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At least 145 records · Page 8Linked to original sources

PubMed2001

Technical assessment of porcine enteroenterostomy performed with ZEUS robotic technology.

BACKGROUND/PURPOSE: Limitations of minimally invasive pediatric surgery include the inability to perform precise anastomoses of 2 to 15 mm. Robotic technology facilitates the performance of endoscopic microsurgical procedures. This study examined the technical feasibility of performing an enteroenterostomy in piglets utilizing ZEUS robotic technology. METHODS: Ten piglets (6.5 to 8.5 kg) underwent enteroenterostomy. Standard laparoscopic techniques were used in the control group (n = 5), and ZEUS robotic technology was used in the experimental group (n = 5). AESOP controlled the camera in both groups. Anesthesia time; surgery time; robotic set-up time; and anastomotic time, patency, diameter, and integrity were compared. RESULTS: No statistical difference existed between the means of the control and experimental groups for anesthesia time (176.0 v 154.0 minute; P =.63), surgery time (143.0 v 139.2 minute; P =.92), anastomosis time (109.4 v 93.0 minutes; P =.56), AESOP set-up time (4.2 v 7.0 minutes; P =.51), and anastomotic diameter (7.062 v 7.362 mm; P =.62). All anastomoses were patent without narrowing. The ZEUS cases averaged 14 minutes faster than the standard laparoscopic cases, even with the ZEUS set-up time included. CONCLUSIONS: These data supports the hypothesis that robotic-assisted enteroenterostomy is technically feasible. ZEUS robotic technology will potentially play an important role in expanding the applications of minimally invasive pediatric surgery.

Anastomosis, Surgical↗

PubMed2002

Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.

Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 +/- 17.9 minutes, 28.5 +/- 28.2 minutes, and 368 +/- 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.

Coronary Artery Bypass↗

PubMed1999

[Applicability of the robot arm for microsurgical operations].

In this project, we evaluated a new robotic arm, RAMS (Robot Assisted Microsurgery) Workstation, for microsurgical procedures. We assigned seven microsurgical tasks to the robotic arm to investigate its capabilities and limitations during microsurgery. The robotic arm was able to function as the primary operating tool in removal of foreign bodies and thrombi as well as in intravascular positioning and holding of needles and catheters. The robot worked with great precision and without vibration. It served as an assisting tool in vessel dissection, ligation of side branches, and microsurgical anastomosis. The main drawbacks include a long warm-up period, the large size, poor rotation of the tip of the robotic arm, and frequent unintended shut-downs. The RAMS Workstation is a precise tool and can assist the surgeon as a "second" or "third hand". It cannot entirely replace the microsurgical instruments held by the surgeon.

Animals↗

PubMed1992

Using a personal robot to teach young children.

Seventy-five preschool children were instructed about birds by a human teacher, a moving personal robot, a stationary personal robot, and a tape recorder. How much the children learned and how much attention the children paid were compared for each type of instruction. The children learned when they were taught by the human teacher and when they were taught by the animated and the stationary robots. The children paid more attention to the live teacher and to the moving robot than they did to the stationary robot or to the tape recorder. The difference between the amount of attention the children paid to the animated robot and the amount of attention they paid to the human teacher was not statistically significant.

Attention↗

PubMed1987

Application of robotics to stereotactic neurosurgery.

Advances in the field of stereotactic neurosurgery have depended on improvements in brain-imaging techniques, as well as development of new stereotactic frame systems. This paper describes the development of a stereotactic system based on a robotics model. The system employs the Unimation Puma Mark II Robotic System, specifically modified for use in stereotactic surgery. The robotic CT stereotactic system is mounted in a dedicated operating suite, containing a CT scanning gantry and adjacent computer room. Stereotactic coordinates are derived from CT scan data obtained intraoperatively and transferred by computer link to the robotic stereotactic system. The robotic arm is driven into place to align with predetermined coordinates. A variety of stereotactic procedures may then be carried out using the robotic 'hand' as a guide to the target. So far, the device has been used, only for lesion biopsy. However, future applications to functional neurosurgery are anticipated.

