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PubMed2006

Care of the patient undergoing robotic-assisted laparoscopic pyeloplasty.

Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.

Academic Medical Centers↗

PubMed2006

Care of the patient undergoing robotic-assisted prostatectomy.

Prostate cancer has many treatment options. In addition to open retropubic and perineal approaches to radical prostatectomy, laparoscopic robotic prostatectomy is available as a newer surgical option. Potential advantages of robotic surgery include reduced pain and trauma, less blood loss, reduced infection risk, shorter hospital stay, faster recovery, and less scarring (Intuitive Surgical, 2005). A variety of nursing care considerations involving pre-operative education and preparation, intra-operative and immediate postoperative care issues, and long-term followup must be understood to meet the needs of a robotic surgical patient. Patient selection is very important to optimize a positive surgical outcome. Just as certain criteria make a good surgical candidate, there are factors that could complicate the surgery or adversely affect recovery.

Aftercare↗

PubMed2006

Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection--case report.

OBJECTIVE: The aim of this study was to describe the first robotic-assisted radical hysterectomy (Piver type III) and bilateral pelvic lymph node dissection for a patient with Stage Ib1 cervical carcinoma. CASE: A 43-year-old woman G1, P1, previously operated on due to endometriosis with removal of the left ovary and fallopian tube, came under our care. In addition, hysteroscopic myomectomy had been done two years before. Otherwise the patient was healthy. Preoperative conization histology revealed 6 mm of stromal infiltration. The patient was offered the da Vinci robotic Wertheim operation for the first time which was well accepted and she was discharged uneventfully on the 4th day postoperatively. Four months later at a routine check-up we found asymptomatic bilateral lymphocysts but otherwise normal status. CONCLUSION: It is fully possible to perform Piver type III laparoscopic radical hysterectomy using the da Vinci robotic system and it seems that radical dissection is much more precise than the conventional laparoscopic radical hysterectomy.

Adult↗

PubMed2006

[Manual and robotic laparoscopic liver resection. Two case-reviews].

INTRODUCTION: Laparoscopic resection of the liver, compared to other laparoscopic procedures of the abdominal cavity, have become used in a clinical practice only in recent years. No literature data on robotic liver resections are available. METHODS: The authors completed 2 laparoscopic resections of the liver. The first case included a 61-year old male indicated for the procedure with a low differenciated hepatocellular carcinoma lesion in SII and SIII segments, measuring 6 cm in a diameter, in a Child A cirrhotic remodellation terrain. In-line RFA-assisted and HandPort-assisted manual laparoscopic left-sided lobectomy was completed. Histological findings confirmed the diagnosis and the R0 resection. Robotic laparoscopic resection of the focal nodular hyperplasia (FNH) lesion, growing from SII and SIII segments and measuring 7x7x5 cm was completed in the other case of a 29-year old female patient. RESULTS AND CONCLUSION: Both patients healed without complications, the hospitalization lasted 8 and 7 days, respectively. HandPort-assisted manual laparoscopic resections of the left liver lobe appears a safe method. The patient may benefit from a smaller entrance into the abdominal cavity, compared with open abdominal procedures. Experience in liver and laparoscopic surgery is a prerequisite, which is also supported by literature data. A pilot study must be conducted in order to assess benefits of robotic laparoscopic liver resections.

Adult↗

PubMed1989

Clinical evaluation of a desktop robotic assistant.

A desktop vocational assistant robotic workstation was evaluated by 24 high-level quadriplegics from the Palo Alto Veterans Affairs Spinal Cord Injury Center. The system is capable of performing daily living and vocational activities for individuals with high-level quadriplegia via voice control. Subjects were asked to use the robot to perform a repertoire of daily living activities, including preparing a meal and feeding themselves, washing their face, shaving, and brushing teeth. Pre- and post-test questionnaires, interviews, and observer assessments were conducted to determine the quality of the robot performance and the reaction of the disabled users toward this technology. Results of the evaluations were generally positive and demonstrated the usefulness of this technology in assisting high-level quadriplegics to perform daily activities and to gain a modicum of independence and privacy in their lives.

