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At least 163 records · Page 9Linked to original sources

PubMed1998

Robotically assisted laparoscopic microsurgical uterine horn anastomosis.

OBJECTIVE: To evaluate the feasibility, safety, and sterility issues with regard to the use of a robotic device to perform uterine horn anastomosis in a live porcine model. DESIGN: Prospective animal study. SETTING: Landrace-Yorkshire pigs in a conventional laboratory setting. INTERVENTION(S): Six female pigs underwent laparoscopic bipolar electrocoagulation of the distal uterine horns. Two weeks later, the uterine horns were reanastomosed laparoscopically with use of a robotic system for microsuturing. Necropsy was performed 4 weeks later to assess postoperative adhesions and anastomosis patency. MAIN OUTCOME MEASURE(S): Tubal patency; secondary measures were operative time, complications, and surgeon fatigue. RESULT(S): The mean (+/-SD) total operative time per animal was 170+/-34 minutes including setting up and dismantling the robotic arms. The robot functioned well with only minor technical problems. All pigs survived both surgeries with no perioperative complications related to the use of the robot. Patency was confirmed after completing each anastomosis (12 anastomoses; 100% patency). Four weeks later, necropsy showed that eight anastomoses were still patent (67%). Only one pig had bilateral occlusion. Surgeon's fatigue was mild for each animal study. CONCLUSION(S): Robotic technology can be used safely in creating laparoscopic microsurgical anastomoses. The robot functioned properly in a sterile operating room environment. Adequate patency rates were achieved during the acute phase and at 4-week follow-up. Robotic technology has the potential to make laparoscopic microsuturing easier.

Anastomosis, Surgical↗

PubMed2003

Robotics and general surgery.

Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease.

Adrenalectomy↗

PubMed2002

Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve?

OBJECTIVES: To evaluate the learning curve between robot-assisted and manual laparoscopic suturing, as well as to assess other skills. Laparoscopic reconstructive procedures have been limited by instrumentation, small working spaces, and fixed angles at the trocar level to place sutures. Robot-assisted laparoscopic suture placement may provide one means of increasing dexterity and facilitating laparoscopic reconstructive procedures. METHODS: Eight physicians participated in this study. A series of five trials were performed to assess dexterity (task 1) and free-hand suturing (task 2). Each task was performed using robot-assisted and manual laparoscopy. The participants were categorized as novice and experienced laparoscopists. Task 1 involved passing sutures through the eye of seven needles positioned 1 cm apart in a P configuration. Task 2 involved tying one surgeon's knot, followed by two subsequent knots. RESULTS: The average time for trials 1 and 5 of task 1, robot-assisted laparoscopy, was 242.6 and 101.8 seconds, respectively (P <0.001). Both groups demonstrated a statistically significant difference (P <0.001) between the first and last trial. The average time for trials 1 and 5 of task 1, manual laparoscopy, was 205.3 and 169 seconds, respectively. The differences in the learning curves for robot-assisted and manual laparoscopy were statistically significant in favor of robotic assistance. Manual laparoscopic suturing did not demonstrate as much of a difference for the experienced surgeon. Overall, the difference in improvement between robot-assisted and manual laparoscopy was not statistically significant. CONCLUSIONS: Robot-assisted laparoscopic allows suturing and dexterity skills to be performed quicker than does manual laparoscopy.

Clinical Competence↗

PubMed2000

Ant-like task allocation and recruitment in cooperative robots.

One of the greatest challenges in robotics is to create machines that are able to interact with unpredictable environments in real time. A possible solution may be to use swarms of robots behaving in a self-organized manner, similar to workers in an ant colony. Efficient mechanisms of division of labour, in particular series-parallel operation and transfer of information among group members, are key components of the tremendous ecological success of ants. Here we show that the general principles regulating division of labour in ant colonies indeed allow the design of flexible, robust and effective robotic systems. Groups of robots using ant-inspired algorithms of decentralized control techniques foraged more efficiently and maintained higher levels of group energy than single robots. But the benefits of group living decreased in larger groups, most probably because of interference during foraging. Intriguingly, a similar relationship between group size and efficiency has been documented in social insects. Moreover, when food items were clustered, groups where robots could recruit other robots in an ant-like manner were more efficient than groups without information transfer, suggesting that group dynamics of swarms of robots may follow rules similar to those governing social insects.

