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This paper describes the first prostatic biopsy on a human patient using a robotic and telerobotic system. This system was designed at the Politecnico di Milano, and the biopsy was performed on April 7, 1995, in the Hospital Policlinico in Milan, Italy.
We describe a convenient, efficient, semiautomated protocol for assaying large numbers of DNA samples for over 20 mutations causing cystic fibrosis. The protocol uses the following: (1) a programmable robotic workstation to perform rapid pipetting and dot-blotting operations, (2) an allele-specific oligonucleotide hybridization in a single water bath without correcting for G+C content of oligonucleotides, and (3) a combinatorial system that allows direct determination of the genotype for more frequent mutations. We have used this system routinely for 16 months for carrier detection and for diagnosis of cystic fibrosis. The method can be readily applied to any combination of allele-specific oligonucleotide assays whether for multiple alleles at one locus or for a few alleles at multiple loci.
Motion detectors in the locust optic lobe and brain fall into two categories: neurones that respond selectively to approaching vs. receding objects and neurones that respond selectively to a particular pattern of image motion over a substantial part of the eye, generated by the locust's own movements through its environment. Neurones from the two categories can be differentiated on the basis of their response to motion at a constant velocity at a fixed distance from the locust: neurones of the first category respond equally well to motion in any direction whereas neurones in the second category respond selectively to one preferred direction of motion. Several of the motion detectors of the first category, responding to approaching objects, share the same input organisation, suggesting that it is important in generating a tuning for approaching objects. Anatomical, physiological, and modelling studies have revealed how the selectivity of the response is generated. The selectivity arises as a result of a critical race between excitation, generated when image edges move out over the eye and delayed inhibition, generated by the same edge movements. For excitation to build up, the velocity and extent of edge motion over the eye must increase rapidly. The ultrastructure of the afferent inputs onto the dendrites of collision sensitive neurones reveals a possible substrate for the interaction between excitation and inhibition. This interpretation is supported by both physiological and immunocytochemical evidence. The input organisation of these neurones has been incorporated into the control structure of a small mobile robot, which successfully avoids collisions with looming objects. The ecological role of motion detectors of the second category that respond to image motion over a substantial part of the visual field, is discussed as is the input organisation that generates this selective response. The broad tuning of these neurones, particularly at low velocities (<0.02 degree/s), suggests they may have a role in navigation during migratory flights at altitude. By contrast, their optimum tuning to high-image velocities suggests these motion detectors are adapted for use in a fast flying insect, which does not spend significant time hovering.
Unicompartmental knee arthroplasty (UKA) has regained popularity in recent years. However, limited data exist on how UKA affects knee biomechanics. The role of the anterior cruciate ligament (ACL) after fixed bearing UKA remains controversial. In this study, a robotic testing system was used to apply a quadriceps/hamstrings load to cadaveric knee specimens in the intact state, after medial UKA, and after transection of the ACL in UKA. The load was applied to the knee from full extension to 120 degrees of flexion in 30 degrees increments. UKA generally did not affect anterior-posterior (AP) femoral position, but did cause external tibial rotation and variations in varus-valgus rotation compared to the intact knee. ACL transection after UKA shifted the femur posteriorly compared to the intact and UKA knees and increased internal tibial rotation compared to the UKA knee at low flexion. The AP motion of the articular contact position in the implant was increased after ACL transection. These data might help explain the mechanism of tibial component loosening and provide insight into further investigations of polyethylene wear in UKA. Based on the kinematic data, the ACL should be functional to provide patients the greatest opportunity for long-term success after medial UKA.
