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PubMed2001

Precision of ACL tunnel placement using traditional and robotic techniques.

The objective of this study was to examine the precision of ACL tunnel placement using: (1) CASPAR (orto MAQUET GmbH Co. KG)--an active robotic system, and (2) four orthopedic surgeons with various levels of experience (between 100 and 3,500 ACL reconstructions). The robotic system and each surgeon drilled tunnels for ACL reconstruction in 10 plastic knees (total n = 50) that included a reference cube in the medial aspect of the proximal tibia and distal femur. For the robotic system, the placement of each tunnel was planned preoperatively using custom software and CT data for each femur and tibia. The robotic system then drilled the tunnels in the femur and tibia based on the preoperative plan. For the surgeons, tunnel placement was accomplished using their preferred technique, which was based on the one-incision arthroscopic technique. The distribution of intra-articular points on the tibia was contained within a sphere of radius 2.0 mm (robot system), 2.1 mm (Fellow 1), 2.4 mm (Fellow 2), 3.4 mm (Experienced Surgeon 1), or 2.0 mm (Experienced Surgeon 2). On the femur, no significant differences in the distribution of intra-articular points could be demonstrated between the robotic system (2.1 mm), Fellow 1 (4.5 mm), Fellow 2 (4.1 mm), Experienced Surgeon 1 (2.3 mm), and Experienced Surgeon 2 (3.0 mm). The direction of the tunnels drilled in the femur and tibia was different with the robotic and traditional techniques. However, the robotic system had the most consistent tunnel directions, while the surgeons' tunnels were more dispersed. Variation in surgeon precision of tunnel placement for ACL reconstruction is greater on the femur than the tibia, and this can be correlated with experience. Our data also suggest that the robotic system has the same precision as the most experienced surgeons.

Anterior Cruciate Ligament↗

PubMed2001

A surface-matching technique for robot-assisted registration.

Successful implementation of robot-assisted surgery (RAS) requires coherent integration of spatial image data with sensing and actuating devices, each having its own coordinate system. Hence, accurate estimation of the geometric relationships between relevant reference frames, known as registration, is a crucial procedure in all RAS applications. The purpose of this paper is to present a new registration scheme, along with the results of an experimental evaluation of a robot-assisted registration method for RAS applications in orthopedics. The accuracy of the proposed registration is appropriate for specified orthopedic surgical applications such as Total Knee Replacement. The registration method is based on a surface-matching algorithm that does not require marker implants, thereby reducing surgical invasiveness. Points on the bone surface are sampled by the robot, which in turn directs the surgical tool. This technique eliminates additional coordinate transformations to an external device (such as a digitizer), resulting in increased surgical accuracy. The registration technique was tested on an RSPR six-degrees-of-freedom parallel robot specifically designed for medical applications. A six-axis force sensor attached to the robot's moving platform enables fast and accurate acquisition of positions and surface normal directions at sampled points. Sampling with a robot probe was shown to be accurate, fast, and easy to perform. The whole procedure takes about 2 min, with the robot performing most of the registration procedures, leaving the surgeon's hands free. Robotic registration was shown to provide a flawless link between preoperative planning and robotic assistance during surgery.

Algorithms↗

PubMed2003

Kinematics and the implementation of an elephant's trunk manipulator and other continuum style robots.

Traditionally, robot manipulators have been a simple arrangement of a small number of serially connected links and actuated joints. Though these manipulators prove to be very effective for many tasks, they are not without their limitations, due mainly to their lack of maneuverability or total degrees of freedom. Continuum style (i.e., continuous "back-bone") robots, on the other hand, exhibit a wide range of maneuverability, and can have a large number of degrees of freedom. The motion of continuum style robots is generated through the bending of the robot over a given section; unlike traditional robots where the motion occurs in discrete locations, i.e., joints. The motion of continuum manipulators is often compared to that of biological manipulators such as trunks and tentacles. These continuum style robots can achieve motions that could only be obtainable by a conventionally designed robot with many more degrees of freedom. In this paper we present a detailed formulation and explanation of a novel kinematic model for continuum style robots. The design, construction, and implementation of our continuum style robot called the elephant trunk manipulator is presented. Experimental results are then provided to verify the legitimacy of our model when applied to our physical manipulator. We also provide a set of obstacle avoidance experiments that help to exhibit the practical implementation of both our manipulator and our kinematic model.