Activities of Daily Living↗

PubMed1995

[Robotics serving the elderly and the handicapped].

Recent data collected by the Japanese government confirm that our society is destined to become a high elderly dominated society. Forecasts show that by 2010 approximately 21% of the population in countries such as France, USA and Japan will be over 65 years old. It is therefore becoming increasingly urgent to solve the problem of integration for the elderly and disable within the socioeconomic structure. The authors tackle the question of how service robots may be applied to resolve this problem. This paper presents a rapid overview of the most recent applications of robotics to the field of services for the elderly and disabled, paying particular attention to research carried out at the Laboratory of Robotics, Department of Mechanics of Milan Politecnico by Prof. S. Rovetta.

Aged↗

PubMed1995

A robotic camera for laparoscopic surgery: conception and experimental results.

The aim of this project was to replace the surgical assistant for common laparoscopic procedures with a robotic camera. The motions of the human camera operator were defined and expressed mathematically by a spherical displacement model. A revolving robotic arm with six degrees of freedom was employed in conjunction with this model as an automated camera in the performance of cholecystectomy, Taylor and Nissen procedures in animals, and cholecystectomy in humans. It represents a first step toward the introduction of robotic technology in laparoscopic surgery.

Animals↗

PubMed1993

Robotic chromatography: development and evaluation of automated instrumentation for assay of glycohemoglobin.

The measurement of glycohemoglobin (GHb) by boronate affinity chromatography is useful in monitoring long-term glucose control in diabetic subjects. The inherent disadvantage of this method is the hands-on time required because the hemoglobin fractions are separated on individual disposable columns. To overcome this disadvantage, we have programmed a Hamilton Microlab 2200 automated pipetting cartesian robot to complete the procedure, from the aspiration of blood from the sample-collection tube to the transfer of the separated hemoglobin fractions to a microtiter plate for absorbance measurement. This automated robotic system can analyze 96 specimens, including patients' samples and control material, in approximately 3 h. The precision (CV) of the method ranged from 1.6% to 3.5% within-run and from 2.7% to 3.5% day-to-day. The results correlated with those obtained with the Accuflex semiautomated robot, which used the identical disposable column, and those obtained with a Primus high-performance liquid chromatograph, which used a regenerated microparticle column. Automation of the GHb procedure allowed improved throughput, reduced labor cost, improved precision, and offered greater laboratory safety.

Autoanalysis↗

PubMedDate not supplied

The ROBODOC clinical trial: a robotic assistant for total hip arthroplasty.

Operating room teams at three U.S. hospitals are participating in a controlled clinical trial to evaluate the use of a surgical robot in total hip arthroplasty. The robot, called the ROBODOC Surgical Assistant System, precisely prepares the femoral canal for the placement of a "press fit" cementless prosthesis. The Food and Drug Administration (FDA) requires that the robot, as an investigational device, be tested in a controlled clinical trial to demonstrate safety and efficacy. The clinical trial will include 300 patients who must meet specific criteria before enrollment and randomization. This article describes the need for new surgical technology, ROBODOC's development history, hardware and software components of the system, the patient population and surgical protocol for the clinical trial, special nursing care requirements, and considerations for patient rehabilitation.

Controlled Clinical Trials as Topic↗

PubMedDate not supplied

MARS--multiple automated robotic synthesizer for continuous flow of peptides.

We have designed and constructed a multiple automated robotic synthesizer, the MARS. Its novel timing procedure for handling multiple synthetic tasks eliminates unnecessary respite time by keeping the robotic arm in continuous operation. Polypropylene syringes equipped at the bottom with polypropylene frits serve as physically independent reaction vessels. All operations are performed by the robotic arm, which is equipped with a specially designed gripper to hold a syringe and to aspirate and dispense liquid. Typically, the MARS synthesizes concurrently 5 to 15 peptides of different length, and once one peptide is finished it automatically starts the synthesis of the next peptide in the queue, assuring a continuous flow of peptides.

