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In this paper, we describe the basic divisions of medical robot, and at the same time their applications filed and developing trend are also been given. Finally some views of the development of medical robot in China are presented.
BACKGROUND: Our increasing knowledge of the genetic basis of inheritable diseases requires the development of automated reliable methods for high-throughput analyses. METHODS: We investigated the combination of semiautomated DNA extraction from blood using a robotic workstation, followed by automated mutation detection using highly specific fluorescent DNA probes, so-called molecular beacons, which can discriminate between alleles with as little as one single-base mutation. We designed two molecular beacons, one recognizing the wild-type allele and the other the mutant allele, to determine genotypes in a single reaction. To evaluate this procedure, we examined the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene, which is associated with an increased risk for cardiovascular disease and neural tube defects. DNA was isolated from 10 microL of fresh EDTA-blood samples by use of a robotic workstation. The DNA samples were analyzed using molecular beacons as well as conventional methods. RESULTS: Both methods were compared, and no differences were found between outcomes of genotyping. CONCLUSIONS: The described assay enables robust and automated extraction of DNA and analysis of up to 96 samples (10 microL of blood per sample) within 5 h. This is superior to conventional methods and makes it suitable for high-throughput analyses.
BACKGROUND: Endoscopic coronary artery bypass grafting (ECABG) has not been possible with traditional techniques. This report details our animal experience determining the feasibility of using a robotically-assisted microsurgical system to perform ECABG. METHODS: Following preliminary work using a cadaveric pig heart model, acute and chronic animal studies were performed. Calves were placed on cardiopulmonary bypass after the left internal mammary artery (LIMA) was harvested. Subxiphoid endoscopic ports (2 instrument, 1 camera) were placed and a robotic system was used to perform ECABG between the LIMA and left anterior descending coronary artery. LIMA graft flow (LIMAQ) was measured, and excised hearts underwent angiographic and histologic analyses. RESULTS: All anastomoses were successfully completed in both the acute and chronic studies (mean time of 33.9 +/- 1.9 and 33.2 +/- 3.4 minutes, respectively). Angiographic patency was 100% in both the acute (8/8) and chronic (6/6) studies, which was confirmed by histology. In the chronic study, there was no difference in LIMAQ between intraoperative and autopsy measurements. CONCLUSIONS: This study shows that ECABG is feasible in an animal model with excellent results. The FDA has recently given approval for clinical trials of this new technology.
BACKGROUND: Robotic surgical instruments enable quick and precise movements and may allow complete endoscopic coronary artery bypass grafting. However, cardiac surgeons will have to become familiar with this technology and endoscopic viewing. We present our training program with special focus on 2D- and 3D-visualization. METHODS: A thoracic skeleton, covered with a neoprene suit, served as model for the chest wall. Either a glove, fixed on a metal plate, or a pig heart were placed inside for training. On the glove, a suture line consisting of two lines of 16 points each, with a distance of 2 mm between each point, was stamped. On the pig heart, the LAD was prepared and incised; subsequently an anastomosis was done using the dissected right coronary artery as a graft. The time required was measured for both models. For suturing, the Zeus System (Computer Motion, Goleta, CA) was used and the third robotic arm positioned the endoscopic camera. The scopes were connected to a 3D-camera and the picture was displayed on a headset with two integrated monitors. Visualization was set to either 2D or 3D. Three surgeons were involved in the study. Each one did at least 12 anastomoses on 2D and 3D. RESULTS: The three surgeons involved showed a clear and rapid learning curve. The times required for the suture line decreased from 12.5 +/- 1.6 to 8.5 +/- 0.5 minutes with 2D and from 11.9 +/- 5.4 to 7.8 +/- 0.5 minutes for 3D respectively. This decrease did reach statistical significance (p = 0.03). In the pig heart model, the anastomosis times decreased from 33.2 +/- 8.4 to 15.7 +/- 0.3 minutes with 3D-visualization, and from 36.2 +/- 2.2 to 29.5 +/- 3.3 minutes with 2D. The decrease in anastomosis time did again reach significance (p = 0.025). At the end of the study, the times achieved with 2D-visualization were significantly longer than those with 3D (p = 0.01). CONCLUSIONS: A surgical training program is mandatory to become familiar with these new technologies. Both models showed learning curves over an acceptable time course. 3D-visualization facilitated quick and precise movements, thus resulting in shorter anastomosis times.
