Chemical Senses by Alexandros G. Sfakianakis: The International Journal of Medical Robotics and Computer Assisted Surgery

Τρίτη 19 Ιουλίου 2016

The International Journal of Medical Robotics and Computer Assisted Surgery

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The International Journal of Medical Robotics and Computer Assisted Surgery

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MRI-guided focused ultrasound robotic system for the treatment of bone cancer

‎Σάββατο, ‎16 ‎Ιουλίου ‎2016, ‏‎6:00:47 πμ | Georgios Menikou, Christos Yiallouras, Marinos Yiannakou, Christakis Damianou

Abstract

Background

A novel MRI-conditional robot was developed that navigates a focused ultrasound (FUS) transducer. With this robotic system the transducer can access bones. The intended application is pain palliation from bone cancer using thermal ablation using FUS.

Methods

The robotic system has four computer-controlled axes (three linear and one angular). The robotic system was manufactured using a digital manufacturing 3D printer, using acrylonitrile butadiene styrene (ABS) plastic. MRI-conditional optical encoders were used to accurately control the robotic system.

Results

The robotic system was successfully tested for MRI safety and compatibility, using fast-gradient pulse sequences and a liquid phantom. The robotic system has been tested for its functionality for creating discrete and multiple (overlapping) lesions in a gel phantom.

Conclusions

An MRI-conditional FUS robotic system was developed that has the potential to create thermal lesions with the intention of treating bone cancer for the purpose of pain palliation. Copyright © 2016 John Wiley & Sons, Ltd.

Locomotion enhancement of an inchworm-like capsule robot using long contact devices

‎Παρασκευή, ‎15 ‎Ιουλίου ‎2016, ‏‎10:25:33 πμ | Jinyang Gao, Guozheng Yan, Zhiwu Wang, Fei Xu, Wei Wang, Pingping Jiang, Dasheng Liu

Abstract

Background

The inchworm-like capsule robot (CR), which consists of two anchoring mechanisms (AMs) and an extensor, is a promising device for exploring the human intestine. However, the slippery intestinal lumen can cause anchoring slippage and the visco-elastic intestine and mesentery can cause stroke loss, which both lower its locomotion performance.

Methods

This paper proposes a method for locomotion enhancement by optimizing the lengths of the contact devices that are installed at the tips of the AM.

Results

Theoretical analysis showed that a longer contact device was more beneficial to avoid slippage and reduce stroke loss, hence enhancing locomotion, which was then verified by ex vivo experiments. The 34.5 mm long contact devices enabled a locomotion efficiency of 54%, while it was only 21% when employing 5 mm long contact devices.

Conclusions

An image-guided automated robot for MRI breast biopsy

‎Τρίτη, ‎12 ‎Ιουλίου ‎2016, ‏‎3:20:49 πμ | Kathryn G. Chan, Tim Fielding, Mehran Anvari

Abstract

Background

The IGAR (Image-guided Automated Robot) is a robotic platform capable of performing highly accurate clinical interventions under image guidance. The IGAR is unique in that it demonstrates MRI compatibility and maintains safe operation, adequate shielding, high image quality, and accurate robotic control even while in an imaging environment. The IGAR is initially intended for breast biopsy.

Methods

Tests for projectile hazards, heating, signal-to-noise ratio loss, and geometric distortion were used to demonstrate MR compatibility. Accuracy and repeatability of the robotic system were tested on benchtop models to establish a baseline of precision.

Results

The IGAR averaged an accuracy of 0.34 mm and a repeatability of 0.2 mm. There was no significant distortion attributable to the robot, no projectile risk, and no unacceptable levels of heating.

Conclusion

Effect of video lag on laparoscopic surgery: correlation between performance and usability at low latencies

‎Δευτέρα, ‎4 ‎Ιουλίου ‎2016, ‏‎3:15:34 πμ | Asli Kumcu, Lotte Vermeulen, Shirley A. Elprama, Pieter Duysburgh, Ljiljana Platiša, Yves Van Nieuwenhove, Nele Van De Winkel, An Jacobs, Jan Van Looy, Wilfried Philips

Abstract

Background

Few telesurgery studies assess the impact of latency on user experience, low latencies are often not studied despite evidence of negative effects, and some studies recruit inexperienced subjects instead of surgeons without evidence that latency affects both groups similarly.

Methods

Fifteen trainees and fourteen laparoscopic surgeons conducted two tasks on a laparoscopy home-trainer at six latencies below 200 milliseconds (ms). Completion time and usability (perceived awareness of latency, inefficiency, disturbance, adaptability, and impact on patient safety) were measured.

Results

Weak correlation between completion time and usability was found. There was significant deterioration in performance and user experience at 105 ms added latency. Surgeons were more negatively affected.

Conclusion

Objective measures insufficiently describe the impact of latency therefore standard measures of user experience should be incorporated in studies. Even low latencies may be detrimental to laparoscopic surgery. Results from non-experts cannot predict the impact of latency on experienced surgeons. Copyright © 2016 John Wiley & Sons, Ltd.

A novel 4-DOF surgical instrument with modular joints and 6-Axis Force sensing capability

‎Δευτέρα, ‎13 ‎Ιουνίου ‎2016, ‏‎1:20:42 μμ | Kun Li, Bo Pan, Fuhai Zhang, Wenpeng Gao, Yili Fu, Shuguo Wang

Abstract

Background

It is difficult for surgeons to exert appropriate forces during delicate operations due to lack of force feedback in robot-assisted minimally invasive surgery (RMIS). A 4-DOF surgical grasper with a modular wrist and 6-axis force sensing capability is developed.

Methods

A grasper integrated with a miniature force and torque sensor based on the Stewart platform is designed, and a cable tension decomposition mechanism is designed to alleviate influence of the cable tension to the sensor. A modularized wrist consisting of four joint units is designed to facilitate integration of the sensor and eliminate coupled motion of the wrist.

Results

Sensing ranges of this instrument are ±10 N and ±160 N mm, and resolutions are 1.2% in radial directions, 5% in axial direction, and 4.2% in rotational directions. An ex vivo experiment shows that this instrument prototype successfully measures the interaction forces.

Conclusions

Video see-through augmented reality for oral and maxillofacial surgery

‎Παρασκευή, ‎10 ‎Ιουνίου ‎2016, ‏‎7:25:58 πμ | Junchen Wang, Hideyuki Suenaga, Liangjing Yang, Etsuko Kobayashi, Ichiro Sakuma

Abstract

Background

Oral and maxillofacial surgery has not been benefitting from image guidance techniques owing to the limitations in image registration.

Methods

A real-time markerless image registration method is proposed by integrating a shape matching method into a 2D tracking framework. The image registration is performed by matching the patient's teeth model with intraoperative video to obtain its pose. The resulting pose is used to overlay relevant models from the same CT space on the camera video for augmented reality.

Results

The proposed system was evaluated on mandible/maxilla phantoms, a volunteer and clinical data. Experimental results show that the target overlay error is about 1 mm, and the frame rate of registration update yields 3–5 frames per second with a 4 K camera.

Conclusions

The significance of this work lies in its simplicity in clinical setting and the seamless integration into the current medical procedure with satisfactory response time and overlay accuracy. Copyright © 2016 John Wiley & Sons, Ltd.

Erratum

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎12:28:07 μμ

Issue Information

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎12:28:05 μμ

No abstract is available for this article.

Potential accuracy of navigated K-wire guided supra-acetabular osteotomies in orthopedic surgery: a CT fluoroscopy cadaver study

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎9:08:23 πμ | Lukas K. Postl, Chlodwig Kirchhoff, Andreas Toepfer, Sonja Kirchhoff, Marcus Schmitt-Sody, Rüdiger Eisenhart-Rothe, Rainer Burgkart

Abstract

Background

The aim of this study was to evaluate the accuracy of supra-acetabular pelvic tumor resections in human, full-body cadavers and under realistic operation room conditions with the help of a navigation system and K-wires as guidance for the oscillating saw.

Methods

Seven hemipelvises from fresh, human, male, full-body cadavers were used. A preoperative and a postoperative CT was performed. Under control of the navigation system K-wires were inserted and served as guidance for the oscillating saw to reduce the error by vibration and jerking movements. The accuracy of the computer aided resections was compared with the accuracy of freehand resections in customized 3D printed pelvises with geometries identical to the cadavers used.

Results

The mean deviation of the navigated osteotomies was 1.9 mm (standard deviation 1.0 mm) significantly (P < 0.001) lower than the mean deviation of freehand osteotomies at 9.2 mm (standard deviation 3.7 mm).

Conclusion

Extending the indication for robot-assisted retroperitoneal partial nephrectomy to antero-lateral renal tumors

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎9:04:04 πμ | Hee Youn Kim, Hyun-Sop Choe, Dong Sup Lee, Jae Mo Yoo, Seung-Ju Lee

Abstract

Background

Robot-assisted retroperitoneal partial nephrectomy (RARPN) is typically employed for posterior renal tumors. This work aimed to extend the indication of RARPN to patients with selected antero-lateral renal tumor.

Methods

Patients who underwent RARPN between December 2013 and September 2015 at the authors' institution were enrolled. Two intersecting lines were drawn on an axial CT image to define the medial/lateral nature of anterior renal tumors. Patients with antero-lateral tumor and posterior tumor were compared.

Results

Antero-lateral tumors constituted 56.1% (32/57) of the total cases. The perioperative outcomes between the two groups were comparable. Although the operation time was longer for the antero-lateral tumor group, it did not show statistical significance. No cases had positive margins. There was one case of Clavien-Dindo grade IIIa complication in the antero-lateral tumor group.

Conclusions

Development of a control algorithm for the ultrasound scanning robot (NCCUSR) using ultrasound image and force feedback

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎8:53:15 πμ | Yeoun Jae Kim, Jong Hyun Seo, Hong Rae Kim, Kwang Gi Kim

Abstract

Background

Clinicians who frequently perform ultrasound scanning procedures often suffer from musculoskeletal disorders, arthritis, and myalgias. To minimize their occurrence and to assist clinicians, ultrasound scanning robots have been developed worldwide. Although, to date, there is still no commercially available ultrasound scanning robot, many control methods have been suggested and researched. These control algorithms are either image based or force based. If the ultrasound scanning robot control algorithm was a combination of the two algorithms, it could benefit from the advantage of each one. However, there are no existing control methods for ultrasound scanning robots that combine force control and image analysis. Therefore, in this work, a control algorithm is developed for an ultrasound scanning robot using force feedback and ultrasound image analysis.

Methods

A manipulator-type ultrasound scanning robot named ‘NCCUSR’ is developed and a control algorithm for this robot is suggested and verified. First, conventional hybrid position–force control is implemented for the robot and the hybrid position–force control algorithm is combined with ultrasound image analysis to fully control the robot. The control method is verified using a thyroid phantom.

Results

It was found that the proposed algorithm can be applied to control the ultrasound scanning robot and experimental outcomes suggest that the images acquired using the proposed control method can yield a rating score that is equivalent to images acquired directly by the clinicians.

Conclusions

The proposed control method can be applied to control the ultrasound scanning robot. However, more work must be completed to verify the proposed control method in order to become clinically feasible. Copyright © 2016 John Wiley & Sons, Ltd.

Preclinical study of transcervical upper mediastinal dissection for esophageal malignancy by robot-assisted surgery

‎Τετάρτη, ‎8 ‎Ιουνίου ‎2016, ‏‎8:34:50 πμ | Kazuhiko Mori, Shuntaro Yoshimura, Yukinori Yamagata, Susumu Aikou, Yasuyuki Seto

Abstract

Background

Robotic surgical systems are potentially applicable to transcervical mediastinal lymph dissection for esophageal malignancy.

Methods

Robot-assisted surgery was performed on a male fresh-frozen human cadaver. Devices for single-port laparoscopic surgery were deployed via one small incision in the left clavicular area. The task for the robot-assisted surgery was the upper mediastinal dissection to the level of the left main bronchus and en bloc harvest of the lymph nodes adherent to the left recurrent laryngeal nerve.

Results

An up-angled 30° scope in the 6 o'clock port and two robotic arms from the 3 and 9 o'clock ports worked effectively together. No collisions of the devices inside the cadaveric body or unexpected traumatic events occurred.

Conclusion

Towards automated spectroscopic tissue classification in thyroid and parathyroid surgery

‎Παρασκευή, ‎20 ‎Μαΐου ‎2016, ‏‎7:01:28 πμ | Rutger M. Schols, Lejla Alic, Fokko P. Wieringa, Nicole D. Bouvy, Laurents P. S. Stassen

Abstract

Background

In (para-)thyroid surgery iatrogenic parathyroid injury should be prevented. To aid the surgeons’ eye, a camera system enabling parathyroid-specific image enhancement would be useful. Hyperspectral camera technology might work, provided that the spectral signature of parathyroid tissue offers enough specific features to be reliably and automatically distinguished from surrounding tissues. As a first step to investigate this, we examined the feasibility of wide band diffuse reflectance spectroscopy (DRS) for automated spectroscopic tissue classification, using silicon (Si) and indium-gallium-arsenide (InGaAs) sensors.

Methods

DRS (350–1830 nm) was performed during (para-)thyroid resections. From the acquired spectra 36 features at predefined wavelengths were extracted. The best features for classification of parathyroid from adipose or thyroid were assessed by binary logistic regression for Si- and InGaAs-sensor ranges. Classification performance was evaluated by leave-one-out cross-validation.

Results

In 19 patients 299 spectra were recorded (62 tissue sites: thyroid = 23, parathyroid = 21, adipose = 18). Classification accuracy of parathyroid–adipose was, respectively, 79% (Si), 82% (InGaAs) and 97% (Si/InGaAs combined). Parathyroid–thyroid classification accuracies were 80% (Si), 75% (InGaAs), 82% (Si/InGaAs combined).

Conclusions

Si and InGaAs sensors are fairly accurate for automated spectroscopic classification of parathyroid, adipose and thyroid tissues. Combination of both sensor technologies improves accuracy. Follow-up research, aimed towards hyperspectral imaging seems justified. Copyright © 2016 John Wiley & Sons, Ltd.

Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system

‎Δευτέρα, ‎16 ‎Μαΐου ‎2016, ‏‎10:51:02 πμ | Patrick J. Schuler, Thomas K. Hoffmann, Johannes A. Veit, Nicole Rotter, Daniel T. Friedrich, Jens Greve, Marc O. Scheithauer

Abstract

Introduction

Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented.

Methods

TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail.

Results

Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures.

Conclusion

Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd.

Motion compensated controller for a tendon-sheath-driven flexible endoscopic robot

‎Τρίτη, ‎5 ‎Απριλίου ‎2016, ‏‎6:36:23 πμ | Wenjun Xu, Carmen C. Y. Poon, Y. Yam, P. W. Y. Chiu

Abstract

Background

A tendon-sheath system (TSS) has the advantages of being relatively compact in size, flexible and low cost, and therefore is favoured in building flexible endoscopic robots to pass through long and tortuous human lumen. TSS, however, is prone to nonlinear behaviors such as backlash, hysteresis and direction dependent properties. A compensation technique is required to improve its positioning performance.

Methods

Tension and elongation models of TSS are analyzed. A feedforward motion compensation controller is designed to compensate the asymmetric backlash behavior of the TSS in real time.

Results

Motion tracking experiments were conducted on a TSS driven two DOFs continuum manipulator. The results showed that using the proposed compensation methods, tracking error can be reduced by 74%.

Conclusions

The proposed compensation method is useful for controlling flexible continuum robots, which are anticipated to have emerging roles in assisting surgeons to perform the increasingly technically challenging endoscopic procedures. Copyright © 2016 John Wiley & Sons, Ltd.

