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PubMed2003

Robotics and ergonomics.

Industrial robotics have proven the benefit of using an untiring machine to perform precise repetitive tasks in uncomfortable or dangerous for humans environments. Highly skilled surgeons are trained to operate and adapt to difficult conditions. They are even capable of developing intelligent mechanisms to exploit a variety of tactile, visual, and other cues. The robotic systems, however, can enhance the surgeon's capability to perform a wide variety of tasks. They cannot replace the surgeon's problem-solving ability. Instead, they will redefine his role. They will significantly enhance the surgeon's skills and dexterity by providing their complementary capabilities and an ergonomically efficient and more user-friendly working environment.

Cost-Benefit Analysis↗

PubMed2003

Robotic versus telerobotic laparoscopic cholecystectomy: duration of surgery and outcomes.

This study found that robotic and telerobotic operations were accomplished with the same mortality, morbidity, blood loss, length of operations and length of stay. The DaVinci operations required longer total operating room time than the AESOP operations. Telerobotic laparoscopic cholecystectomy achieved the same clinical outcomes as standard robotic laparoscopic cholecystectomy in this small trial. This study justifies further comparison of these techniques in a randomized prospective trial.

Body Mass Index↗

PubMed2003

Robotic surgery: from past to future--a personal journey.

A review of the history of robotic surgery--from its beginnings in a collaboration of engineers, computer scientists, and a plastic surgeon from Stanford Research Institute (SRI) and the NASA-Ames Research Center to the next generation of systems on the drawing board in the Department of Defense--provides a rich and colorful look at the author's participation in its development. Although Dr. Satava has participated in the development of other systems (orthopedic, ophthalmologic, and neurosurgical) that have contributed to the current distribution of robotic, computer-aided, and image-guided surgical systems, this article focuses on the development of the telemanipulation systems used for thoracic, abdominal, and pelvic surgery. Based upon emerging technologies, speculation is provided on the next generation of systems.

Clinical Competence↗

PubMed2003

Incorporating robotics into an open-heart program.

The above described clinical series show that after a careful and thorough training program and stepwise introduction of surgical telemanipulation systems, application of telemanipulations is safe and shows acceptable results. Still, OR times are longer than for conventional procedures, and the operation is demanding, and expensive. The main shortcoming is that the procedure is only suitable for a highly selected patient population. However, despite all the clinical experience gathered in various centers, this technique is still evolving and in its beginning. There are some very promising developments that will improve the benefit of telemanipulators. For the first time, the separation of the surgeon from the surgical field facilitates training of surgeons on simulators. This might lead to a higher standard of surgical performance. Progress in sensor technology will make tactile-force feedback available, and new 3 D-visualization systems are designed to provide a better depth perception and higher resolution of the endoscopic image. Virtual stabilizing systems will enable robotic systems to operate on a virtual arrested heart without the need for CPB or mechanical stabilizers. These and other research topics summarized under the term augmented reality will enhance the natural senses and abilities of the surgeon. More and more, automatization will find its way into the OR. Preoperatively collected data about the patient's anatomy will be used to create safety margins, the robotic system will allow for the surgeon's movements, and instruments will be able to find their way to the surgical site without remote control. Because a stepwise approach has led to the clinical results that we and others have now achieved, it is the basis for further step-by-step development of the application of telemanipulation systems in coronary artery bypass grafting, and possibly other endoscopic procedures in cardiac surgery.

Animals↗

PubMed2003

Robotic renal and adrenal surgery.

Technology today is evolving at a dramatic rate. Quantum development has occurred in the area of robotic enhancement technology (RET) in the last decade. Incorporation of RET with advanced telecommunication technologies is a recent integration in medicine, with growth potential and application in the delivery of modern health care. There remain, however, many areas which need to be further improved and evaluated before clinical applications of the robot become accepted in adrenal and renal minimally invasive surgery.

Adrenal Gland Diseases↗

PubMed2002

Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience.

