port. Angiographic follow-up at 1 year showed patency of the graft. Since September 2001, robot-enhanced left mammary artery harvesting has been performed in another 18 patients without complications.

Aged↗

PubMed2003

Development of an endoscopic robotic system with two hands for various gastric tube surgeries.

This paper presents the first report on an endoscopic robot with two manipulators which performed surgical work to resect the mucosal layer of the stomach of pigs without penetrating the body surface. We designed and developed an endoscopic surgical robot system which possesses two arm shaped manipulators for various kinds of surgery in the gastric tubes. The distal part of the manipulator functions as forceps and they are able to hold and handle soft tissues through the cooperative efforts of the right and left arms. And it is also able to incise the gastric wall by holding an electronic scalpel (brought in from the instrument channel) with the manipulator on the right side while opening the sectioning plane on the left side which was take out. With this system we succeeded in the mucosal resection of a large portion of the stomach wall of a pig during experimental surgery. It can be said that this is a new approach robotic surgery in the gastric tube with this kind of surgical robot.

Animals↗

PubMed2004

Automated kinematic generator for surgical robotic systems.

Unlike traditional assembly line robotic systems that have a fixed kinematic structure associated with a single tool for a structured task, next-generation robotic surgical assist systems will be required to use an array of end-effector tools. Once a robot is connected with a tool, the kinematic equations of motion are altered. Given the need to accommodate evolving surgical challenges and to alleviate the restrictions imposed by the confined minimally invasive environment, new surgical tools may resemble small flexible snakes rather than rigid, cable driven instruments. Connecting to these developing articulated tools will significantly alter the overall kinematic structure of a robotic system. In this paper we present a technique for real-time automated generation and evaluation of manipulator kinematic equations that exhibits the combined advantages of existing methods-speed and flexibility to kinematic change--without their disadvantages.

Biomechanical Phenomena↗

PubMed2005

Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury.

BACKGROUND AND PURPOSE: Performance of therapist-assisted, body-weight-supported treadmill training (BWSTT) to enhance walking ability of people with neurological injury is an area of intense research. Its application in the clinical setting, however, is limited by the personnel and labor requirements placed on physical therapists. Recent development of motorized ("robotic") rehabilitative devices that provide assistance during stepping may improve delivery of BWSTT. CASE DESCRIPTION: This case report describes the use of a robotic device to enhance motor recovery and ambulation in 3 people following motor incomplete spinal cord injury. INTERVENTIONS: Changes in motor impairment, functional limitations, and locomotor disability were monitored weekly during robotic-assisted BWSTT and following transition to therapist-assisted BWSTT with the assistance of one therapist. OUTCOMES: Following this training, 2 patients recovered independent over-ground walking and another improved his gait speed and endurance. DISCUSSION: The use of robotic devices may assist physical therapists by providing task-specific practice of stepping in people following neurological injury.

Adolescent↗

PubMed2004

Robotic prostatectomy - a review.

OBJECTIVE: To review the current medical literature on robotic prostatectomy (RP) and report clinical outcomes of this newly developed technique. DATA SOURCE: A MEDLINE search was performed using the following headings: prostate cancer, radical prostatectomy, robotics, robot assisted, laparoscopy, telesurgery. In addition, recently published abstracts on RP were reviewed. STUDY SELECTION: Studies that reported clinical and pathological variables of patients undergoing RP were included in this meta-analysis. DATA EXTRACTION: Data were extracted from published articles and abstracts. DATA SYNTHESIS: Robotic systems enhance surgeons' technical abilities and offer the potential of precise surgical technique. Short-term follow-up studies demonstrate that RP is at least comparable in efficacy to open and laparoscopic prostatectomy, including clinical and pathologic parameters. RP has benefits of minimal invasiveness, decreased blood loss, and quicker recovery compared with open surgery. Functional and cancer control results are still immature, but most studies reported favorable outcomes. CONCLUSIONS: RP is a promising minimally invasive surgical approach for men with prostate cancer. Short-term clinical and pathological results are comparable to those with open and laparoscopic prostatectomy.

