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Study of human forearm posture maintenance with a physiologically based robotic arm and spinal level neural controller.

The goals of this research are: (1) to apply knowledge of human neuro-musculo-skeletal motion control to a biomechanically designed, neural controlled, 'anthroform' robotic arm system, (2) to demonstrate that such a system is capable of responses that match those of the human arm reasonably well in comparable experiments, and (3) to utilize the anthroform arm system to study some controversial issues and to predict new phenomena of the human motion control system. A physiologically analogous artificial neural network controller and an anatomically accurate robotic testing elbow are applied in this study. In order to build the physical elbow system to have mechanical properties as close as possible to the human arm, McKibben pneumatic artificial muscles, force sensors, and mechanical muscle spindles are integrated in the system with anatomically accurate muscle attachment points. A physiologically analogous, artificial neural network controller is used to emulate the behavior of spinal segmental reflex circuitry including Ia and Ib afferent feedbacks. Systematic experiments of elbow posture maintenance are performed and compared with physiological experimental data. New experiments are performed in which responses to torque perturbation are measured when selected afferent pathways are blocked. A 'covariance diagram' is introduced. And a linear model is used to help to analyze the roles of system components. The results show that muscle co-contraction and Ia afference with gamma dynamic motoneuron excitation are two efficient ways to increase joint stiffness and damping, which in turn reduces the mechanical sensitivity of the joint to external perturbation and shortens the settling time of the system.

Afferent Pathways↗

Surgeon workload and motion efficiency with robot and human laparoscopic camera control.

BACKGROUND: Surgeons are now being assisted by robotic systems in a wide range of laparoscopic procedures. Some reports have suggested that robot-assisted camera control (RACC) may be superior to a human driver in terms of quality of view and directional precision, as well as long-term cost savings. Therefore, we setout to investigate the impact of RACC of surgeon motion efficiency. METHODS: Twenty pigs were randomized to undergo a standardized laparoscopic Nissen fundoplication with either a human or RACC system, the AESOP 2000. All procedures were performed by the same surgical fellow. Time was recorded for dissection and suture phases. Inertial motion sensors were used to monitor both the surgeon's hands and the camera. Digitized data were analyzed to produce summary measures related to overall motion. RESULTS: The operative times were slightly longer with RACC (mean 80.2 +/- 20.6 vs 73.1 +/- 15.4 min, not significant). With regard to operative times and surgeon motion measures, the only statistically significant differences were for setup and breakdown times, which contributed <15% to the total time for the procedure. CONCLUSION: In terms of impact on surgeon motion efficiency and operative time under normal surgical conditions, RACC is essentially the same as an expert human driver. However, careful planning and structuring of the surgical suite may yield some small gains in operative time.

Animals↗

Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing.

BACKGROUND: This study presents a novel technique for laparoscopic ventral hernia repair using the da Vinci Robot and intracorporeal suturing. Thus, it offers an alternative to transabdominal sutures and tackers. METHODS: A ventral hernia model was created in six pigs. The mesh was fixed to the circumference of the fascia using interrupted sutures. The outer border of the mesh was then fixed to the posterior fascia using running sutures. RESULTS: There were no complications. The depth and location of the interrupted and running sutures were confirmed postmortem. CONCLUSIONS: The transabdominal sutures and tackers used in laparoscopic ventral hernia repair can be the focus for postoperative pain and adhesions. As an alternative, the da Vinci Robot can be used to facilitate intracorporeal suturing of the mesh directly to the fascial edge and to secure the circumference of the mesh to the posterior fascia. The preliminary results are promising and represent a safe method that can be implemented in humans.

Animals↗

Robot-assisted choledochotomy: feasibility.

Because clearing stones from the common bile duct is demanding with conventional laparoscopic techniques, the "da Vinci" robotic system can be of additional value in inserting a kehr drain and suturing the common bile duct. As far as we could ascertain, we report the first case of a laparoscopic choledochotomy with the assistance of this robotic system. Thanks to it, we were able to suture the common bile duct meticulously.

Aged↗

A robotic wide-angle view endoscope using wedge prisms.