Enabling technologies for robot assisted ultrasound tomography

‎Τετάρτη, ‎30 ‎Μαρτίου ‎2016, ‏‎12:51:14 μμ | Fereshteh Aalamifar, Rishabh Khurana, Alexis Cheng, Xiaoyu Guo, Iulian Iordachita, Emad M. Boctor

Abstract

Currently available ultrasound (US) tomography systems suggest utilizing cylindrical transducers that can be used for a specific organ. In this paper, our focus is on an alternative way of creating US tomographic images that could be used for other anatomies and more general applications. This system consists of two conventional US probes facing each other while one or several of the transducers in one probe can act as the transmitter and the rest as the receiver. Aligning the two US probes is a challenging task. To address this issue, we propose a robot assisted US tomography system in which one probe is operated freehanded and another by a robotic arm. In this paper, enabling technologies for this system are described. With the current prototype, a reconstruction precision of 4.12, 1.73, and 2.23 mm for the three calibrations, and an overall alignment repeatability in the range of 5–9 mm were achieved. Copyright © 2016 John Wiley & Sons, Ltd.

Design and control of a novel gastroscope intervention mechanism with circumferentially pneumatic-driven clamping function

‎Τετάρτη, ‎30 ‎Μαρτίου ‎2016, ‏‎7:12:00 πμ | Yanmin Li, Hao Liu, Siwen Hao, Hongyi Li, Jianda Han, Yunsheng Yang

Abstract

Background

Robot-assisted manipulation is promising for solving problems such as understaffing and the risk of infection in gastro-intestinal endoscopy. However, the commonly used friction rollers in few existing systems have a potential risk of deforming flexible endoscopes for non-uniform clamping.

Methods

This paper presents a robotic system for a standard flexible endoscope and focuses on a novel gastroscope intervention mechanism (GIM), which provides circumferentially uniform clamping with an airbag. The GIM works with a relay-on mechanism in a way similar to manual operation. The shear stiffness of airbag and the critical slipping force (CSF) were analysed to determine the parameters of the airbag. A fuzzy PID controller was employed to realize a fast response and high accuracy of pneumatic actuation. Experiments were performed to evaluate the accuracy, stiffness and CSF. In vitro and in vivo animal experiments were also carried out.

Results

The GIM realized an accuracy of 0.025 ± 0.2 mm and –0.03 ± 0.25° for push–pull and rotation without delivery resistance. Under < 10 N delivery resistance, the error caused by the airbag stiffness was < 0.24 mm. A quadratic polynomial could be used to describe the relationship between the CSF and pneumatic pressure.

Conclusions

The novel GIM could effectively deliver gastroscopes. The pneumatic-driven clamping method proposed could protect the gastroscope by circumferentially uniform clamping force and the CSF could be properly controlled to guarantee operating safety. Copyright © 2016 John Wiley & Sons, Ltd.

Recent advances in robot-assisted head and neck surgery

‎Τετάρτη, ‎16 ‎Μαρτίου ‎2016, ‏‎8:40:53 πμ | Daniel T. Friedrich, Marc O. Scheithauer, Jens Greve, Thomas K. Hoffmann, Patrick J. Schuler

Abstract

Objective

This article reviews current clinical applications and experimental developments for robotic surgery in the head and neck with special focus on financial challenges, current clinical trials, and the controversial aspect of haptic and tactile feedback.

Data sources

Literature was screened using the pubmed library. Information on clinical trials was excerpted from the National Institute of Health database. Additional data on experimental developments were gathered by personal communication.

Results

A steep increase in clinical applications for robotic surgery in the head and neck is determined as possible indications extend. Clinical trials are mostly non-randomized. A wide range of new robotic systems are expected to come into clinical use in the near future.

Conclusion

As head and neck surgeons become more familiar with robotic surgery some patients evidently benefit from new technologies. Increased competition between the systems will certainly drive technological improvement and decrease the financial burden. Copyright © 2016 John Wiley & Sons, Ltd.

Robot-assisted laparoscopic myomectomy for deep intramural myomas

‎Τετάρτη, ‎16 ‎Μαρτίου ‎2016, ‏‎8:35:42 πμ | So Yeon Kang, In-Cheul Jeung, Youn-Jee Chung, Hyun-Kyung Kim, Chae Rim Lee, Tanvi S. Mansukhani, Mee-Ran Kim

Abstract

Background

To evaluate the efficacy of robot-assisted laparoscopic myomectomy for deep intramural myomas.

Methods

We have conducted a retrospective study for 170 patients who underwent robot-assisted laparoscopic myomectomy by a single operator of tertiary university hospital.

Results

There were 100 cases of robot-assisted laparoscopic myomectomy for deep intramural myomas. The patients had 3.8±3.5 myomas on average, and the mean size of the largest myoma of each patient was 7.5±2.1 centimeters in diameter. Mean operative time was 276.4±97.1 minutes, and mean console time was 146.0±62.7 minutes. Thirty two patients had surgeries for other gynecologic conditions such as pelvic endometriosis or endometrial polyps along with myomectomy at the same time. All the patients recovered without any major complication. After the surgery, nine(75.0 %) of the 12 women pursuing a pregnancy became pregnant.

Conclusion

Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation

‎Δευτέρα, ‎14 ‎Μαρτίου ‎2016, ‏‎1:59:50 μμ | S. Janki, K. W. J. Klop, S. M. Hagen, T. Terkivatan, M. G. H. Betjes, T. C. K. Tran, J. N. M. Ijzermans

Abstract

Background

It is important to minimize risks associated with live donor nephrectomy. In this study we evaluated the results of left-sided robot-assisted donor nephrectomies in comparison with standard techniques.

Methods

Data on perioperative results, kidney function, and recipient and graft survival were collected. All left-sided laparoscopic and hand-assisted procedures were selected as control groups.

Results

Fifty-nine robot-assisted procedures were performed by two surgeons. Operative time was significantly longer in the robot-assisted group compared with both control groups. However, it decreased significantly during procedures 40–59 compared with procedures 20–39 (P = 0.014) to median 172.5 (114.0–242.0) min. One conversion to the open approach occurred in the robot group due to a bleeding of the renal artery stump. No difference was found between all techniques at 3 months post-donation.

Conclusion

Accuracy and postoperative assessment of pedicle screw placement during scoliosis surgery with computer-assisted navigation: a meta-analysis

‎Τετάρτη, ‎9 ‎Μαρτίου ‎2016, ‏‎3:28:38 πμ | Wei Tian, Cheng Zeng, Yan An, Chao Wang, Yajun Liu, Jianing Li

Abstract

Background

Accurate insertion of pedicle screws in scoliosis patients is a challenge for surgeons. Computer-assisted navigation techniques might help improve the accuracy of screw placement, thereby avoiding complications. Thus, the objective of this present work is to compare the accuracy and postoperative assessment of pedicle screw placement in scoliosis patients using a computer-assisted navigation technique and using a conventional free-hand method.

Methods

A search of the PubMed, Cochrane, and Web of Science databases was executed. In vivo comparative studies that assessed the accuracy and postoperative evaluation of pedicle screw placement in scoliosis patients with or without navigation techniques were chosen and analyzed.

Results

The accuracy of pedicle screw insertion was significantly increased when using the navigation system, although the average operative time and correction rate was not significantly different from that with non-navigated surgery.

Conclusion

The navigation technique improves the accuracy of pedicle screw placement during scoliosis surgery without prolonging the operative time or decreasing the deformity correction effect. Copyright © 2016 John Wiley & Sons, Ltd.

Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow

‎Δευτέρα, ‎7 ‎Μαρτίου ‎2016, ‏‎7:13:03 πμ | Ahmad Alenezi, Aamir Motiwala, Susannah Eves, Rob Gray, Asha Thomas, Isabelle Meiers, Haytham Sharif, Hanif Motiwala, Marc Laniado, Omer Karim

Abstract

Objective

The paper describes novel real-time ‘in situ mapping’ and ‘sequential occlusion angiography’ to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS).

Materials and methods

Data were collected and assessed for 60 patients (61 tumours) between 2009 and 2013. 31 (50.8%) tumours underwent ‘Global Ischaemia’, 27 (44.3%) underwent ‘Selective Ischaemia’ and 3 (4.9%) were removed ‘Off Clamp Zero Ischaemia’. Demographics, operative variables, complications, renal pathology and outcomes were assessed.

Results

Median PADUA score was 9 (range 7–10). The mean warm ischaemia time in selective ischaemia was less and statistically significant than in global ischaemia (17.1 and 21.4, respectively). Mean operative time was 163 min. Postoperative complications (n = 10) included three (5%) Clavien grade 3 or above. Malignancy was demonstrated in 47 (77%) with negative margin in 43 (91.5%) and positive margin in four (8.5%). Long-term decrease in eGFR post selective ischaemia robotic partial nephrectomy was less compared with global ischaemia (four and eight, respectively) but not statistically significant.

Conclusions

This technique is safe, feasible and cost-effective with comparable perioperative outcomes. The technical aspects elucidate the role of intraoperative CEUS to facilitate and ascertain selective ischaemia. Further work is required to demonstrate long-term oncological outcomes. Copyright © 2016 John Wiley & Sons, Ltd.

Issue Information

‎Παρασκευή, ‎4 ‎Μαρτίου ‎2016, ‏‎10:32:44 πμ

No abstract is available for this article.

A zero phase adaptive fuzzy Kalman filter for physiological tremor suppression in robotically assisted minimally invasive surgery

‎Τρίτη, ‎1 ‎Μαρτίου ‎2016, ‏‎7:34:13 πμ | Hongqiang Sang, Chenghao Yang, Fen Liu, Jintian Yun, Guoguang Jin, Fa Chen

Abstract

Background

Hand physiological tremor of surgeons can cause vibration at the surgical instrument tip, which may make it difficult for the surgeon to perform fine manipulations of tissue, needles, and sutures.

Methods

A zero phase adaptive fuzzy Kalman filter (ZPAFKF) is proposed to suppress hand tremor and vibration of a robotic surgical system. The involuntary motion can be reduced by adding a compensating signal that has the same magnitude and frequency but opposite phase with the tremor signal.

Results

Simulations and experiments using different filters were performed. Results show that the proposed filter can avoid the loss of useful motion information and time delay, and better suppress minor and varying tremor.

Conclusions

The ZPAFKF can provide less error, preferred accuracy, better tremor estimation, and more desirable compensation performance, to suppress hand tremor and decrease vibration at the surgical instrument tip. Copyright © 2016 John Wiley & Sons, Ltd.

Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery

‎Τρίτη, ‎1 ‎Μαρτίου ‎2016, ‏‎7:31:09 πμ | Véronique Phé, Susanna Cattarino, Jérôme Parra, Marc-Olivier Bitker, Vanina Ambrogi, Christophe Vaessen, Morgan Rouprêt

Abstract

Background

The utility of the virtual-reality robotic simulator in training programmes has not been clearly evaluated. Our aim was to evaluate the impact of a virtual-reality robotic simulator-training programme on basic surgical skills.

Methods

A simulator-training programme in robotic surgery, using the da Vinci Skills Simulator, was evaluated in a population including junior and seasoned surgeons, and non-physicians. Their performances on robotic dots and suturing-skin pod platforms before and after virtual-simulation training were rated anonymously by surgeons experienced in robotics.

Results

39 participants were enrolled: 14 medical students and residents in surgery, 14 seasoned surgeons, 11 non-physicians. Junior and seasoned surgeons’ performances on platforms were not significantly improved after virtual-reality robotic simulation in any of the skill domains, in contrast to non-physicians.

Conclusions

The benefits of virtual-reality simulator training on several tasks to basic skills in robotic surgery were not obvious among surgeons in our initial and early experience with the simulator. Copyright © 2016 John Wiley & Sons, Ltd.

Early operative outcomes and learning curve of robotic assisted giant paraesophageal hernia repair

‎Τρίτη, ‎1 ‎Μαρτίου ‎2016, ‏‎6:47:42 πμ | Inderpal S. Sarkaria, M. Jawad Latif, Valentino J. Bianco, Manjit S. Bains, Valerie W. Rusch, David R. Jones, Nabil P. Rizk

Abstract

Background

We have previously described our technique of robotic-assisted giant paraesophageal hernia repair (RA-GPEHR). The purpose of this study was to report our initial experience, early outcomes and learning curve with RA-GPEHR using a four-arm robotic platform.

Methods

24 consecutive patients presenting with symptomatic giant paraesophageal hernias (GPEH) underwent RA-GPEHR from April 2011 to February 2014. Peri-operative data and short-term patient outcomes were assessed by retrospective review of a prospectively maintained database.

Results

Median age was 62 years (range 44–84). 15 (63%) patients underwent fundoplication and 9 (37%) gastropexy. Median procedure time was 277 min (range: 185–485) and decreased steadily over the experience. There were no intra-operative complications or surgical mortality. No patients experienced dysphagia in the early post-operative period.

Conclusions

RA-GPEHR is safe, with reported short-term operative and functional outcomes similar to conventional laparoscopic approaches. The initial learning curve appears relatively short for experienced minimally invasive esophageal surgeons. Copyright © 2016 John Wiley & Sons, Ltd.

A force-sensing surgical tool with a proximally located force/torque sensor

‎Παρασκευή, ‎26 ‎Φεβρουαρίου ‎2016, ‏‎9:36:34 πμ | W. Schwalb, B. Shirinzadeh, J. Smith

Abstract

Background

Robotic surgery has seen a rapid increase in popularity in the last few decades because advantages such as increased accuracy and dexterity can be realized. These systems still lack force-feedback, where such a capability is believed to be beneficial to the surgeon and can improve safety.

Method

In this paper a force-feedback enabled surgical robotic system is described in which the developed force-sensing surgical tool is discussed in detail. The developed surgical tool makes use of a proximally located force/torque sensor, which, in contrast to a distally located sensor, requires no miniaturization or sterilizability.

Results

Experimental results are presented, and indicate high force sensing accuracies with errors <0.09 N.

Conclusions

It is shown that developing a force-sensing surgical tool utilizing a proximally located force/torque sensor is feasible, where a tool outer diameter of 12 mm can be achieved. For future work it is desired to decrease the current tool outer diameter to 10 mm. Copyright © 2016 John Wiley & Sons, Ltd.

Current status of robotic single-port colonic surgery

‎Τετάρτη, ‎24 ‎Φεβρουαρίου ‎2016, ‏‎5:30:28 πμ | Sung Uk. Bae, Woon Kyung Jeong, Seong Kyu Baek

Abstract

Introduction

The present paper reviews evidence and examines updates in single-port robotic surgery for colonic diseases reported in contemporary studies.

Materials and Methods

A comprehensive online systematic search of PubMed databases was carried out in June 2015, identifying studies conducted on robotic single-port colectomy from 2008 to 2015.

Results

The advantages and disadvantages of several available port-access systems, techniques for configuring robotic arms, and robotic surgical platforms, were presented.

Conclusions

Current studies show that single-port robotic colectomy is a safe and feasible procedure despite the lack of supporting evidence. Although significant advancements in the development and modification of single-access ports, configuration of robotic arms, and robotic surgical platforms have been achieved in the field of single-port robotic surgery for colonic disease, significant improvements to surgical platforms for single-port robotic surgery are needed. Copyright © 2016 John Wiley & Sons, Ltd.