Humans↗

PubMedDate not supplied

Robotic systems and surgical education.

This experimental study aimed at evaluating the efficiency of robots in the learning of surgical techniques. We recruited 40 surgeons, divided them into 2 groups of 20, each of which used the robotic system. The first group consisted of experienced physicians, and the second group comprised physicians in training. Each surgeon was allowed to use the da Vinci robotic system for 30 minutes twice in the span of 24 hours. The practice time period was divided into 15 minutes for tying and placement of sutures and 15 minutes for incisions and vascular suturing. We recorded the times required for the performances, and a statistically significant outcome was obtained. With variance analysis (ANOVA), it has been shown that the time needed to perform the exercises depends in a statistically significant way on the kind of test to be performed (P<0.01), the experience of the surgeon (P<0.001), and the kind of operation (P<0.025). Robotic systems can be an optimal tool both for residents and experienced surgeons, for learning of basic surgical tasks and for perfection of clinical skills. The use of the system has great potential in surgical training, offering a reduction in the learning period, enabling checking for errors, and allowing an evaluation of the capabilities obtained. Final goals are a drastic reduction in the learning curve, a better technique, with a significant reduction in surgical errors and complications, with greater safety for the patient.

Educational Measurement↗

PubMedDate not supplied

Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies.

OBJECTIVE: To evaluate the feasibility of integrating robot-assisted technology in the performance of laparoscopic staging of gynecologic malignancies. METHODS: Seven patients underwent robot-assisted laparoscopic staging procedures for gynecologic cancers. Data were collected and analyzed as a retrospective case series analysis. RESULTS: We attempted 7 robot-assisted laparoscopic staging procedures with no conversions to laparotomy. The median lymph node count for lymphadenectomy was 15 (range, 4 to 29). Mean operating time was 257 minutes (range, 174 to 345). The average estimated blood loss was 50 mL. One patient developed sinusitis and required intravenous antibiotics. The median hospital stay was 2 days. CONCLUSION: Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.

Adult↗

PubMed2002

[A novel miniature robotic endoscope design for intestinal inspection].

This paper makes a comparison between the traditional endoscope system and the active robotic endoscope system, discusses the human intestine-working conditions of the robotic endoscope system in detail and its design requirements. An active robotic endoscope system based on earthworn-locomotion principles is proposed here and besides, its structure and locomotion mechanism are analyzed. A new method of human intestinal intervention is brought out and it can prevent the robotic endoscope guided by a cone-shaped guide pipe from being jammed or damaged.

Biomimetics↗

PubMedDate not supplied

The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac.

OBJECTIVE: The scarred or obliterated anterior cul-de-sac may pose a challenge to hysterectomy by any route. Conventional laparoscopic hysterectomy is fraught with technical limitations that limit the ability to compensate for the altered anatomy. This study will evaluate the feasibility of applying robot-assisted laparoscopy to managing these patients. METHODS: Six patients with suspected pelvic adhesive disease involving the anterior cul-de-sac underwent robot-assisted laparoscopic hysterectomy for benign indications. Data were collected and analyzed as a retrospective case series analysis. RESULTS: We attempted 6 robot-assisted laparoscopic hysterectomies with no conversions to laparotomy. The mean uterine weight was 121.7 g (range, 70 to 166.3). Mean operating time was 254 minutes (range, 170 to 368). The average estimated blood loss was 87.5 mL. One patient developed a delayed vaginal cuff hematoma. The average length of hospital stay was 1.3 days. CONCLUSION: Robot-assisted laparoscopic hysterectomy is a feasible technique in patients with a scarred or obliterated anterior cul-de-sac and may provide a tool to overcome the surgical limitations seen with conventional laparoscopy.

Adult↗

PubMed2005

Robotics in colorectal surgery.