Algorithms↗

PubMedDate not supplied

[Primary rotatory stability of hip endoprostheses stems after manual and robot assisted implantation].

AIM: In our study we compared the primary rotatory stability of hip endoprostheses which were implanted with the help of a robot with that of manually implanted stems. METHOD: We examined three different types of prosthesis-stems: Osteolock (Stryker-Howmedica), CBC (Mathys), Excia (Aesculap). Furthermore, we examined two types of prostheses which could not be implanted with a robot (Sl-Plus/Endoplus; Hipstar/Stryker-Howmedica). 10 stems of each prosthesis type were implanted in identical polyurethane foam blocks; 5 of them were implantated manually, 5 with the help of a robot (CASPAR, URS-Ortho). After implantation, a defined rotatory stress was put on the stem with the help of a torquing machine. The torsional moment which was necessary until the stem broke out of the foam was documented with the help of special software. RESULTS: In all types of prostheses the use of the robot system led to a higher rotatory stability compared to the manual group. Among the three tested types of prosthesis stems, the CBC stem is significantly more stable for rotatory forces after robot-assisted implantation compared to the other two types. After manual implantation there was no difference in stability between the different stems. The Zweymüller stem and the Hipstar prosthesis did very well, even in comparison to the robot-implanted group. The results of the Zweymüller stem and the robot-implanted CBC Stem were similar, and a significantly higher rotatory stability of the Hipstar prosthesis compared to every other stem was observed. CONCLUSION: Using a robot, the rotatory stability of hip endoprostheses can be improved. However, the design of the stems seems to be even more important for the stability than the implantation technique.

Arthroplasty, Replacement, Hip↗

PubMed2004

Anatomic guide for port placement for daVinci robotic radical prostatectomy.

BACKGROUND AND PURPOSE: At present, robotic arm port placement for daVinci trade mark robot-assisted laparoscopic radical prostatectomy is based on the umbilicus. However, the robotic arm has a maximum manufactured required working distance of 25 cm. Accordingly, normal variability of patient height, weight, and umbilical location can leave the working arms too short to reach the membranous urethra. We present data to support port placement using the pubis, rather than the umbilicus, as the landmark. MATERIALS AND METHODS: If we assume the 25-cm working distance of the robot arm (Z) equals the hypotenuse of a triangle and the Y axis is the sum of the distance from the membranous urethra to the skin (Y1) plus the displacement of the skin secondary to CO(2) insufflation (Y2), then the horizontal distance X is from the robot port site to the pubis. To ascertain Y1, we randomly selected the CT scans of 25 men and measured the depth from the skin over the pubis to the membranous urethra. To determine Y2, we measured the change in height from the table of the port site after CO(2) insufflation in 11 robotic laparoscopic prostatectomies. RESULTS: The average distance of Y1 was 11 cm; Y2 was 6 cm. Using the formula (Z(2) - (Y1 + Y2)(2))(1/2), the maximum distance X from the port site to the pubis, for an average man, should not exceed 18 cm. CONCLUSION: The optimal landmark for calculating the placement of ports for the daVinci robotic arm placement should be the pubis and not the umbilicus. Tall men (>72 inches) are at risk for exceeding functional robot arm length, and in these men, port sites should not be more than 18 cm from the pubis.

Equipment Design↗

PubMed2006

An ontology for a Robot Scientist.

