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At least 109 records · Page 6Linked to original sources

PubMed2001

Remote percutaneous renal access using a new automated telesurgical robotic system.

Previous clinical application of remote telesurgery has been the use of a novel system of video teleconferencing equipment along with remote control of a laparoscopic camera at distances over 11,000 miles. Recently, a robotic system has been developed to assist with percutaneous renal surgery. This robot has been incorporated into the telesurgical system to allow remote needle placement into the renal collecting system under radiological guidance. The main component of the telesurgical system is a low degree of freedom robot called "PAKY" (percutaneous access of the kidney). It is custom designed for fluoroscopic guided percutaneous needle insertion into the renal collecting system. The robot is a six-degrees of freedom device. However, when the skin entry site is fixed and held in position, only two degrees of freedom are required to orient the needle in the correct plane for accurate insertion. Remote control of the robot was accomplished over a plain old telephone system (POTS) line. On June 17, 1998, the first remote telerobotic percutaneous renal access procedure was performed between the Johns Hopkins Hospital, Baltimore, Maryland, and Tor Vergata University, Rome, Italy. This new telesurgical robot was successful in term of obtaining percutaneous access within 20 min, with two attempts to obtain entry into the collecting system. This robot represents the first system for performing remote telesurgical interventions in the kidney and demonstrates the feasibility and safety of assisting accurate and rapid needle access to the kidney during percutaneous procedures.

Aged↗

PubMed2003

Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system.

PURPOSE: We developed and assessed the feasibility of extraperitoneal laparoscopic radical prostatectomy performed using the da Vinci (Intuitive Surgical, Mountain View, California) robotic system. MATERIALS AND METHODS: In June 2002, 4 consecutive patients with clinically localized prostate cancer underwent extraperitoneal, robotic assisted laparoscopic radical prostatectomy. After development of the extraperitoneal space the surgeon performed laparoscopic prostatectomy from the remote control unit. The assistant aligned and exchanged robotic instruments and used conventional laparoscopic instruments to facilitate prostatectomy. Perioperative data and pathological results were recorded. RESULTS: No difficulties were noted when developing the extraperitoneal space. All additional steps were successfully performed with telerobotics. More distal placement of the robotic ports appeared to improve the feasibility of the extraperitoneal approach. The peritoneum acted as a natural bowel retractor and the distal port placement facilitated use of the assistant ports. Mean operative time was 274 minutes (range 124 to 360). Mean catheterization time and hospital stay were 2.7 and 5.3 days, respectively. A positive margin was observed in 1 patient and pathological stage was pT2 in 3 and pT3 in 1. No postoperative complications or open conversions were observed. CONCLUSIONS: The extraperitoneal approach was feasible with the da Vinci robotic system. Distal port placement for the robot appeared to create an ergonomic environment for the surgeon and assistant and more direct prostatic access. While additional clinical experience is required, the extraperitoneal approach may ultimately provide advantages for robotic and nonrobotic laparoscopic radical prostatectomy.

Aged↗

PubMed1999

Robotics for surgery.

Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.

Biomedical Engineering↗

PubMed1994

Robot for CT-guided stereotactic neurosurgery.

At the 1989 meeting of the World Society for Stereotactic and Functional Neurosurgery in Maebashi, the authors presented the concept and design of a stereotactic neurosurgical robot. The first prototype has now been completed and has entered clinical testing. The characteristics are as follows. The robot is positioned behind the CT scan and operates inside the CT gantry. It is linked to the CT table and moves freely along its longitudinal axis, allowing for intraoperative scanning at any cranial level. The patient's body rests on the CT table, but the stereotactic headframe is fixed to the robot, allowing precise measurements of the head position under stereotactic conditions. During scanning, each CT slice appears immediately on the robotic workstation for selection of target and trajectory. In addition to the tool for automatic penetration of the skin, skull, and meninges, the robot is able to handle two other stereotactic instruments and to perform a complete stereotactic procedure without physical intervention by the physician. So far, depth electrodes and biopsy instruments have been developed for use by the robot. Since all parts of the robot were designed solely for stereotactic neurosurgery, integration of safety aspects was optimized. The first operations using an aspiration biopsy probe were successfully performed on 2 patients with malignant intracerebral cystic lesions on September 4, 1993.

Humans↗

PubMed1995

Evolving mobile robots in simulated and real environments.