A minimally invasive approach has not yet become the gold standard in colorectal procedures, despite its proven advantages in postoperative recovery. This is in part the result of the technical limitations in today's standard laparoscopy, and the advanced surgical skills that are required. Robotic technology overcomes some of these limitations by successfully providing intuitive motion and enhanced precision and accuracy, in an environment that is much more ergonomic. While currently performed in only few designated centers, this technology has already been applied in almost every major procedure performed to treat both benign and malignant conditions of the large bowel. The feasibility of performing these procedures using robotic systems has been reported in several series. Conversion and complication rates are low, and short term results are comparable to conventional laparoscopy. However, no clear advantages to patients have been demonstrated yet. Furthermore, robotic technology is associated with a significant increase in time consumed during surgery and cost of care. Nevertheless, a great potential for patients benefit in the future may exist with this technology. Increasing clinical experience with these systems, further technological developments, and continuous research are required before robotic technology can be routinely incorporated into surgical procedures on the colon and rectum.

Animals↗

PubMed2006

Internal thoracic artery to left anterior descending anastomosis performed on the beating heart by endoscopic robot assistance using a new distal connector.

BACKGROUND: Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. METHODS: Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. RESULTS: The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from the analysis. The total device deployment time was 2 minutes 4 seconds (SD 50 s) in 4 of 6 survivors, which remained hemodynamically stable and in sinus rhythm until euthanasia. Coronary angiography and transonic flow measurements were used to verify patency. CONCLUSION: The JoMed distal graft connector may facilitate the use of robot-assisted endoscopic bypass on a beating heart. Long-term patency issues will need to be assessed.

Animals↗

PubMed2006

[Effects of medical robot-assisted surgical navigation system in distal locking of femoral intramedullary nails: an experimental study].

OBJECTIVE: To investigate the effects of medical robot-assisted surgical navigation system based on fluoroscopic images in distal locking of femoral intramedullary nails. METHODS: Using a robot-assisted computer-guided system designed based on modularization and minimization that permitted C-arm alignment assistance and real-time navigation control, provided constant feedback without the need for radiologic updates, thus avoiding constant X-ray exposure. The C-arm was used to collect the orthotopic and lateral X-ray images into the computer so as to calculate the locations of the target points. Nails were locked into 5 plastic femurs (Swiss Sybone, 35 holes), 2 dry human femoral specimens (12 holes), and one leg of fresh human cadaver (6 holes). Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded. RESULTS: All distal holes were locked successfully. In 6 (11.1%) of the 53 holes the drill bit touched the canal of the locking hole, albeit with no damage to the nail. The fluoroscopy time of per screw was 1.83 +/- 0.31 seconds. CONCLUSION: The medical robot-assisted surgical navigation system enables the physicians to precisely navigate surgical instruments throughout the procedure using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional X-ray exposure is not required for tool navigation. The idea of a robot-assisted surgical navigation system is practicable.

Bone Nails↗

PubMedDate not supplied

[Robotic surgery: considerations after 250 procedures].

The aim of this study was to investigate the results of the first 250 procedures performed on 216 patients with the da Vinci Robotic Surgical System (34/216 patients were submitted to double procedure). The purpose of the da Vinci surgical system is to exactly translate the surgeon's hand movements to the robotic arms that manipulate the laparoscopic instruments, thus facilitating minimally invasive surgery. The da Vinci system has been available in our department since 2001. The first 50 procedures were simple cases (cholecystectomies and transperitoneal hernia repairs) and were performed during the learning curve of the surgical team. The last 200 procedures were more complex cases. Time of preparation of the robot gradually decreased with growing experience. The total conversion rate (to standard laparoscopy and to open surgery) was 4.8% (12/250); conversion to laparotomy was 2.8% (7/250). Morbidity was 8.8% (19/216), and reoperation was needed in 6 patients. Mortality was 1.8% (4/216). We conclude that robotic surgery has now moved beyond the learning phase with the device and may be routinely used in selected, more complex cases, such as colorectal surgery and surgery of the gastro-oesophageal junction. The device can also be used in pancreatic and gastric surgery.

Adult↗

PubMed2006

Computer-enhanced telemanipulation in mitral valve repair: preliminary experience in Canada with the da Vinci robotic system.