Strategy of robotic surgeons to exert public influence through Twitter

‎Τετάρτη, ‎24 ‎Φεβρουαρίου ‎2016, ‏‎3:09:19 πμ | Hendrik Borgmann, Jan Woelm, Karen Nelson, Kilian Gust, Rene Mager, Michael Reiter, David Schilling, Georg Bartsch, Roman Blaheta, Axel Haferkamp, Igor Tsaur

Abstract

Background

Twitter is gaining growing popularity as a communication platform and potential tool to influence the public in medical matters. The aim here is to examine whether and how robotic surgeons use Twitter more influentially than other urologists.

Methods

Robotic surgeons and other urologists that tweeted at the European urology congress were compared by assessing Twitter Follower/Following Ratio, Retweet Rank and Percentile and their Twitter strategies.

Results

Robotic surgeons had a significantly higher Twitter Follower/Following Ratio (2.1, 1.4–2.4) and Retweet Rank percentile (92.1%, 90.5–93%) than other urologists (1.2, 0.8–2.1 and 88.9%, 87.3–91.7%, respectively). Robotic surgeons used original tweet content and links more often than other urologists (69.4% vs 53.8%, and 19.8% vs 12.5%, respectively).

Conclusions

Robotic surgeons had a higher public influence on Twitter than other urologists and posted original tweets and links in tweets and profiles more frequently. This strategy might optimize Twitter use by healthcare professionals in the future. Copyright © 2016 John Wiley & Sons, Ltd.

Real-time in vitro intravascular reconstruction and navigation for endovascular aortic stent grafting

‎Τρίτη, ‎9 ‎Φεβρουαρίου ‎2016, ‏‎11:54:06 πμ | Chaoyang Shi, Carlos Tercero, Xianliang Wu, Seiichi Ikeda, Kimihiro Komori, Kiyohito Yamamoto, Fumihito Arai, Toshio Fukuda

Abstract

Background

Trans-catheter endovascular stent grafting minimizes trauma and increases the benefitting patient population. However, the alignment between stent graft branches and vasculature branches remains time-consuming and challenging, and such techniques require a significant amount of contrast agent for imaging.

Methods

A new framework for intravascular reconstruction based on sensor fusion between intravascular ultrasound (IVUS) imaging and electromagnetic (EM) tracking was proposed. A new image processing method was presented to realize fully automatic processing of IVUS imaging and 3D reconstruction in real time, as well as branch detection for alignment and deployment. Complementary navigation using CT data allows for efficient catheter advancement and assistant clinical judgement.

Results

The reconstruction of an in vitro descending aorta phantom with branches was realized at 35 Hz, with cross-section radius average error of 0.64 mm.

Conclusion

The proposed method demonstrates significant potential for clinical applications, enables navigation for precise alignment and placement for stent grafting to reduce surgical time, and decreases hemorrhagic collisions and the use of contrast agent. Copyright © 2016 John Wiley & Sons, Ltd.

Total robotic radical rectal resection with da Vinci Xi system: single docking, single phase technique

‎Τετάρτη, ‎3 ‎Φεβρουαρίου ‎2016, ‏‎7:55:05 πμ | Anup Sunil Tamhankar, Sudhir Jatal, Avanish Saklani

Abstract

Objective

This study aims to assess the advantages of Da Vinci Xi system in rectal cancer surgery. It also assesses the initial oncological outcomes after rectal resection with this system from a tertiary cancer center in India.

Introduction

Robotic rectal surgery has distinct advantages over laparoscopy. Total robotic resection is increasing following the evolution of hybrid technology. The latest Da Vinci Xi system (Intuitive Surgical, Sunnyvale, USA) is enabled with newer features to make total robotic resection possible with single docking and single phase.

Methods and results

Thirty-six patients underwent total robotic resection in a single phase and single docking. We used newer port positions in a straight line. Median distance from the anal verge was 4.5 cm. Median robotic docking time and robotic procedure time were 9 and 280 min, respectively. Median blood loss was 100 mL. One patient needed conversion to an open approach due to advanced disease. Circumferential resection margin and longitudinal resection margins were uninvolved in all other patients. Median lymph node yield was 10. Median post-operative stay was 7 days. There were no intra-operative adverse events.

Conclusion

The latest Da Vinci Xi system has made total robotic rectal surgery feasible in single docking and single phase. With the new system, four arm total robotic rectal surgery may replace the hybrid technique of laparoscopic and robotic surgery for rectal malignancies. The learning curve for the new system appears to be shorter than anticipated. Early perioperative and oncological outcomes of total robotic rectal surgery with the new system are promising. Copyright © 2016 John Wiley & Sons, Ltd.

A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy

‎Τετάρτη, ‎27 ‎Ιανουαρίου ‎2016, ‏‎9:34:06 πμ | Brian K. P. Goh, Chung Yip Chan, Hui-Ling Soh, Ser Yee Lee, Peng-Chung Cheow, Pierce K. H. Chow, London L. P. J. Ooi, Alexander Y. F. Chung

Abstract

Background

This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP).

Methods

The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from 2006 to 2015 were retrospectively reviewed.

Results

Thirty-nine patients who met our study criteria were included. Eight patients underwent RDP and 31 had LDP. There were 10 (25.6%) open conversions. Six (15.4%) patients had major (> grade 2) morbidities and there was no in-hospital mortality. There were 14 (35.9%) grade A and 9 (23.1%) grade B pancreatic fistulas. Comparison between RDP and LDP demonstrated no significant difference between the patients’ baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies (3 (37.5%) vs 25 (80.6%), P=0.016) and splenic-vessel preservation (5 (62.5%) vs 4 (12.9%), P=0.003) in RDP. Comparison between outcomes demonstrated that RDP was associated with a longer median operation time (452.5 (range, 300–685) vs 245 min (range, 85–430), P=0.001) and increased frequency of the procedure completed purely laparoscopically (8 (100%) vs 18 (58.1%), P=0.025).

Conclusions

RDP can be safely adopted and is equivalent to LDP in most perioperative outcomes. It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Copyright © 2016 John Wiley & Sons, Ltd.

Robotic management of gastric stromal tumors (GIST): a single Middle Eastern center experience

‎Τετάρτη, ‎27 ‎Ιανουαρίου ‎2016, ‏‎9:33:57 πμ | Hassan Al-Thani, Ayman El-Menyar, Ahammed Mekkodathil, Hesham Elgohary, Abdel Hakem Tabeb

Abstract

Background

Surgical resection is the gold standard treatment for gastrointestinal stromal tumors (GISTs). This paper describes the authors' experience in the management of posterior gastric wall GISTs through the robotic surgical approach.

Methods

A case-series analysis for surgically resected GISTs was conducted between 2009 and 2010. All patients were followed up until mid-2015.

Results

Robotic resection was performed in four cases. There was no evidence of bleeding or leak in all cases. The median hospital length of stay was 8 (5–8) days. No post-operative morbidity or mortality was reported during the follow-up duration (mean ± SD; 40.25 ± 35 months).

Conclusion

Findings show that the robotic assisted surgical approach to the removal of posterior wall gastric stromal tumors is associated with 100% disease-free survival rate. Copyright © 2016 John Wiley & Sons, Ltd.

Structured training and competence assessment in colorectal robotic surgery. Results of a consensus experts round table

‎Δευτέρα, ‎25 ‎Ιανουαρίου ‎2016, ‏‎10:24:04 πμ | Wanda Petz, Giuseppe Spinoglio, Gyu Seog Choi, Amjad Parvaiz, Cesar Santiago, Slawomir Marecik, Pier Cristoforo Giulianotti, Paolo Pietro Bianchi

Abstract

Background

A structured training is a key element for the learning of techniques with a high level of complexity, such as robotic colorectal surgery.

Methods

This study reports the results of an expert consensus round table held during the 6th Clinical Robotic Surgery Association (CRSA) congress, focusing on recommendations in robotic colorectal surgery.

Results

Three sequential steps are proposed for training: a basic module, to learn basic robotic skills and general competencies; an advanced module, to acquire skills to safely perform a colorectal resection, and tutored clinical practice providing procedures of increasing complexity.

Each specific skill of the basic module and performance of each surgical step of a colorectal procedure was evaluated and rated from 1 to 3.

Conclusions

Defining requirements to begin robotic colorectal activity, delineation of structured training programs and objectification of the acquired competences are key elements for a safe and efficient learning of robotic colorectal surgery. Copyright © 2016 John Wiley & Sons, Ltd.

Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®

‎Δευτέρα, ‎25 ‎Ιανουαρίου ‎2016, ‏‎10:22:08 πμ | Luca Morelli, Simone Guadagni, Gregorio Di Franco, Matteo Palmeri, Giovanni Caprili, Cristiano D'Isidoro, Luigi Cobuccio, Emanuele Marciano, Giulio Di Candio, Franco Mosca

Abstract

Background

The aim of this study was to compare the short-term outcomes of robotic rectal resection with total mesorectal excision (TME) for rectal cancer, with the use of the new da Vinci Xi® (Xi-RobTME group) and the da Vinci Si® (Si-RobTME group).

Methods

Ten patients with histologically confirmed rectal cancer underwent robot-assisted TME with the use of the new da Vinci Xi. The outcomes of Xi-RobTME group were compared with a Si-RobTME group selected using a case-matched methodology.

Results

Overall operative times and mean hospital stays were shorter in the Xi-RobTME group. Surgeries were fully robotic with a complete take-down of the splenic flexure in all Xi-RobTME cases, while only four cases of the Si-RobTME group were fully robotic, with two cases of complete take-down of the splenic flexure.

Conclusions

A modular force-controlled robotic instrument for minimally invasive surgery – efficacy for being used in autonomous grasping against a variable pull force

‎Δευτέρα, ‎25 ‎Ιανουαρίου ‎2016, ‏‎10:16:30 πμ | Seyed Mohsen Khadem, Saeed Behzadipour, Alireza Mirbagheri, Farzam Farahmand

Abstract

Background

Many deficiencies of minimally invasive robotic surgery systems can be eliminated by using automated laparoscopic tools with force measurement and control capability.

Method

A fully modular, automated laparoscopic instrument with a proximal force sensory system was designed and fabricated. The efficacy of the instrument was evaluated experimentally when functioning in an autonomous force-controlled grasping scheme.

Results

The designed instrument was shown to work easily with standard laparoscopic tools, with the whole distal part detachable for autoclave sterilization. The root mean squared error (RMSE) of the actual pinch force from the target ramp was 0.318 N; it was 0.402 N for a sinusoidal pull force, which dropped by 21% using a static friction compensation. A secure grasping condition was achieved, in spite of this error, by applying a sufficiently large margin from the slip boundary.

Conclusions

With a simple and practical design, the instrument enjoys affordability, versatility and autoclave sterilizability for clinical usage, with an acceptable performance for being used in an auto-grasping control scheme. Copyright © 2016 John Wiley & Sons, Ltd.

A new system for evaluation of armrest use in robotic surgery and validation of a new ergonomic concept – armrest load

‎Δευτέρα, ‎18 ‎Ιανουαρίου ‎2016, ‏‎11:48:25 πμ | K. Yang, M. Perez, C. Perrenot, N. Hubert, J. Felblinger, J. Hubert

Abstract

Background

The da Vinci robot provides a sitting position and an armrest to decrease workload and increase dexterity. We investigated the surgeon's ergonomic behaviour by installing force sensors on the dV-Trainer® simulator's armrest to measure the 'armrest load' during the performance of simulated exercises.

Methods

Five experts and 48 novices performed two robotic simulation exercises on the dV-Trainer. We calculated the armrest load and evaluated their armrest-using habits. Overall score and workspace range were evaluated automatically by the simulator and compared with armrest load.

Results

Statistically significant differences exist for overall score, workspace range and armrest load between novices and experts.

Conclusion

The armrest load score is a direct, sensitive measure for the ergonomic evaluation of a simulator's armrest use. This experience-dependent ergonomic difference between experts and novices (p = 0.007) highlights the importance of ergonomic training for novice robot users. Copyright © 2016 John Wiley & Sons, Ltd.

Redirecting pedicle screws: a revision spinal fusion strategy using three-dimensional image guidance

‎Τρίτη, ‎12 ‎Ιανουαρίου ‎2016, ‏‎9:47:04 πμ | Jang W. Yoon, Eric W. Nottmeier, Gazanfar Rahmathulla, Douglas S. Fenton, Stephen M. Pirris

Abstract

Background

Pedicle screws are a preferred method for spinal fixation because of their three-column support and rigid posterior stabilization. The purpose of this study was to evaluate the outcome of patients requiring pedicle screw redirection, and to describe a technique using cone-beam computed tomography (cbCT).

Methods

A retrospective review of 30 patients undergoing revision spinal fusion with redirection of pedicle screws was performed. Fifty pedicle screws were redirected in these patients using cbCT-based 3D image guidance. They were graded pre- and post-operatively using an established grading system.

Results

No complications occurred in this study as a result of redirection. No pedicle breach was noted in all of the redirected pedicle screws.

Conclusion

Redirection of misplaced pedicle screws using cbCT-based 3D image guidance seems to be safe and accurate in our experience. Further studies are needed to establish its safety, accuracy, fusion rate, and clinical outcome compared with other methods. Copyright © 2016 John Wiley & Sons, Ltd.

Patient-specific assessment of dysmorphism of the femoral head–neck junction: a statistical shape model approach

‎Παρασκευή, ‎8 ‎Ιανουαρίου ‎2016, ‏‎9:29:08 πμ | Vikas Khanduja, Nick Baelde, Andreas Dobbelaere, Jan Van Houcke, Hao Li, Christophe Pattyn, Emmanuel A. Audenaert

Abstract

Background

Objective quantification of anatomical variations about the femur head–neck junction in pre-operative planning for surgical intervention in femoro-acetabular impingement is problematic, as no clear definition of average normal anatomy for a specific subject exists.

Methods

We have defined the normal-equivalent of a subject's anatomy by using a statistical shape model and geometric shape optimization for finding correspondences, while excluding the femoral head–neck junction during the fitting procedure. The presented technique was evaluated on a cohort of 20 patients.

Results

Difference in α-angle measurement between the actual morphology and the predicted normal-equivalent, averaged 1.3° (SD 1.7°) in the control group versus 8° (SD 7.3°) in the patient group (p < 0.05).

Conclusions

Defining normal equivalent anatomy is effective in quantifying anatomical dysmorphism of the femoral head–neck junction and as such can improve presurgical analysis of patients diagnosed with femoro-acetabular impingement. Copyright © 2016 John Wiley & Sons, Ltd.

Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer

‎Παρασκευή, ‎8 ‎Ιανουαρίου ‎2016, ‏‎9:27:50 πμ | Gang Wang, Zhiming Wang, Zhiwei Jiang, Jiang Liu, Jian Zhao, Jieshou Li

Abstract

Background

Urinary and sexual dysfunction is the potential complication of rectal cancer surgery. The aim of this study was to evaluate the urinary and sexual function in male patients with robotic surgery for rectal cancer.

Methods

This prospective study included 137 of the 336 male patients who underwent surgery for rectal cancer. Urinary and male sexual function was studied by means of a questionnaire based on the International Prostatic Symptom Score and International Index of Erectile Function. All data were collected before surgery and 12 months after surgery.

Results

Patients who underwent robotic surgery had significantly decreased incidence of partial or complete erectile dysfunction and sexual dysfunction than patients with laparoscopic surgery. The pre- and post-operative total IPSS scores in patients with robotic surgery were significantly less than that with laparoscopic surgeries.

Conclusions

Robotic surgery shows distinct advantages in protecting the pelvic autonomic nerves and relieving post-operative sexual dysfunction.

