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PubMedDate not supplied

Robotics and computer-assisted orthopaedic surgery.

These are just a few representative applications of the synergistic use of computer and robotic technology assisting the orthopaedic surgeon. While the individual systems are certain to change over time, the basic principles of correlating radiographic and anatomic data through a registration process, and displaying additional instrument or implant information through smart tools and surgical navigation are certain to become an increasingly important aspect of joint arthroplasty, deformity correction, and spinal and trauma surgery. Only the orthopaedic surgeon who clearly understands the goals, applications, and limitations of these systems can decide which are appropriate for his patients, his hospital, and his practice. Determining the cost and time benefits, both before and after an obligatory "learning curve" requires a complex interaction of capital investments, time savings, and outcome research on both safety and efficacy issues. The orthopaedist who understands and applies these technologies will help his patients to achieve the best possible care. Excellent resources in the literature on this topic include the September, 1998, issue of Clinical Orthopaedics and Related Research, a symposium on "Computer-Assisted Orthopaedic Surgery: Medical Robots and Image Guided Surgery"; Guest editor, Anthony M. DiGioia, III, MD. Also, the January, 2000, issue of Operative Techniques in Orthopaedics, "Medical Robotics and Computer-Assisted Orthopaedic Surgery. Guest editors: Anthony M. DiGioia, III, M.D. and Branislav Jaramaz, Ph.D. Additional Internet based information is available from the Journal of Computer Aided Surgery (formerly: Journal of Image Guided Surgery), at http://journals.wiley.com/.

Arthroplasty, Replacement, Hip↗

PubMed2002

Evaluation of acute traumatic changes of the coronary artery wall after robotically assisted endoscopic coronary artery bypass grafting.

BACKGROUND: There is concern that the technical limitations of robotic systems used in endoscopic coronary artery bypass grafting (CABG) may lead to increased trauma of the anastomotic site. To examine this issue, we compared the acute traumatic changes of the coronary artery wall caused by conventional manual suturing and robotically assisted suturing for anastomoses using the ZEUS telemanipulator (Computer Motion Inc., Goleta, CA) in a laboratory setting. METHODS: Coronary artery bypass grafting was performed on isolated porcine hearts. Fifteen anastomoses (with harvested porcine right coronary artery (RCA) segments) were carried out using the ZEUS microsurgical telemanipulator (group Z), while 15 further anastomoses were performed with a conventional manual technique (group M) using Gore-Tex CV-8 suture material. Specimens were taken from each anastomotic site and from native parts of the left anterior descending artery (LAD) (control group). Morphological changes of the cellular and fibrous components of the lamina intima and lamina media, and the shape and maximum diameter of the puncture mark, were examined by light microscopy (LM), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Vascular endothelial damage and denudation were graded on a score from 1 to 5. RESULTS: In each group, 14 specimens were evaluated. SEM findings showed a significantly higher degree of endothelial denudation in group Z and group M compared to the control group, while group Z was significantly more affected than group M. Likewise, the maximum diameter of the puncture mark was significantly larger in group Z than in group M. TEM and LM studies supported these results. In addition, LM revealed that in five specimens of group Z the shape of the stitch through the artery wall was not cylindrical, as in the other cases, but was asymmetrical and displayed a superficial furrow on the side of the vascular lumen. CONCLUSION: The results indicate that there is an increased incidence of damage to the coronary artery wall caused by the microsurgical telemanipulator. Further studies are necessary to determine whether the differences between conventional and robotic-assisted suturing techniques will have an effect on the long-term outcome of coronary artery bypass grafting.

Anastomosis, Surgical↗

PubMed2002

[Robot-assisted (Da Vinci) laparoscopic uretero-pelvic junction repair. Results of experimental surgery in a series of 14 pigs].

