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At least 1,189 records · Page 66Linked to original sources

PubMed2006

Robot-assisted laparoscopic radical cystoprostatectomy and totally intracorporeal ileal neobladder.

PURPOSE: To describe robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal orthotopic ileal neobladder construction. METHODS: With the use of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA), we performed laparoscopic radical cystectomy and intracorporeal construction of an orthotopic ileal neobladder (modified W pouch). RESULTS: The total operative time was 12 hours, and the estimated blood loss was 100 mL. There were no intraoperative or postoperative complications, and the patient?s hospital stay was 5 days. At early follow-up, oncologic and functional results are good. CONCLUSION: Robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal ileal neobladder construction is technically feasible. However, its role in the management of invasive bladder cancer remains to be defined.

Aged↗

PubMed2006

Case report: robot-assisted laparoscopic reconstruction of a ureteropelvic junction disruption.

PURPOSE: We present our experience with robot-assisted laparoscopic repair of a ureteropelvic junction (UPJ) disruption in a child. CASE REPORT: An 11-year-old boy was found to have a UPJ disruption after being struck by an automobile. After unsuccessful retrograde ureteral-stent placement, a percutaneous nephrostomy tube was placed for a planned delayed repair because of the patient's multiple injuries. One month later, the patient underwent laparoscopic repair with the DaVinci robotic system using a four-port transperitoneal technique. At 3 months' follow-up, a diuretic renogram demonstrated no obstruction. CONCLUSION: A minimally invasive laparoscopic approach using the DaVinci system is feasible in the repair of a traumatic UPJ disruption.

Child↗

PubMed2006

Robot-assisted thoracoscopic esophagectomy with the patient in the prone position.

We describe a new technique of esophagectomy by robot-assisted thoracoscopy with the patient in the prone position, followed by laparoscopy and left cervicotomy with the patient in the supine position. We report two procedures performed November 2002 and September 2003. The technique should allow more thorough lymph node removal while reducing postoperative pain and morbidity. The thoracoscopy is robot-assisted and the articulations within the pleural cavity improve the surgeon's dexterity and reduce trocar movements. The prone position allows mobilization of the esophagus with only three trocars because the lung, which is partially deflated, does not block access. With the patient in the prone position, bleeding does not obscure the operative field. Stomach mobilization, gastric tube creation, and celiac lymphadenectomy are performed by laparoscopy. The esogastric anastomosis is a totally mechanical side-to-side anastomosis realized by left cervicotomy.

Carcinoma, Squamous Cell↗

PubMed2002

Using robotics to fold proteins and dock ligands.

The problems of protein folding and ligand docking have been explored largely using molecular dynamics or Monte Carlo methods. These methods are very compute intensive because they often explore a much wider range of energies, conformations and time than necessary. In addition, Monte Carlo methods often get trapped in local minima. We initially showed that robotic motion planning permitted one to determine the energy of binding and dissociation of ligands from protein binding sites (Singh et al., 1999). The robotic motion planning method maps complicated three-dimensional conformational states into a much simpler, but higher dimensional space in which conformational rearrangements can be represented as linear paths. The dimensionality of the conformation space is of the same order as the number of degrees of conformational freedom in three-dimensional space. We were able to determine the relative energy of association and dissociation of a ligand to a protein by calculating the energetics of interaction for a few thousand conformational states in the vicinity of the protein and choosing the best path from the roadmap. More recently, we have applied roadmap planning to the problem of protein folding (Apaydin et al., 2002a). We represented multiple conformations of a protein as nodes in a compact graph with the edges representing the probability of moving between neighboring states. Instead of using Monte Carlo simulation to simulate thousands of possible paths through various conformational states, we were able to use Markov methods to calculate the steady state occupancy of each conformation, needing to calculate the energy of each conformation only once. We referred to this Markov method of representing multiple conformations and transitions as stochastic roadmap simulation or SRS. We demonstrated that the distribution of conformational states calculated with exhaustive Monte Carlo simulations asymptotically approached the Markov steady state if the same Boltzman energy distribution was used in both methods. SRS permits one to calculate contributions from all possible paths simultaneously with far fewer energy calculations than Monte Carlo or molecular dynamics methods. The SRS method also permits one to represent multiple unfolded starting states and multiple, near-native, folded states and all possible paths between them simultaneously. The SRS method is also independent of the function used to calculate the energy of the various conformational states. In a paper to be presented at this conference (Apaydin et al., 2002b) we have also applied SRS to ligand docking in which we calculate the dynamics of ligand-protein association and dissociation in the region of various binding sites on a number of proteins. SRS permits us to determine the relative times of association to and dissociation from various catalytic and non-catalytic binding sites on protein surfaces. Instead of just following the best path in a roadmap, we can calculate the contribution of all the possible binding or dissociation paths and their relative probabilities and energies simultaneously.