Biopsy↗

PubMed2002

Robotic percutaneous access to the kidney: comparison with standard manual access.

PURPOSE: To evaluate the efficiency, accuracy, and safety of robotic percutaneous access to the kidney (PAKY) for percutaneous nephrolithotomy in comparison with conventional manual techniques. MATERIALS AND METHODS: We compared the intraoperative access variables (number of access attempts, time to successful access, estimated blood loss, complications) of 23 patients who underwent robotic PAKY with the remote center of motion device (PAKY-RCM) with the same data from a contemporaneous series of 23 patients who underwent conventional manual percutaneous access to the kidney. The PAKY-RCM incorporates a robotic arm and a friction transmission with axial loading system to accurately position and insert a standard 18-gauge needle percutaneously into the kidney. The blood loss during percutaneous access was estimated on a four-point scale (1 = minimal to 4 = large). The color of effluent urine was graded on a four-point scale (1 = clear to 4 = red). RESULTS: The mean target calix width was 13.5 +/- 9.2 mm in the robotic group and 12.2 +/- 4.5 mm in the manual group (P = 0.57). When comparing PAKY-RCM with standard manual techniques, the mean number of attempts was 2.2 +/- 1.6 v 3.2 +/- 2.5 (P = 0.14), time to access was 10.4 +/- 6.5 minutes v 15.1 +/- 8.8 minutes (P = 0.06), estimated blood loss score was 1.3 +/- 0.49 v 1.7 +/- 0.66 (P = 0.14), and color of effluent urine following access was 2.0 +/- 0.90 v 2.1 +/- 0.7 (P = 0.82). The PAKY-RCM was successful in obtaining access in 87% (20 of 23) of cases. The other three patients (13%) required conversion to manual techniques. There were no major intraoperative complications in either group. CONCLUSIONS: Robotic PAKY is a feasible, safe, and efficacious method of obtaining renal access for nephrolithotomy. The number of attempts and time to access were comparable to those of standard manual percutaneous access techniques. These findings provide the groundwork for the development of a completely automated robot-assisted percutaneous renal access device.

Blood Loss, Surgical↗

PubMed2001

Laparoscopic radical prostatectomy with a remote controlled robot.

PURPOSE: Robotics in surgery is a recent innovation. This technology offers a number of attractive features in laparoscopy. It overcomes the difficulties with fixed port sites by restoring all 6 degrees of freedom at the instrument tips, provides new possibilities for miniaturization of surgical tasks and allows remote controlled surgery. We investigated the applicability of remote controlled robotic surgery to laparoscopic radical prostatectomy. MATERIALS AND METHODS: Our previous experience with laparoscopic prostatectomy served as a basis for adapting robotic surgery to this procedure. A surgeon at a different location who activated the tele-manipulators of the da Vinci* robotic system performed all steps of the intervention. A scrub nurse and second surgeon who stood at patient side had limited roles to port and instrument placement, exposure of the operative field, assistance in hemostasis and removal of the operative specimen. Our patient was a 63-year-old man presenting with a T1c tumor discovered on 1 positive sextant biopsy with a 3+3 Gleason score and 7 ng./ml. preoperative serum prostate specific antigen. RESULTS: The robot provided an ergonomic surgical environment and remarkable dexterity enhancement. Operating time was 420 minutes, and the hospital stay lasted 4 days. The bladder catheter was removed 3 days postoperatively, and 1 week later the patient was fully continent. Pathological examination showed a pT3a tumor with negative margins. CONCLUSIONS: Robotically assisted laparoscopic radical prostatectomy is feasible. This new technology enhances surgical dexterity. Further developments in this field may have new applications in laparoscopic tele-surgery.

Humans↗

PubMed2002

Applications of robotic surgery in pediatric patients.