MOTIVATION: A Robot Scientist is a physically implemented robotic system that can automatically carry out cycles of scientific experimentation. We are commissioning a new Robot Scientist designed to investigate gene function in S. cerevisiae. This Robot Scientist will be capable of initiating >1,000 experiments, and making >200,000 observations a day. Robot Scientists provide a unique test bed for the development of methodologies for the curation and annotation of scientific experiments: because the experiments are conceived and executed automatically by computer, it is possible to completely capture and digitally curate all aspects of the scientific process. This new ability brings with it significant technical challenges. To meet these we apply an ontology driven approach to the representation of all the Robot Scientist's data and metadata. RESULTS: We demonstrate the utility of developing an ontology for our new Robot Scientist. This ontology is based on a general ontology of experiments. The ontology aids the curation and annotating of the experimental data and metadata, and the equipment metadata, and supports the design of database systems to hold the data and metadata. AVAILABILITY: EXPO in XML and OWL formats is at: http://sourceforge.net/projects/expo/. All materials about the Robot Scientist project are available at: http://www.aber.ac.uk/compsci/Research/bio/robotsci/.

Artificial Intelligence↗

PubMed2003

Laparoscopic microsurgical tubal anastomosis with and without robotic assistance.

BACKGROUND: We previously reported our results with laparoscopic microsurgical tubal anastomosis with robotic assistance. The purpose of this study was to compare the duration of the procedure and hospitalization, blood loss and clinical outcomes for laparoscopic microsurgical tubal anastomosis performed with and without robotic assistance. METHODS: This was a retrospective comparative case study in an academic tertiary referral centre. Laparoscopic microsurgical tubal anastomosis was performed on 10 women with robotic assistance and the subsequent 15 patients underwent the procedure without the robot. The length of the procedure, estimated blood loss (EBL), time until hospital discharge, tubal patency and clinical pregnancy rates were compared. RESULTS: The operative times were 2 h longer with robotic assistance (P < 0.001). The increased EBL with the use of the robot (70 +/- 68 ml versus 20 +/- 16 ml) was statistically but not clinically significant. The robot provided no benefit in patient recovery. Tubal patency and clinical pregnancy rates were not significantly different. CONCLUSIONS: Robotic assistance increases operative times of laparoscopic tubal anastomosis without an appreciable improvement in patient recovery or clinical outcomes.

Adult↗

PubMed2001

Prospective clinical trial of robotically assisted endoscopic coronary grafting with 1-year follow-up.

OBJECTIVE: To follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. SUMMARY BACKGROUND DATA: Recently there has been an interest in using robotics and computers to enhance the surgeon's ability to perform endoscopic cardiac surgery. This interest has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instruments, it has not been possible to perform coronary surgery. METHODS: Nineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to construct the LITA-LAD anastomosis. All other required grafts were completed by conventional techniques. RESULTS: Seventeen LITA-LAD grafts (89%) had adequate intraoperative flow. The mean LITA-LAD graft flow was 38.5 +/- 5 mL/min. At 8 weeks, LITA-LAD grafts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 +/- 4.2 months, all patients were NYHA class I and there were no adverse cardiac events. CONCLUSIONS: The results from the first prospective clinical trial of robotically assisted endoscopic coronary bypass surgery in the United States showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabling technology allowing the performance of endoscopic coronary anastomoses.

Aged↗

PubMed2004

Robotics in urology.

PURPOSE OF REVIEW: Robotic urologic surgery, an exciting and new emerging frontier in the field of urology, has tremendous potential to progress in the future. It is important, therefore, that urologists keep abreast of the new technologies, their limitations, and the possibility of incorporating them in day-to-day surgery. There are a substantial number of reports on performing complex urological procedures with robotic assistance in humans that document their safety, efficacy and feasibility. RECENT FINDINGS: Most of the recent reports pertaining to robotic surgery have been in the domain of localized cancer of the prostate (radical prostatectomy), bladder cancer (radical cystectomy and urinary diversion for muscle invasive bladder cancer), kidney surgery (nephrectomy, donor nephrectomy and pyeloplasty), and adrenal surgery. There are also a few anecdotal reports. SUMMARY: With the potential advantages and latent qualities of robotic assistance in minimally invasive surgery over conventional surgery, robot-assisted surgeries may be developed to the next level and lead to a future revolution of the way surgery is performed. Robot-assisted radical prostatectomy in the management of localized cancer of the prostate is one such example. The impact of robotics is therefore very promising. However, controlled clinical trials and comparisons from various centers are needed. Other important concerns are the cost and training implications. Future application may also allow integration of pre- and intraoperative imaging in the management of urological diseases. In the not too distant future, newer robotic instruments will be added to the armamentarium for performing different urological procedures.