Animals↗

PubMed2001

[Robotics. A new dimension in otorhinolaryngology?].

Robots have entered into many aspects of human life, including operative medicine. However, current medical robots have nothing in common with anthropomorphic robots as known in science fiction novels. We distinguish manipulators, working on a master-slave principle, from robots. Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more axes." The success of robots is based on their precision, lack of fatigue, and speed of action. Potential fields of application for manipulators lie in endonasal surgery and for robots in lateral skull base surgery, including mastoidectomy and drilling a cavity for implantable hearing systems and cochlear implants. We performed a number of experiments at the department of anatomy with respect to robotic lateral skull base surgery. This paper reviews the current use of manipulators and robots in operative medicine and their potential applications in otorhinolaryngology.

Equipment Design↗

PubMed2005

A critical comparison of robotic versus conventional laparoscopic splenectomies.

The benefit of robotic systems for general surgery is a matter of debate. We compare our initial series of robotic splenectomies with our first series of conventional laparoscopic ones. A retrospective analysis of the first six robotic versus the first six conventional laparoscopic splenectomies is presented. Patients were matched with regard to age, body-mass index, ASA score, and preoperative platelet levels. All procedures were performed by a single surgeon. Size and weight of the resected specimens were comparable in both groups. Median overall operating time was 154 (range, 115-292) min for the robotic and 127 (range, 95-174) min for the laparoscopic group. No complications occurred. There were no open conversions. The median postoperative hospital stay was 7 (robotic group) and 6 (laparoscopic group) days. Median average costs were 6927 dollars for the robotic procedure versus $4084 for the conventional laparoscopic procedure (p < 0.05). Minimally invasive splenectomies are feasible using either conventional laparoscopic techniques or the da Vinci robotic system. In this analysis, procedures performed with the da Vinci robotic system resulted in prolonged overall operative time and significantly higher procedural costs. The use of a robotic system for laparoscopic splenectomy offers, at this stage, no relevant benefit and thus is not justified.

Adult↗

PubMed2001

Fly-like visuomotor responses of a robot using aVLSI motion-sensitive chips.

We explore the use of continuous-time analog very-large-scale-integrated (aVLSI) neuromorphic visual preprocessors together with a robotic platform in generating bio-inspired behaviors. Both the aVLSI motion sensors and the robot behaviors described in this work are inspired by the motion computation in the fly visual system and two different fly behaviors. In most robotic systems, the visual information comes from serially scanned imagers. This restricts the form of computation of the visual image and slows down the input rate to the controller system of the robot, hence increasing the reaction time of the robot. These aVLSI neuromorphic sensors reduce the computational load and power consumption of the robot, thus making it possible to explore continuous-time visuomotor control systems that react in real-time to the environment. The motion sensor provides two outputs: one for the preferred direction and the other for the null direction. These motion outputs are created from the aggregation of six elementary motion detectors that implement a variant of Reichardt's correlation algorithm. The four analog continuous-time outputs from the motion chips go to the control system on the robot which generates a mixture of two behaviors--course stabilization and fixation--from the outputs of these sensors. Since there are only four outputs, the amount of information transmitted to the controller is reduced (as compared to using a CCD sensor), and the reaction time of the robot is greatly decreased. In this work, the robot samples the motion sensors every 3.3 ms during the behavioral experiments.

Animals↗

PubMed2003

Robot-assisted laparoscopic choledochojejunostomy.