OBJECTIVES: Robotic assistance may enhance the precision of anatomic dissection and increase the feasibility of performing laparoscopic radical prostatectomy for most surgeons. We performed a prospective comparison of 30 consecutive patients undergoing conventional radical retropubic prostatectomy (RRP) and 30 initial patients undergoing robot-assisted anatomic prostatectomy (RAP) at our institution. METHODS: The study design was a prospective nonrandomized comparison of anatomic RRP performed using the technique of Walsh and RAP performed with the da Vinci surgical system. We evaluated the baseline patient and tumor characteristics (age, body mass index, serum prostate-specific antigen, Gleason score, and clinical stage), intraoperative parameters (operative time, blood loss, and need for transfusion), postoperative parameters (pain score, hospitalization duration, catheter duration), histopathologic parameters, and complications in the two groups. RESULTS: The preoperative parameters were comparable for both groups of patients. The mean setup time for RAP was 0.95 hours. The mean operating time was 2.3 hours for RRP and 4.8 hours for RAP (P <0.001). One patient required conversion from RAP to RRP because of a lack of progress. The mean blood loss was 970 mL for RRP and 329 mL for RAP (P <0.001). The drop in hemoglobin was greater in the RRP group (4.4 versus 1.2 g in RAP; P <0.05). The mean pain score on postoperative day 1 was 7 in the RRP group and 4 in RAP group (P = 0.05). The mean hospital stay was 56 hours in the RRP group and 36 hours in the RAP group (P value not significant). Sixty-three percent of the RAP and 0% of the RRP groups were discharged within 23 hours (P <0.001). The mean duration of postoperative catheterization was 14 days for the RRP and 11 days for the RAP groups (difference not significant). The pathologic stage, margin status, and prostate-specific antigen values were not different between the two groups. The setup time, operative time, blood loss amount, and catheterization duration were significantly reduced after the first 20 patients. CONCLUSIONS: Currently, RAP is a longer procedure than RRP. However, the blood loss is minimal and patients feel less pain and are discharged earlier from the hospital. In our hands, the margin status and complication rates were comparable for both techniques.

Aged↗

PubMedDate not supplied

Automation and Robotics for Human Mars Exploration (AROMA).

Automation and Robotics (A&R) systems are a key technology for Mars exploration. All over the world initiatives in this field aim at developing new A&R systems and technologies for planetary surface exploration. From December 2000 to February 2002 Kayser-Threde GmbH, Munich, Germany lead a study called AROMA (Automation and Robotics for Human Mars Exploration) under ESA contract in order to define a reference architecture of A&R elements in support of a human Mars exploration program. One of the goals of this effort is to initiate new developments and to maintain the competitiveness of European industry within this field.

Automation↗

PubMed2006

[Da Vinci advanced robotic laparoscopic surgery: origin and current clinical application in urology, and comparison with open and laparoscopic surgery].

Over the last decade, open surgery, which is able to perform large extirpations and repairs of fragile tissues, is gradually being substituted with laparoscopic surgery due to the high benefits the latter entails for the patients, an also due to the learning difficulties for surgeons who must make up for such deficiencies applying higher efforts and a larger amount of stress. Robotic surgery stands in for the limitations of conventional laparoscopic surgery by means of performing more ergonomic and more accurate surgeries, particularly in the case of the most complex and difficult to access operations, such as radical prostatectomy. This review will perform a reminder of the history and clinical applications of new advanced and robotic technologies, and also a comparison with open surgery and conventional laparoscopy.

Equipment Design↗

PubMed1989

Simplified procedures for the determination of fenoldopam and its metabolites in human plasma by high-performance liquid chromatography with electrochemical detection: comparison of manual and robotic sample preparation methods.

Quantitative analytical methods, based on high-performance liquid chromatography with electrochemical detection, were developed for fenoldopam and its metabolites in human plasma. Two extraction methods, a liquid-liquid extraction method for fenoldopam and its methoxy metabolites and a liquid-solid extraction procedure for the sulfate and glucuronide conjugates of fenoldopam were developed. The extractions can either be performed manually or by robot. The limit of detection for fenoldopam, its sulfate and methoxy metabolites was 0.025, 2 and 0.5 ng/ml, respectively, at a signal to noise ratio of 4. The intra-assay and inter-assay coefficients of variation for both manual and robotic extraction procedures were comparable. These methods were suitably selective and sensitive for pharmacokinetic and metabolic studies of fenoldopam.

Adult↗

PubMedDate not supplied

A new framework for vision-enabled and robotically assisted minimally invasive surgery.

This paper presents our on-going research at bringing the state-of-the-art in vision and robotics technologies to enhance the emerging minimally invasive surgery, in particular the laparoscopic surgical procedure. A framework that utilizes intelligent visual modeling, recognition, and serving capabilities for assisting the surgeon in maneuvering the scope (camera) in laparoscopy is proposed. The proposed framework integrates top-down model guidance, bottom-up image analysis, and surgeon-in-the-loop monitoring for added patient safety. For the top-down directives, high-level models are used to represent the abdominal anatomy and to encode choreographed scope movement sequences based on the surgeon's knowledge. For the bottom-up analysis, vision algorithms are designed for image analysis, modeling, and matching in a flexible, deformable environment (the abdominal cavity). For reconciling the top-down and bottom-up activities, robot servoing mechanisms are realized for executing choreographed scope movements with active vision guidance. The proposed choreographed scope maneuvering concept facilitates the surgeon's control of his/her visual feedback in a handless manner, reduces the risk to the patient from inappropriate scope movements by an assistant, and allows the operation to be performed faster and with greater ease. In this paper, we describe the new framework and present some preliminary results on laparoscopic image analysis for segmentation and instrument localization, and on instrument tracking.