The problem of the validity of simulation is particularly relevant for methodologies that use machine learning techniques to develop control systems for autonomous robots, as, for instance, the artificial life approach known as evolutionary robotics. In fact, although it has been demonstrated that training or evolving robots in real environments is possible, the number of trials needed to test the system discourages the use of physical robots during the training period. By evolving neural controllers for a Khepera robot in computer simulations and then transferring the agents obtained to the real environment we show that (a) an accurate model of a particular robot-environment dynamics can be built by sampling the real world through the sensors and the actuators of the robot; (b) the performance gap between the obtained behaviors in simulated and real environments may be significantly reduced by introducing a "conservative" form of noise; (c) if a decrease in performance is observed when the system is transferred to a real environment, successful and robust results can be obtained by continuing the evolutionary process in the real environment for a few generations.

Algorithms↗

PubMed1999

Voice-controlled robotic arm in laparoscopic surgery.

AIM: To report on our experience with a voice-directed robotic arm for scope management in different procedures for "solo-surgery" and in complex laparoscopic operations. METHODS: A chip card with orders for the robotic arm is individually manufactured for every user. A surgeon gives order through a microphone and the optic field is thus under direct command of the surgeon. RESULTS: We analyzed 200 cases of laparoscopic procedures (gallbladder, stomach, colon, and hernia repair) done with the robotic arm. In each procedure the robotic arm worked precisely; voice understanding was exact and functioned flawlessly. A hundred "solo-surgery" operations were performed by a single surgeon. Another 96 complex videoscopic procedures were performed by a surgeon and one assistant. In comparison to other surgical procedures, operative time was not prolonged, and the number of used ports remained unchanged. CONCLUSION: Using the robotic arm in some procedures abolishes the need for assist ance. Further benefit accrued by the use of robotic assistance includes greater stability of view, less inadvertent smearing of the lens, and the absence of fatigue. The robotic arm can be used successfully in every operating theater by all surgeons using laparoscopy.

Acoustics↗

PubMed2000

Robotic remote laparoscopic nephrectomy and adrenalectomy: the initial experience.

PURPOSE: We evaluated the feasibility of performing laparoscopic nephrectomy and adrenalectomy exclusively by using robotic telepresent technology from a remote workstation and compared outcomes with those of conventional laparoscopy in an acute porcine model. MATERIALS AND METHODS: Five pigs underwent bilateral laparoscopic nephrectomy (robotic in 5 and conventional in 4) and adrenalectomy (robotic in 4 and conventional in 3). In the 9 robotic laparoscopic procedures all intraoperative manipulations were completely performed telerobotically from a remote workstation without any conventional laparoscopic assistance on site. Animals were sacrificed acutely. RESULTS: Robotic laparoscopic nephrectomy required significantly longer total operative (85.2 versus 38.5 minutes, p = 0.0009) and actual surgical (73.4 versus 27.5 minutes, p = 0.0002) time than conventional laparoscopy. However, blood loss and adequacy of surgical dissection were comparable in the 2 groups. Robotic laparoscopic adrenalectomy required longer total operative (51 versus 32.3 minutes, p = 0.13) and actual surgical (38.5 versus 18.7 minutes, p = 0.14) time than conventional laparoscopy. The solitary complication in this study was an inferior vena caval tear during robotic right adrenalectomy, which was adequately repaired by sutures telerobotically in a remote manner. CONCLUSIONS: To our knowledge we present the initial experience with remote telerobotic laparoscopic nephrectomy and adrenalectomy. Telepresent laparoscopic surgery is feasible.

Adrenalectomy↗

PubMed2001

Robotic assisted, laparoscopic pelvic lymph node dissection in humans.