BACKGROUND: Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support surgeons in delicate laparoscopic interventions. The purpose of this study is to assess the efficacy and safety of performing a laparoscopic choledochojejunostomy and Roux-en-Y reconstruction with the aid of a robotic system. METHODS: Ten laparoscopic procedures were performed in pigs with the da Vinci robotic system and compared to 10 procedures performed by laparotomy (controls). Operation room time, anastomoses time, blood loss, and complications were recorded. The effectiveness of the anastomoses was evaluated by postoperative observation for 14 days and by measuring passage, circumference, and number of stitches. RESULTS: Operating room time was significantly longer for the robot-assisted group than for controls (140 vs 82 min, p < 0.05). The anastomoses times were longer in the robot-assisted cases but not statistically significant (biliodigestive anastomosis, 29 vs 20 min; intestinal anastomosis, 30 vs 15 min), Blood loss was less than 10 cc in all robot-assisted cases and 30 cc (10-50 cc) in the controls. In both groups, there were no intraoperative complications. In the control group, one pig died of gastroparesis on postoperative day 6. In the robot-assisted group, one pig died on postoperative day 7 due to a volvulus of the jejunum. At autopsy, a bilioma was found in one pig in the robot-assisted group. In all pigs, the biliodigestive and intestinal anastomoses were macroscopically patent with an adequate passage. Circumference and number of stitches were similar. CONCLUSION: The safety and efficacy of robot-assisted laparoscopic choledochojejunostomy was proven in this study. The procedure can be performed within an acceptable time frame.

Anastomosis, Roux-en-Y↗

PubMed2006

Thoracoscopic robot-assisted bronchoplasty.

BACKGROUND: In robotic surgery, the ideal position of the system, as well as the optimal working angles and the proper positioning of the thoraco ports position is very important. No robot-assisted bronchoplasty has been reported. Our study describes use of the da VinciTM surgical system (Intuitive Surgical, Inc.) for robotic sleeve upper lobectomy in a human fresh cadaver. METHODS: A male cadaver was placed in the left lateral decubitus position. After thoracoscopic upper lobectomy was performed through the working port and the two ports, the robotic system was then set up behind the cadaver. The working port allowed introduction of the optical scope and the robotic surgical arms were inserted into the thoraco ports. The right bronchus was dissected and wedge was cut out with the robotic scissors. After standard lymph node dissection, end-to-end bronchial anastomosis was performed with robotic instruments. Once the anastomosis was complete, air leakage was checked with saline solution placed in the pleural cavity. RESULTS: Thoracoscopic robot-assisted bronchoplasty was performed successfully. CONCLUSIONS: In evaluating various positions of the system we demonstrated that our technique is sufficient approaches to robotic bronchoplasty. This procedure offers specific advantages over conventional bronchoplasty with accuracy and safety.

Anastomosis, Surgical↗

PubMed2004

Robotic and laparoscopic surgery for treatment of colorectal diseases.

PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS: The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da Vinci robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS: The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 +/- 77 minutes vs. robotic group, 240 +/- 61 minutes), specimen length (laparoscopic group, 29 +/- 11 cm vs. robotic group, 27 +/- 13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 +/- 9 vs. robotic group, 17 +/- 10). It took significantly longer to prepare the operating room and patient in the robotic group (24 +/- 12 minutes) than in the laparoscopic group (18 +/- 7 minutes). There were three conversions to laparotomy in the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS: Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.

Aged↗

PubMed2005

Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum.

BACKGROUND: We report our initial experience with the application of robotic-assisted technologies to the treatment of diseases of the anterior mediastinum. METHODS: Between October 2001 and December 2003, 18 consecutive patients with anterior mediastinal masses were referred for diagnosis and treatment. Fifteen patients underwent robotic-assisted surgery with the da Vinci robotic system. A single surgical team performed all operations. Resection was accomplished by either median sternotomy or robotic-assisted techniques. RESULTS: Fourteen patients underwent successful robotic-assisted thymectomy. One patient underwent robotic-assisted biopsy of a mass that was later determined to be a poorly differentiated carcinoma, 3 patients underwent complete thymectomy by median sternotomy for biopsy-proven extracapsular thymoma, 7 patients had thymoma, and 3 had myasthenia gravis. There were 2 patients each with benign thymic cysts and thymic hyperplasia. Primary thymic carcinoid, thymolipoma, papillary thyroid cancer, and poorly differentiated carcinoma were present in 1 patient each. No conversions, intraoperative complications, or deaths occurred in the 15 patients who underwent robotic-assisted resection. The mean operative time was 96 minutes (range 62 to 132 minutes). The mean robotic time was 48 minutes (range 22 to 76). The median hospital stay was 2 days. All patients are doing well, with a median follow-up of 1 year. CONCLUSIONS: Robotic-assisted surgery of the anterior mediastinum, and particularly thymectomy, can be performed safely and efficiently. The increased visualization and instrument dexterity afforded by this technology provides an optimal minimally invasive approach to the anterior mediastinum. From this experience we have formulated a comprehensive treatment algorithm for the surgical evaluation and treatment of patients with anterior mediastinal diseases.