An automated liquid chromatographic assay using unattended robotic sample preparation has been developed and validated to quantitate 3,7-dimethoxy-4-phenyl-N-1H-tetrazol-5-yl-4H-furo(3,2-b)indole-2- carboxamide (CI-922) in human plasma. The drug and internal standard 2 were isolated from plasma by solid-phase extraction onto Bond-Elut C-18 cartridges. Plasma interferences were selectively removed, and the compounds were eluted from the cartridge. Separation was achieved at ambient temperature using a C-18 column (5 microns, 4.0 X 150 mm) with an isocratic eluant consisting of acetonitrile:water:glacial acetic acid (45:55:1). The column effluent was monitored spectrophotometrically at 340 nm. Peak-height ratios were proportional to plasma concentrations of 1 over the range 0.025-5.0 micrograms/mL, and the recovery of 1 from plasma was 63.5%. Calibration curve precision was +/- 6.7%, based on relative standard deviations (RSD) of 1.9 to 6.7% for calibration standards. The accuracy of calibration curves was +/- 7.2%, with relative errors ranging from -7.2 to 3.6%. Assay precision was +/- 4.8%, based on RSD values of 3.9, 4.8, and 3.4% for spiked control samples of pooled human plasma containing 0.20, 1.50, and 2.50 micrograms/mL of 1, respectively. Assay accuracy was -0.7 to 2.0%. This method has been used to analyze 1 in clinical plasma samples.
BACKGROUND: A robotically guided linear accelerator has recently been developed which provides frameless radiosurgery with high precision. Potential advantages for the pediatric population include the avoidance of the cognitive decline associated with whole brain radiotherapy, the ability to treat young children with thin skulls unsuitable for frame-based methods, and the possible avoidance of general anesthesia. We report our experience with this system (the "Cyberknife") in the treatment of 21 children. PROCEDURES: Cyberknife radiosurgery was performed on 38 occasions for 21 patients, age ranging from 8 months to 16 years (7.0 +/- 5.1 years), with tumors considered unresectable. Three had pilocytic astrocytomas, two had anaplastic astrocytomas, three had ependymomas (two anaplastic), four had medulloblastomas, three had atypical teratoid/rhabdoid tumors, three had craniopharyngiomas, and three had other pathologies. The mean target volume was 10.7 +/- 20 cm(3), mean marginal dose was 18.8 +/- 8.1 Gy, and mean follow-up is 18 +/- 11 months. Twenty-seven (71%) of the treatments were single-shot and eight (38%) patients did not require general anesthesia. RESULTS: Local control was achieved in the patients with pilocytic and anaplastic astrocytoma, three of the patients with medulloblastoma, and the three with craniopharyngioma, but not for those with ependymoma. Two of the patients with rhabdoid tumors are alive 16 and 35 months after this diagnosis. There have been no procedure related deaths or complications. CONCLUSION: Cyberknife radiosurgery can be used to achieve local control for some children with CNS tumors without the need for rigid head fixation.
The speed of the human genome project (Lander, E. S., Linton, L. M., Birren, B., Nusbaum, C. et al., Nature 2001, 409, 860-921) was made possible, in part, by developments in automation of sequencing technologies. Before these technologies, sequencing was a laborious, expensive, and personnel-intensive task. Similarly, automation and robotics are changing the field of proteomics today. Proteomics is defined as the effort to understand and characterize proteins in the categories of structure, function and interaction (Englbrecht, C. C., Facius, A., Comb. Chem. High Throughput Screen. 2005, 8, 705-715). As such, this field nicely lends itself to automation technologies since these methods often require large economies of scale in order to achieve cost and time-saving benefits. This article describes some of the technologies and methods being applied in proteomics in order to facilitate automation within the field as well as in linking proteomics-based information with other related research areas.
Robotic surgical systems such as Intuitive Surgical's da Vinci system provide a rich source of motion and video data from surgical procedures. In principle, this data can be used to evaluate surgical skill, provide surgical training feedback, or document essential aspects of a procedure. If processed online, the data can be used to provide context-specific information or motion enhancements to the surgeon. However, in every case, the key step is to relate recorded motion data to a model of the procedure being performed. This paper examines our progress at developing techniques for "parsing" raw motion data from a surgical task into a labelled sequence of surgical gestures. Our current techniques have achieved >90% fully automated recognition rates on 15 datasets.
