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Moustris G, Tzafestas C, Konstantinidis K. A long distance telesurgical demonstration on robotic surgery phantoms over 5G. Int J Comput Assist Radiol Surg 2023; 18:1577-1587. [PMID: 37095315 PMCID: PMC10124680 DOI: 10.1007/s11548-023-02913-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Using robotic technology and communications infrastructure to remotely perform surgery has been a persistent goal in medical research in the past three decades. The recent deployment of the Fifth-Generation Wireless Networks has revitalized the research efforts in the telesurgery paradigm. Offering low latency and high bandwidth communication, they are well suited for applications that require real-time data transmission and can allow smoother communication between surgeon and patient, making it possible to remotely perform complex surgeries. In this paper, we investigate the effects of the 5 G network on surgical performance during a telesurgical demonstration where the surgeon and the robot are separated by nearly 300 km. METHODS The surgeon performed surgical exercises on a robotic surgery training phantom using a novel telesurgical platform. The master controllers were connected to the local site on a 5 G network, teleoperating the robot remotely in a hospital. A video feed of the remote site was also streamed. The surgeon performed various tasks on the phantom such as cutting, dissection, pick-and-place and ring tower transfer. To assess the usefulness, usability and image quality of the system, the surgeon was subsequently interviewed using three structured questionnaires. RESULTS All tasks were completed successfully. The low latency and high bandwidth of the network resulted into a latency of 18 ms for the motion commands while the video delay was about 350 ms. This enabled the surgeon to operate smoothly with a high-definition video from about 300 km away. The surgeon viewed the system's usability in a neutral to positive way while the video image was rated as of good quality. CONCLUSION 5 G networks provide significant advancement in the field of telecommunications, offering faster speeds and lower latency than previous generations of wireless technology. They can serve as an enabling technology for telesurgery and further advance its application and adoption.
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Affiliation(s)
- George Moustris
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
| | - Costas Tzafestas
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
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2
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Oh H, Sasaki H, Michael B, Matsubara T. Bayesian Disturbance Injection: Robust imitation learning of flexible policies for robot manipulation. Neural Netw 2023; 158:42-58. [PMID: 36442373 DOI: 10.1016/j.neunet.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/30/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
Humans demonstrate a variety of interesting behavioral characteristics when performing tasks, such as selecting between seemingly equivalent optimal actions, performing recovery actions when deviating from the optimal trajectory, or moderating actions in response to sensed risks. However, imitation learning, which attempts to teach robots to perform these same tasks from observations of human demonstrations, often fails to capture such behavior. Specifically, commonly used learning algorithms embody inherent contradictions between the learning assumptions (e.g., single optimal action) and actual human behavior (e.g., multiple optimal actions), thereby limiting robot generalizability, applicability, and demonstration feasibility. To address this, this paper proposes designing imitation learning algorithms with a focus on utilizing human behavioral characteristics, thereby embodying principles for capturing and exploiting actual demonstrator behavioral characteristics. This paper presents the first imitation learning framework, Bayesian Disturbance Injection (BDI), that typifies human behavioral characteristics by incorporating model flexibility, robustification, and risk sensitivity. Bayesian inference is used to learn flexible non-parametric multi-action policies, while simultaneously robustifying policies by injecting risk-sensitive disturbances to induce human recovery action and ensuring demonstration feasibility. Our method is evaluated through risk-sensitive simulations and real-robot experiments (e.g., table-sweep task, shaft-reach task and shaft-insertion task) using the UR5e 6-DOF robotic arm, to demonstrate the improved characterization of behavior. Results show significant improvement in task performance, through improved flexibility, robustness as well as demonstration feasibility.
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Affiliation(s)
- Hanbit Oh
- Division of Information Science, Graduate School of Science and Technology, NAIST, 8916-5, Takayama-cho, Ikoma-city, 630-0192, Nara, Japan.
| | - Hikaru Sasaki
- Division of Information Science, Graduate School of Science and Technology, NAIST, 8916-5, Takayama-cho, Ikoma-city, 630-0192, Nara, Japan
| | - Brendan Michael
- Division of Information Science, Graduate School of Science and Technology, NAIST, 8916-5, Takayama-cho, Ikoma-city, 630-0192, Nara, Japan
| | - Takamitsu Matsubara
- Division of Information Science, Graduate School of Science and Technology, NAIST, 8916-5, Takayama-cho, Ikoma-city, 630-0192, Nara, Japan
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Wang L, Yu Y, Wang J, Li S, Jiang T. Evaluation of the learning curve for robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy. Front Surg 2022; 9:969418. [PMID: 35937606 PMCID: PMC9354576 DOI: 10.3389/fsurg.2022.969418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The robotic surgical system is being used in various bariatric procedures. However, only a few studies with very small sample size are present on robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy (SADI-S). Moreover, to date, the learning curve of robotic SADI-S has been poorly evaluated yet. Objective This retrospective study aimed to estimate the learning curve of robotic SADI-S. Methods 102 consecutive patients who underwent robotic SADI-S between March 2020 and December 2021 were included. Textbook outcome standard was performed to comprehensively evaluate clinical outcome of robotic SADI-S. Based on the textbook outcome, we evaluated the learning curve of robotic SADI-S by the cumulative sum (CUSUM) method. Results The mean operative time was 186.13 ± 36.91 min. No conversion to laparotomy or deaths occurred during the study period. The rate of complications was 6.9% (n = 7), of which major complications were identified in 2.9% (n = 3), including 2 gastric leakages and 1 respiratory failure. A total of 60 patients reached the textbook outcome standard. The rate of textbook outcome was positive and was steadily increasing after the number of surgical cases accumulated to the 58th case. Taking the 58th case as the boundary, all the patients were divided into the learning stage group (the first 58 patients) and mastery stage group (the last 44 patients). The rate of complications, proportion of abdominal drainage tubes and postoperative hospital stay were significantly higher in the learning stage group compared with the mastery stage group (P < 0.05). No significant difference was observed between the two groups in terms of patient demographic data, operative times, reoperations and readmission. Conclusion Robotic SADI-S is a feasible and reproducible surgical technique with a learning curve of 58 cases.