Algorithms↗

PubMed1987

A robotic sample preparation scheme for the high performance liquid chromatographic determination of ivermectin in animal plasma.

A lengthy sample preparation scheme for the high performance liquid chromatographic determination of the antiparasitic agent ivermectin at ppb concentrations in animal plasma is adapted to a laboratory robotic system. Sample treatment involves both liquid-liquid partitioning and solid phase extraction. Specific modifications to the manual procedure include the use of serial vortex mixings in place of batchwise lateral shaking and the substitution of small (6 mL), disposable solid phase extraction columns driven by compressed gas for large (25 mL), gravity-fed, reusable glass columns. Coupling these columns to an automated solvent dispensing device simplifies handling of the large solvent volumes prescribed in the manual procedure. A productivity gain over the manual procedure is realized when operating the robotic system in the single sample mode, and an additional gain is achieved by integrating the system for multiple sample handling. Equivalence to the manual procedure is demonstrated.

Animals↗

PubMed1997

Robotic solid-phase extraction of amphetamines from urine for analysis by gas chromatography-mass spectrometry.

We have evaluated the use of the Hamilton Microlab 2200 robotic pipetting system modified to conduct solid-phase extractions of amphetamines from urine. The Hamilton system is a programmable XYZ robotic sample handling instrument compatible with commercial solid-phase extraction (SPE) columns in the most commonly available sizes. During the extraction and elution steps, the system delivers programmable positive pressure with pressure controlled feedback so as to ensure consistent recovery. The system increases sample throughput while reducing technician hands-on time and improving sample-to-sample and batch-to-batch consistency. In comparison with the manual SPE method, the automated scheme provides similar analyte recovery, accuracy, and precision and a reduced potential for laboratory errors. The method's upper limits of linearity, detection, and lquantitation were, respectively, 10,000, 100, and 100 ng/mL for amphetamine and 25,000, 50, and 50 ng/mL for methamphetamine. Extraction recoveries for the compounds ranged from 88 to 101%. Carryover amounted to less than 0.02% even at 50,000 ng/mL concentrations of analyte. A typical automated run required 20 min of technician time versus 90 min for a corresponding manual SPE procedure. The automated procedure proved to be a reliable and labor-efficient addition to the laboratory.

Amphetamines↗

PubMed2005

High-throughput molecular testing of ticks using a liquid-handling robot.

To meet the need for high-throughput sample testing, DNA extraction kits based on the 96-well plate format have been developed for use with blood and tissue samples. These methods have not been applied to DNA extractions from ticks. To meet this need, we developed a high-throughput method for DNA extraction and polymerase chain reaction (PCR) testing of tick samples. A liquid-handling robot was used to extract DNA in a 96-well binding column plate with vacuum manifold. The quantity, purity, and quality of DNA recovered from Ixodes scapularis Say, 1821 nymphs with this method were reproducible and comparable with existing manual DNA extraction techniques. The DNA yield from pools of five nymphal ticks averaged 0.432 +/- 0.04 microg (95% CI). The robot also prepared real-time PCR reactions in 96-well plates, directly from the extracted DNA. A modification of the existing P20 tool resulted in accurate pipetting of 1- to 2-microl volumes with a reproducibility of +/- 0.038 microl when dispensing 1.0 microl. By using this process, 96 samples can be extracted and tested while reducing human labor to approximately 30 min.

Animals↗

PubMed2003

Anesthesia for robotic repair of the mitral valve: a report of two cases.

IMPLICATIONS: We describe the anesthetic management of two patients who underwent successful mitral valve repair with use of a robot-assisted cardiac surgical technique. We describe the robot used, as well as the surgical procedure, and highlight aspects of the anesthetic management, in particular the need for one-lung ventilation and the utility of transesophageal echocardiography.

Adult↗

PubMed2002

Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.

OBJECTIVE: To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. SUMMARY BACKGROUND DATA: Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances. METHODS: To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service). RESULTS: The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery. CONCLUSIONS: Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.

Aged↗

PubMed2002

Robotics and coronary artery surgery.

Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology. With a combined experience of 125 patients, several groups have independently demonstrated the clinical feasibility of totally endoscopic coronary artery bypass with two commercially available robotic telemanipulation systems. Additional enabling technology is needed to overcome the challenges currently limiting development and widespread application of totally endoscopic off-pump multivessel coronary artery bypass surgery.