We address the problem of the stitching task in endoscopic surgery using a circular needle under robotic assistance. Our main focus is to present an algorithm for suturing using guidance virtual fixtures (VF) that assist the surgeon to move towards a desired goal. A weighted multi-objective, constraint optimization framework is used to compute the joint motions required for the tasks. We show that with the help of VF, suturing can be performed at awkward angles without multiple trials, thus avoiding damage to tissue. In this preliminary study we show the feasibility of our approach and demonstrate the promise of cooperative assistance in complex tasks such as suturing.
In 16th Century Prague, Rabbi Loew created a Golem, a humanoid made of clay, to protect his community. When the Golem became too dangerous to his surroundings, he was dismantled. This Jewish theme illustrates some of the guiding principles in its approach to the moral dilemmas inherent in future technologies, such as artificial intelligence and robotics. Man is viewed as having received the power to improve upon creation and develop technologies to achieve them, with the proviso that appropriate safeguards are taken. Ethically, not-harming is viewed as taking precedence over promoting good. Jewish ethical thinking approaches these novel technological possibilities with a cautious optimism that mankind will derive their benefits without coming to harm.
The high speed of saccades means that they cannot be guided by visual feedback, so that any saccadic control system must know in advance the correct output signals to fixate a particular retinal position. To investigate neural-net architectures for learning this inverse-kinematics problem we simulated a 4 deg-of-freedom robot camera-head system, in which the head could pan and tilt and the cameras pan and verge. The main findings were: (1) Linear nets, multilayer perceptrons (MLPs) trained by backpropagation, and cerebellar model arithmetic computers (CMACs) all learnt rapidly to 5-10% accuracy when given perfect error feedback. (2) For additional accuracy (down to 2%) two-layer nets learnt much faster than a single MLP or CMAC: the best combination tried was to have a CMAC learn the errors of a trained linear net. (3) Imperfect error signals were provided by a crude controller whose output was simply proportional to retinal input in the relevant axis, thereby providing a mechanism for (a) controlling the camera-head system when the feedforward neural net controller was wrong or inoperative, and (b) converting sensory error signals into motor error signals as required in supervised learning. It proved possible to train neural-net controllers using these imperfect error signals over a range of learning rates and crude-controller gains. These results suggest that appropriate neural-net architectures can provide practical, accurate and robust adaptive control for saccadic movements. In addition, the arrangement of a crude controller teaching a sophisticated one may be similar to that used by the primate saccadic system, with brainstem circuitry teaching the cerebellum.
Task-oriented repetitive movements can improve muscle strength and movement co-ordination in patients with impairments due to neurological lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate and document the rehabilitation of movements. The paper provides an overview of existing devices that can support movement therapy of the upper extremities in subjects with neurological pathologies. The devices are critically compared with respect to technical function, clinical applicability, and, if they exist, clinical outcomes.
The successful motor rehabilitation of stroke patients requires an intensive and task-specific therapy approach. The plasticity of the adult human brain provides opportunities to enhance traditional rehabilitation programs for these individuals. Intensive robot-aided sensorimotor training may have a positive effect on reducing impairment and disability and increasing reorganization of the adult brain. This approach may therefore efficaciously complement standard post-stroke multidisciplinary programs as shown by recent experimental trials.