BACKGROUND: The aim was to develop a new type of robotic wide-angle view endoscope that does not require rotation or bending of the endoscope to move the field of view. This endoscope allows the surgeon to make extensive observations in a small space. It is safe because it avoids the possibility of hitting organs accidentally. METHODS: The system consists of an endoscope with a zoom facility and two wedge prisms at the tip. Each prism is set on its own sleeve at the end of the endoscope, and both prisms rotate independently about the axis of the endoscope. RESULTS: In the in vivo experiment, the high quality of the image was confirmed, and almost whole liver could be observed without the observer moving the endoscope itself. CONCLUSIONS: This system provides safe robotic endoscopic surgery because of the high quality of the image. It has great significance for future clinical use.

Animals↗

The benefits of stereoscopic vision in robotic-assisted performance on bench models.

BACKGROUND: Previous studies have failed to establish clear advantages for the use of stereoscopic visualization systems in minimal-access surgery. The aim of this study was to objectively assess whether stereoscopic visualization improves performance on bench models using the da Vinci robotic system. METHODS: Eleven surgeons carried out a series of four tasks. Positional data streamed from the da Vinci system was analyzed by means of a previously validated custom-designed software-package. An independent blinded observer scored errors. Statistical analysis included the Wilcoxon signed rank test. A p < 0.05 was deemed significant. RESULTS: We found significant improvements in all tasks and for all parameters (p < 0.05). In addition, a significantly lower number of errors was scored using the stereoscopic mode as compared to the standard two-dimensional image (p < 0.001). CONCLUSION: Robotic-assisted performance on bench models is more efficient and accurate using stereoscopic visualization.

Data Display↗

Robot-assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a comparative study.

BACKGROUND: The efficacy of conventional laparoscopic cholecystectomy (CLC) was compared with robot-assisted laparoscopic cholecystectomy (RLC). Surgical trainees performed the LC to avoid the surgeon's experience bias. METHODS: Two surgical trainees performed 10 CLCs and 10 RLCs at random with a Zeus-Aesop Surgical Robotic System. The primary efficacy parameters were the total time and the number of actions involved in the procedure. The secondary parameters were setup and dissection times, and the number of grasping and dissection actions. Surgical complications were evaluated. RESULTS: For CLC and RLC, respectively, the total times were 95.4 +/- 28 min and 123.5 +/- 33.3 min and the total actions were 420 +/- 176.3 and 363.5 +/- 158.2. For CLC, the times required for setup (21 +/- 10.4 min) and dissection (50.2 +/- 17.7 min) were less than for RLC (33.8 +/- 11.3 min and 72 +/- 24.3 min, respectively). The numbers of grasping and dissection actions were not significantly different: 41.4 +/- 26.5 and 378 +/- 173.7, respectively, for CLC versus 48.9 +/- 27 and 314.6 +/- 141.9, respectively, for RLC. CONCLUSION: Although feasible, RLC requires significantly more time than CLC because of slower performed actions.

Adult↗

Optimal port placement and enhanced guidance in robotically assisted cardiac surgery.

BACKGROUND: Optimal port placement and enhanced guidance in robotically assisted cardiac surgery is required to improve preoperative planning and intraoperative navigation. METHODS: Offline optimal port placement is planned on a three-dimensional virtual reconstruction of the patient's computed tomography scan. Using this data, an accurate in vivo port placement can be performed, which is achieved by augmented reality techniques superimposing virtual models of the thorax and the teleoperator arms on top of the real worldview. RESULTS: A new system incorporating both port placement planning and intraoperative navigation in robotically assisted minimally invasive heart surgery was established to aid the operative workflow. A significant reduction of operation time by improved planning and intraoperative support is anticipated. CONCLUSIONS: The enhanced intraoperative orientation possibilities may lead to further decrease in operation time and have the continuing ability to improve quality.

Cardiovascular Surgical Procedures↗

Laparoscopic visual field. Voice vs foot pedal interfaces for control of the AESOP robot.