BACKGROUND: Investigation into the surgical application of robot technology continues to expand. We report on the first case series of robotic-assisted mitral valve (RAMV) repair in Canada with use of the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, Calif.). METHODS: Between February 2004 and August 2004, 10 patients with normal left ventricular function and severe mitral valve regurgitation underwent RAMV repair with use of the da Vinci system. Peripheral cardiopulmonary bypass, transthoracic aortic cross-clamping and antegrade cardioplegia were used in all cases. A minithoracotomy in the fourth intercostal space and 2 ports in the third and fifth intercostal spaces allowed surgical access. All mitral valve valvuloplasties and band annuloplasties were done endoscopically with robotic assistance. RESULTS: Nine of 10 patients had successful valve repair, and 1 had conversion to mitral valve replacement due to persistent regurgitation. There were no deaths, strokes or need for sternotomy. One patient required re-exploration for bleeding. CONCLUSION: Minimally invasive RAMV repair is feasible and safe with promising early postoperative results when performed by experienced surgical personnel accomplished in both mitral valve procedures and robotic techniques.

Adult↗

PubMed2006

[Robotically and video-assisted thoracoscopic interruption of patent ductus arteriosus].

Over the past decade, video-assisted thoracoscopic techniques have been used in the pediatric population. Recently, the computer-enhanced robotic system has been applied to video-assisted thoracoscopic interruption of patent ductus arteriosus (VATS-PDA). We focused on the utility of a voice-controlled robotic arm (automated endoscope system for optimal positioning: AESOP 3000) in VATS-PDA. Thirteen infants weighing 4.2 approximately 12.6 (mean 6.6) kg underwent robotically assisted VATS-PDA. Robotically assisted VATS-PDA is comparable with closure by means of the conventional video-assisted thoracoscopic technique.

Child, Preschool↗

PubMed2006

Robot-assisted radical prostatectomy in obese patients.

OBJECTIVES: Few centers perform extraperitoneal robot assisted radical prostatectomy. The average patient weight is increasing to the mildly obese. Little is known as to the difficulty-impact, obesity may have on robot-assisted extraperitoneal prostatectomy (RAP). We assess our own experience with obese patients undergoing RAP. MATERIALS AND METHODS: Information on 375 consecutive patients undergoing robot-assisted extraperitoneal prostatectomy by a single surgeon was gathered. Obesity is defined as having a body mass index (BMI) greater than 30 kg/m2. Patients with BMI >/= 30 were compared to those with BMI < 30. Specific comparators between the groups were: age, total operating time, estimated blood loss, total prostate specific antigen (PSA), specimen weight, pathological stage, grade and margin, complications, and functional outcomes. RESULTS: Sixty-seven men were identified as obese. When comparing the two groups, no statistically significant difference (p > .05) was noted in operative time (229 versus 217 min), blood loss (205 versus 175 ml), PSA, clinical and pathologic stages, specimen weight, and complications. 15% of non-obese patients had a positive margin compared to 12% of obese patients (p > .05). The 6-month continence rate in patients with a BMI >/= 30 was 92% versus 97% in patients with a BMI < 30. CONCLUSIONS: The extraperitoneal approach to performing a robot-assisted prostatectomy is not associated with increased morbidity in the obese patient. There were no statistically significant differences noted in oncological or functional outcomes between the two groups.

Adult↗

PubMed1991

Application of robotics and image processing to automated colony picking and arraying.

We describe a system that applies image processing and robotic techniques to automatically pick individual colonies from square petri dishes and array them in 96-well microtiter plates. Digital images of the colony distribution in the dishes are acquired using a video camera and frame buffer. Commercial image processing software is used to identify individual colonies and determine their locations. A Hewlett-Packard Microassay System robot reads the resulting coordinate file for each dish, picks cells from each identified colony and transfers the cells into a microtiter plate well. A disposable pipet tip is used as the sterile implement for colony picking. Custom holders position the dishes accurately and provide common coordinate systems for imaging and picking. The system is calibrated to account for the depth of agar in the dishes. The robot can process up to 10 dishes and 20 plates (1920 colonies) in a single run. It has successfully arrayed a cosmid library of the S. pombe genome consisting of approximately 6000 colonies in 30 petri dishes in about 40 hours of robot time. Future enhancements to the system are discussed.

Cells, Cultured↗