For the collision avoidance with a medical robot with 6 DOF a virtual simulation system is presented. Manipulator and obstacles are modelled by geometric primitives. Collisions are detected in the Cartesian workspace by hierarchical distance computation based on the given CAD model. The application initially being addressed is maxillofacial surgery, where the safety of the patient is the main requirement,because of the closeness to vital parts. The simulation system allows the surgeon to check up the trajectory of the robot before the current operation begins.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) requires surgeons the precision of hand skill and the mental concentration, since it needs to work on beating hearts. We propose a surgical robot system that compensates motions of organs during operations. The motion canceling robot system consists of three technologies visual synchronization, motion synchronization and master slave control. In this paper, we verify the effectiveness of the prototype system by in-vivo experiment.
Approximately 150,000 total hip replacements annually are performed in Germany, with an increasing incidence of implants carried out on young subjects. Due to aseptic loosening, this group will undergo some revision arthroplasty after 15 years. Therefore, a permanent fixation appears mandatory. In case of posttraumatic or postoperative anatomical changes, exact preoperative planning by x-rays is extremely difficult. This might result in a higher rate of complications (e.g., displacement of the implanted prosthesis, fractures of the proximal femur), as documented by the available literature. The preoperative planning with CT images obtained at the 3D workstation shows the exact cortical situation, while the robot-assisted surgery allows the precise execution of the preoperative plan during surgery. By this point of time, long-term results of computer-guided, robot-assisted implantation of endoprosthesic devices are still lacking. However, the preliminary data indicate good results by means of anatomical position of the endoprosthesis and perioperative complications.
Now being built at NASA-Ames is a small robot that will work independently alongside astronauts in space. About the size of a softball, the 5-in.-diam. Personal Satellite Assistant (PSA) will serve as an intelligent robot, providing another set of eyes and ears and an extra nose to the crew and ground support personnel. The device will move and operate on its own in the microgravity environment of space-based vehicles. Yuri Gawdiak, principal investigator for the projects, expects astronauts to fly a demonstration model of the device aboard a Space Shuttle in about two years. The first crew to use PSAs will test the examine safety issues. Those tests, if successful, will lead to a demonstration aboard the International Space Station. Gawdiak says the project has an annual budget of about $500,000.
A 44-year-old male patient with an undefined mass in the left ventricular endocardium was scheduled for minimally invasive cardiac surgery. Ventricular investigation and tissue biopsies were completed with the help of a voice-controlled robotic arm. Pathologic examination revealed non-bacterial thrombotic endocarditis. In addition to videoscopy, robotic assistance allows an easier diagnostic and therapeutic approach of intraventricular pathologies.
This paper discusses the make-up of the foreing endoscopic robotic system, the model of the moving mechanism, and the application of the squirmy robot. It will provide a new means for minimally invasive surgery, and be valuable to the development of the domestic modern medical engineering.
Navigator is a three-dimensional C-T scan image localization device, which supplies the surgeon with a real time relationship of surgical instruments with pathological lesion and vital organs. Robot controls surgical devices movements according to a various sophisticated programming, in order to palliate the imperfection of their manual use. Navigators and robots, frequently connected, allow a precise control of the instruments course, improving accuracy and efficiency of most surgical procedures. It is necessary to contribute to their improvement and development, taking in count the economic, ethic and legal problems which may be encountered.
OBJECTIVE: In 1998, we designed a robot for transurethral resection that consisted of a master arm and a slave arm that reproduced the movements of the master. We describe the innovative master arm developed in two university departments that supersedes the mere "joystick" concept to become a true, operative surgical instrument. METHODS: The new master arm was developed from a conventional resectoscope working element integrated into a robotic manipulative device and fitted with angular displacement sensors. Each sensor, part of a computer-controlled feed back system commands the position and movements of the slave arm which, in turn, move the resectoscope. The surgeon freely chooses and manages precisely within a three-dimensional surgical field four basic resectoscope maneuvers; horizontal and vertical displacement, penetration-withdrawal, and rotation; he also controls the movements and operation of the resectoscope cutting loop. Additional computer-programs provide the surgeon with an error-free, fail-safe surgical instrument that denies any movements outside the planned surgical field. RESULTS: The fact that the new easily used instrument is similar in shape and works like conventional resectoscopes greatly helps familiarization and training. Advanced technology reduces the number of errors usually associated with fatigue or inexperience of the surgeon. CONCLUSIONS: The new surgical instrument handles just like conventional instruments so surgeons do not need to change their usual operating procedures. In addition, an early-warning program detects instantly and denies inappropriate maneuvers. This facility confers peace of mind to the surgeon and ensures patient satisfaction.