BACKGROUND: In order for robotic devices to be introduced successfully into surgical practice, the development of transparent surgeon/machine interfaces is critical. METHODS: This study evaluated the standard foot pedal for the AESOP robot compared to a voice control interface. Speed, accuracy, learning curves, durability of learning at 2 weeks, and operator-interface failures were analyzed in an ex vivo model. RESULTS: Foot control was faster and had less operator-interface failures. Voice control was more accurate as measured by "pass points." The foot control learning curve reached a plateau at the third trial, while the voice control did not fully plateau. Durability of learning favored the foot control but was not significantly different. CONCLUSIONS: Currently, the voice control is more accurate and has the advantage of not requiring the surgeon to look away from the operative field. However, it is slower and may require more attention as an interface. As voice recognition software continues to advance, speed and transparency are anticipated to improve.

Equipment Design↗

Improving precise positioning of surgical robotic instruments by a three-side-view presentation system on telesurgery.

For faultless collaboration among the surgeon, surgical staffs, and surgical robots in telesurgery, communication must include environmental information of the remote operating room, such as behavior of robots and staffs, vital information of a patient, named supporting information, in addition to view of surgical field. "Surgical Cockpit System, " which is a telesurgery support system that has been developed by the authors, is mainly focused on supporting information exchange between remote sites. Live video presentation is important technology for Surgical Cockpit System. Visualization method to give precise location/posture of surgical instruments is indispensable for accurate control and faultless operation. In this paper, the authors propose three-side-view presentation method for precise location/posture control of surgical instruments in telesurgery. The experimental results show that the proposed method improved accurate positioning of a telemanipulator.

Humans↗

Robot-assisted radical cystectomy and urinary diversion.

Radical cystectomy remains the standard for muscle-invasive, organ-confined urothelial carcinoma of the bladder. With the emergence of minimally invasive approaches for the treatment of urologic cancers, technologic advances using laparoscopy have led to the development of robotic assistance to increase the feasibility of performing this formidable operation. In this article, we describe the procedure of robotic-assisted laparoscopic radical cystectomy with urinary diversion and review the pertinent literature.

Carcinoma, Transitional Cell↗

Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost.

Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse short-term data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.

Costs and Cost Analysis↗

Ophthalmic microsurgical robot and associated virtual environment.

An ophthalmic virtual environment has been developed as part of a teleoperated microsurgical robot built to perform surgery on the eye. The virtual environment is unique in that it incorporates a detailed continuum model of the anatomical structures of the eye, its mechanics and optical properties, together with a less detailed geometric-mechanical model of the face. In addition to providing a realistic visual display of the eye being operated on, the virtual environment simulates tissue properties during manipulation and cutting and the forces involved are determined by solving a mechanical finite element model of the tissue. These forces are then fed back to the operator via a force reflecting master and so the surgeon can experience both the visual and mechanical sensations associated with performing surgery. The virtual environment can be used to enhance the images produced by the camera on the microsurgical slave robot during surgery and as a surgical simulator in which it replaces these images with computer graphics generated from the eye model.

Computer Graphics↗

Trotting, pacing and bounding by a quadruped robot.

This paper explores the quadruped running gaits that use the legs in pairs: the trot (diagonal pairs), the pace (lateral pairs), and the bound (front and rear pairs). Rather than study these gaits in quadruped animals, we studied them in a quadruped robot. We found that each of the gaits that use the legs in pairs can be transformed into a common underlying gait, a virtual biped gait. Once transformed, a single set of control algorithms produce all three gaits, with modest parameter variations between them. The control algorithms manipulated rebound height, running speed, and body attitude, while a low-level mechanism coordinated the behavior of the legs in each pair. The approach was tested with laboratory experiments on a four-legged robot. Data are presented that show the details of the running motion for the three gaits and for transitions from one gait to another.

Algorithms↗

Application of robotic technology to automated sequence fingerprint analysis by oligonucleotide hybridisation.