Minimally invasive surgery is increasingly becoming the standard approach to treatment for pediatric patients. Infants present a technical challenge due to the small size of structures and the small workspace available. Master-slave robotic surgical telemanipulators help overcome this challenge by facilitating microsurgery in a confined workspace. The Zeus Robotic Surgical System (Computer Motion, Inc., Goleta, CA, U.S.A.) was used to develop the robotic approach and to evaluate the technical feasibility of performing four technically challenging procedures that are typically performed in infants. Robotic enteroenterostomy, hepaticojejunostomy, portoenterostomy, and esophagoesophagostomy were performed in piglets and compared with the same procedures performed by standard minimally invasive techniques. Enteroenterostomy, hepaticojejunostomy, and esophagoesophagostomy procedures were successfully developed and are technically feasible. The portoenterostomy procedure needs further study to validate data from the second set of experiments, showing a lower complication rate in the robotic group. Survivor studies are needed to fully elucidate the advantages that may be provided by the robotic approach.

Adolescent↗

PubMed2003

Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy.

PURPOSE: For a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our knowledge we report the initial experience with robot assisted LRP of a surgeon without laparoscopic experience. MATERIALS AND METHODS: Following a 1-day da Vinci (Intuitive Surgical, Mountain View, California) robotic laparoscopic training course and 2 cadaveric robotic LRPs an experienced oncologist (TEA) without laparoscopic experience performed 45 robotic LRPs. RESULTS: All procedures were successfully completed laparoscopically with no rectal injuries or transfusions. The learning curve to 4-hour proficiency was 12 patients and mean operating time subsequently was 3.45 hours (range 2.5 to 5.1). Mean blood loss was 145 cc (range 25 to 350), the mean postoperative day 1 decrease in hemoglobin was 2.6 mg/dl (range 1.9% to 5.1) and mean hospital stay was 36 hours (range 18 to 168). Mean Gleason score was 6.8, mean prostate volume was 50.5 gm (range 12.5 to 163) and the margin positive rate was 35.5%. Four patients (8.8%) had a total of 6 complications, which were managed conservatively. Catheterization time was 7 days (range 7 to 42). Continence (0 pads) was 33% at 1 week, 63% at 1 month and 81% at 3 months. CONCLUSIONS: A laparoscopically naïve yet experienced open surgeon successfully transferred open surgical skills to a laparoscopic environment in 8 to 12 cases using a robotic interface. This outcome is comparable to the reported experience of skilled laparoscopic surgeons after more than 100 LRPs.

Aged↗

PubMed2003

A test bed for insect-inspired robotic control.

Flying insects are remarkable examples of sophisticated sensory-motor control systems. Insects have solved the fundamental challenge facing the field of mobile robots: robust sensory-motor mapping. Control models based on insects can contribute much to the design of robotic control systems. We present our work on a preliminary robotic control system inspired by current behavioural and physiological models of the fruit fly, Drosophila melanogaster. We designed a five-degrees-of-freedom robotic system that serves as a novel simulation/mobile robot hybrid. This design has allowed us to implement a fly-inspired control system that uses visual and mechanosensory feedback. Our results suggest that a simple control scheme can yield surprisingly robust fly-like robotic behaviour.

Adaptation, Physiological↗

PubMed1997

Robotic and neuronal simulation of the hippocampus and rat navigation.

The properties of hippocampal place cells are reviewed, with particular attention to the nature of the internal and external signals that support their firing. A neuronal simulation of the firing of place cells in open-field environments of varying shape is presented. This simulation is coupled with an existing model of how place-cell firing can be used to drive navigation, and is tested by implementation as a miniature mobile robot. The sensors on the robot provide visual, odometric and short-range proximity data, which are combined to estimate the distance of the walls of the enclosure from the robot and the robot's current heading direction. These inputs drive the hippocampal simulation, in which the robot's location is represented as the firing of place cells. If a goal location is encountered, learning occurs in connections from the concurrently active place cells to a set of 'goal cells', which guide subsequent navigation, allowing the robot to return to an unmarked location. The system shows good agreement with actual place-cell firing, and makes predictions regarding the firing of cells in the subiculum, the effect of blocking long-term synaptic changes, and the locus of search of rats after deformation of their environment.