As human will stay for long duration in isolated sites like ISS there will be a need to perform quick and reliable diagnosis to evaluate the gravity of the pathology in presence of clinical symptoms. Many pathological situations (abnormal heart rate, pericardic collection, mitral prolaps, cholecystis, renal lithiasis, normal and ectopic pregnancies, ovarian cyst, acute appendicitis, phlebitis ... ) may occur even if all the astronauts are absolutely normal and healthy preflight. Ultrasound echography and Doppler are non invasive methods easy to use in space and very well adapted and used in routine for such diagnosis at the hospital. The objective of the present project was to design a method that guarantee a reliable echographic diagnostic in an isolated site (space station or earth site) by a Medical Doctor located at the expert site that should be the Nasa control center for ISS. It is supposed that there is only a non sonographer person in the isolated site and that the transmission system (audio, video, numeric..) is the only link between the 2 sites. Two options are proposed: (a) A 3D realtime acquisition echograph that can record quickly all the echos of a volume containing the organ suspected to have a lesion, all these echo information being sent to the ground and processed by the ground experts, (b) A robotic arm that hangs the echo probe in the isolated site tele-operated (through sattelite network) from the ground by an expert in clinical ultrasound. (As the expert moves the joystick of his ground computer the robotic arm reproduces the same movements on the probe).
BACKGROUND: Ovarian transposition is the anatomical relocation of the ovaries from the pelvis to the abdomen. Transposition is beneficial in women who are to undergo pelvic radiation, because it allows maintenance of ovarian function and preservation of assisted reproductive capacity. METHODS: The da Vinci surgical system (Intuitive Surgical, Mountainview, CA, USA) was used to perform an endoscopic ovarian transposition. The ovaries were mobilized on their respective infundibulopelvic ligaments and sutured to the ipsilateral pericolic gutters. RESULTS: A series, of laboratory sessions using the da Vinci system was completed at our institution's training facility. Surgical experience included cadaveric pelvic dissection and abdominopelvic procedures on anesthetized porcine models. Additional didactic and laboratory training, including a certification examination, was obtained from Intuitive Surgical, Inc. The first clinical case of robotically assisted endoscopic ovarian transposition was performed. CONCLUSIONS: Robotically assisted endoscopy was successfully used for ovarian transposition.
Traditionally mitral valve surgery has been performed via median sternotomy. However, a renaissance in cardiac surgery is occurring. Cardiac operations are being performed through smaller and alternative incisions with enhanced technological assistance. Specifically, minimally invasive mitral valve surgery has become standard for many surgeons. At our institution, we have developed a robotic mitral surgery program with the da Vinci(TM) telemanipulation system. This system allows the surgeon to perform complex mitral valve operations through small port sites rather than a traditional median sternotomy. Our techniques and initial results are reported as is a brief overview of the evolution of robotic cardiac surgery.
This paper presents STARS (Simulation and Transfer Architecture for Robotic Surgery), a versatile system that aims at enhancing minimally invasive robotic surgery through patient-dependent optimized planning, realistic simulation, safe supervision, and augmented reality. The underlying architecture of the proposed approach is presented, then each component is detailed. An experimental validation is conducted on a dog for a coronary bypass intervention using the Da Vinci(TM) surgical system focusing on planing, registration, and augmented reality trials.
Minimally invasive surgery has been increasing in its adaptability to a wide range of procedures. Initially used in general surgery for cholecystectomy its use has now expanded to include Nissen fundoplications, Heller myotomies, donor nephrectomies, and total esophagectomies. Technological advancements have evolved to include robotic systems for performance of complex surgical procedures. We report on our experience of using robotic-assisted technology to perform a transhiatal total esophagectomy.
A robotic workstation has been constructed that automates the deprotection of peptides with trifluoroacetic acid-labile side-chain protecting groups and cleavage from acid-labile resins. The workstation was constructed around a Zymark robot arm and is integrated with a peptide synthesis workstation. Peptide resin samples are deprotected and cleaved with a trifluoroacetic acid/scavenger cocktail that accommodates all common protecting groups used with Fmoc chemistry. Aqueous-ether continuous extraction is used to remove the scavengers and reaction by-products. The apparatus cleaves a 50-500-mg sample of peptide resin every 2 hours and provides the peptides as an aqueous solution in 10% HOAc. Crude peptides obtained with this apparatus are free from residual scavengers and range in yield from 50%-80%. This method is applicable to all but the most hydrophobic peptides and minimizes human contact with the noxious cleavage reagents.