PURPOSE: We evaluate the feasibility and efficacy of robotic assisted, laparoscopic pelvic lymph node dissection for locally advanced prostate cancer staging. MATERIALS AND METHODS: Robotic assisted, laparoscopic pelvic lymph node dissection was performed in 10 consecutive patients with mainly T3 M0 prostatic carcinoma (robotic group). Operative, postoperative and pathological parameters were compared with the results of the last 10 patients undergoing conventional, laparoscopic pelvic lymph node dissection performed with similar indications by the same operator (laparoscopy group). RESULTS: All operations were performed according to the established protocol with no specific intraoperative or postoperative complications. No conversion was required, and no technical incidents were observed in the robotic group. Mean operating time plus or minus standard deviation for the robotic group was 125 +/- 57 minutes (range 75 to 215), significantly longer than that for the laparoscopy group, which was 60 +/- 15 minutes (p = 0.0013). In the robotic group 2 patients presented with postoperative lymphoceles revealed in 1 by deep venous thrombosis and in the second by obturator pain. In the laparoscopy group 1 patient presented with acute urinary retention. The histological results concerning the number of lymph nodes removed were similar in both groups (p = 0.5). CONCLUSIONS: We show the technical feasibility of robotic assisted, laparoscopic pelvic lymph node dissection in humans. Although the benefit of this technique has not yet been established, predictable technological improvements would suggest the development of telesurgery and an improved precision of surgical procedure.

Aged↗

PubMed1999

Endoscopic coronary artery bypass graft (ECABG) procedure with robotic assistance.

BACKGROUND: Technical details of the Robotically assisted endoscopic coronary artery bypass graft (ECABG) procedure on the cadaver model are reported. Moreover, this study will provide essential techniques, steps, and procedural development concepts necessary to introduce the ZEUS Robotic Surgical System (Computer Motion, Inc., Goleta, CA) into the human operating room. METHODS: Between August 1998 and March 1999, an ECABG procedure was performed on 10 cadaver torsos. The cadaver torso was placed in the left anterior oblique (LAO) position. The left and right internal mammary arteries (IMA) were taken down endoscopically. The ends of the IMA's were intracorporeally prepared. An upper partial sternotomy was demonstrated for perfusion cannulation and proximal anastomoses for multiple vessel revascularization. An arteriotomy was created with an endoscopic scalpel. The IMA was anastomosed to a chosen coronary using robotic assistance. The patency was verified by probing and injecting of methylene blue. RESULTS: Templates were developed to determine the placement of the robotic arms. Port templates were developed to both harvest the IMA's and perform the desired anastomoses. The following vessels were accessed through the developed port templates and retraction of the heart: left anterior descending (LAD), right coronary artery (RCA), diagonal (D(1)), obtuse marginal (OM(1) and OM(2)), and posterior descending artery (PDA). CONCLUSIONS: The use of robotic assistance during an ECABG procedure on a cadaver model is feasible. This study is a necessary and useful progression from the use of robotics in the animal lab to the use of robotics in the human operating room.

Coronary Artery Bypass↗

PubMed2001

[Development of a system for robot aided teeth alignment of complete denture].

OBJECTIVE: To develop a robot aid aligning artificial teeth for complete denture. METHODS: The CRS-450, a 6-direction-free robot was utilized to make the grasped object realize any position and pose, and to develop an adjustable tooth arrangement machine. The geometry parameters of the shape of agomphious jaw were obtained through 3-D laser scanning and measuring system. The math's model, which was set up according to senior prosthodontic experts' experiences on tooth arrangement, was used to control program of experts in arranging teeth, 3-D denture simulation, and robots in arranging teeth. The program used VC++ and RAPL robot languages. When the teeth arrangement plan was formed, the data were transmitted to a robot, who would fix the position and finish the fabrication of complete denture. RESULTS: A complete system of robot-aided complete denture teeth arranging was set up and tried using this system to make an artificial dentition for a patient. There were still some errors in the articulation of the dentition, which needed adjustment and perfection. CONCLUSIONS: We succeed in using robot to fabricate artificial dentition for the first time. Although the dentition is not perfect in articulation, the system's scientific significance is profound. The results have proved that the designing idea and technical routine are workable.

Denture Design↗

PubMed2002

[Initial use of the newly developed voice-controlled robot system for a solitary pulmonary arterio-venous malformation].

We herein report an initial experience of thoracoscopic surgery for a solitary arterior-venous malformation (PAVM) with the AESOP 3000 HR voice-controlled robot to hold a thoracoscope. A 52-year-old woman was hospitalized due to a transient loss of consciousness. A brain magnetic resonance image and electroencephalogram (EEG) were normal. A chest computed tomogram indicated a suspicion of PAVM. The definite diagnosis of the PAVM was made by the 3-dimensional computed tomogram and pulmonary angiography. Thoracoscopic operation with the voice-controlled robot (AESOP 3000 HR) was conducted. The operating staffs were able to assemble the AESOP 3000 HR robotic system safely and quickly without difficulty. The robot functioned without problems throughout the procedure. No complications or events related or unrelated to the maneuvers of the robot during the operation were noted. The procedure of the pulmonary resection with the voice-controlled robot was successfully preformed by a single surgeon. The operating time was 110 minutes, and the volume of the intraoperative bleeding was 10 g. The postoperative course was uneventful. The use of the AESOP 3000 HR robot may be more convenient and friendly in thoracoscopic procedure.