Animals↗

PubMed1999

CRIGOS: a compact robot for image-guided orthopedic surgery.

The CRIGOS (compact robot for image-guided orthopedic surgery) project was set up for the development of a compact surgical robot system for image-guided orthopedic surgery based on user requirements. The modular system comprises a compact parallel robot and a software system for planning of the surgical interventions and for supervision of the robotic device. Because it is not sufficient to consider only technical aspects in order to improve in clinical routine the therapeutic outcome of conventional interventions, a user-centered and task-oriented design process has been developed which also takes human factors into account. The design process for the CRIGOS system was started from requirement analysis of various orthopedic interventions using information gathered from literature, questionnaires, and workshops with domain experts. This resulted in identification of conventional interventions for which the robotic system would improve the medical and procedural quality. A system design concept has been elaborated which includes definitions of components, functionalities, and interfaces. Approaches to the acquisition of calibrated X-rays will be presented in the paper together with design and evaluation of a first human-computer interface. Finally, the first labtype parallel robot based on low-cost standard components is presented together with the first evaluation results concerning positioning accuracy.

Humans↗

PubMed2001

Localization and control of a rehabilitation mobile robot by close human-machine cooperation.

In the field of rehabilitation robotics, a mobile personal robot represents an attractive solution, especially in economic terms in comparison with a desktop workstation. A manipulator arm mounted on a mobile robot can facilitate the restoration of the disabled user's manipulative function. In order both to encourage the person to participate in the task at hand and to be cost effective, close human-machine cooperation is essential. The person controls the robot via a remote station and develops strategies to successfully carry out a mission. The main problems encountered by the person during the execution of a mission are electing to change modes, and the mode transition itself. We have examined two aspects of this cooperation: 1) information exchange between human and machine for decision-making and 2) giving to operators complementary and redundant modes to command the system. An experiment has been conducted to study these two aspects. This paper focuses on the control of robot movements in an indoor environment and especially on localization parameters, human-like robot behavior, and the value of proposing complementary control modes to the operator.

Persons with Disabilities↗

PubMed2000

Assessing human-robotic performance for vocational placement.

This paper describes the results of an exploratory study of the use of standard occupational therapy assessment tests to measure the effective manipulation ability of individuals with disabilities using a robotic aid. Robotic manipulators have been explored for use as a vocational accommodation to support the job placement of individuals with severe manipulation disabilities. One of the factors that has impeded the transfer of this work is the lack of practical information that is relevant to the vocational placement process. The preliminary performance data presented in this paper provides an indication of robot-assisted manipulation skill that rehabilitation professionals may use to better understand the potential for use of this technology in providing greater job opportunities for people with severe manipulation impairment. Three different assessment tests were administered to nine different subjects with severe physical disabilities using a computer-controlled robotic workstation to perform the manipulation requirements of the tests. In all cases, the subjects, who were otherwise unable to physically perform the tasks without the robot, were able to perform manipulation tasks a factor of 20-700 times less than that of the performance indicated in published norms. Although these performance levels are modest in terms of nondisabled populations, supporting data is also provided that suggests that individuals with severe manipulation deficits could have access to a much wider range of vocational opportunities with an appropriate implementation of robot technology.

Activities of Daily Living↗

PubMedDate not supplied

The Leipzig experience with robotic valve surgery.