Use of robot-specific resources and operating room times: the case of Telelap Alf-X robotic hysterectomy

‎Παρασκευή, ‎8 ‎Ιανουαρίου ‎2016, ‏‎9:25:20 πμ | Cristiano Rossitto, Salvatore Gueli Alletti, Federica Romano, Alessandra Fiore, Silvia Coretti, Marco Oradei, Matteo Ruggeri, Americo Cicchetti, Marco Marchetti, Francesco Fanfani, Giovanni Scambia

Abstract

Introduction

The aim of this study was to identify, quantify and evaluate the use of robotic materials and operating theatre times in Telelap ALF-X robotic hysterectomy.

Materials and methods

Cost analysis was performed on 81 patients who underwent a Telelap ALF-X robotic hysterectomy. Data were collected during a phase II study trial conducted at the University Hospital A. Gemelli, Catholic University, Rome. According to micro-costing technique, surgical team costs, materials and operating theatre usage were recorded during each surgical intervention. Cost data were provided by the hospital's accounting office. Probabilistic sensitivity analysis was carried out in order to test the robustness of the results by assuming an Inv-norm random variable.

Results

The base case analysis showed a cost/patient of €3391.82. The new robotic device requires a low consumption of robotic materials. Sensitivity analysis showed that the most sensitive cost driver was use of the operating theatre.

Conclusion

Image quality and effective dose of a robotic flat panel 3D C-arm vs computed tomography

‎Παρασκευή, ‎18 ‎Δεκεμβρίου ‎2015, ‏‎11:28:15 πμ | Michael Kraus, Eric Fischer, Florian Gebhard, Peter H. Richter

Abstract

Background

The aim of this study was to determine the effective dose and corresponding image quality of different imaging protocols of a robotic 3D flat panel C-arm in comparison to computed tomography (CT).

Methods

Dose measurements were performed using a Rando–Alderson Phantom. The phantom was exposed to different scanning protocols of the 3D C-arm and the CT. Pedicle screws were inserted in a fresh swine cadaver. Images were obtained using the same scanning protocols.

Results

At the thoracolumbar junction, the effective dose was comparable for 3D high-dose protocols, with (4.4 mSv) and without (4.3 mSv) collimation and routine CT (5 mSv), as well as a dose-reduction CT (4.0 mSv). A relevant reduction was achieved with the 3D low-dose protocol (1.0 mSv). Focusing on Th6, a similar reduction with the 3D low-dose protocol was achieved. The image quality of the 3D protocols using titanium screws was rated as ‘good’ by all viewers, with excellent correlation.

Conclusions

Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases

‎Παρασκευή, ‎18 ‎Δεκεμβρίου ‎2015, ‏‎11:27:48 πμ | Yusheng Shi, Chenghong Peng, Baiyong Shen, Xiaxing Deng, Jiabin Jin, Zhichong Wu, Qian Zhan, Hongwei Li

Abstract

Background

As a tissue-sparing procedure, pancreatic enucleation has become an alternative for benign or borderline pancreatic tumours; it has been proved to be safe and feasible. To date, a large sample size of robotic pancreatic enucleation has not been reported. This study aimed to discuss the clinical evaluation and postoperative complications after robotic pancreatic enucleation and compare it with open surgery.

Methods

Patients who underwent robotic or open pancreatic enucleation during December 2010–December 2014 at Shanghai Ruijin Hospital, affiliated with the Shanghai Jiaotong University School of Medicine in China, were included. Clinical data were collected and analysed.

Results

Patients were divided into an open group and a robotic group: 26 patients underwent robotic pancreatic enucleation, of whom 13 patients were female. The mean age was 51.7 years, the operation time was 125.7 ± 58.8 min, blood loss was 49.4 ± 33.4 ml and mean tumour size was 18.8 ± 7.9 mm; 17 patients underwent open pancreatic enucleation, of whom 11 were female. The mean age was 54.6 ± 17.2 min, blood loss was 198.5 ± 70.7 ml and mean tumour size was 3.5 ± 1.9 cm. Pathology included insulinomas, intrapancreatic mucinous neoplasmas (IPMNs), pancreatic neuro-endocrine tumours (PNETs), solid pseudopapillary tumours (SPTs) and serous cystadenomas (SCAs). Robotic pancreatic enucleations were associated with less trauma, shorter operation time, less blood loss and faster wound recovery compared with open pancreatic enucleation. Pancreatic fistulas (PFs) were the main complication that occurred in the robotic group; infection also occurred in the open group. All patients recovered after effective drainage and the use of somatostatin. The mean follow-up time was 25 months. No recurrence was discovered, and one patient in the open group suffered endocrine insufficiency.

Conclusion

Robotic pancreatic enucleation is a safe and effective surgical procedure for pancreatic benign and borderline tumours. It produces less trauma than open pancreatic enucleation and might extend the indications for enucleation. The PF rate after surgery is still high and a long-term follow-up needs to be performed. Copyright © 2015 John Wiley & Sons, Ltd.

Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it

‎Τετάρτη, ‎9 ‎Δεκεμβρίου ‎2015, ‏‎11:07:28 πμ | Leandro Cardoso Barchi, Carlos Eduardo Jacob, Maurice Youssef Franciss, Guilherme Tommasi Kappaz, Edison Dias Rodrigues Filho, Bruno Zilberstein

Abstract

Background

Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci® Surgical System. This may be due to intrinsic difficulties during oesophago–jejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases.

Methods

In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48–74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero–lateral EJA using a linear stapler. An entero–enterostomy is also performed in the upper abdomen.

Results

The mean operative time was 408 (range 340–481) min. The mean time for digestive tract reconstruction was 57 (range 47–68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28–52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0.

Conclusion

This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience. Copyright © 2015 John Wiley & Sons, Ltd.

Measurement of tremor transmission during microsurgery

‎Τετάρτη, ‎9 ‎Δεκεμβρίου ‎2015, ‏‎11:05:31 πμ | David I. Verrelli, Yi Qian, James Wood, Michael K. Wilson

Abstract

Background

Tremor is a major impediment to performing fine motor tasks, as in microsurgery. However, conventional measurements do not involve tasks representative of microsurgery.

Method

We developed a low-cost surgical simulator incorporating a force transducer capable of detecting and quantifying the effects of tremor upon high-fidelity silicone replicas of cardiac vessels and substrate muscle. Experienced and trainee surgeons performed simulated anastomoses on this rig. We characterized procedures in terms of tremor intensity, based on Lomb–Scargle periodograms.

Results

Distinctive force oscillations occurred at 8–12 Hz, characteristic of enhanced physiological tremor, yielding peaks in power spectral density. These early results suggest a significantly lower transmission of tremor to the operative field by the experienced surgeon in comparison to the trainees.

Conclusions

This new device quantifies the action of tremor upon a manipulandum during a complex task, which may be used for assessment and providing feedback to trainee surgeons. Copyright © 2015 John Wiley & Sons, Ltd.

Task analysis of laparoscopic camera control schemes

‎Τετάρτη, ‎9 ‎Δεκεμβρίου ‎2015, ‏‎10:52:33 πμ | R. Darin Ellis, Anthony J. Munaco, Luke A. Reisner, Michael D. Klein, Anthony M. Composto, Abhilash K. Pandya, Brady W. King

Abstract

Background

Minimally invasive surgeries rely on laparoscopic camera views to guide the procedure. Traditionally, an expert surgical assistant operates the camera. In some cases, a robotic system is used to help position the camera, but the surgeon is required to direct all movements of the system. Some prior research has focused on developing automated robotic camera control systems, but that work has been limited to rudimentary control schemes due to a lack of understanding of how the camera should be moved for different surgical tasks.

Methods

This research used task analysis with a sample of eight expert surgeons to discover and document several salient methods of camera control and their related task contexts.

Results

Desired camera placements and behaviours were established for two common surgical subtasks (suturing and knot tying).

Conclusion

Robot-assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review

‎Δευτέρα, ‎9 ‎Νοεμβρίου ‎2015, ‏‎11:51:00 πμ | Emilio Vicente, Yolanda Quijano, Benedetto Ielpo, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Luis Malave, Valentina Ferri, Antonio Ferronetti, Riccardo Caruso

Abstract

Background

Robotic techniques are claimed to be an alternative to laparoscopic and open approaches for gastrointestinal stromal tumors (GIST) treatment. Our aim is to present our single center experience and a literature review.

Materials and methods

From June 2012 to August 2014, six patients with preoperative diagnosis of GIST were treated by robotic surgery at Sanchinarro University Hospital.

Results

Two GIST tumors were localized in the second part of the duodenum, one in the first portion, two in the gastricantrum and another in the angular notch. Surgical procedures performed were two subtotal gastrectomies, one gastric wedge resection and three duodenal enucleations. None of the interventions needed conversion to open surgery. Mean operative time was 245 min (150–540). Mean hospital stay was 10.5 days (6–24). All lesions had microscopically negative resection margins. Mean follow-up was 24 months (8–33) with a disease-free survival rate of 100%.

Conclusions

Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection

‎Πέμπτη, ‎5 ‎Νοεμβρίου ‎2015, ‏‎4:53:36 πμ | Dai Hoon Han, Sung Hoon Choi, Eun Jung Park, Dae Ryong Kang, Gi Hong Choi, Jin Sub Choi

Abstract

Background

This study was designed to compare perioperative and oncologic outcomes between minimally invasive liver resection (MILR) and conventional open liver resection (COLR) for hepatocellular carcinoma (HCC) using a propensity-score matched analysis.

Methods

Ninety-nine patients who received MILR were matched with 198 patients treated with COLR out of 928 patients with HCC who received curative liver resection from 2002 to 2012. A multivariable logistic model based on factors related to the patient, tumor, and surgical procedure was used to estimate a propensity score.

Results

The MILR group experienced significantly less intraoperative blood loss (mean: 389.55 vs 580.66 mL; P = 0.008), lower complication rates (13.1% vs 24.7%; P = 0.020), and a shorter length of hospital stay (mean: 8.40 vs 13.39 days; P < 0.001). The two groups did not differ significantly in disease-free (P = 0.701) or overall survival (P = 0.086).

Conclusions

Computer-assisted surgery and intraoral welding technique for immediate implant-supported rehabilitation of the edentulous maxilla: case report and technical description

‎Πέμπτη, ‎5 ‎Νοεμβρίου ‎2015, ‏‎4:53:28 πμ | Alberto Maria Albiero, Renato Benato

Abstract

Background

Complications are frequently reported when combining computer assisted flapless surgery with an immediate loaded prefabricated prosthesis. The authors have combined computer-assisted surgery with the intraoral welding technique to obtain a precise passive fit of the immediate loading prosthesis.

Methods

An edentulous maxilla was rehabilitated with four computer assisted implants welded together intraorally and immediately loaded with a provisional restoration.

Results

A perfect passive fit of the metal framework was obtained that enabled proper osseointegration of implants. Computer assisted preoperative planning has been shown to be effective in reducing the intraoperative time of the intraoral welding technique. No complications were observed at 1 year follow-up.

Conclusions

This guided-welded approach is useful to achieve a passive fit of the provisional prosthesis on the inserted implants the same day as the surgery, reducing intraoperative time with respect to the traditional intraoral welding technique. Copyright © 2015 John Wiley & Sons, Ltd.

Da Vinci single site© surgical platform in clinical practice: a systematic review

‎Τρίτη, ‎3 ‎Νοεμβρίου ‎2015, ‏‎11:22:00 πμ | Luca Morelli, Simone Guadagni, Gregorio Di Franco, Matteo Palmeri, Giulio Di Candio, Franco Mosca

Abstract

Background

The Da Vinci single-site© surgical platform (DVSSP) is a set of single-site instruments and accessories specifically dedicated to robot-assisted single-site surgery.

Methods

The PubMed database from inception to June 2015 was searched for English literature on the clinical use of DVSSP in general surgery, urology and gynecology.

Results

Twenty-nine articles involving the clinical application of DVSSP were identified; 15 articles on general surgery (561 procedures), four articles on urology (48 procedures) and 10 articles on gynecology (212 procedures). All studies have proven the safety and feasibility of the use of DVSSP. The principal reported advantage is the restoration of intra-abdominal triangulation, while the main reported limitation is the lack of the endowrist.

Conclusions

Da Vinci systems have proven to be valuable assets in single-site surgery, owing to the combination of robot use with the dedicated single-incision platform. However, case–control or prospective trials are warranted to draw more definitive conc lusions. Copyright © 2015 John Wiley & Sons, Ltd.

Design, development and evaluation of a compact telerobotic catheter navigation system

‎Τρίτη, ‎3 ‎Νοεμβρίου ‎2015, ‏‎11:17:40 πμ | Mohammad Ali Tavallaei, Daniel Gelman, Michael Konstantine Lavdas, Allan C. Skanes, Douglas L. Jones, Jeffrey S. Bax, Maria Drangova

Abstract

Background

Remote catheter navigation systems protect interventionalists from scattered ionizing radiation. However, these systems typically require specialized catheters and extensive operator training.

Methods

A new compact and sterilizable telerobotic system is described, which allows remote navigation of conventional tip-steerable catheters, with three degrees of freedom, using an interface that takes advantage of the interventionalist's existing dexterity skills. The performance of the system is evaluated ex vivo and in vivo for remote catheter navigation and ablation delivery.

Results

The system has absolute errors of 0.1 ± 0.1 mm and 7 ± 6° over 100 mm of axial motion and 360° of catheter rotation, respectively. In vivo experiments proved the safety of the proposed telerobotic system and demonstrated the feasibility of remote navigation and delivery of ablation.

Conclusion

The proposed telerobotic system allows the interventionalist to use conventional steerable catheters; while maintaining a safe distance from the radiation source, he/she can remotely navigate the catheter and deliver ablation lesions. Copyright © 2015 John Wiley & Sons, Ltd.

Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients

‎Τετάρτη, ‎21 ‎Οκτωβρίου ‎2015, ‏‎1:27:03 μμ | Jin C. Kim, Jong L. Lee, Yong S. Yoon, Abdulrahman M. Alotaibi, Jihun Kim

Abstract

Background

There have been few studies describing the use of indocyanine green (ICG) fluorescent imaging during robot-assisted (RA) sphincter-saving operations (SSOs) and assessing its potential role in reducing anastomotic leak (AL).

Methods

A consecutive cohort of 436 rectal cancer patients who underwent curative RA SSOs were prospectively enrolled during 2010–2014, including 123 patients with ICG imaging (ICG⁺ group) and 313 patients without ICG imaging (ICG^– group).

Results

ICG imaging appeared to be helpful in identifying competent perfusion of the bowel adjacent to the anastomosis in 13 patients (10.6%) who might be susceptible to bowel ischaemia, including restrictive mesocolon. AL was remarkably greater in the ICG^– group compared with the ICG⁺ group (5.4% vs 0.8%; p = 0.031).

Conclusions

ICG imaging during RA SSO provides accurate real-time knowledge of the perfusion status at or near the anastomosis, specifically reducing AL in patients who may incur bowel ischaemia. Copyright © 2015 John Wiley & Sons, Ltd.

Quasi-non-linear deformation modeling of a human liver based on artificial and experimental data

‎Τρίτη, ‎13 ‎Οκτωβρίου ‎2015, ‏‎7:56:40 πμ | Firat Dogan, M. Serdar Celebi

Abstract

Background

Researchers working on error-prevention theories have shown that the use of replica models within simulation systems has improved operating skills, resulting in better patient outcomes.

Methods

This study aims to provide material test data specifically for a human liver to validate the accuracy of viscoelastic soft tissue models. This allows the validation of virtual surgery simulators by comparison with physical test data obtained from material tests on a viscoelastic silicone gel pad.