UNLABELLED: 14 human femurs were scanned by CAT and 3D reconstructed. In every specimen digital documentation of CCD and antetorsion (AT) angle was performed. With a special software package (Orthodoc) virtual preoperative planning for implantation of a cementless total hip alloplasty was undertaken. The specimens were randomised into two groups, one of which had manual and the other one robot implantation of the femoral component. After implantation all specimens were evaluated again by CAT and CCT and AT angle were documented again. The preoperative CCD angle was 126.7 degrees (SD = 4.0) in the manual group and 127.8 degrees (SD = 4.3) in the robodoc group. Postoperatively the angle averaged 131.9 degrees (SD = 0.8) in the manual group and 133.2 degrees (SD = 1.9) in the robodoc group. Significant differences were found for the AT angle in both groups. The preoperative AT angle in the manual group was 31.3 degrees (SD = 8.8), decreasing to 20.5 degrees (SD = 9.5) after implantation. In the robodoc group this angle was 30.9 degrees (SD = 8.0) before and 31.3 degrees (SD = 8.7) after implantation. The difference between pre- and postoperative AT angle averaged 10.8 degrees (SD = 6.4) in the manual group and only 0.4 degree (SD = 0.9) in the robodoc-group. CONCLUSIONS: With the technique used, preoperative planning in hip alloarthroplasty is much more accurate than with the conventional technique with plain X-ray. The virtual preoperative planning can be transferred to the intraoperative setting with high precision. These factors may lead to an increase in outcome quality.
We report on our first five robot-assisted laparoscopic cholecystectomies and one fundoplication (Da Vinci system). No postoperative complications were observed. For the cholecystectomies (three elective and two acute cases) mean operation time was 1 h 35 min, and mean hospital stay was 5 days; for fundoplication the operation time was 2 h 15 min. The main advantages seem to be improved visualization by using a stereo camera und ease of precise dissection by micromechanical instruments directed by masterslaves from a distant console. The main disadvantage is the high cost. To fully evaluate the benefit for the patient, prospective clinical trials are warranted.
The aim of this study is to report the relative advantages and disadvantages of the radical prostatectomy with a laparoscopic (LRP) and a robotic (RALP) approach. A medline search was performed. Published data regarding perioperative parameters, complications, oncological results, functional results were analyzed. Shorter learning curves have been reported with the RALP. Intra-operative and post-operative outcomes appear to be comparable between the two approaches. The average time for LRP is 234 min (151-453) versus 182 min (141-250) for RALP. Estimated blood loss for the LRP averages 482 ml (185-850) versus 234 ml (75-500) for the RALP. Complication rates in single institution studies are similar. Long-term outcomes data on PSA progression is not yet available for LRP or RALP due to their relatively short existence. RALP appears to offer a significant benefit to the laparoscopically naïve surgeon with respect to learning curve when compared to LRP. This, however, comes at an increased cost. Intra-operative and post-operative outcomes appear to be similar. Longer follow-up data is necessary to compare oncological and functional outcomes.
Following the popularization of Vattikuti Institute Prostatectomy technique of robotic radical prostatectomy (RARP) by Menon et al., RARP has been gaining steady acceptance as a preferred alternative to both open and laparoscopic radical prostatectomy (LRP). Up until now, radical retropubic prostatectomy has been considered the gold standard for treatment of organ confined prostate cancer. Despite significant improvements in intraoperative blood loss and functional outcomes, driven primarily by the description of anatomical radical prostatectomy by Walsh, the perioperative morbidity, analgesic requirement, and recovery times have remained disadvantages of the open approach. LRP has been unable to gain widespread acceptance because of technical difficulty and a steep learning curve. The da Vinci assisted approach incorporates the advantages of minimally invasive approach while improving upon the results of the open approach. This paper traces the evolution of RARP and describes technical modifications incorporated at the Vattikuti Urology Institute including operative data, complications, and functional outcomes.
Robotic and laparoscopic surgical methods (RLM) are increasingly being used for urological oncological procedures. We compared the outcomes in a cohort of patients undergoing procedures by either RLM or open methods (OM) at a single institution. The data on 279 consecutive patients undergoing major urological oncological procedures from September 2000 to June 2005 was entered into a Microsoft Access database and queried. Continuous variables were compared using the Wilcoxon rank sum test and categorical variables were compared using Fisher's exact test. P values were compared to a significance level of 0.05. Of the 279 patients who underwent urological oncological surgeries, OM and RLM were used in 139 (49.8%) and 140 (50.2%) of patients, respectively. Numbers of perioperative mortalities and morbidities were not statistically different in the OM group versus the RLM group. Primary urological oncological surgeries can be performed without significantly increased perioperative complications by RLM compared to OM.