Animals↗

PubMed1994

A computer-aided walking rehabilitation robot.

Even with recent techniques, a significant number of patients with multiple injuries cannot be mobilized at an early stage despite the fixation of all fractures. Conventional mobilization aids are not able to provide the prescribed weight bearing needed in fractures, especially those involving both the lower limbs. Robotics is a current technology aimed at improving the quality of medical care. To this end, Takatoshi Ide developed the mobility rehabilitation robot, the REHABOT. This apparatus facilitates rehabilitation by providing secure postural support and prescribed weight bearing during ambulation. The REHABOT has been used for early mobilization and gait training of severely disabled patients at different hospitals in Japan during the last 6 years. In most of the cases, this training has resulted in earlier improvement of ambulatory capability. In this paper we report the use of this device for early ambulation in two patients with multiple fractures involving the extremities and the spine. Early mobilization was achieved by initially reducing the weight bearing to 30% of body weight followed by a gradual increase governed by patient tolerance. The average length of training for these two patients was 18 days. The average total distance was 5.5 km and total walking duration was 4.5 h. After the completion of the training both patients were able to walk independently.

Adult↗

PubMed1988

Robotics and teleoperator-controlled devices.

This paper presents a rationale for and a summary of tasks and missions to which mobile and stationary robots and other teleoperator-controlled devices could be assigned in response to the accidental release of radioactive and other hazardous/toxic materials to the environment. Many of these vehicles and devices currently support operation and maintenance of nuclear power plants and other nuclear industry facilities. This paper also discusses specific missions for these devices at the Three Mile Island and Chernobyl nuclear power plant sites at the time of the accidents. Also discussed is the status of devices under development for future applications, as well as research on robotics.

Accidents↗

PubMed1999

Robotic recovery of highly radioactive resin.

As the ALARA coordinator at Waterford 3 Nuclear Steam Electric Station, I have seen radiological challenges in many forms. Some are handled as routine with little effort, while others can severely challenge even the finest Health Physics staff. One such event occurred on 26 December 1997, during a routine recirculation of the Spent Resin Tank, when contents of an unknown origin spilled from the tank. Technicians performing initial actions to contain the spill monitored radiation levels of 5-20 rem h21 (50-200 mSv) at waist level. Based on photographs and visual accounts it was estimated that approximately 30-40 ft3 (0.57-1.12 m3) of resin had spilled into the pump room. A sample of the resin indicated that dose rates at the floor would exceed 100 rem h21 (1 Sv h21). It was clear, given the volume of material spilled and dose rates in the room, that robots would be required for any type of recovery effort. This presented another problem in that Waterford 3 did not own a robot, and we had no experience in this area.

Cost-Benefit Analysis↗

PubMed2003

An analysis of the accuracy of the CyberKnife: a robotic frameless stereotactic radiosurgical system.

OBJECTIVE: The use of stereotactic radiosurgical systems to treat intracranial and extracranial tumors and other lesions requires a high degree of accuracy in target identification and localization. The purpose of this study was to evaluate the total system accuracy of the CyberKnife (Accuray, Inc., Sunnyvale, CA), a frameless, image-guided, stereotactic radiosurgery system. METHODS: Clinically relevant accuracy or application accuracy of the CyberKnife radiosurgery system is based on 1) the beam delivery accuracy, which combines the robot and the camera image tracking system, and 2) target localization accuracy, which combines computed tomographic (CT) imaging and treatment planning. Clinically relevant accuracy can be measured by delivering a radiation dose to phantoms, in which the target is defined on a set of CT images using all components of the CyberKnife system, including the treatment planning software, the robot, the camera tracking system, and the linear accelerator. Clinically relevant accuracy was measured in head phantoms loaded with packs of radiochromic film. The accuracy measured is the displacement of the dose contours from the treatment plan to that measured in the radiosurgically exposed phantom. RESULTS: Measurements of mean errors of the second-generation CyberKnife system at Stanford University Medical Center, installed in 2001, ranged from 0.7 mm for a CT slice thickness of 0.625 mm to 1.97 mm for a CT slice thickness of 3.75 mm. CONCLUSION: The frameless, image-guided, second-generation CyberKnife radiosurgery system has a clinically relevant accuracy of 1.1 +/- 0.3 mm when CT slice thicknesses of 1.25 mm are used. CyberKnife precision is comparable to published localization errors in current frame-based radiosurgical systems.

Artifacts↗

PubMed2000

A comparative experimental study evaluating the performance of surgical robots aesop and endosista.

The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.