Results

The results proved that stress behavior and relaxation curves of Aquaflex® experiment and FEM simulation are close if average liver response and respective material parameters and model are used.

Conclusions

The precise representation of manipulated tissues used in virtual surgery trainers involves the accurate characterization of mechanical properties of the tissue. Consequently, successful implementations of these mechanical properties in a mathematical model of the deforming organ are of major importance. Copyright © 2015 John Wiley & Sons, Ltd.

Robotic single-site versus laparo-endoscopic single-site surgery for adnexal tumours: a propensity score-matching analysis

‎Παρασκευή, ‎9 ‎Οκτωβρίου ‎2015, ‏‎6:31:58 πμ | Jiheum Paek, Jung-Dong Lee, Tae Wook Kong, Suk-Joon Chang, Hee-Sug Ryu

Abstract

Background

The aim of this study was to compare the surgical outcomes of robotic single-site (RSS) and laparo-endoscopic single-site (LESS) surgery for adnexal tumours and evaluate the feasibility of RSS surgery.

Methods

RSS surgery was performed using the da Vinci Single-Site® surgical platform and LESS surgery using a single multi-channel port system. Surgical outcomes were compared between RSS (n = 20) and LESS (n = 228) after 1:4 propensity score matching.

Results

After the propensity score matching, the RSS group showed longer operating times than the LESS (91.1 vs 66.1 min; p = 0.001). While the LESS showed 1.3% of major complication rates, the RSS group had no perioperative complication. For the LESS, 2.5% of patients needed additional port insertion.

Conclusions

The RSS surgery for adnexal tumours could be performed safely without complications or additional port insertion. Although it showed a longer operating time, further experience and technical refinements will continue to improve operative results. Copyright © 2015 John Wiley & Sons, Ltd.

Robot-assisted laparoscopic (RAL) procedures in general surgery

‎Τετάρτη, ‎7 ‎Οκτωβρίου ‎2015, ‏‎7:46:30 πμ | Orhan Alimoglu, Julide Sagiroglu, Ibrahim Atak, Ali Kilic, Tunc Eren, Mujgan Caliskan, Gurhan Bas

Abstract

Background

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures.

Method

Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery.

Results

Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality.

Conclusion

Joint kinematics of surgeons during lumbar pedicle screw placement

‎Τετάρτη, ‎7 ‎Οκτωβρίου ‎2015, ‏‎7:26:27 πμ | Jeong-Yoon Park, Kyung-Hyun Kim, Sung-Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Yong-Eun Cho

Abstract

Background

A surgical robot for spine surgery has recently been developed. The objective is to assess the joint kinematics of the surgeon during spine surgery.

Methods

We enrolled 18 spine surgeons, who each performed pedicle screw placement, and used an optoelectronic motion analysis system. Using three-dimensional (3D) motion images, distance changes in five joints and angle changes in six joints were calculated during surgery.

Results

Distance fluctuations increased gradually from the proximal to the distal joint. Angle fluctuations were largest at the distal point but did not gradually increase, and the elbow showed the second largest fluctuation. Changes along the X axis were larger than those of the Y and Z axes.

Conclusion

The distances gradually increased from proximal portions of the body to the hand. In angle changes, the elbow was most dynamic during pedicle screw placement. The surgeons' whole joints carry out a harmonic role during lumbar pedicle screw placement. Copyright © 2015 John Wiley & Sons, Ltd.

Towards scene adaptive image correspondence for placental vasculature mosaic in computer assisted fetoscopic procedures

‎Τετάρτη, ‎7 ‎Οκτωβρίου ‎2015, ‏‎7:24:48 πμ | Liangjing Yang, Junchen Wang, Takehiro Ando, Akihiro Kubota, Hiromasa Yamashita, Ichiro Sakuma, Toshio Chiba, Etsuko Kobayashi

Abstract

Background

Visualization of the vast placental vasculature is crucial in fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome treatment. However, vasculature mosaic is challenging due to the fluctuating imaging conditions during fetoscopic surgery.

Method

A scene adaptive feature-based approach for image correspondence in free-hand endoscopic placental video is proposed. It contributes towards existing techniques by introducing a failure detection method based on statistical attributes of the feature distribution, and an updating mechanism that self-tunes parameters to recover from registration failures.

Results

Validations on endoscopic image sequences of a phantom and a monkey placenta are carried out to demonstrate mismatch recovery. In two 100-frame sequences, automatic self-tuned results improved by 8% compared with manual experience-based tuning and a slight 2.5% deterioration against exhaustive tuning (gold standard).

Conclusion

This scene-adaptive image correspondence approach, which is not restricted to a set of generalized parameters, is suitable for applications associated with dynamically changing imaging conditions. Copyright © 2015 John Wiley & Sons, Ltd.

Robot-assisted laparoscopic resection of large retroperitoneal paraganglioma – initial experience from China

‎Τετάρτη, ‎7 ‎Οκτωβρίου ‎2015, ‏‎7:24:24 πμ | Leilei Xia, Tianyuan Xu, Xianjin Wang, Liang Qin, Xiang Zhang, Xiaohua Zhang, Zhaowei Zhu, Shan Zhong, Zhoujun Shen

Abstract

Background

There have been only four cases of robot-assisted laparoscopic resection of retroperitoneal paraganglioma (PGL) in the literature. Here we present our experience on robot-assisted laparoscopic resection of large PGL in four patients to further evaluate its safety and efficacy.

Methods

From March 2013 to January 2015, four patients with large PGL underwent robot-assisted laparoscopic resection. The tumors were located on the left side and adjacent to the aorta. Patients' demographics, intraoperative and postoperative data were collected, including intraoperative hemodynamic outcomes.

Results

In all cases, the PGLs were successfully removed robotically without conversion to open surgery and no intraoperative or postoperative complication occurred. The operative time ranged from 58–113 min, and estimated blood loss ranged from 50–350 mL. There were no significant intraoperative hemodynamic instabilities. The postoperative hospital stay ranged from 4–6 days.

Conclusions

With the advantages of robotic system, robot-assisted resection of large retroperitoneal PGL is feasible, safe and efficient. The robotic system has the potential to expand surgical treatment modalities for complex PGL. Copyright © 2015 John Wiley & Sons, Ltd.

Using motion parallax for laparoscopic surgery

‎Τετάρτη, ‎7 ‎Οκτωβρίου ‎2015, ‏‎7:23:57 πμ | He Su, Jianmin Li, Huaifeng Zhang, Jinhua Li, Shuxin Wang

Abstract

Background

In typical stereo display systems, the reproduced 3D scene is distorted when the observer moves. Motion parallax is an important depth cue that has the ability to correct this distortion. More importantly, motion parallax enables the observer to look around objects to provide a better view.

Methods

A robotically assisted laparoscope prototype was designed to provide motion parallax. A study to adjust the camera-head mapping ratio (gain of motion parallax) was performed. A series of phantom tests was conducted to test the effectiveness of motion parallax.

Results

The experimental results showed that the motion parallax was effective, and the gain of motion parallax was subjective. For a regular laparoscope view distance, larger image zooming rates required smaller gain; for the same equivalent image size, further observer distance decreased the optimal gain.

Conclusions

Performance comparison of various feature detector-descriptors and temporal models for video-based assessment of laparoscopic skills

‎Τρίτη, ‎29 ‎Σεπτεμβρίου ‎2015, ‏‎12:45:13 μμ | Constantinos Loukas, Evangelos Georgiou

Abstract

Background

Despite the significant progress in hand gesture analysis for surgical skills assessment, video-based analysis has not received much attention. In this study we investigate the application of various feature detector-descriptors and temporal modeling techniques for laparoscopic skills assessment.

Methods

Two different setups were designed: static and dynamic video-histogram analysis. Four well-known feature detection-extraction methods were investigated: SIFT, SURF, STAR-BRIEF and STIP-HOG. For the dynamic setup two temporal models were employed (LDS and GMMAR model). Each method was evaluated for its ability to classify experts and novices on peg transfer and knot tying.

Results

STIP-HOG yielded the best performance (static: 74–79%; dynamic: 80–89%). Temporal models had equivalent performance. Important differences were found between the two groups with respect to the underlying dynamics of the video-histogram sequences.

Conclusions

Temporal modeling of feature histograms extracted from laparoscopic training videos provides information about the skill level and motion pattern of the operator. Copyright © 2015 John Wiley & Sons, Ltd.

An MRI-conditional motion phantom for the evaluation of high-intensity focused ultrasound protocols

‎Τρίτη, ‎29 ‎Σεπτεμβρίου ‎2015, ‏‎12:42:32 μμ | George Sagias, Christos Yiallouras, Kleanthis Ioannides, Christakis Damianou

Abstract

Background

The respiratory motion of abdominal organs is a serious obstacle in high-intensity focused ultrasound (HIFU) treatment with magnetic resonance imaging (MRI) guidance. In this study, a two-dimensional (2D) MRI-conditional motion phantom device was developed in order to evaluate HIFU protocols in synchronized and non-synchronized ablation of moving targets.

Materials and methods

The 2D phantom device simulates the respiratory motion of moving organs in both the left–right and craniocaudal directions. The device consists of MR-conditional materials which have been produced by a three-dimensional (3D) printer.

Results

The MRI compatibility of the motion phantom was tested successfully in an MRI scanner. In vitro experiments were carried out to evaluate HIFU ablation protocols that are minimally affected by target motion.

Conclusion

It was shown that only in synchronized mode does HIFU produce thermal lesions, as tested on a gel phantom mimicking the moving target. The MRI-conditional phantom device was shown to be functional for its purpose and can be used as an evaluation tool for testing HIFU protocols for moving targets in an MRI environment. Copyright © 2015 John Wiley & Sons, Ltd.

Robot-sewn Ivor-Lewis anastomosis: preliminary experience and technical details

‎Τρίτη, ‎29 ‎Σεπτεμβρίου ‎2015, ‏‎12:41:36 μμ | Stefano Bongiolatti, Mario Annecchiarico, Michele Di Marino, Bernardo Boffi, Sara Borgianni, Alessandro Gonfiotti, Luca Voltolini, Andrea Coratti

Abstract

Introduction

Robot-assisted minimally invasive esophagectomy with intra-thoracic anastomosis showed encouraging results but there is a lack of data to demonstrate the safety and feasibility.

Objective

The aim of this study is to report our experience in RA-ILE (robotic-assisted Ivor-Lewis esophagectomy) with robotic hand-sewn anastomosis.

Methods

This is a retrospective study of patients who underwent robotic-assisted esophagectomy in prone position with intrathoracic anastomosis for malignant neoplasm of the esophagus or esophago-gastric junction.

Results

From January 2012 to December 2014 we performed eight completely robot-assisted esophagectomy without intra-operative complication. The mortality rate at 30-day was zero. In two patients we observed a partial leakage of the gastric tube that required revision.

The mean operative time was 499 ± 46 min including robotic set up and patient positioning. The median hospital-stay was 10 days. Complete (R0) resection was accomplished in all patients and the mean number of lymph nodes removed was 37.6 ± 14 .7.

Conclusions

This preliminary experience suggests that robotic-assisted RA-ILE for malignant lesions is a real surgical option compared with conventional surgery with satisfactory results. Copyright © 2015 John Wiley & Sons, Ltd.

The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery

‎Παρασκευή, ‎28 ‎Αυγούστου ‎2015, ‏‎6:46:15 πμ | Jorge Lagares-Garcia, Abigail O'Connell, Anthony Firilas, Christopher Chad Robinson, Bonnie P. Dumas, Monika E. Hagen

Abstract

Background

Robotic surgery has been developed to address the technical limitations of laparoscopic surgery and might result in similar outcomes for patients with low and high body mass index (BMI).

Methods

Demographic, peri-operative data and surrogate oncologic markers for colorectal cancer of patients that underwent robotic colorectal procedures were collected in a prospective database and analyzed.

Results

103 consecutive patients (36 normal-weight, 33 overweight, 34 obese) underwent robotic colorectal surgery from 11/2011 to 05/2012. While operating room (OR) time was longer for the obese patients (123.4 vs 137.9 and 154.7 min), results for estimated blood loss (104.2 vs 153 and 155.9 mL), conversions (2.8 vs 6.1 and 5.9%), complications (19.4 vs 21.2 and 32.4%), re-admissions (11.1 vs 112.1 and 20.6) and mortality (0% for all) were comparable. BMI did not affect the surrogate markers in patients with malignancies.

Conclusions

Robotic total endoscopic sutureless aortic valve replacement: proof of concept for a future surgical setting

‎Τρίτη, ‎18 ‎Αυγούστου ‎2015, ‏‎12:23:31 μμ | Marco Vola, Pablo Maureira, Radwan Kassir, Jean-François Fuzellier, Salvatore Campisi, Fabien Doguet, Jean-Noel Albertini, Vito Giovanni Ruggieri, Thierry Folliguet

Abstract

Background

Sutureless valves have recently enabled closed chest aortic valve replacement. This paper evaluates the feasibility of a robotic telemanipulation during thoracoscopic sutureless aortic valve implantation in cadavers.

Methods

Cadavers were prepared with a five thoracosopic trocar setting, with a transthoracic clamp inserted in the first right intercostal space and the optics inserted in the second. Seven sutureless valve implantations were scheduled using 5 Sorin Perceval and 2 Medtronic 3f Enable valves.

Results

In all cases performance of pericardial suspension, aortotomy and root exposure required less than 20 min. Native valve excision and sutureless bioprosthesis implantation was technically feasible in all cases. A satisfactory prosthesis sealing was ascertained visually and the absence of paravalvular leakages was assessed with a nerve hook test around the prosthetic flange.

Conclusions

Toward teleoperated needle steering under continuous MRI guidance for prostate percutaneous interventions

‎Τετάρτη, ‎12 ‎Αυγούστου ‎2015, ‏‎8:13:13 πμ | Reza Seifabadi, Fereshteh Aalamifar, Iulian Iordachita, Gabor Fichtinger

Abstract

Background

To propose a human-operated in-room master–slave bevel-tip needle steering system under continuous MRI guidance for prostate biopsy, in which the patient is kept in the scanner at all times and the process of needle placement is under continuous control of the physician.

Methods

A 2-DOF MRI-compatible needle steering module is developed and integrated with an existing 4-DOF transperineal robot, creating a 6-DOF robotic platform for prostate interventions. An MRI-compatible 2-DOF master robot is also developed to enable remote needle steering. An MRI-compatible 2-DOF force/torque sensor was used on the master side. Bevel-tip needle steering is implemented in order to compensate for the targeting error due to needle–tissue interaction.

Results

MRI-compatibility results demonstrated maximum 20% loss in signal to noise ratio (SNR). Robot functionality was not influenced by the magnetic field. Targeting error was reduced from 4.2 mm to 0.9 mm as a result of bevel-tip needle steering.

Conclusions

A three-dimensional large deformation model for soft tissue using meshless method

‎Τρίτη, ‎11 ‎Αυγούστου ‎2015, ‏‎1:27:21 μμ | Mohammad Reza Dehghan, Abdolreza Rahimi, Heidar Ali Talebi, Mohammad Zareinejad

Abstract

Background

Recently, a great number of studies have been carried out to model soft tissue deformation in contact with surgical instruments to aid the development of surgical simulators. Precise methods to model the soft tissue such as the Finite Element Method (FEM) lack accuracy in large deformations.

Methods

An innovative meshless method is used, which has high precision and is applicable to large deformations. The meshless simulation method is implemented for a 2D beam and a 3D cube. Experiments are conducted for two silicone-gel samples to verify the correctness of the method.