OBJECTIVES: The study describes the single-center experience using robot-assisted videoscopic mitral valve surgery and the early results with a remote telemanipulator-assisted approach for mitral valve repair. MATERIAL AND METHODS: Out of a series of 230 patients who underwent minimally invasive mitral valve surgery, in 167 patients surgery was performed with the use of robotic assistance. A voice-controlled robotic arm was used for videoscopic guidance in 152 cases. Most recently, a computer-enhanced telemanipulator was used in 15 patients to perform the operation remotely. RESULTS: The mitral valve was repaired in 117 and replaced in all other patients. The voice-controlled robotic arm (AESOP 3000) facilitated videoscopic-assisted mitral valve surgery. The procedure was completed without the need for an additional assistant as "solo surgery." Additional procedures like radiofrequency ablation and tricuspid valve repair were performed in 21 and 4 patients, respectively. Duration of bypass and clamp time was comparable to conventional procedures (107 A 34 and 50 A 16 min, respectively). Hospital mortality was 1.2%. Using the da Vinci telemanipulation system, remote mitral valve repair was successfully performed in 13 of 15 patients. CONCLUSION: Robotic-assisted less invasive mitral valve surgery has evolved to a reliable technique with reproducible results for primary operations and for reoperations. Robotic assistance has enabled a solo surgery approach. The combination with radiofrequency ablation (Mini Maze) in patients with chronic atrial fibrillation has proven to be beneficial. The use of telemanipulation systems for remote mitral valve surgery is promising, but a number of problems have to be solved before the introduction of a closed chest mitral valve procedure.

Adult↗

PubMedDate not supplied

Robotically assisted coronary artery bypass grafting: a prospective single center clinical trial.

AIM: This prospective study was performed as a Phase 1 Food and Drug Administration clinical trial to assess the safety and feasibility of robotically assisted coronary artery bypass grafting (CABG). METHODS: Eighteen patients undergoing elective CABG were enrolled in this study. Full sternotomy was performed in 17 of 18 patients, while cardiopulmonary bypass and cardioplegic arrest was used in all cases. Robotically assisted CABG of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD) was performed through three ports using a robotically assisted microsurgical system. Conventional techniques were used to perform all other grafts. Blood flow in the LITA graft was measured in the operating room, and when necessary, angiography was performed. Six weeks after the operation, all patients underwent selective coronary angiography of the LITA graft. RESULTS: Robotically assisted coronary artery anastomoses were successfully completed in all patients. Blood flow through the LITA graft was adequate in 16 of 18 patients (89%). The two inadequate grafts were revised successfully by hand. Six weeks after the operation, angiography demonstrated a graft patency of 100% (13 of 13). Mean follow-up has been over 190 days. All patients remain New York Heart Association Angina Class I. CONCLUSION: Robotic assistance represents an enabling technology that may allow the surgeon to perform endoscopic coronary artery anastomoses. Further clinical trials are needed to explore the clinical potential and value of robotically assisted CABG.

Coronary Artery Bypass↗

PubMed2004

Insect walking and robotics.

With the advent of significant collaborations between researchers who study insect walking and robotics engineers interested in constructing adaptive legged robots, insect walking is once again poised to make a more significant scientific contribution than the numbers of participants in the field might suggest. This review outlines current knowledge of the physiological basis of insect walking with an emphasis on recent new developments in biomechanics and genetic dissection of behavior, and the impact this knowledge is having on robotics. Engineers have begun to team with neurobiologists to build walking robots whose physical design and functional control are based on insect biology. Such an approach may have benefits for engineering, by leading to the construction of better-performing robots, and for biology, by allowing real-time and real-world tests of critical hypotheses about how locomotor control is effected. It is argued that in order for the new field of biorobotics to have significant influence it must adopt criteria for performance and an experimental approach to the development of walking robots.

Animals↗

PubMed2001

Development of robotic enhanced endoscopic surgery for the treatment of coronary artery disease.

BACKGROUND: The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team. METHODS AND RESULTS: Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64+/-10.5 years, left ventricular ejection fraction 68+/-12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (n=156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (n=37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (n=8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration. CONCLUSIONS: The introduction of this new surgical tool enables the development of new endoscopic procedures. Our results gained during the development of robotic enhanced CABG motivate us to establish a set standard for the totally endoscopic treatment of patients with 1-vessel coronary artery disease.

Anesthesia↗