Automation↗

PubMed1996

Robotics and the changing face of the clinical laboratory.

Rapid changes in healthcare coupled with parallel advances in technology have stimulated the evolution of new approaches for laboratory automation. In particular, the emergence of commercially available laboratory robotic systems offers promise for streamlining the clinical laboratory. Increasing cost-containment pressures make the application of this technology extremely attractive, and several organizations have begun to systematically integrate robotic devices into their laboratory automation schemes. Integration of these technologies, however, presents many challenges for software developers, instrument manufacturers, and laboratory workers. Differing needs across laboratories require flexibility and intelligence in robots, instruments, and control systems. Standardization of mechanical and electronic interfaces will be key to making these systems easy to integrate. Systems engineering, aided by simulation modeling and artificial intelligence schemes, will be important to assist in the design of optimal configurations. Software for the overall control of integrated automation will be needed that can be tailored by the laboratorian to fit the requirements of the individual laboratory. Thus, laboratory workers will need to be actively involved in implementing this new wave of laboratory automation, becoming well-versed in computers, electronics, and systems engineering.

Autoanalysis↗

PubMed2026

Hybrid robotic transversus abdominis release (hrTAR) for complex ventral hernias: a systematic review and preliminary synthesis.

Hybrid robotic transversus abdominis release (hrTAR) combines robotic posterior component separation with a planned limited open phase. Evidence supporting this strategy is sparse. Following PRISMA 2020, we searched PubMed, Embase, Scopus, and the Cochrane Library and registered the protocol in PROSPERO (CRD420261303285). Eligible studies reported hrTAR outcomes for ventral or incisional hernia repair. Findings were synthesized narratively; no pooled effect estimates were calculated. Three reports contained 85 hrTAR cohort entries. Because two reports came from the same institution and overlap could not be excluded, this total should not be interpreted as a unique-patient count. Surgical-site outcomes were heterogeneous: two reports used SSO endpoints (4% and 5%), whereas another reported surgical-site events in 25% of patients, including seroma and wound infection. Mean length of stay ranged from 1.8 to 3.7 days; the sample-size-weighted mean across studies reporting means was 2.9 days. One propensity-matched comparison reported shorter hospitalization and lower 30-day SSO with hrTAR than open TAR. No perioperative deaths or recurrences were reported during limited follow-up. hrTAR appears feasible in selected patients, but available evidence is exploratory. Standardized prospective multicenter studies with non-overlapping cohorts and longer follow-up are needed before comparative effectiveness, economic value, or wider adoption can be supported.

Humans↗

PubMed1999

A virtual robot to model the use of regenerated legs in a web-building spider.

The garden cross orb-spider, Araneus diadematus, shows behavioural responses to leg loss and regeneration that are reflected in the geometry of the web's capture spiral. We created a virtual spider robot that mimicked the web construction behaviour of thus handicapped real spiders. We used this approach to test the correctness and consistency of hypotheses about orb web construction. The behaviour of our virtual robot was implemented in a rule-based system supervising behaviour patterns that communicated with the robot's sensors and motors. By building the typical web of a nonhandicapped spider our first model failed and led to new observations on real spiders. We realized that in addition to leg position, leg posture could also be of importance. The implementation of this new hypothesis greatly improved the results of our simulation of a handicapped spider. Now simulated webs, like the real webs of handicapped spiders, had significantly more gaps in successive spiral turns compared with webs of nonhandicapped spiders. Moreover, webs built by the improved virtual spiders intercepted prey as well as the digitized real webs. However, the main factors that affected web interception frequency were prey size, size of capture area and individual variance; having a regenerated leg, surprisingly, was relatively unimportant for this trait. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1986

Does your hospital need a robot or a management trainer? On advising the health care executive who is interested in innovation, but uncommitted to it.