OBJECTIVE: Experimental feasibility of repair of the ureteropelvic junction syndrome by robot. MATERIAL AND METHODS: 14 procedures were performed in 14 pigs by a laparoscopic technique using the Da Vinci robot in the experimental surgery laboratory. RESULTS: This robot provides real 3D vision by means of articulated intracorporeal instruments controlled from a console. It can be used to perform laparoscopic procedures almost as easily as open surgery. Operators with no previous experience of laparoscopic surgery were able to rapidly perform relatively complex procedures. CONCLUSION: This technique should allow a reduction of the learning curve and should facilitate operations that are difficult to perform by conventional laparoscopic surgery, especially when reconstruction is necessary, with decreased fatigue for the surgeon.

Humans↗

PubMed2003

Robotic atrial septal defect repair and endoscopic treatment of atrial fibrillation.

Computer (robotic) enhancement has 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 use of the da Vinci surgical system in two totally endoscopic ("closed chest") cardiac operations: atrial septal defect closure and pulmonary vein isolation of atrial fibrillation. ASD closure: Fifteen patients underwent repair of a secundum-type atrial septal defect or patent foramen ovale 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 endoballoon inflation. Via three port incisions in the right chest, the entire operation including pericardiotomy; bicaval occlusion; atriotomy; atrial septopexy; and atrial closure was 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. In one case, a recurrent shunt was identified and repaired on POD 5. Median ICU length of stay (LOS) was 20 hours, and median hospital LOS was 4 days. Atrial fibrillation surgery: This report also describes the pathway that we have pursued in the development of a totally endoscopic operation for atrial fibrillation. Beginning with animal models, we tested various ablative energy sources; methods of ablation; and minimally invasive approaches. This work has led to the development of a variety of minimally invasive surgical approaches including a totally endoscopic, robotically assisted beating heart procedure for the treatment of atrial fibrillation.

Atrial Fibrillation↗

PubMed2003

A single bicaval venous cannula used for optimization of endoscopic robotically assisted procedures of the heart.

Robotically assisted heart operation is one of the minimally invasive approaches that have revolutionized many surgical procedures. Robotic procedures on the heart, however, are by no means routine, and their optimization requires development of new instruments and techniques. Described here is the robotically assisted use in a sheep model of a new peripherally inserted bicaval venous cannula in the totally endoscopic closure of atrial septal defect. The exposure of the surgical target area was successful with no obstructions in the surgical view. The cannula shows sufficient flow characteristics for cardiopulmonary bypass. Subsequent suturing of the atrial septum defect was achieved without complications in the 4 experimental animals.

Animals↗

PubMed2003

Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach.

PURPOSE: For optimal biventricular pacing, the left ventricular (LV) lead has been found to be best placed in the area where optimal concordance is achieved between the LV pacing site and the site of the most delayed LV wall. For anatomical or technical reasons, the placement of the LV lead via the coronary sinus at the intended target area of the LV is often not possible. An option for avoiding these drawbacks is the surgical implantation of the LV lead under direct vision. This report describes 3 epicardial lead implantation techniques that are less invasive. METHODS: In 80 patients with advanced heart failure and left bundle branch block, epicardial LV leads for biventricular pacing were implanted with 3 different methods: (1) left lateral mini-thoracotomy; (2) a video-assisted thoracoscopy approach using lead implantation tools; and (3) a robotically enhanced telemanipulation system. Video films are provided for all 3 techniques in The Heart Surgery Forum online. RESULTS: Independent of the surgical techniques, the intended lead location on the LV was achieved in all patients. Acute and 3-month LV lead thresholds were satisfactory in 79 patients (99%). Two lead displacements were observed. One thoracotomy was carried out after thoracoscopic lead placement because the patient developed an early exit block. Five patients who underwent an operation with the robot needed a conversion to thoracotomy because of technical failure of the robot (2 patients) or massive pleural adhesions (3 patients). There were no severe adverse events related to any technique. Three patients died in the hospital from the progression of end-stage heart failure. CONCLUSION: Epicardial lead implantation for biventricular pacing is feasible with all 3 surgical techniques. Each method allows optimal lead implantation under direct vision and therefore reduces the incidence of nonresponders resulting from suboptimal lead placement.