Adrenalectomy↗

PubMed2002

Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using da Vinci.

In the past decade, robot-assisted surgery has become increasingly used to assist in minimally invasive surgical procedures. In this article we review the evolution of robotic devices, from the first use of an industrial robot for stereotactic biopsies to pioneering work with robots used for hip and prostate surgery, to the development of robotic guidance systems that enabled solo endoscopic surgery, to telemanipulative surgery with master-servant computer-enhanced robotic devices. In addition, we review our early experience with da Vinci Robotic Surgical Systems (Intuitive Surgical, Inc., Mountain View, CA, U.S.A.), which we used to perform robot-assisted laparoscopic cholecystectomies.

Adult↗

PubMed2002

Comparison of laparoscopic colectomy with and without the aid of a robotic camera holder.

The use of a robotic camera holder (AESOP 3000; Computer Motion, Inc., Santa Barbara, CA, U.S.A.) during laparoscopic surgery is slowly becoming more popular with laparoscopic surgeons. However, few published reports document the effects of the robot on operative outcomes or operative times. In the current study, we compared the use of a voice-controlled robotic camera holder to a human camera holder in a series of laparoscopic colectomies. The outcome data measured included the number of patients with postoperative complications, the patients' length of stay at the hospital, and the operative times for the procedures. There were 2 complications among the 11 patients in group 1 (colectomies performed without a robotic camera holder), versus 2 complications among the 15 patients in group 2 (colectomies performed with a robotic camera holder) (P = NS). Patients in group 1 had an average length of stay of 4.1 days, versus 4.4 days for those in group 2 (P = NS). The operative time for group 1 was 235 minutes, compared with 213 minutes for group 2 (P = NS). The use of a voice-controlled robotic camera holder does not alter the length of the operative procedure, the patient's length of stay, or postoperative morbidity. However, surgeons often have a subjective sense that there is less smudging, fogging, and inadvertent movements of the laparoscope when it is controlled by a robotic system. In addition, using a voice-controlled robot as a camera holder does eliminate the need for a surgical assistant.

Adult↗

PubMed2006

Assessment of intraoperative safety in transoral robotic surgery.

INTRODUCTION: Robotic technology has been safely integrated into thoracic and abdominopelvic surgery, and the early experience has been very promising with very rare complications related to robotic device failure. Recently, several reports have documented the technical feasibility of transoral robotic surgery (TORS) with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy, base-of-tongue resection, supraglottic laryngectomy, and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration, tooth injury, mucosal laceration, mandible fracture, cervical spine fracture, and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. METHODS: To test this hypothesis, we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. RESULTS: Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth, mandible, and cervical spine fracture could not be achieved. CONCLUSIONS: Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally, we discuss several strategies to increase patient safety in TORS.

Cadaver↗

PubMed2004

Surgical robotics in otolaryngology: expanding the technology envelope.

PURPOSE OF REVIEW: Surgical robotics arose as an extension of virtual reality and robotic technology developed by the United States Department of Defense. Current surgical robotic systems have been used to perform a variety of minimally invasive surgical procedures. RECENT FINDINGS: The Food and Drug Administration recently granted approval for the clinical use of two surgical robotic systems. Laboratory and clinical experience suggests that the use of surgical robotics is associated with some distinct advantages and disadvantages when compared with conventional open procedures. Robotic surgery has recently been described in the head and neck, and as a result the otolaryngologist should have a basic understanding of the potential applications of surgical robotics in head and neck surgery. SUMMARY: Surgical robotic technology is evolving but appears to have a distinct place in the surgical armamentarium.