Humans↗

PubMed2003

Experiences in robotically enhanced IMA-preparation as initial step towards totally endoscopic coronary artery bypass grafting.

AIM: To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA). METHOD: Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO(2) insufflation and single lung ventilation using electrocautery. RESULTS: In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7+/-1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7+/-21.1 and 99.2+/-8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9+/-13.1 s, clip applier 72.8+/-28.4 s). CONCLUSION: Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.

Aged↗

PubMed2002

Robotic preparation of Sodium Acetate C 11 Injection for use in clinical PET.

Sodium Acetate C 11 Injection is a radiopharmaceutical commonly used for clinical studies with positron emission tomography (PET). We have designed a fully-automated robotic system for the compounding of this 20-minute half-lived tracer in the clinical setting. The system is comprised of five modular workstations that are configured in a flexible manner to accommodate all of the steps in the production of the labeled drug. The Trapping Station isolates cyclotron-produced [11C]CO(2) gas from the target and directs carbonation of methylmagnesium Grignard in diethyl ether. The Heating Station hydrolyzes the intermediate, and removes ether and unreacted [11C]CO(2) from the mixture. The Extraction Station removes ionic and organic contaminants from the drug using solid-phase extraction (AG 11A8 and C18 resin). The Filtration Station sterilizes the radiopharmaceutical, and tests membrane patency post filtration. The Assay Station measures the weight and radioactivity content of the Final Product Container, facilitating calculation of activity concentration in a remote manner. Rapid quality control methodology has also been developed that is suitable for pre-release analysis of the drug product. For a 7.5 min irradiation with a 40 microA proton beam, 223-300 mCi of Acetate C 11 Injection with purity meeting USP standards is produced within 23 min. This robotic system is a reliable method for producing Sodium Acetate C 11 Injection, USP in the clinical setting with minimal personnel exposure. Moreover, its design flexibility permits synthesis of additional (11)C- or (18)F-labeled PET tracers within the same shielded hot cell.

Carbon Isotopes↗

PubMed2004

Early experience with robot-assisted laparoscopic radical prostatectomy.

INTRODUCTION: We assessed the feasibility of a robot-assisted laparoscopic radical prostatectomy (rLRP) programme through a review of our early experience. PATIENTS AND METHODS: Seventeen patients underwent rLRP between 1 February 2003 and 31 December 2003 at Singapore General Hospital. All patients had histologically confirmed adenocarcinoma on prostate biopsy and a negative bone scan. The Da Vinci robot was employed. The Montsouris technique was used for our first eight patients, and the Vattikuti Institute Prostatectomy technique was used for all subsequent patients. We studied perioperative parameters and early surgical outcome prospectively. RESULTS: The mean age at diagnosis was 63.9 +/- 5.6 years. The median Gleason sum was 6 (range, 5-9), and mean pretreatment prostate-specific antigen level was 10.5 +/- 5.4 ng/mL. The mean set-up time was 34 +/- 18 minutes, and mean dissection time was 247 +/- 43 minutes. Perioperative blood loss averaged 494 +/- 330 mL, and three patients required blood transfusion. Normal diet was resumed after 1.7 +/- 0.6 days. The mean duration of bladder catheterization was 9.8 +/- 6.1 days, and mean hospital stay was 2.7 +/- 1.3 days. There was no perioperative mortality or major complications, and no conversion to open radical prostatectomy. From Case 9 onwards, there was significant reduction in operating time (284 vs 215 minutes), blood loss (650 vs 400 mL) and hospital stay (3.8 vs 1.8 days). CONCLUSIONS: rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

Adenocarcinoma↗

PubMed2001

Can robots make good models of biological behaviour?

UNLABELLED: How should biological behaviour be modelled? A relatively new approach is to investigate problems in neuroethology by building physical robot models of biological sensorimotor systems. The explication and justification of this approach are here placed within a framework for describing and comparing models in the behavioural and biological sciences. First, simulation models--the representation of a hypothesis about a target system--are distinguished from several other relationships also termed "modelling" in discussions of scientific explanation. Seven dimensions on which simulation models can differ are defined and distinctions between them discussed: 1. RELEVANCE: whether the model tests and generates hypotheses applicable to biology. 2. Level: the elemental units of the model in the hierarchy from atoms to societies. 3. Generality: the range of biological systems the model can represent. 4. Abstraction: the complexity, relative to the target, or amount of detail included in the model. 5. Structural accuracy: how well the model represents the actual mechanisms underlying the behaviour. 6. Performance match: to what extent the model behaviour matches the target behaviour. 7. Medium: the physical basis by which the model is implemented. No specific position in the space of models thus defined is the only correct one, but a good modelling methodology should be explicit about its position and the justification for that position. It is argued that in building robot models biological relevance is more effective than loose biological inspiration; multiple levels can be integrated; that generality cannot be assumed but might emerge from studying specific instances; abstraction is better done by simplification than idealisation; accuracy can be approached through iterations of complete systems; that the model should be able to match and predict target behaviour; and that a physical medium can have significant advantages. These arguments reflect the view that biological behaviour needs to be studied and modelled in context, that is, in terms of the real problems faced by real animals in real environments.