Aged↗

PubMedDate not supplied

Accuracy of a robotic system for the reproduction of condylar movements: a preliminary report.

OBJECTIVE: Methods in restorative dentistry have to meet stringent accuracy requirements. The accuracy of robotic systems used for the reproduction of condylar movements has not been determined. The purpose of this study was to assess the accuracy of the robot system, ROSY, a robotlike electronic simulator (developed by the author) that reproduces condylar movements previously recorded on a patient. METHOD AND MATERIALS: The simulator consists of a custom-designed ultrasonic system that records mandibular movements in all three dimensions (vertical, horizontal, and coronal) with six degrees of freedom. The simulator automatically reproduces all movements around these axes with a robotic system with six stepper motors. The accuracy of the simulator was measured for all directions in space by registering eccentric jaw positions on both sides of 10 subjects in two ways: (1) by the ultrasound registration system; and (2) simultaneously with an interocclusal recording medium. The standard deviation and interquartile range of the differences between the measurements based on these two approaches were used to statistically describe the accuracy of ROSY. RESULTS: The accuracy of the entire system was better than 0.28 mm. CONCLUSION: The electronic simulator comes with an accuracy that may render it suitable for clinical applications.

Computer Simulation↗

PubMed2004

Robot-assisted sutureless minimally invasive mitral valve repair.

Our institution has performed over 100 robot-assisted mitral valve repairs. The procedure has shown many advantages to conventional sternotomy-based repair. However, the robotic approach leads to longer cross-clamp and bypass times than conventional sternotomy. As a result of the increased risk of myocardial damage and arrhythmias from lengthy arrest times, nitinol U-clips have been used in the laboratory and currently in patients for the tissue-annuloplasty ring approximation. The technology replaces the time-consuming task of knot tying, as well as provides better visualization during placement of the annuloplasty ring. The animal studies show excellent tissue incorporation. Short-term echocardiographic imaging shows durability without evidence of mitral stenosis or regurgitation. Further studies are ongoing in our patient population, and the data suggest shorter, more efficient and effective robot-assisted mitral valve repairs.

Cardiac Surgical Procedures↗

PubMed2004

[Use of the Zeus robotic surgical system for cardiac surgery].

The development of closed chest cardiopulmonary bypass systems has opened the door for totally endoscopic cardiac surgery. We used the robotic surgical system ZEUS for closure of the atrial septal defect (ASD) in three patients. Under one-lung ventilation, Port-Access cardiopulmonary bypass system of the drainage from the right internal jugular vein and the the right femoral vein and the return to the right femoral artery was started after port placement at the forth intercostal space of the right thoracic wall. ASD direct closure was achieved by using robotic surgical system ZEUS under cardiac arrest. The three patients were discharged in 7 days after the operation uneventfully. The robotic surgical system ZEUS can make cardiac surgeries less invasive than ever.

Cardiac Surgical Procedures↗

PubMed2005

Development of a navigation function for an endosocopic robot surgery system.

An endoscopic robot system that we reported at MMVR11 is able to perform various surgical procedures in the stomach by using two manipulators. However, it is difficult for surgeons to recognize the 3D location and the direction of the endoscope's tip in the abdominal region during robotic surgery. In this research, we have developed a navigation function that enables image-guided surgery by superimposing the patient's abdominal organ structure onto the endoscopic image. In this paper, we describe the overview of the navigation for the robot system and the result of an animal experiment done while applying the system.

Endoscopy↗

PubMedDate not supplied

Robotically enhanced coronary artery bypass surgery.