Results

The meshless results in 2D and 3D show better accuracy for large deformations in comparison with the FEM. This method is used to model human organs such as liver and gallbladder.

Conclusion

Clinical factors affecting the accuracy of a CT-based active infrared navigation system

‎Παρασκευή, ‎31 ‎Ιουλίου ‎2015, ‏‎1:36:28 μμ | Yajun Liu, Jingwei Zhao, Mingxing Fan, Yanwei Lv, Wenyong Liu, Wei Tian

Abstract

Background

Computer-assisted navigation technology has been widely used during spine surgery; however, the desired accuracy cannot be easily obtained and sustained. Our goal was to determine whether and how clinical factors affect the accuracy of a CT-based active infrared navigation system.

Methods

Using the Sawbone model, we recorded the clinical accuracy of the navigation system, based on several clinical statuses.

Results

Clinical accuracy may change when the height or angle of the bed is changed. Within the visible area of the camera, the nearer the distance between the camera and the model, the better the clinical accuracy. The clinical accuracy of the CT-based active infrared navigation system may decrease due to exposure to shadowless lamps.

Conclusions

The clinical accuracy of the CT-based active infrared navigation system may be influenced by the clinical status of shadowless lamps, different distances between the camera and model and different postures of the surgical bed. Copyright © 2015 John Wiley & Sons, Ltd.

Design, testing and modelling of a novel robotic system for trans-oesophageal ultrasound

‎Παρασκευή, ‎31 ‎Ιουλίου ‎2015, ‏‎1:31:47 μμ | Shuangyi Wang, James Housden, Davinder Singh, Kaspar Althoefer, Kawal Rhode

Abstract

Background

Trans-oesophageal echocardiography (TOE) has been widely utilized for cardiac disease diagnosis and interventional procedure guidance. However, the TOE operator is required to manually manipulate the probe, often for long periods of time and sometimes in an X-ray environment where there is exposure to ionizing radiation.

Methods

A novel robotic manipulation system for remote control of commercial TOE probes has been developed and tested. The system has four degrees of freedom (DOFs) and is characterized by a kinematic model. The accuracy of the model and the error propagation were analysed.

Results

The prototype system was shown to exhibit the required function in terms of the mechanical reliability and range of motion. The forward kinematic model can accurately predict the trajectory of the probe tip movement. The average point-to-point errors were 2.60 mm and 3.55°.

Conclusions

Robotic assistance provided by the proposed system may improve the TOE operating environment. The proposed forward kinematic model can be further employed for automatic control. Copyright © 2015 John Wiley & Sons, Ltd.

Enhanced torque-based impedance control to assist brain targeting during open-skull neurosurgery: a feasibility study

‎Παρασκευή, ‎31 ‎Ιουλίου ‎2015, ‏‎1:31:08 μμ | E. Beretta, F. Nessi, G. Ferrigno, F. Di Meco, A. Perin, L. Bello, G. Casaceli, F. Raneri, A. De Benedictis, E. De Momi

Abstract

Background

Cooperatively-controlled robotic assistance could provide increased positional accuracy and stable and safe tissue targeting tasks during open-skull neurosurgical procedures, which are currently performed free-hand.

Methods

Two enhanced torque-based impedance control approaches, i.e. a variable damping criterion and a force-feedback enhancement control, were proposed in combination with an image-based navigation system. Control systems were evaluated on brain-mimicking phantoms by 13 naive users and 8 neurosurgeons (4 novices and 4 experts).

Results

In addition to a 60% reduction of user effort, the combination of the proposed strategies showed comparable performances with respect to state-of-the-art admittance controller, thus satisfying the clinical accuracy requirements (below 1 mm), reducing the hand tremor (by a factor of 10) and the tissue's indentation overshooting (by 80%).

Conclusion

Although the perceived reliability of the system should be improved, the proposed control was suitable to assist targeting procedures, such as brain cortex stimulation, allowing for accurate, stable and safe contact with soft tissues. Copyright © 2015 John Wiley & Sons, Ltd.

Transperitoneal robotic resection of benign primary retroperitoneal tumors: can it be widely used?

‎Πέμπτη, ‎23 ‎Ιουλίου ‎2015, ‏‎12:56:47 μμ | Tian Zhang, Xinjing Wang, Liangchao Zhao, Fei Liu, Hao Chen, Xiaxing Deng, Chenghong Peng, Baiyong Shen

Abstract

Background

This article was aimed to show the safety, flexibility and other advantages of transperitoneal robot-assisted resection of benign primary retroperitoneal tumors.

Methods

Ten patients underwent robotic surgeries, and 31 underwent laparotomy surgeries from 2012 to 2014. The perioperative data, including tumor size, operation time, and other parameters were analyzed.

Results

The tumor sizes of the two groups were not different (robotic group vs laparotomy group: 5.47 vs 5.32 cm, respectively; P = 0.777). The differences in the blood loss (robotic group vs laparotomy group: 80.00 vs. 146.08 mL, respectively; P = 0.021), time of oral intake (robotic group vs laparotomy group: 2.12 vs. 3.42 d, respectively; P = 0.045) and post-operation hospital stay (robotic group vs laparotomy group: 5.40 vs. 8.77 d, respectively; P = 0.004) were statistically significant and lower in the robotic group.

Conclusion

Robotic pancreaticoduodenectomy: comparison of complications and cost to the open approach

‎Πέμπτη, ‎23 ‎Ιουλίου ‎2015, ‏‎12:56:22 μμ | E. H. Baker, S. W. Ross, R. Seshadri, R. Z. Swan, D. A. Iannitti, D. Vrochides, J. B. Martinie

Abstract

Background

Robotic pancreaticoduodenectomy (RP) has shown some advantages over open pancreaticoduodenectomy (OP) but no data has been published providing a cost comparison.

Methods

Retrospective analysis of all pancreaticoduodenectomies at a single quaternary cancer referral center was performed. Patient demographics, comorbidities, operative characteristics, complications, and charge data were recorded, and then compared using standard statistical methods.

Results

71 pancreaticoduodenectomies were performed: 22 RP and 49 OP. Patients undergoing OP had similar demographics, comorbidities, pathology, and oncologic characteristics as patients undergoing RP. While operative charges were higher for RP, once inpatient stay associated costs and follow-up costs were included, there was no difference in total costs between RP and OP.

Conclusions

Patients undergoing RP have equivalent rates of R0 resection as OP, and benefit from decreased number of complications, surgical site infections, and length of stay in the intensive care unit. Once cost of complications and follow-up are incorporated, no significant difference between procedures exists. Copyright © 2015 John Wiley & Sons, Ltd.

Changes in the loadings on the shoulder girdle in the case of scapulothoracic fusion

‎Σάββατο, ‎18 ‎Ιουλίου ‎2015, ‏‎7:56:50 πμ | Halil Atmaca, Levent Uğur, Arif Özkan, Alberto Grassi Mantelli, Fehmi Erzincanli

Abstract

Background

Scapulothoracic fusion (STF) may be an alternative and salvage procedure in the treatment of scapular winging. The biomechanical effects of this procedure on the shoulder girdle have not been previously considered. The purpose of this study is to demonstrate the relationship between STF and the stress distribution pattern of the shoulder girdle.

Methods

Three-dimensional solid modeling of the shoulder girdle was carried out using virtual finite element modeling. STF was applied to the reference model obtained in a computer environment. Dynamic and nonlinear analysis was performed.

Results

Stress distributions in joints and ligaments were calculated. With respect to loading on the joints, maximum equivalent stresses increased on acromioclavicular (AC) and GH joints in the case of STF during abduction and flexion respectively.

Conclusion

Results revealed that STF is a non-physiological, static procedure leading to load increase on GH and AC joint cartilages, which may be a cause of potential joint osteoarthritis. Copyright © 2015 John Wiley & Sons, Ltd.

Totally robotic isolated caudate-lobe liver resection for hydatid disease: report of a case

‎Παρασκευή, ‎17 ‎Ιουλίου ‎2015, ‏‎9:27:50 πμ | Fabrizio Di Benedetto, Roberto Ballarin, Giuseppe Tarantino

Abstract

Background

Hepatic caudatectomy has always been considered a challenging procedure, because of the complex anatomy and deep location of this segment. Herein we report the first case of a totally robotic isolated caudate-lobe liver resection ever performed for hydatid disease.

Methods

A 55 year-old man was referred to our institution after diagnosis was made of a 5.6 cm hepatic lesion of the caudate lobe. Radiological suspicion was for hydatid disease. The patient underwent robotic-assisted hepatic caudatectomy.

Results

The operative time was 280 min and the estimated blood loss was 200 ml. The postoperative course was uneventful. The drain was removed on post-operative day 3 and the patient was discharged on post-operative day 6.

Conclusion

Robotic resection of the caudate lobe is a technically feasible procedure, which nevertheless requires high hepato-pancreato-biliary surgery skills, both in open an mini-invasive approaches. It provides several technical advantages in the field of mini-invasive surgery, yet assuring patient safety. Copyright © 2015 John Wiley & Sons, Ltd.

Experimental evaluation of co-manipulated ultrasound-guided flexible needle steering

‎Τετάρτη, ‎15 ‎Ιουλίου ‎2015, ‏‎12:51:02 μμ | Momen Abayazid, Claudio Pacchierotti, Pedro Moreira, Ron Alterovitz, Domenico Prattichizzo, Sarthak Misra

Abstract

Background

A teleoperation system for bevel-tipped flexible needle steering has been evaluated. Robotic systems have been exploited as the main tool to achieve high accuracy and reliability. However, for reasons of safety and acceptance by the surgical community, keeping the physician tightly in the loop is preferable.

Methods

The system uses ultrasound imaging, path planning, and control to compute the desired needle orientation during the insertion and intuitively passes this information to the operator, who teleoperates the motion of the needle's tip. Navigation cues about the computed orientation are provided through haptic and visual feedback to the operator to steer the needle.

Results

The targeting accuracy of several co-manipulation strategies were studied in four sets of experiments involving human subjects with clinical backgrounds.

Conclusions

Experimental results show that receiving feedback regarding the desired needle orientation improves the targeting accuracy by a factor of 9 with respect to manual insertions. Copyright © 2015 John Wiley & Sons, Ltd.

Augmented reality visualization of deformable tubular structures for surgical simulation

‎Δευτέρα, ‎6 ‎Ιουλίου ‎2015, ‏‎12:15:43 μμ | Vincenzo Ferrari, Rosanna Maria Viglialoro, Paola Nicoli, Fabrizio Cutolo, Sara Condino, Marina Carbone, Mentore Siesto, Mauro Ferrari

Abstract

Background

Surgical simulation based on augmented reality (AR), mixing the benefits of physical and virtual simulation, represents a step forward in surgical training. However, available systems are unable to update the virtual anatomy following deformations impressed on actual anatomy.

Methods

A proof-of-concept solution is described providing AR visualization of hidden deformable tubular structures using nitinol tubes sensorized with electromagnetic sensors. This system was tested in vitro on a setup comprised of sensorized cystic, left and right hepatic, and proper hepatic arteries. In the trial session, the surgeon deformed the tubular structures with surgical forceps in 10 positions.

Results

The mean, standard deviation, and maximum misalignment between virtual and real arteries were 0.35, 0.22, and 0.99 mm, respectively.

Conclusion

The alignment accuracy obtained demonstrates the feasibility of the approach, which can be adopted in advanced AR simulations, in particular as an aid to the identification and isolation of tubular structures. Copyright © 2015 John Wiley & Sons, Ltd.

Assessment of respiration-induced vertebral motion in prone-positioned patients during general anaesthesia

‎Παρασκευή, ‎3 ‎Ιουλίου ‎2015, ‏‎2:21:21 μμ | Yajun Liu, Cheng Zeng, Mingxing Fan, Lin Hu, Chi Ma, Wei Tian

Abstract

Background

Robotic techniques are beginning to be applied to spine surgery, but safety is always a concern. Respiration-induced motion during surgery could lead to inaccurate robot-assisted pedicle screw placement. Accurate positional information for vertebral movement is needed to develop new techniques to eliminate or adjust respiration-induced motion and improve the accuracy of robotic spine surgery.

Methods

An optical tracking system was attached to patients' backs to track the motion of the C3, C7, T7, T12, L4 and S1 vertebral bodies. Monitoring was done in the operating room, with patients under general anaesthesia.

Results

Measured motion (peak to peak) during breathing was greater in T7 (2.2593 mm), T12 (2.2665 mm) and L4 (1.6054 mm) than in other segments. Anterior–posterior motion was greater than either left–right or superior–inferior motion.

Conclusion

In-bore prostate transperineal interventions with an MRI-guided parallel manipulator: system development and preliminary evaluation

‎Παρασκευή, ‎26 ‎Ιουνίου ‎2015, ‏‎10:01:28 πμ | Sohrab Eslami, Weijian Shang, Gang Li, Nirav Patel, Gregory S. Fischer, Junichi Tokuda, Nobuhiko Hata, Clare M. Tempany, Iulian Iordachita

Abstract

Background

Robot-assisted minimally-invasive surgery is well recognized as a feasible solution for diagnosis and treatment of prostate cancer in humans.

Methods

This paper discusses the kinematics of a parallel 4 Degrees-of-Freedom (DOF) surgical manipulator designed for minimally invasive in-bore prostate percutaneous interventions through the patient's perineum. The proposed manipulator takes advantage of four sliders actuated by MRI-compatible piezoelectric motors and incremental rotary encoders. Errors, mostly originating from the design and manufacturing process, need to be identified and reduced before the robot is deployed in clinical trials.

Results

The manipulator has undergone several experiments to evaluate the repeatability and accuracy (about 1 mm in air (in x or y direction) at the needle's reference point) of needle placement, which is an essential concern in percutaneous prostate interventions.

Conclusion

Robotic sleeve gastrectomy for morbid obesity: report of a 5 year experience

‎Παρασκευή, ‎12 ‎Ιουνίου ‎2015, ‏‎8:20:34 πμ | Andreas Alexandrou, Eleftherios Mantonakis, Emmanouil Pikoulis, Theodora Margariti, Nikos Dimitrokallis, Theodoros Diamantis

Abstract

Background

Robotic bariatric procedures are nowadays in the surgeon's arsenal for the treatment of morbid obesity. With proven efficacy and advantages in gastric bypass procedures, we attempted to employ robotics and study the results in the other major bariatric procedure, sleeve gastrectomy.

Methods

We used the da Vinci S® system to perform 19 robotic sleeve gastrectomies (RSGs) and reviewed the 5-year results as far as excess body weight loss is concerned, and amelioration of obesity-related comorbidities.

Results

Mean percentage of excess body weight loss (%EWL) was 64.4%, 67.1%, 61.7%, 63.1%, 64.8% for the first, second, third, fourth and fifth year, respectively. Neither of our two patients with diabetes mellitus (0%) or hypertension (0%) showed remission, while all six of our patients (100%) showed remission of their sleep apnoea after 5 years.

Conclusions

Robotic sleeve gastrectomy is an effective procedure as far as initial excess weight loss is concerned and this loss is well maintained 5 years post-operatively, a finding similar to relevant data after conventional laparoscopic sleeve gastrectomy. Copyright © 2015 John Wiley & Sons, Ltd.

Simultaneous localization and calibration for electromagnetic tracking systems

‎Πέμπτη, ‎28 ‎Μαΐου ‎2015, ‏‎9:52:18 πμ | Hossein Sadjadi, Keyvan Hashtrudi-Zaad, Gabor Fichtinger

Abstract

Background

In clinical environments, field distortion can cause significant electromagnetic tracking errors. Therefore, dynamic calibration of electromagnetic tracking systems is essential to compensate for measurement errors.