Behavior↗

PubMedDate not supplied

Use of operating windows in the assessment of integrated robotic systems for the measurement of bioprocess kinetics.

This study examines the utility of an automated liquid handling robot integrated with a microwell plate reader to enable the rapid acquisition of bioprocess kinetic data. The relationship between the key parameters for liquid handling accuracy and precision and the sample detection period has been characterized for typical low-viscosity (<2.0 mPa x s) aqueous and organic phases and for a high-viscosity aqueous phase (60 mPa x s), all exhibiting Newtonian rheology. The use of a simple graphical method enables the suitability of a given automation platform to be assessed once the user has determined the minimum sample detection period and the minimum accurate and precise dispense volume. This provides for a reduction in the duration of any experiment by maximizing well usage within each microwell plate. The suitability of employing an integrated automation platform to gather kinetic data for systems typical of those encountered in bioprocessing is analyzed via a series of case studies. Application to alkaline cell lysis, where disruption is complete within 120 s, showed that the range of available dispense volumes and the number of wells that can be utilized is limited. In contrast, analysis of a system exhibiting slow process kinetics, the fermentation of Escherichia coli TOP10 pQR239 in microwell plates, demonstrated that, for a typical sample detection period of 30 min, the only restrictions on the degree of well utilization are the liquid handling accuracy and precision and the volume capacity of the liquid handling robot. Finally, liquid-liquid extraction, an example of a kinetically independent operation, was also examined. In this case, only a single equilibrium measurement is required, which means that the only restrictions to the utilization of the integrated devices are the liquid handling accuracy and precision. Integrated automation platforms represent a powerful process development tool over traditional experimental methods used for bioprocess development. Smaller volumes of reagent and sample can be used to achieve greater throughput, while high levels of reproducibility and sensitivity are maintained.

Biotechnology↗

PubMedDate not supplied

Space robotics--DLR's telerobotic concepts, lightweight arms and articulated hands.

The paper briefly outlines DLR's experience with real space robot missions (ROTEX and ETS VII). It then discusses forthcoming projects, e.g., free-flying systems in low or geostationary orbit and robot systems around the space station ISS, where the telerobotic system MARCO might represent a common baseline. Finally it describes our efforts in developing a new generation of "mechatronic" ultra-light weight arms with multifingered hands. The third arm generation is operable now (approaching present-day technical limits). In a similar way DLR's four-fingered hand II was a big step towards higher reliability and yet better performance. Artificial robonauts for space are a central goal now for the Europeans as well as for NASA, and the first verification tests of DLR's joint components are supposed to fly already end of 93 on the space station.

Automation↗

PubMed2004

Control methods and the performance of the robotic testing system for human musculoskeletal joints.

Biomechanical testing of human musculoskeletal joints not only requires qualified testing machines and devices, but also needs an excellent control method to obtain better experimental results. In this paper, we take the human functional spinal unit (FSU) as an example to study how to improve the performance of the robotic testing system. First, the mechanical characteristics of FSU are described and the simplified model (rigid body-spring system) for the specimen is given. Because the location of the center of rotation (COR) of the specimen affects the performance of the system, a comprehensive analysis on the location of COR is carried out. The performance of the robotic testing system can also be improved through the improvement of the control method. Two control methods have been proposed in this paper: one is the improved hybrid control, the other is fuzzy logic control.

Algorithms↗

PubMed2006

Biomechanics: robotic whiskers used to sense features.

Whiskers mimicking those of seals or rats might be useful for underwater tracking or tactile exploration. Several species of terrestrial and marine mammals with whiskers (vibrissae) use them to sense and navigate in their environment--for example, rats use their whiskers to discern the features of objects, and seals rely on theirs to track the hydrodynamic trails of their prey. Here we show that the bending moment--sometimes referred to as torque--at the whisker base can be used to generate three-dimensional spatial representations of the environment, and we use this principle to construct robotic whisker arrays that extract precise information about object shape and fluid flow. Our results will contribute to the development of versatile tactile-sensing systems for robotic applications, and demonstrate the value of hardware models in understanding how sensing mechanisms and movement control strategies are interlocked.

Animals↗