BACKGROUND: Robotically enhanced telemanipulation surgery is a fast developing technique which allows totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart as well as arrested heart. METHODS AND RESULTS: Between December 2002 and February 2004, 125 patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system (Intuitive Surgical Inc., California). Eleven patients underwent totally endoscopic coronary artery bypass surgery. Of them 9 were done on beating heart while 2 were done on arrested heart. One hundred and fourteen patients had endoscopic takedown of internal mammary artery followed by minimally invasive direct coronary artery bypass in 63 patients and left anterolateral thoracotomy in 51 patients. The internal mammary artery mobilization time was 42 min (35-74 min) while the left internal mammary artery to left anterior descending artery anastomosis time ranged from 20 to 36 min for the totally endoscopic coronary artery bypass patients. In 1 patient, the right internal mammary artery was anastomosed to diagonal artery totally endoscopically. The mean internal mammary artery flow by Doppler measurement done in patients undergoing minimally invasive direct coronary artery bypass was 64 ml/min. Seven patients required conversion to median sternotomy and coronary bypass surgery on beating heart. The mean intensive care unit stay was 1.2 days and the mean hospital stay 4.5 days. There was 1 in-hospital mortality. All 11 patients who underwent totally endoscopic bypass surgery had coronary angiography done at 3 months interval which showed 100% patency in 10 patients while one patient had 50% anastomotic narrowing for which coronary angioplasty was done in the same sitting. CONCLUSIONS: Using telematic technology, a complete endoscopic anastomosis is possible in both single vessel and suitable double vessel disease patients. The use of robotics is now extended to achieve complete myocardial revascularization by harvesting both the internal mammary arteries and making a small thoracotomy for direct anastomosis as well.

Adult↗

PubMed2005

[Laparoscopic cholecystectomy with remote zeus surgical robotic system: report of 16 cases].

OBJECTIVE: To explore the methodology and operative essentials of laparoscopic cholecystectomy with remote Zeus surgical robotic system. METHODS: Based on strict training and successful experiment in animal model of swine, laparoscopic cholecystectomy using Zeus robotic system was performed on 16 patients with biliary diseases, including choledocholithiasis, cholelithiasis, polyposis of gallbladder, and chronic cholecystitis, 10 males and 16 females, aged 33 (14 approximately 27), 26 April to 31 August 2004. The general data, preoperative preparation time, operation time, amount of bleeding, complications, and hospitalization time were analyzed. RESULTS: All operations were performed without event. Along with the accumulation of experience the preoperative preparation time was shortened from 90 min to 30 min with an average of 41.7 min, and the operation time from 120 min to 30 min with an average of 64.4 min. The average amount of bleeding was 27.7 ml, and the average postoperative hospitalization time was 2.4 d. A telephone follow-up 30 days after operation showed no abnormality. CONCLUSION: Laparoscopic cholecystectomy with Zeus surgical robotic system is feasible and reliable with the advantages of clearer images in the field of operation, more precise handling, and remote surgery or education.

Adolescent↗

PubMed2005

Improving efficiency of a small forensic DNA laboratory: validation of robotic assays and evaluation of microcapillary array device.

AIM: To present validation studies performed for the implementation of existing and new technologies to increase the efficiency in the forensic DNA Section of the Palm Beach County Sheriff's Office (PBSO) Crime Laboratory. METHODS: Using federally funded grants, internal support, and an external Process Mapping Team, the PBSO collaborated with forensic vendors, universities, and other forensic laboratories to enhance DNA testing procedures, including validation of the DNA IQ magnetic bead extraction system, robotic DNA extraction using the BioMek2000, the ABI7000 Sequence Detection System, and is currently evaluating a micro Capillary Array Electrophoresis device. RESULTS: The PBSO successfully validated and implemented both manual and automated Promega DNA IQ magnetic bead extractions system, which have increased DNA profile results from samples with low DNA template concentrations. The Beckman BioMek2000 DNA robotic workstation has been validated for blood, tissue, bone, hair, epithelial cells (touch evidence), and mixed stains such as semen. There has been a dramatic increase in the number of samples tested per case since implementation of the robotic extraction protocols. The validation of the ABI7000 real-time quantitative polymerase chain reaction (qPCR) technology and the single multiplex short tandem repeat (STR) PowerPlex16 BIO amplification system has provided both a time and a financial benefit. In addition, the qPCR system allows more accurate DNA concentration data and the PowerPlex 16 BIO multiplex generates DNA profiles data in half the time when compared to PowerPlex1.1 and PowerPlex2.1 STR systems. The PBSO's future efficiency requirements are being addressed through collaboration with the University of California at Berkeley and the Virginia Division of Forensic Science to validate microcapillary array electrophoresis instrumentation. Initial data demonstrated the electrophoresis of 96 samples in less than twenty minutes. CONCLUSION: The PBSO demonstrated, through the validation of more efficient extraction and quantification technology, an increase in the number of evidence samples tested using robotic/DNA IQ magnetic bead DNA extraction, a decrease in the number of negative samples amplified due to qPCR and implementation of a single multiplex amplification system. In addition, initial studies show the microcapillary array electrophoresis device (microCAE) evaluation results provide greater sensitivity and faster STR analysis output than current platforms.