Methods

It is proposed to integrate the motion model of the tracked instrument with redundant EM sensor observations and to apply a simultaneous localization and mapping algorithm in order to accurately estimate the pose of the instrument and create a map of the field distortion in real-time. Experiments were conducted in the presence of ferromagnetic and electrically-conductive field distorting objects and results compared with those of a conventional sensor fusion approach.

Results

The proposed method reduced the tracking error from 3.94±1.61 mm to 1.82±0.62 mm in the presence of steel, and from 0.31±0.22 mm to 0.11±0.14 mm in the presence of aluminum.

Conclusions

With reduced tracking error and independence from external tracking devices or pre-operative calibrations, the approach is promising for reliable EM navigation in various clinical procedures. Copyright © 2015 John Wiley & Sons, Ltd.

A 3D machine vision method for non-invasive assessment of respiratory function

‎Τετάρτη, ‎13 ‎Μαΐου ‎2015, ‏‎12:59:05 μμ | L. N. Smith, M. L. Smith, M. E. Fletcher, A. J. Henderson

Abstract

Background

Respiratory function testing is important for detecting and monitoring illness, however, it is difficult for some patients, such as the young and severely ill, to perform conventional tests that require cooperation and/or patient contact.

Method

A new method was developed for non-contact breathing measurement, employing photometric stereo to capture the surface topography of the torso of an unconstrained subject. The surface is integrated to calculate time-dependent volume changes during respiration.

Results

The method provides a useful means of continuously measuring volume changes during respiration with high spatial and temporal resolution. The system was tested by comparison with pneumotachometry equipment and a clear periodic signal, of a frequency corresponding to the reference data, was observed.

Conclusion

The approach is unique in performing breathing monitoring (with potential diagnostic capability) for unconstrained patients in virtually any lighting conditions (including darkness during sleep) and in a non-contact, unobtrusive (i.e. using imperceptible light) fashion. Copyright © 2015 John Wiley & Sons, Ltd.

Hybrid position/force control of an active handheld micromanipulator for membrane peeling

‎Δευτέρα, ‎11 ‎Μαΐου ‎2015, ‏‎11:56:57 πμ | Trent S. Wells, Sungwook Yang, Robert A. MacLachlan, Louis A. Lobes, Joseph N. Martel, Cameron N. Riviere

Abstract

Background

Peeling procedures in retinal surgery require micron-scale manipulation and control of sub-tactile forces.

Methods

Hybrid position/force control of an actuated handheld microsurgical instrument is presented as a means for simultaneously improving positioning accuracy and reducing forces to prevent avoidable trauma to tissue. The system response was evaluated, and membrane-peeling trials were performed by four test subjects in both artificial and animal models.

Results

Maximum force was reduced by 56% in both models compared with position control. No statistically significant effect on procedure duration was observed.

Conclusions

A hybrid position/force control system has been implemented that successfully attenuates forces and minimizes unwanted excursions during microsurgical procedures such as membrane peeling. Results also suggest that improvements in safety using this technique may be attained without increasing the duration of the procedure. Copyright © 2015 John Wiley & Sons, Ltd.

Robotic oncologic complexity score – a new tool for predicting complications in computer-enhanced oncologic surgery

‎Τετάρτη, ‎6 ‎Μαΐου ‎2015, ‏‎3:55:56 πμ | Olivia Sgarbura, Victor Tomulescu, Irinel Popescu

Abstract

Background

While there is little doubt that robotic interventions have already opened new horizons in surgery due to its inherent complexity, there is still an unmet need for tools allowing center-to-center performance comparisons. A complexity score could be a valuable instrument for further research.

Methods

The items of the robotic oncologic complexity score (ROCS) were based on risk factors identified in previous studies. We attempt to build the score and validate it on 400 consecutive cases of robotic oncologic surgery. The primary endpoint is to assess the value of ROCS in predicting major complications.

Results

The mean ROCS in the group was 3.3(+/−1.4). Different correlations were calculated: the score and the complications (r=0.38), the major complications (r=0.42), Clavien grade (r=0.5), the operating time (r=0.35), and the length of stay (r=0.47). On the ROC-curve a score >4 has the best specificity and sensibility for predicting major complications (P<0.05).

Conclusion

An effective visualization technique for depth perception in augmented reality-based surgical navigation

‎Τετάρτη, ‎6 ‎Μαΐου ‎2015, ‏‎3:55:42 πμ | Hyunseok Choi, Byunghyun Cho, Ken Masamune, Makoto Hashizume, Jaesung Hong

Abstract

Background

Depth perception is a major issue in augmented reality (AR)-based surgical navigation. We propose an AR and virtual reality (VR) switchable visualization system with distance information, and evaluate its performance in a surgical navigation set-up.

Methods

To improve depth perception, seamless switching from AR to VR was implemented. In addition, the minimum distance between the tip of the surgical tool and the nearest organ was provided in real time. To evaluate the proposed techniques, five physicians and 20 non-medical volunteers participated in experiments.

Results

Targeting error, time taken, and numbers of collisions were measured in simulation experiments. There was a statistically significant difference between a simple AR technique and the proposed technique.

Conclusions

We confirmed that depth perception in AR could be improved by the proposed seamless switching between AR and VR, and providing an indication of the minimum distance also facilitated the surgical tasks. Copyright © 2015 John Wiley & Sons, Ltd.

Radiographic comparison of cross-sectional lumbar pedicle fill when placing screws with navigation versus free-hand technique

‎Δευτέρα, ‎4 ‎Μαΐου ‎2015, ‏‎11:56:45 πμ | Stephen M. Pirris, Eric W. Nottmeier, Michael O'Brien, Gazanfar Rahmathulla, Mark Pichelmann

Abstract

Background

Pedicle screws are often used for spinal fixation. Increasing the percentage of pedicle that is filled with the screw presumably yields greater fixation. It has not been shown whether spinal navigation helps surgeons more completely fill their instrumented pedicles.

Methods

Fifty consecutive patients from each arm (navigated and free-hand) were retrospectively reviewed. The cross-sectional area of each instrumented lumbar pedicle and screw were measured using an automatic area calculation tool. The coronal images and measurements were blinded to the surgeons.

Results

The instrumented pedicles in the navigated patients were significantly more filled by screws than the pedicles in the non-navigated patients (P < 0.001).

Conclusion

Obtaining a higher cross-sectional percentage fill of the pedicle with a screw is expected to provide greater spinal fixation in instrumented fusion surgery. This study shows that utilizing spinal navigation helps to more completely fill the pedicles that are being instrumented. Copyright © 2015 John Wiley & Sons, Ltd.

Video-based 3D reconstruction, laparoscope localization and deformation recovery for abdominal minimally invasive surgery: a survey

‎Πέμπτη, ‎30 ‎Απριλίου ‎2015, ‏‎10:21:50 πμ | Bingxiong Lin, Yu Sun, Xiaoning Qian, Dmitry Goldgof, Richard Gitlin, Yuncheng You

Abstract

Background

The intra-operative three-dimensional (3D) structure of tissue organs and laparoscope motion are the basis for many tasks in computer-assisted surgery (CAS), such as safe surgical navigation and registration of pre-operative and intra-operative data for soft tissues.

Methods

This article provides a literature review on laparoscopic video-based intra-operative techniques of 3D surface reconstruction, laparoscope localization and tissue deformation recovery for abdominal minimally invasive surgery (MIS).

Results

This article introduces a classification scheme based on the motions of a laparoscope and the motions of tissues. In each category, comprehensive discussion is provided on the evolution of both classic and state-of-the-art methods.

Conclusions

Video-based approaches have many advantages, such as providing intra-operative information without introducing extra hardware to the current surgical platform. However, an extensive discussion on this important topic is still lacking. This survey paper is therefore beneficial for researchers in this field. Copyright © 2015 John Wiley & Sons, Ltd.

System design and animal experiment study of a novel minimally invasive surgical robot

‎Παρασκευή, ‎24 ‎Απριλίου ‎2015, ‏‎7:52:51 πμ | Wei Wang, Jianmin Li, Shuxin Wang, He Su, Xueming Jiang

Abstract

Background

Robot-assisted minimally invasive surgery has shown tremendous advances over the traditional technique. However, currently commercialized systems are large and complicated, which vastly raises the system cost and operation room requirements.

Methods

A MIS robot named ‘MicroHand’ was developed over the past few years. The basic principle and the key technologies are analyzed in this paper. Comparison between the proposed robot and the da Vinci system is also presented. Finally, animal experiments were carried out to test the performance of MicroHand.

Results

Fifteen animal experiments were carried out from July 2013 to December 2013. All animal experiments were finished successfully.

Conclusions

The proposed design method is an effective way to resolve the drawbacks of previous generations of the da Vinci surgical system. The animal experiment results confirmed the feasibility of the design. Copyright © 2015 John Wiley & Sons, Ltd.

Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy?

‎Παρασκευή, ‎24 ‎Απριλίου ‎2015, ‏‎7:48:52 πμ | Tsung-Yuan Tsai, Dimitris Dimitriou, Jing-Sheng Li, Young-Min Kwon

Abstract

Background

The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique.

Methods

Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared.

Results

Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group.

Conclusion

This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd.

Single-incision robotic colectomy: are costs prohibitive?

‎Τετάρτη, ‎22 ‎Απριλίου ‎2015, ‏‎10:02:37 πμ | John C. Byrn, Jennifer E. Hrabe, John G. Armstrong, Christopher A. Anthony, Mary E. Charlton

Abstract

Background

The feasibility, safety, and costs of single-incision robotic colectomy (SIRC) are not known.

Methods

A retrospective review was conducted, comparing the initial 29 consecutive SIRC procedures performed to 36 multiport laparoscopic colectomies (MLC).

Results

The groups did not differ significantly on age, body mass index, gender, ASA classification, smoking status, steroid usage or rate of diabetes. Procedure time, conversion rate, infectious complications and length of stay did not differ significantly. The ratio of observed:expected direct hospital costs statistically favoured MLC, although there was no statistical difference between groups for contribution margin, or for observed and expected direct hospital costs.

Conclusions

These results demonstrate safety and technical feasibility for SIRC in selected patients with short-term outcomes and hospital costs comparable to MLC. Contribution margin remained positive and expected costs exceeded observed for SIRC. Increased costs for SIRC are a concern. The comparable but relatively high mortality in both groups may represent an institutional approach to colectomy where significant comorbidity is not a contraindication to minimally invasive surgery. Copyright © 2015 John Wiley & Sons, Ltd.

Roux-en-Y gastric bypass for super obese patients: what approach?

‎Δευτέρα, ‎20 ‎Απριλίου ‎2015, ‏‎5:48:04 πμ | Nicolas C. Buchs, Dan E. Azagury, François Pugin, Minoa K. Jung, Olivier Huber, Gilles Chassot, Philippe Morel

Abstract

Background

Super obese (SO) patients with a Body Mass Index (BMI) ≥ 50 kg/m² still represent a real anesthesiological and surgical challenge. While the best procedure to perform in this population remains unclear, robotic technology has been proposed to accomplish Roux-en-Y gastric bypass (RYGB). The study aim is to report our experience of robotic RYGB for SO patients and to compare it with open and laparoscopic surgery.

Methods

From July 1997 to March 2014, all consecutive RYGB cases for SO patients were collected in a dedicated database and reviewed retrospectively. Two hundred and fourteen SO patients were operated on: 65 by a robotic approach (30.4%), 54 by a laparoscopic approach (25.2%), and 95 using an open approach (44.4%). Peri- and post-operative data were compared between the three approaches.

Results

There were more male patients in the robotic group, but with a slightly lower BMI. The operative time was longer for the robotic (+27 min) and laparoscopic (+21 min) groups in comparison with the open group (P < 0.05). Overall, there were less reoperations (P < 0.05) and a shorter hospital stay (P < 0.05) in the robotic group in comparison with other groups. Of note there was also a trend in favor of robotics with less conversions (P = 0.08) and less postoperative complications (P ≥ 0.05).

Conclusions

Robotic RYGB can be performed safely in super obese patients with results that compare favorably with laparoscopic and open surgery. However, the robotic approach has a longer operative time. The exact role of robotics for super obese population needs to be clarified in larger and randomized trials before drawing definitive conclusions. Copyright © 2015 John Wiley & Sons, Ltd.

Using preoperative imaging for intraoperative guidance: a case of mistaken identity

‎Δευτέρα, ‎20 ‎Απριλίου ‎2015, ‏‎5:45:32 πμ | Archie Hughes-Hallett, Philip Pratt, Erik Mayer, Martin Clark, Justin Vale, Ara Darzi

Abstract

Background

Surgical image guidance systems to date have tended to rely on reconstructions of preoperative datasets. This paper assesses the accuracy of these reconstructions to establish whether they are appropriate for use in image guidance platforms.

Methods

Nine raters (two experts in image interpretation and preparation, three in image interpretation, and four in neither interpretation nor preparation) were asked to perform a segmentation of ten renal tumours (four cystic and six solid tumours). These segmentations were compared with a gold standard consensus segmentation generated using a previously validated algorithm.

Results

Average sensitivity and positive predictive value (PPV) were 0.902 and 0.891, respectively. When assessing for variability between raters, significant differences were seen in the PPV, sensitivity and incursions and excursions from consensus tumour boundary.

Conclusions

This paper has demonstrated that the interpretation required for the segmentation of preoperative imaging of renal tumours introduces significant inconsistency and inaccuracy. Copyright © 2015 John Wiley & Sons, Ltd.

Online estimation of laser incision depth for transoral microsurgery: approach and preliminary evaluation

‎Πέμπτη, ‎16 ‎Απριλίου ‎2015, ‏‎1:01:18 μμ | Loris Fichera, Diego Pardo, Placido Illiano, Jesùs Ortiz, Darwin G. Caldwell, Leonardo S. Mattos

Abstract

Background

The use of lasers in transoral surgery enables precise tissue incision with minimal adverse effects on surrounding structures. Nonetheless, the lack of haptic feedback during laser cutting impairs the surgeon's perception of the incision depth, potentially leading to undesired tissue damage.

Methods

This paper presents a novel approach, based on statistical regression analysis, to estimate the laser incision depth in soft tissue. User trials were conducted in a laser surgery set-up, to verify the effectiveness of online estimation of incision depth in supporting precise tissue cutting.

Results

The estimation accuracy was verified on ex vivo muscle tissue, revealing a root mean squared error (RMSE) of 0.1 mm for depths ranging up to 1.4 mm. Online estimation of depth has the potential to significantly improve the incision control of users.

Conclusions

The proposed approach was successful in producing estimations of laser cutting depth in ex vivo muscle tissue. Further investigation is required to validate this approach on other types of tissue. Providing depth estimation during laser cutting allows users to perform more precise incisions. Copyright © 2015 John Wiley & Sons, Ltd.

Robotic vs laparoscopic radical hysterectomy for cervical cancer: a meta-analysis

‎Δευτέρα, ‎30 ‎Μαρτίου ‎2015, ‏‎11:44:40 πμ | Jing Zhou, Bing Hong Xiong, Li Ma, Yong Cheng, Wei Huang, Lin Zhao

Abstract

Background

To evaluate whether the safety and efficacy of robotic radical hysterectomy (RRH) in patients with cervical cancer (CC) are equivalent to those of laparoscopic radical hysterectomy (LRH).

Methods

The Pubmed, Embase, Cochrane Library, Ovid and Web of Science databases were searched. Studies documenting a comparison of RRH with LRH for CC were selected. Operative and recovery outcomes, common morbidity, and oncological parameters were evaluated.