Adult↗

PubMed2004

First experiences with the da Vinci operating robot in thoracic surgery.

OBJECTIVES: The da Vinci surgical robotic system was purchased at our institution in June 2001. The aim of this trial was to evaluate the applicability of the da Vinci operation robot for general thoracic procedures. METHODS: The da Vinci surgical system consists of a console connected to a surgical arm cart, a manipulator unit with two instrument arms and a central arm to guide the endoscope. The surgical instruments are introduced via special ports and attached to the arms of the robot. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transfer the surgeon's movements to the tip of the instruments. The so-called 'EndoWrist technology' offers seven degrees of movement, thus exceeding the capacity of a surgeon's hand in open surgery. We evaluated the role of the robot for several thoracic procedures such as thymectomies, fundoplications, esophageal dissections, resection of mediastinal masses and a pulmonary lobectomy. RESULTS: A total of 10 thymectomies, 16 fundoplications, 4 esophageal dissections, 5 extirpations of benign mediastinal masses and 1 right lower lobectomy was performed with the robot. One resection of a paravertebral neurogenic tumor had to be converted due to surgical problems. A lesion to a left recurrent laryngeal nerve caused transient hoarseness after the extirpation of an ectopic parathyroid in the aortopulmonary window in one patient. The postoperative courses were uneventful and patients were discharged between postoperative days 3 and 8 (with the exception of patients who underwent dissection for esophageal cancer and the patient with conversion to an open access). CONCLUSIONS: Advanced general thoracic procedures can be performed safely with the da Vinci robot allowing precise dissection in remote and difficult-to-reach areas. This benefit becomes evident most elegantly in thymectomies, which at our institution have become a routine procedure with the robot. The rigid anatomy of the chest seems to be an ideal condition for robotic surgery. A major limitation for robotic surgery is the lack of more appropriate instruments. This disadvantage becomes most evident in pulmonary lobectomies.

Adult↗

PubMed2004

Surgical robotics: impact of motion scaling on task performance.

BACKGROUND: Robotic systems have been shown to enhance surgical dexterity, and the advantage has been hypothesized to result from the removal of tremor and addition of motion scaling. But these purported gains over traditional laparoscopic instrumentation have not been quantified. This study was designed to compare the surgical accuracy between conventional laparoscopic instruments and a robotic surgical system and evaluate the importance of tremor filtration (TF) and motion scaling (MS) in these robotic systems. STUDY DESIGN: Fifteen participants with no previous surgical experience were enrolled. To simulate microsurgical techniques, a 29-gauge needle was used to puncture the center of 6 microscopic archery targets (circle diameters 0.5, 1.5, and 2.5 mm). The robotic system was configured to three different degrees of MS and compared with the unassisted laparoscopic platforms in accuracy. RESULTS: Accuracy with robotic assistance with TF alone (1:1 MS) was not significantly different from unassisted laparoscopic control. Both moderate (2.5:1) and fine (7:1) MS significantly improved accuracy over traditional laparoscopic control (p < 0.001 for both). Robotic assistance with MS equalized the performance of both hands (p = 0.03) in precision, and manual laparoscopy demonstrated no statistical difference in handedness (p = 0.80). CONCLUSIONS: Motion scaling, rather than tremor filtration, plays the major role in the enhanced accuracy seen in robotic surgical systems. Robotic assistance with MS significantly improved accuracy above laparoscopic instruments alone and robotic assistance with tremor filtration alone. MS also creates ambidexterity in an otherwise unidextrous population, optimizing the surgeon's ability to undertake tasks requiring microsurgical accuracy.