California↗

PubMed2005

[Robot-assisted surgery].

Computer-enhanced surgical systems are becoming common worldwide. Currently, 331 da Vinci surgical systems have been installed. Robotic surgery was successfully performed on more than 20,000 patients in 2004. Intuitive Surgical has received FDA clearance for laparoscopic and thoracoscopic procedures, including hysterectomy or prostatectomy, as well as cardiac revascularization. The Japanese "Future Project" team has developed a prototype of a smaller surgical robotic system and successfully performed telesurgery on animals between Tokyo and Fujinomiya on August 8, 2002, and between Fukuoka and Seoul on March 2, 2005. Robotic surgery will lead to dramatic progress in medicine with the development of surgical navigation systems, simulation systems, and telementoring systems.

General Surgery↗

PubMed2006

Real-time augmented feedback benefits robotic laparoscopic training.

Robotic laparoscopic surgery has revolutionized minimally invasive surgery for treatment of abdominal pathologies. However, current training techniques rely on subjective evaluation. There is a lack of research on the type of tasks that should be used for training. Robotic surgical systems also do not currently have the ability to provide feedback to the surgeon regarding success of performing tasks. We trained medical students on three laparoscopic tasks and provided real-time feedback of performance during training. We found that real-time feedback can benefit training if the feedback provides information that is not available through other means (grip force). Subjects that received grip force feedback applied less force when the feedback was removed. Other forms of feedback (speed and relative phase) did not aid or impede training. Secondly, a relatively short training period (10 trials for each task) significantly improved most objective measures of performance. We also showed that robotic surgical performance can be quantitatively measured and evaluated. Providing grip force feedback can make the surgeon more aware of the forces being applied to delicate tissue during surgery.

Adult↗

PubMed2006

Integrating surgical robots into the next medical toolkit.

Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.

Robotics↗

PubMed2006

Planning and analyzing robotized TMS using virtual reality.

Transcranial Magnetic Stimulation (TMS) is a powerful method to examine the brain and non-invasively treat disorders of the central nervous system. Magnetic stimulation of the motor cortex results in the activation of corresponding muscle groups. Hereby, accurate placement of the TMS coil to the patient's head is crucial to successful stimulation. We developed a way to position the TMS coil using a robot and navigate it in virtual reality based on an online registration of the cranium relative to 3D magnetic resonance imaging data. By tracking the head and robotic motion compensation, fixation of the patient's head becomes obsolete. Furthermore, a novel method for motor cortex mapping is presented. The robotized TMS system is used to obtain the characteristic field of a TMS coil. This field is registered to the field of motor evoked potential measurements at the patient's head to yield a prediction of the motoric center of a target muscle.

Brain Mapping↗

PubMed2005

[Robotic surgery: toy or tool?].

Telemanipulation has been developed for industrial purposes since the 1970s. More recently, telemanipulated arms entered the operating room. This paper briefly describes the history of surgical robotics and discusses the advantages and disadvantages for both patients and surgeons. The authors advocate the development of robotic surgery, as it facilitates the training of young surgeons and can be useful during certain phases of an operation. Thus, robotic surgery is more a promising tool than a simple toy.

Humans↗