Arteriovenous Malformations↗

PubMedDate not supplied

Robot-assisted surgery: the future is here.

According to L. Wiley Nifong, director of robotic surgery at East Carolina University's Brody School of Medicine, "Nationally, only one-fourth of the 15 million surgeries performed each year are done with small incisions or what doctors call 'minimally invasive surgery'." Robots could raise that number substantially (Stark 2002). Currently, healthcare organizations use robot technology for thoracic, abdominal, pelvic, and neurological surgical procedures. Minimally invasive surgery reduces the amount of inpatient hospital days, and the computer in the system filters any hand tremors a physician may have during the surgery. The use of robot-assisted surgery improves quality of care because the patient experiences less pain after the surgery. Robot-assisted surgery demonstrates definite advantages for the patient, physician, and hospital; however, healthcare organizations in the United States have yet to acquire the technology because of implementation costs and the lack of FDA (Food and Drug Administration) approval for using the technology for certain types of heart procedures. This article focuses on robot-assisted surgery advantages to patients, physicians, and hospitals as well as on the disadvantages to physicians. In addition, the article addresses implementation costs, which creates financial hurdles for most healthcare organizations; offers recommendations for administrators to embrace this technology for strategic positioning; and enumerates possible roles for robots in medicine.

Device Approval↗

PubMed1990

Robotic transportation.

Mobile robots perform fetch-and-carry tasks autonomously. An intelligent, sensor-equipped mobile robot does not require dedicated pathways or extensive facility modification. In the hospital, mobile robots can be used to carry specimens, pharmaceuticals, meals, etc. between supply centers, patient areas, and laboratories. The HelpMate (Transitions Research Corp.) mobile robot was developed specifically for hospital environments. To reach a desired destination, Help-Mate navigates with an on-board computer that continuously polls a suite of sensors, matches the sensor data against a pre-programmed map of the environment, and issues drive commands and path corrections. A sender operates the robot with a user-friendly menu that prompts for payload insertion and desired destination(s). Upon arrival at its selected destination, the robot prompts the recipient for a security code or physical key and awaits acknowledgement of payload removal. In the future, the integration of HelpMate with robot manipulators, test equipment, and central institutional information systems will open new applications in more localized areas and should help overcome difficulties in filling transport staff positions.

Hospital Departments↗

PubMed1990

Laboratory robotics and artificial intelligence.

Intelligent robots, which incorporate artificial intelligence in their controlling software, are the next step in bringing the laboratory robot to its full potential. The areas currently under study in our laboratory are improved user interfaces for laboratory robotics, the integration of object-oriented databases into robot control programs, and strategies to optimize multi-step procedures. The ultimate goal of this work is the Standard Robotics Method. The Standard Robotics Method we envision would allow a robotic method to be transferred from one laboratory to another.

Artificial Intelligence↗

PubMed2026

Robot-assisted versus freehand cannulated-screw fixation for femoral neck fractures: a systematic review of technical, clinical and adoption outcomes.