We describe our production line for the rapid analysis of large cDNA libraries applying robotic techniques to automatically pick, amplify, array, hybridise and analyse the clones. We also outline the current state of the hybridisation techniques and describe anticipated future developments of the system. Our approach faces the large-scale analysis of cDNA clones with partial sequence analysis by oligonucleotide fingerprinting in the following way: after picking of individual colonies and arraying them automatically in quadruple density (384-well) microtitre plates, the cDNA clones are amplified by an automated waterbath polymerase chain reaction (PCR), which allows us to run about 46,000 reactions in parallel. The PCR products are automatically transferred to nylon membranes in a high density pattern using a robotic device. We routinely produce twelve 22 cm x 22 cm membranes in 90 min. Each membrane contains 20,736 clones, although much higher densities might be feasible using both miniaturized glass matrices and fluorescence based hybridisation techniques. Theoretical analysis and preliminary computer simulations indicate that about 100-200 sequence specific hybridisations of octanucleotides to about 100,000 PCR products of 1000-1500 base-pairs length will generate sufficient information for classifying the clones into groups of identical or related genes and to identify a large number of previously uncharacterized cDNA clones.

Biotechnology↗

Dye laser treatment of port-wine stains: comparison of the continuous-wave dye laser with a robotized scanning device and the pulsed dye laser.

BACKGROUND: Despite good results in the treatment of most port-wine stains (PWS) with continuous-wave visible-light lasers, light PWS and those in certain locations respond less favorably and have a higher risk of scarring. Robotized scanning devices such as the Hexascan device have been developed for continuous-wave laser sources to produce greater target specificity, to increase reproducibility of results, and to decrease the incidence of adverse effects. OBJECTIVE: The purpose of this study was to compare the effects of the same wavelength of light (585 nm) on test sites within PWS with the flashlamp-pumped pulsed dye laser and a continuous-wave tunable dye laser scanned through a Hexascan robotized scanning device. METHODS: Two adjacent, noncontiguous sites within PWS were treated in 29 patients, one site with the flashlamp-pumped pulsed dye laser and the other with an argon-pumped continuous-wave tunable dye laser affixed to a Hexascan device. RESULTS: Twenty-eight patients completed the study. The pulsed dye laser was found to be superior to the continuous-wave dye laser with the Hexascan device in 45% of patients, whereas the continuous-wave tunable dye laser with the Hexascan device was considered superior in 15%. There was no difference in the remaining 40%. Undesirable side effects were infrequent with both treatments. There was no significant difference in hypopigmentation or atrophic and hypertrophic scarring, but hyperpigmentation was more frequent with the continuous-wave dye laser with the Hexascan device. CONCLUSION: Both the pulsed dye laser and continuous tunable-wave dye laser with the Hexascan device produce slight lightening after one treatment. The pulsed dye laser produces slightly greater lightening than the continuous-wave tunable dye laser with the Hexascan device 6 weeks after treatment of test areas within PWS in 40% of those treated. It also produced slightly less hypopigmentation and hyperpigmentation.

Adolescent↗

Robotic sample preparation and high-performance liquid chromatographic analysis of verlukast in human plasma.

A fully automated HPLC assay has been developed and validated for the quantitation of verlukast, a leukotriene D4 antagonist, in human plasma. An upgraded Zymate I robotic system was utilized to perform protein precipitation and on-line injection followed by reversed-phase HPLC with fluorescence detection. Inter-day accuracy and precision were 100.8 and 4.6%, respectively, for the low quality control standards (0.125 microgram/ml). The automated robotic method was shown to be more efficient and accurate than the manual method.

Bronchodilator Agents↗

Future developments in high-technology abdominal surgery: ultrasound, stereo imaging, robotics.

The surgical world is experiencing a revolution brought about by the proliferation of minimally invasive techniques. These developments have had most impact on abdominal surgery and chest surgery, but there are ramifications affecting other fields as well. One feature of this change is the increasing dependence of surgeons on technology. Developments in video imaging, ultrasound and robotics are required to make complex endoscopic procedures surgeon-friendly, just as the minimally invasive approach has made surgery more patient-friendly. In the future, integration of stereo imaging systems, computers, microrobots and robotic manipulators will result in technically sophisticated but ergonomic operating systems that will allow surgeons to perform endoscopically almost any type of surgery that can be done today.

Abdomen↗