Adult↗

PubMed1989

Robotics in biomedical chromatography and electrophoresis.

The ideal laboratory robot can be viewed as "an indefatigable assistant capable of working continuously for 24 h a day with constant efficiency". The development of a system approaching that promise requires considerable skill and time commitment, a thorough understanding of the capabilities and limitations of the robot and its specialized modules and an intimate knowledge of the functions to be automated. The robot need not emulate every manual step. Effective substitutes for difficult steps must be devised. The future of laboratory robots depends not only on technological advances in other fields, but also on the skill and creativity of chromatographers and other scientists. The robot has been applied to automate numerous biomedical chromatography and electrophoresis methods. The quality of its data can approach, and in some cases exceed, that of manual methods. Maintaining high data quality during continuous operation requires frequent maintenance and validation. Well designed robotic systems can yield substantial increase in the laboratory productivity without a corresponding increase in manpower. They can free skilled personnel from mundane tasks and can enhance the safety of the laboratory environment. The integration of robotics, chromatography systems and laboratory information management systems permits full automation and affords opportunities for unattended method development and for future incorporation of artificial intelligence techniques and the evolution of expert systems. Finally, humanoid attributes aside, robotic utilization in the laboratory should not be an end in itself. The robot is a useful tool that should be utilized only when it is prudent and cost-effective to do so.

Chemistry, Clinical↗

PubMed2002

Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.

OBJECTIVE: To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke. DESIGN: Randomized controlled trial, 6-month follow-up. SETTING: A Department of Veterans Affairs rehabilitation research and development center. PARTICIPANTS: Consecutive sample of 27 subjects with chronic hemiparesis (>6mo after cerebrovascular accident) randomly allocated to group. INTERVENTIONS: All subjects received twenty-four 1-hour sessions over 2 months. Subjects in the robot group practiced shoulder and elbow movements while assisted by a robot manipulator. Subjects in the control group received neurodevelopmental therapy (targeting proximal upper limb function) and 5 minutes of exposure to the robot in each session. MAIN OUTCOME MEASURES: Fugl-Meyer assessment of motor impairment, FIMtrade mark instrument, and biomechanic measures of strength and reaching kinematics. Clinical evaluations were performed by a therapist blinded to group assignments. RESULTS: Compared with the control group, the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment (P<.05) and also after 2 months of treatment (P<.05). The robot group had larger gains in strength (P<.02) and larger increases in reach extent (P<.01) after 2 months of treatment. At the 6-month follow-up, the groups no longer differed in terms of the Fugl-Meyer test (P>.30); however, the robot group had larger improvements in the FIM (P<.04). CONCLUSIONS: Compared with conventional treatment, robot-assisted movements had advantages in terms of clinical and biomechanical measures. Further research into the use of robotic manipulation for motor rehabilitation is justified.

Aged↗

PubMed2005

An automated robotic approach with redundant navigation for minimal invasive extended transsphenoidal skull base surgery.

BACKGROUND: The aim of this work was to determine the feasibility of a robotic-assisted and fully automated approach to the sphenoid sinus. An image-guided robotic system was designed to address potential human errors in performing transsphenoidal sinus surgery by combining the reproducible accuracy of a robotic system with standard computer navigation. METHODS: A six-degrees of freedom robotic assistance system and an opto-electrical navigation system were combined for image-guided assistance with redundantly controlled robotics. Newly designed endoscopic instruments for robotic surgery have been developed and are described. Telemanipulatory, as well as fully automated procedures, were tested on cadaveric heads as part of a preclinical trial. RESULTS: A fully automated sphenoidotomy as well as a telemanipulatory sphenoidectomy were performed successfully on cadaveric heads. Intraoperative performance, accuracy assessment studies, as well as possible sources of stereotactic offsets are described. The mean measured robotic reproducibility accuracy was 0.056 mm (range: 0.02 - 0.14 mm) and the mean overall navigated robotic accuracy, including all transformation and registration errors was 1.53 mm (range: 1.13 - 1.89 mm) respectively. CONCLUSION: A system for robot-guided surgery in combination with redundant navigational control was developed. It allows highly accurate maneuvers, performed either in a telemanipulation mode as master-slave system or in a fully automated fashion. A sphenoidectomy on cadaveric heads was performed in both telemanipulation and fully automated modes. The overall intraoperative accuracy was in the range of the resolution of the CT images and stereotactic offsets were caused mainly due to deflections of the endoscopic operating instrument.