Robot-assisted guidance may improve the technical precision of percutaneous cannulated-screw fixation for femoral neck fractures. Whether these procedural advantages translate into better clinical outcomes remains uncertain. We compared robot-assisted and conventional freehand fixation in adults with femoral neck fractures. MEDLINE, Embase and CINAHL were searched from inception to 15 July 2026 without language restrictions. Google Scholar was used only as a supplementary search source, together with forward and backward citation searching. Comparative studies of robot-assisted versus freehand fluoroscopy-guided cannulated-screw fixation were included. Risk of bias was assessed using RoB 2 and ROBINS-I, with the Newcastle-Ottawa Scale used as a complementary appraisal of non-randomised studies. Random-effects meta-analyses included prediction intervals and prespecified sensitivity analyses. The protocol was registered prospectively (PROSPERO CRD420261465038). Sixteen comparative studies involving 1,293 participants were included. Of these, 597 underwent robot-assisted fixation and 696 underwent freehand fixation. Two studies reporting random allocation and 14 non-randomised studies were included in the study. Robot-assisted fixation was associated with fewer guide-wire manipulations, greater screw-placement accuracy and 13.9 fewer fluoroscopic acquisitions per procedure (95% confidence interval [CI] -20.3 to -7.5). Earlier radiographic healing and modestly higher final Harris Hip Scores were also observed. Pooled estimates suggested lower risks of union failure, avascular necrosis and composite complications. Fluoroscopy duration, overall operative time and reoperation did not differ significantly. Heterogeneity was substantial for several continuous outcomes, with prediction intervals crossing the null for several estimates, indicating that the magnitude of benefit varied considerably between studies. Some clinical associations were also sensitive to eligibility-restricted analyses. Robot-assisted cannulated-screw fixation improves technical execution compared with freehand fixation. Patient-important clinical superiority and economic value have not been established, and evidence concerning learning curves, operator acceptability and system reliability remains insufficient. Current evidence does not support routine widespread adoption; adequately powered multicentre randomised trials incorporating economic and implementation evaluation are required.

Humans↗

PubMed1999

Development and in vitro testing of a miniature robotic system for computer-assisted colonoscopy.

In this article we present a new concept for computer-assisted colonoscopy based on a miniature robot capable of propelling itself semiautonomously along the colon. The miniature robot is designed to perform the same functions as current colonoscopy systems-i.e., visualization and tissue sampling for biopsy-and exploits an innovative inchworm-like locomotion principle based on adhering to the colon wall by vacuum suction. The miniature robot is connected by a thin and flexible umbilical cable to an external control unit; this unit provides pneumatic actuation signals in the appropriate sequence to the miniature robot, and information on the robot's functioning to the endoscopist, who can either teleoperate or directly supervise its operation. A prototype colonoscopy system using this robot has been fabricated and tested in vitro, with promising results. The proposed concept has strong potential for further development, since miniaturization and functional integration of instrumentation and tools, together with computer assistance, not only make colonoscopy more acceptable, but can also open up a wide range of new applications in endoluminal diagnosis, therapy, and surgery.

Animals↗

PubMed2001

State of the art in surgical robotics: clinical applications and technology challenges.

Although it has been over 15 years since the first recorded use of a robot for a surgical procedure, the field of medical robotics is still an emerging one that has not yet reached a critical mass. Although robots have the potential to improve the precision and capabilities of physicians, the number of robots in clinical use is still very small. In this review article, we begin with a short historical review of medical robotics, followed by an overview of clinical applications where robots have been applied. The clinical applications are then discussed; they include neurosurgery, orthopedics, urology, maxillofacial surgery, radiosurgery, ophthalmology, and cardiac surgery. We conclude with a listing of technology challenges and research areas, including system architecture, software design, mechanical design, imaging compatible systems, user interface, and safety issues.

Computer Systems↗

PubMed1997

Autonomy in robots and other agents.

The word "autonomous" has become widely used in artificial intelligence, robotics, and, more recently, artificial life and is typically used to qualify types of systems, agents, or robots: we see terms like "autonomous systems," "autonomous agents," and "autonomous robots." Its use in these fields is, however, both weak, with no distinctions being made that are not better and more precisely made with other existing terms, and varied, with no single underlying concept being involved. This ill-disciplined usage contrasts strongly with the use of the same term in other fields such as biology, philosophy, ethics, law, and human rights, for example. In all these quite different areas the concept of autonomy is essentially the same, though the language used and the aspects and issues of concern, of course, differ. In all these cases the underlying notion is one of self-law making and the closely related concept of self-identity. In this paper I argue that the loose and varied use of the term autonomous in artificial intelligence, robotics, and artificial life has effectively robbed these fields of an important concept. A concept essentially the same as we find it in biology, philosophy, ethics, and law, and one that is needed to distinguish a particular kind of agent or robot from those developed and built so far. I suggest that robots and other agents will have to be autonomous, i.e., self-law making, not just self-regulating, if they are to be able effectively to deal with the kinds of environments in which we live and work: environments which have significant large scale spatial and temporal invariant structure, but which also have large amounts of local spatial and temporal dynamic variation and unpredictability, and which lead to the frequent occurrence of previously unexperienced situations for the agents that interact with them.

Animals↗