Executives of small hospitals and home health services have heard that this is the Age of Computers, Telecommunications, Robotics, and Gene Engineering, and they wonder if their organizations might benefit from the high technology and advanced management tools employed by big corporations and "leading edge" hospitals. But they are too tired and busy to greatly expand their technical/managerial expertise, especially since there are so many choices among possible innovations, ranging from robotics to management training, each choice demanding different new expertise, and each requiring an investment of time and energy. We helped several health care executives to identify their options for innovation. We offered a scoring scheme to sort out the innovation options (a simple but effective way to decide what innovation would be "right" for their organization), and a simple, "back of the envelope" tutorial on robotics in health care. The principle is to allow the administrators to make a quick evaluation of the paths they might wish to travel. Our point here is that for every "natural-born" innovator, there must be dozens of interested but uncommitted persons who need some gentle, simple help. To the extent that the diffusion of medical systems depends on a mass market, these fence-sitters must receive help and guidance.

Automation↗

PubMed2005

Robotic Laparoscopic Fundoplication.

Gastroesophageal reflux disease is a very common disorder, and both medical and surgical treatments have shown outstanding results. Whereas proton pump inhibitors are the mainstay of treatment, laparoscopic fundoplication has become a very attractive alternative due to its efficacy and low morbidity. There are defined patient categories that may benefit more from laparoscopy than medical therapy, but a conclusive comparison between the two is lacking. Robotic laparoscopic fundoplication can be performed safely without increased morbidity. Potential advantages include enhanced precision, improved dexterity, and remote telesurgical applications. Disadvantages include increased cost and prolonged operative times. Further studies and more long-term outcome data are needed to fully evaluate the procedure. Robotic surgery is currently in its infancy and not cost effective but has a very promising future. With further development of automatization and miniaturization features, robotic surgery may prove more efficient than conventional laparoscopy.

Journal Article↗

PubMed1996

Use of robotics technology to measure friction in animal joints.

A new system to measure friction in animal joints has been designed. The system utilizes a robotic arm. Force control of the robotic arm was used to survey the geometry of a sliding surface before the friction of the joint is measured. This enables the precise measurement of friction in joints of complex shape. To test the reliability of the new system we took friction measurements from 10 rabbit stifles. The experimental conditions were: (i) intact joints, (ii) joints after the surfaces were washed. The mean values of the frictional coefficients were 0.008 in the intact joints and 0.015 in the washed joints. These mean values were similar to some previous results obtained from canine hip joints under the same experimental conditions. Furthermore, the standard deviations in this study were smaller than in the previous study. These facts suggest that the new system is reliable. RELEVANCE:--The pathology of osteoarthritis is related to the lubrication mechanisms of joints. In any study of the lubrication mechanisms, an accurate friction measurement is important. In this study we used robotics technology to measure friction in joints.

Journal Article↗

PubMedDate not supplied

The evolution and early experience with robot-assisted mitral valve surgery.

Cardiac surgeons, with a warranted enthusiasm, have embraced minimally invasive surgery. The acceleration of technological advances in optics, instrumentation, and cardiopulmonary bypass has allowed safe, effective, and efficient minimally invasive cardiac procedures. In this Technology Focus section, we review the evolution and early experience with robot-assisted mitral valve surgery. The articles of leading minimally invasive cardiac surgeons, both American and European, are reviewed to define the development toward cardiac robotic surgery. The current state of robotic mitral surgery is described.

Journal Article↗

PubMed1998

Visually guided movements: learning with modular neural maps in robotics.

Robotics involves complex processing and requires modular controllers. For the connectionist approach, the adaptation of each module within the global system remains a major problem to be solved. This paper proposes the idea that biological learning can take advantage of the structures of the modules and the nature of modular decomposition. Therefore, we address this problem starting with the architecture of the system. We illustrate this approach using a robotic application: the visual servoing of the arm's end-effector. The on-line adaptation of a simple controller permits excellent results. To process several variables, and to limit the size of the memory required, this controller is decomposed into modules, in the image of sensorial or motor processing centers. The learning of the modules is realized on-line, a bi-directional architecture permits the adaptation of each module using a simple algorithm. The results obtained with various modular arrangements, both during intensive computer simulations and on our robotic platform, confirm the practical interest of this approach.

Journal Article↗