Evaluation Studies as Topic↗

PubMed2001

Robotic and telesurgery: will they change our future?

In urology, at the end of the last millennium, there was an increasing use of computerized technology, extracorporeal shock wave lithotripsy, microwave therapy and high-energy focused ultrasound. However, experience with manipulating robots in urological surgery is still very limited. Laparoscopic surgery is handicapped by a reduction of the range of motion because of the fixed trocar position. The da Vinci system is the first surgical system to address all these problems adequately. The system consists of two main components: the surgeon's viewing and control console with three-dimensional imaging and the surgical arm unit that positions and manoeuvres detachable surgical instruments. The surgeon performs the procedure seated at the console holding specially designed instruments. Telerobotic laparoscopic radical prostatectomy provides advantages such as stereovision, dexterity and tremor filtering, but there is a learning curve with the device, mainly because of the magnification, the three-dimensional image and the lack of tactile feedback. However, after only a short period of time, the experienced surgeon is able to become familiar with the device. The impact of robotics in urological surgery is therefore very promising, and we are convinced that it will totally change the future of urological surgery.

Equipment Design↗

PubMed2005

Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain.

PURPOSE: Laparoscopic prostatectomy, whether or not coupled with robotic assistance, is often considered less invasive than open radical retropubic prostatectomy (RRP). Minimal postoperative pain has been reported following robot assisted laparoscopic prostatectomy (RALP) but there have been few comparative studies with RRP. We compared perioperative narcotic use and patient reported pain in a prospective patient series. MATERIALS AND METHODS: Between June 2003 and May 2004, 314 patients underwent radical prostatectomy at our institution, including RALP in 159, RRP in 154 and conversion in 1. All patients were treated on a postoperative clinical pathway that included 30 mg ketorolac intravenously immediately postoperatively, followed by 15 mg intravenously every 6 hours. No regional anesthesia (epidural/spinal) narcotics or patient controlled analgesic pumps were used. All narcotic use was converted to morphine sulfate equivalents for purpose of analysis. A Likert scale of 0 to 10 was used to assess pain on the day of surgery, and on postoperative days 1 and 14. RESULTS: The total mean morphine sulfate equivalent +/- SD in patients in the RALP and RRP groups was low and, when corrected for length of stay, it was not statistically different (22.41 +/- 1.13 vs 23.01 +/- 1.16 mg, p = 0.72). Mean Likert pain perception scores were low at all time points in the RALP and RRP groups but statistically lower on the day of surgery in the RALP cohort (2.05 +/- 1.99 vs 2.60 +/- 2.25, p = 0.027). Patient reported mean pain scores were almost identical for RALP vs RRP on postoperative days 1 (1.76 +/- 1.87 vs 1.73 +/- 1.77, p = 0.880) and 14 (2.51 +/- 1.91 vs 2.42 +/- 1.84, p = 0.722). CONCLUSIONS: Perioperative narcotic use and patient reported pain are low regardless of the surgical approach used for radical prostatectomy. RALP did not provide a clinically meaningful decrease in pain compared with RRP, primarily because of the low pain scores reported in each group. Outcomes other than pain will ultimately determine the role of laparoscopic radical prostatectomy and RALP.

Aged↗

PubMed2005

Update on laparoscopic and robotic radical prostatectomy.

PURPOSE OF REVIEW: Laparoscopic and robotic-assisted prostatectomy have been proposed as alternatives to traditional open retropubic prostatectomy. In this review, we update the more recent data concerning the results, technical trends and controversies regarding these novel, minimally invasive procedures. RECENT FINDINGS: As a result of improved patient selection, a better understanding of surgical anatomy, and refinements in surgical techniques, traditional retropubic prostatectomy set the standards very high, leaving little room for improvement. In this review, the results of laparoscopic prostatectomy are compared with contemporary in addition to historical series. Besides the transperitoneal laparoscopic approach, which was almost exclusively used in the initial series, the introduction and development of the extraperitoneal laparoscopic approach meant a significant change in the surgical strategy of a number of teams worldwide. The relative merits of the transperitoneal and extraperitoneal approaches are discussed. Robotic radical prostatectomy is a promising technical innovation that allows us to overcome many of the inherent limitations of laparoscopic surgery. As a result of financial constraints, the experience has been limited to a few centres worldwide. SUMMARY: Although long-term results are still lacking, novel minimally invasive techniques seem to fulfil the highest standards of radical prostatectomy in terms of early oncological cure, functional results and morbidity. A standardization of data collection and evaluation methodology will be indispensable for a better comparison of the different series.

Blood Loss, Surgical↗