Cadaver↗

PubMed2005

Robotic versus conventional laparoscopic skill acquisition: implications for training.

BACKGROUND AND PURPOSE: Despite the growing interest in surgical robotics, very little study has been done regarding the acquisition of the skills needed to perform robotic surgery safely. The purpose of this study was to determine whether skills are transferred between conventional laparoscopy and robotically assisted surgery. SUBJECTS AND METHODS: Intracorporeal knot tying was used for evaluating laparoscopic skills for time and error performance. Twenty medical students without any laparoscopic experience were randomized into two groups. Group A initially performed knot tying with conventional laparoscopic instruments, were trained with the daVinci Robotic System, and then performed knot tying with conventional laparoscopy. Group B performed knot tying with robotics, trained with standard laparoscopy, and completed post-training knot tying with robotics. Pretraining and post-training tasks were videotaped and analyzed using a detailed scoring system by one independent referee, who was blinded to the subjects' experience. RESULTS: Pre-training knot tying was faster with robotics (4.4 v 9.9 minutes; P < 0.001). The mean composite scores were 27.4 for group A and 57.4 for group B (P = 0.09), and the error scores were 57.1 and 42.1 (P = 0.29), respectively. Post-training time for knot completion decreased to 6.7 minutes and 3.4 minutes for groups A and B, respectively. Composite scores increased significantly, from 27.4 to 66.1 for group A and 57.4 to 81.8 for group B. Error scores decreased to 32.9 for group A (P = 0.1) and 16.2 in group B (P = 0.02). CONCLUSIONS: There appears to be reciprocal transfer of skills between conventional laparoscopy and robotically assisted surgery. However, this transference is incomplete. Our results suggest that training with either technique or conventional laparoscopy is superior to training with robotics alone.

Clinical Competence↗

PubMed2006

Mentoring console improves collaboration and teaching in surgical robotics.

BACKGROUND: One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. MATERIALS AND METHODS: The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. RESULTS: Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P < 0.01) and by 34% compared to single-resident operation (P < 0.001). While swap mode was found to be most helpful during parts of surgical procedures that require multiple hands (such as isolation and division of vessels), nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). CONCLUSION: The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

Animals↗

PubMed2006

Effect of robotic-assisted treadmill training and chronic quipazine treatment on hindlimb stepping in spinally transected rats.

The purpose of this study was to determine if robotic-assisted treadmill training improved hindlimb stepping in complete spinal cord transected (ST) rats. In addition, we examined whether chronic quipazine treatment would enhance the effectiveness of robotic-assisted training. Hindlimb stepping was examined in four groups of ST rats: trained + quipazine; trained + vehicle; untrained + quipazine; and untrained + vehicle. To train the rats to step, a robotic device was used that moved the hindlimbs in a semi-fixed trajectory during treadmill stepping. The robotic device was also used to assess treadmill stepping. Quipazine or vehicle was administered to the lumbar spinal cord using an intrathecal cannula. The groups that received robotic-assisted training performed more stepping movements on the treadmill than the untrained groups 10 weeks after ST. However, no differences were found between the robotic-assisted and untrained groups 16 weeks after ST. Kinematic analyses revealed that abnormally small step cycles were performed by all of the groups of ST rats. There was no significant effect of combining robotic-assisted training and quipazine treatment on stepping recovery. These data suggest that robotic-assisted training may generate hindlimb sensory stimuli that are effective in enhancing the ability of the lumbar spinal cord to generate hindlimb stepping. However, the effectiveness of robotic-assisted training may be limited to the early stages of recovery following spinal cord transection.

Animals↗