Results

Compared with LRH, RRH was associated with less blood loss and shorter hospital stay. There were no significant differences in operative time, complications, mortality, transfusion, conversions, number of retrieved lymph nodes, recurrence or disease-free survival between the two groups.

Conclusion

RRH for CC is safe and feasible and may be an alternative treatment for CC. More multicentre randomized controlled trials investigating the long-term oncological outcomes are required to determine the advantages of RRH over LRH in CC. Copyright © 2015 John Wiley & Sons, Ltd.

Introducing robotic surgery into an endometrial cancer service–a prospective evaluation of clinical and economic outcomes in a UK institution

‎Δευτέρα, ‎30 ‎Μαρτίου ‎2015, ‏‎10:59:36 πμ | Thomas E. J. Ind, Chris Marshall, Matthew Hacking, Michelle Harris, Liz Bishop, Desmond Barton, Jane E. Bridges, John H. Shepherd, Marielle Nobbenhuis

Abstract

Background

We have assessed how the introduction of robotics in a publicly funded endometrial cancer service affects clinical and economic outcomes.

Methods

The study included 196 women. Costs were divided into those for wards, high dependency, staffing, theatres, pharmacy, blood products, imaging, pathology and rehabilitation. Capital depreciation was included.

Results

Prior to the introduction of robotics, 78/130 (60.0%) cases were performed open, compared to 17/66 (25.8%) afterwards ( p < 0.0001). The median operative time increased 37 min (95% CI 17–55 min; p = 0.0002); the median blood loss was 55 ml lower (95% CI 0–150 ml; p = 0.0181); the stay was 2 days shorter (95% CI 1–3; p < 0.0001). Complications reduced from 64/130 (49.2%) to 19/66 (28.8%) ( p = 0.0045). Costs reduced from £11 476 to £10 274 ( p = 0.0065). Conversions for 'straight stick' surgery were 18.2% (14/77) compared to 0.0% (0/24) for robotics ( p = 0.0164).

Conclusions

Introducing robotics resulted in fewer laparotomies, shorter stays, fewer complications and lower costs. © 2015 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery Published by John Wiley & Sons Ltd.

Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer

‎Τετάρτη, ‎25 ‎Μαρτίου ‎2015, ‏‎12:08:28 μμ | Ching-Hui Chen, Li-Hsuan Chiu, Huang-Hui Chen, Cindy Chan, Wei-Min Liu

Abstract

Background

The purpose of this study was to evaluate the feasibility of robotic surgery and compare its surgical outcomes with those of laparoscopic surgery and laparotomy, with regard to performing staging surgery to manage ovarian cancer.

Methods

One hundred and thirty-eight women who received surgical staging procedures for treatment of stage IA–IIIC epithelial ovarian cancer and borderline tumours were retrospectively included in the study. All enrolled cases were reviewed for patient demographics, peri-operative parameters, complications and survival.

Results

The operation time and blood loss was significantly reduced in the robotic and laparoscopic groups. Moreover, robotic surgery was associated with decreased postoperative pain score. The length of hospital stay and time to full diet resumption were also shortened for those who underwent robotic and laparoscopic procedures. Survival analysis and complication rates were similar between the two groups.

Conclusion

MRI guided focused ultrasound robotic system for the treatment of gynaecological tumors

‎Τετάρτη, ‎25 ‎Μαρτίου ‎2015, ‏‎11:58:48 πμ | Eva Epaminonda, Theoharis Drakos, Christina Kalogirou, Margarita Theodoulou, Christos Yiallouras, Christakis Damianou

Abstract

Background

A novel MRI-conditional robot that navigates focused ultrasound (FUS) for the treatment of gynaecological tumors endovaginally was developed.

Methods

The robotic system has two PC-controlled axes (linear and angular). The robotic system was manufactured using a digital manufacturing 3D printer using acrylonitrile butadiene styrene (ABS) plastic. Evaluation of the device was performed in a 1.5T MRI using excised porcine tissue.

Results

The robotic system was successfully tested for MRI safety and compatibility. The robotic system has been tested for its functionality for creating multiple (overlapping) lesions in an in vitro model.

Conclusions

An MRI-conditional FUS robotic system was developed that has the potential to create thermal lesions with the intention of treating gynaecological tumors. In the future a third axis will be needed that lifts the robot up or down in order to access vaginas which are at a variable height from the MRI table. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical application of a vascular interventional robot in cerebral angiography

‎Τρίτη, ‎17 ‎Μαρτίου ‎2015, ‏‎11:46:01 πμ | Wang-sheng Lu, Wu-yi Xu, Feng Pan, Da Liu, Zeng-min Tian, Yanjun Zeng

Abstract

Background

Cardiovascular and cerebrovascular diseases have become the leading cause of death for people, and endovascular surgery has become the main therapeutic method. Robot technology would overcome some limitations of conventional surgery, and has good prospects.

Methods

A total of 15 patients received cerebral angiography assisted by a vascular interventional robot following preoperative examination, with approval from the hospital ethics committee and informed consent by the patients' families.

Results

Robot-assisted angiography was performed quickly and smoothly without surgical complications. The remote positioning accuracy was 1.05 ± 0.28 mm. The time staff were exposed to the digital subtraction angiography (DSA) machine was 0 min. The entire experimental process was mechanized and automated.

Conclusion

This system achieved the preliminary purposes, including a reduction in radiation for the surgeons, facilitation of the application of interventional procedures, a decrease in operation time, and an improvement in operation quality. Copyright © 2015 John Wiley & Sons, Ltd.

The impact of robotics on the mode of benign hysterectomy and clinical outcomes

‎Τετάρτη, ‎4 ‎Μαρτίου ‎2015, ‏‎10:56:23 πμ | Anthony A. Luciano, Danielle E. Luciano, Jessica Gabbert, Usha Seshadri-Kreaden

Abstract

Background

The impact of robotics on benign hysterectomy surgical approach, clinical outcomes, and learning curve is still unclear.

Methods

Review of abdominal, vaginal, laparoscopic, or robotic cases in 156 US hospitals in the Premier Research Database.

Results

Of 289 875 hysterectomies, abdominal cases decreased from 2005–2010 (60–33%) and minimally invasive approaches increased (40–67%). Conversion rates were: 0.04% for vaginal, 2.5% for robotic, and 7.2% for laparoscopy (P < 0.001). Robotic surgery time was longest (3.4 h vs. 2.2 vaginal, 2.5 abdominal, 2.7 laparoscopy, P < 0.001). Robotic complication rate was lowest (14.8% vs. 16.2% vaginal, 18.6% laparoscopy, 28.9% abdominal, P < 0.001). Hospital stay was longer following abdominal surgery (3.5 days vs. 1.8 robotic, 1.9 vaginal, 1.8 laparoscopy, P < 0.001). Robotic surgery times and conversion and complication rates improved with experience (2.8 h, 2%, and 13.9%, respectively), even with increasing complexity.

Conclusions

Unilateral robotic hybrid mini-maze: a novel experimental approach

‎Δευτέρα, ‎2 ‎Μαρτίου ‎2015, ‏‎6:12:31 πμ | Mohammad Moslemi, Badi Rawashdeh, Mark Meyer, Duy Nguyen, Robert Poston, Farid Gharagozloo

Abstract

Background

A complete Cox maze IV procedure is difficult to accomplish using current endoscopic and minimally invasive techniques. These techniques are hampered by inability to adequately dissect the posterior structures of the heart and place all necessary lesions. We present a novel approach, using robotic technology, that achieves placement of all the lesions of the complete maze procedure.

Methods

In three cadaveric human models, the technical feasibility of using robotic instruments through the right chest to dissect the posterior structures of the heart and place all Cox maze lesions was performed.

Results

The entire posterior aspect of the heart was dissected in the cadaveric model facilitating successful placement of all Cox maze IV lesions with robotic assistance through minimally invasive incisions.

Conclusion

The robotic Cox maze IV procedure through the novel right thoracic approach is feasible. This obviates the need for sternotomy and avoids the associated morbidity of the conventional Cox-maze procedure. Copyright © 2015 John Wiley & Sons, Ltd.

A virtual reality-based method of decreasing transmission time of visual feedback for a tele-operative robotic catheter operating system

‎Πέμπτη, ‎19 ‎Φεβρουαρίου ‎2015, ‏‎4:17:11 πμ | Jin Guo, Shuxiang Guo, Takashi Tamiya, Hideyuki Hirata, Hidenori Ishihara

Abstract

Background

An Internet-based tele-operative robotic catheter operating system was designed for vascular interventional surgery, to afford unskilled surgeons the opportunity to learn basic catheter/guidewire skills, while allowing experienced physicians to perform surgeries cooperatively. Remote surgical procedures, limited by variable transmission times for visual feedback, have been associated with deterioration in operability and vascular wall damage during surgery.

Methods

At the patient's location, the catheter shape/position was detected in real time and converted into three-dimensional coordinates in a world coordinate system. At the operation location, the catheter shape was reconstructed in a virtual-reality environment, based on the coordinates received. The data volume reduction significantly reduced visual feedback transmission times.

Results

Remote transmission experiments, conducted over inter-country distances, demonstrated the improved performance of the proposed prototype. The maximum error for the catheter shape reconstruction was 0.93 mm and the transmission time was reduced considerably.

Conclusions

Robotic approach using simple and radical hysterectomy for endometrial cancer with long-term follow-up evaluation

‎Πέμπτη, ‎12 ‎Φεβρουαρίου ‎2015, ‏‎1:01:14 πμ | Gianluca Raffaello Damiani, Daniela Turoli, Gennaro Cormio, Paolo Croce, Viviana Merola, Maria Gaetani, Dario Recalcati, Antonio Pellegrino

Abstract

Background

Feasibility and outcome of robotic-assisted laparoscopy (RAL) for endometrial cancer was evaluated with a mean follow-up of 4 years.

Methods

Robotic hysterectomy (RH) and type B robotic radical hysterectomy (RRH), with or without pelvic lymphadenectomy (PLH), was performed on 51 consecutive patients. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 25% of cases were IA, while 20%, 53% and 2% of cases were, respectively, IB, II and IIIA stage.

Results

Twenty-eight patients underwent RRH + PLH (54.9%), four patients underwent RH with concurrent nodal sampling (NS) (7.8%); a total of 32 PLH were performed (62.6%).The median operative time for RRH + PLH was 255 min (range: 160–435). Pathology confirmed the adequacy of the surgical specimen.

Conclusion

Our data support the adoption of RAL staging in patients with endometrial cancer, including those with cervical involvement, and demonstrate good long-term outcomes. Copyright © 2015 John Wiley & Sons, Ltd.

Accuracy of a flapless protocol for computer-guided zygomatic implant placement in human cadavers: expectations and reality

‎Τρίτη, ‎27 ‎Ιανουαρίου ‎2015, ‏‎9:34:26 πμ | Guido Schiroli, Francesca Angiero, Antoniettel Zangerl, Stefano Benedicenti, Franco Ferrante, Gerlig Widmann

Abstract

Background

This work evaluated the accuracy and safety of a protocol for minimally-invasive flapless zygomatic implant placement that uses computer-guided stereolithographic mucosa-supported surgical templates.

Methods

A total of six zygomatic implants were placed in three formalin-fixed human cadaver heads, with edentulous and severely atrophic posterior maxillae. CT scans of each cadaver head were performed after zygomatic implant placement, to evaluate the lateral error (LE) at implant tip and base, and the angular error (AE) of the implant body.

Results

Excluding the implant placed outside the drilling channel, the LE at the implant base was less than 1 mm in all cases. The average LE at the tip was 3.86 mm, and the AE was less than 6° in all cases, with an average of 4.5°.

Conclusion

Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential. Copyright © 2015 John Wiley & Sons, Ltd.

Anteromedial and posterolateral graft kinematics of a double-bundle ACL reconstruction: a 3D computer simulation

‎Τρίτη, ‎27 ‎Ιανουαρίου ‎2015, ‏‎9:16:53 πμ | Xudong Liu, Jing-Sheng Li, Ali Hosseini, Thomas J. Gill, Guoan Li

Abstract

Background

The posterolateral graft has been reported to fail more frequently than the anteromedial graft in double-bundle ACL reconstructions. This study investigated the graft kinematics using a 3D modelling technique.

Methods

Twenty subjects performed a stair-ascending activity under dual fluoroscopy surveillance. A double-bundle ACL reconstruction was simulated on those healthy knees using an anteromedial portal technique. The graft–tunnel interaction was described using the graft–tunnel angle and the range of the graft–tunnel edge contact (GTEC).

Results

The femoral graft–tunnel angle of the anteromedial/posterolateral graft was 97.6 ± 7.5/100.7 ± 7.7° and the tibial graft–tunnel angle was 158.8 ± 6.5/146.5 ± 8.9° at knee extension. The femoral GTEC ranges were 23.2 ± 5.3–28.1 ± 7.6° for both grafts and the tibial GTEC ranges were 27.3 ± 2.2–34.5 ± 2.1° during stair-ascending.

Conclusion

The femoral graft–tunnel angle was larger than on the tibial side and the GTEC angles influenced the PL graft more, implying that grafts may experience a less optimal biomechanical environment at the femoral tunnels. Copyright © 2015 John Wiley & Sons, Ltd.

Intelligent vision guide for automatic ventilation grommet insertion into the tympanic membrane

‎Τρίτη, ‎27 ‎Ιανουαρίου ‎2015, ‏‎9:04:28 πμ | Wenchao Gao, Kok Kiong Tan, Wenyu Liang, Chee Wee Gan, Hsueh Yee Lim

Abstract

Background

Otitis media with effusion is a worldwide ear disease. The current treatment is to surgically insert a ventilation grommet into the tympanic membrane. A robotic device allowing automatic grommet insertion has been designed in a previous study; however, the part of the membrane where the malleus bone is attached to the inner surface is to be avoided during the insertion process.

Methods

This paper proposes a synergy of optical flow technique and a gradient vector flow active contours algorithm to achieve an online tracking of the malleus under endoscopic vision, to guide the working channel to move efficiently during the surgery.

Results

The proposed method shows a more stable and accurate tracking performance than the current tracking methods in preclinical tests.

Conclusion

Development and preliminary assessment of a robotic platform for neuroendoscopy based on a lightweight robot

‎Τρίτη, ‎20 ‎Ιανουαρίου ‎2015, ‏‎5:13:08 πμ | Marta Niccolini, Virginia Castelli, Costanza Diversi, Byungjeon Kang, Federico Mussa, Edoardo Sinibaldi

Abstract

Background

Ventriculostomy is a widely performed neurosurgical procedure; some risk factors can be mitigated by computer/robot-assisted approaches. Platforms fostering synergistic robot–surgeon integration are pursued, for which lightweight robots with compliant controlled joints must be assessed (because compliance hampers accuracy).

Methods

We developed a platform encompassing, in particular, a lightweight robot and an optical tracker also used to enhance robot accuracy. Based on specifications by neurosurgeons, we designed a neuroendoscope-handling interface and assessed targeting accuracy in a model ventriculostomy where the robot was operated both autonomously and in hands-on (i.e. co-operative) mode.

Results

Targeting errors were systematically below the procedure accuracy threshold (1 mm); the rms targeting errors were 0.51 and 0.54 mm for autonomous and hands-on control, respectively. No significant difference was observed between the considered control modes. Very positive feedback was gathered from neurosurgeons.

Πληροφορίες

Τρίτη 19 Ιουλίου 2016

The International Journal of Medical Robotics and Computer Assisted Surgery

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