Animals↗

PubMed2005

Robotic techniques for upper limb evaluation and rehabilitation of stroke patients.

This paper presents two robot devices for use in the rehabilitation of upper limb movements and reports the quantitative parameters obtained to characterize the rate of improvement, thus allowing a precise monitoring of patient's recovery. A one degree of freedom (DoF) wrist manipulator and a two-DoF elbow-shoulder manipulator were designed using an admittance control strategy; if the patient could not move the handle, the devices completed the motor task. Two groups of chronic post-stroke patients (G1 n = 7, and G2 n = 9) were enrolled in a three week rehabilitation program including standard physical therapy (45 min daily) plus treatment by means of robot devices, respectively, for wrist and elbow-shoulder movements (40 min, twice daily). Both groups were evaluated by means of standard clinical assessment scales and a new robot measured evaluation metrics that included an active movement index quantifying the patient's ability to execute the assigned motor task without robot assistance, the mean velocity, and a movement accuracy index measuring the distance of the executed path from the theoretic one. After treatment, both groups improved their motor deficit and disability. In G1, there was a significant change in the clinical scale values (p < 0.05) and range of motion wrist extension (p < 0.02). G2 showed a significant change in clinical scales (p < 0.01), in strength (p < 0.05) and in the robot measured parameters (p < 0.01). The relationship between robot measured parameters and the clinical assessment scales showed a moderate and significant correlation (r > 0.53 p < 0.03). Our findings suggest that robot-aided neurorehabilitation may improve the motor outcome and disability of chronic post-stroke patients. The new robot measured parameters may provide useful information about the course of treatment and its effectiveness at discharge.

Aged↗

PubMed2006

Robotic ocular surgery.

BACKGROUND: Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures. AIMS: To examine the use of a commercially available surgical robot for ocular microsurgery. METHODS: Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360 degrees -rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography. RESULTS: Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level. CONCLUSIONS: Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state-of-the-art surgical skill and technology.

Animals↗

PubMed2006

Distributed coordination of simulated robots based on self-organization.

Distributed coordination of groups of individuals accomplishing a common task without leaders, with little communication, and on the basis of self-organizing principles, is an important research issue within the study of collective behavior of animals, humans, and robots. The article shows how distributed coordination allows a group of evolved, physically linked simulated robots (inspired by a robot under construction) to display a variety of highly coordinated basic behaviors such as collective motion, collective obstacle avoidance, and collective approach to light, and to integrate them in a coherent fashion. In this way the group is capable of searching and approaching a lighted target in an environment scattered with obstacles, furrows, and holes, where robots acting individually fail. The article shows how the emerged coordination of the group relies upon robust self-organizing principles (e.g., positive feedback) based on a novel sensor that allows the single robots to perceive the group's "average" motion direction. The article also presents a robust solution to a difficult coordination problem, which might also be encountered by some organisms, caused by the fact that the robots have to be capable of moving in any direction while being physically connected. Finally, the article shows how the evolved distributed coordination mechanisms scale very well with respect to the number of robots, the way in which robots are assembled, the structure of the environment, and several other aspects.

Animals↗

PubMed2005

In vivo robotic laparoscopy.

Laparoscopy reduces patient trauma but limits the surgeon's ability to view or touch the surgical environment directly. The surgeon's ability to visualize and manipulate target organs can be improved using currently available external robotic systems. However, tool tip orientation and optimal camera placement remain limited because the robot instruments and cameras are still constrained by the entry incisions. Placing a robot completely within the abdominal cavity would provide an unconstrained platform that could provide an enhanced field of view from arbitrary angles and dexterous manipulators not constrained by the abdominal wall fulcrum effect. Several in vivo robots have been developed and successfully tested in a porcine model. These in vivo robots have been used to observe trocar and tool insertions and placement, and to provide additional camera angles that improved surgical visualization. Equipped with a grasper, such robots will provide task assistance. These in vivo robots will be much less expensive than the current generation of large external robotic surgical systems and will ultimately allow a surgeon to be a remote first responder irrespective of the location of the patient.

Animals↗