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Anaglyph stereo virtual dissection: a novel inexpensive method for stereoscopic visualisation of intracardiac anatomy on CT angiogram. Cardiol Young 2021; 31:1958-1961. [PMID: 33851903 DOI: 10.1017/s1047951121001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Three-dimensional visualisation is invaluable for evaluating cardiac anatomy. Patient-specific three-dimensional printed models of the heart are useful but require significant infrastructure. The three-dimensional virtual models, derived from 3D echocardiography, computed tomographic (CT) angiography or cardiac magnetic resonance (CMR), permit excellent visualisation of intracardiac anatomy, but viewing on a two-dimensional screen obscures the third dimension. Various forms of extended reality, such as virtual reality and augmented reality, augment the third dimension but only using expensive equipment. Herein, we report a simple technique of anaglyph stereoscopic visualisation of three-dimensional virtual cardiac models. The feasibility of achieving stereovision on a personal computer, using open-source software, and the need for inexpensive anaglyph glasses for viewing make it extremely cost-effective. Further, the retained depth perception of resulting stereo images in electronic and printed format makes sharing with other members of the team easy and effective.
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Haapiainen H, Murtola TJ, Raitanen M. 3D laparoscopic prostatectomy: A prospective single-surgeon learning curve in the first 200 cases with oncologic and functional results. Scand J Urol 2021; 55:242-248. [PMID: 33792488 DOI: 10.1080/21681805.2021.1898465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies for 3D-laparoscopic prostatectomy (3D-LRP) learning curve and surgical results are lacking. Combining 3D vision to LRP attenuates differences compared to Robotic assisted laparoscopic prostatectomy (RALP) with similar mini-invasiveness but lower costs. MATERIALS AND METHODS Two hundred consecutive men with localized prostate cancer underwent 3D-LRP at Seinäjoki central hospital between 2013 and 2018. Oncological and functional results were documented. Long-term functional evaluation was done using EPIC-26 survey. Clavien-Dindo classification was used to assess complications during first 3 months. All operations were performed by a single surgeon (M.R.) with no experience of LRP or 3D-LRP. The learning curve was assessed by evaluating urethral anastomosis- and total operative time. Perioperative and postoperative data was collected prospectively during surgery and at subsequent control visits up to minimum of 1 year. RESULTS A plateau in anastomosis time was reached after 30 cases and in operative time after 60 cases. Median operative time was 114 min (78-258 min) and median time for anastomosis was 25 min (11-90 min). Median blood loss was 150 ml (10-800 ml); 93.5% of the patients were discharged within the first 3 days. Clavien-Dindo ≥3a complications occurred in 6.5%. Positive surgical margins occurred in 23%. One-year after the operation, 93.3% had PSA ≤ 0.1; 91.9% of the patients were dry or used one daytime pad. EPIC-26 scores were as follows: Urinary incontinence 79.25 (14.5-100), urinary irritative/obstructive 93.75 (31.25-100), bowel 100 (33.33-100), sexual 36.17 (0-100) and hormonal 95 (37.5-100). CONCLUSION The learning curve for 3D laparoscopic prostatectomy is comparable to RALP, which makes it a cost-effective alternative with comparable oncological and functional results.
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Affiliation(s)
- Henry Haapiainen
- Seinäjoki Central hospital, the hospital district of South Ostrobothnia, Finland
| | - Teemu J Murtola
- Seinäjoki Central hospital, the hospital district of South Ostrobothnia, Finland.,Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere, Finland
| | - Mika Raitanen
- Seinäjoki Central hospital, the hospital district of South Ostrobothnia, Finland
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Yun JJ, Kim EY, Ahn EJ, Kim JK, Choi JH, Park JM, Park SH. A retrospective single-center study comparing clinical outcomes of 3-dimensional and 2-dimensional laparoscopic cholecystectomy in acute cholecystitis. Ann Hepatobiliary Pancreat Surg 2019; 23:339-343. [PMID: 31824999 PMCID: PMC6893058 DOI: 10.14701/ahbps.2019.23.4.339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/05/2023] Open
Abstract
Backgrounds/Aims Laparoscopic cholecystectomy (LC) has become widely used and preferred standard treatment for gallbladder (GB) disease in many countries. In this study, we aimed to compare the overall clinical outcomes of 3-dimensional (3D) LC system with those of the 2D LC method. Methods We retrospectively analyzed patients who underwent LC for acute cholecystitis between January 2010 and March 2019 at the National Medical Center in Korea. We entered them into 3D LC (group A) and 2D LC (group B) groups. We used Olympus CLV-190 laparoscopic device with dual lenses, capable of displaying both 3D and 2D images. Postoperative variables considered for evaluating between-group differences in clinical outcomes included diet resumption period after surgery, postoperative hospital length-of-stay, outpatient department follow-up period, surgical time, and postoperative surgery-related complications (blood loss and open conversion). Results We analyzed 278 acute cholecystitis patients (Group A, n=116; Group B, n=162). Compared to group B, group A had a significantly reduced surgical time and postoperative hospital stay. Although underlying diseases and abdominal surgical history were more prevalent in the 3D LC group, no significant between-group differences in blood loss and open conversion rate were observed. Conclusions The 3D imaging system offered many advantages over 2D LC, including reduced surgical time and shorter postoperative hospital stay; therefore, it has significance in reducing hospital costs.
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Affiliation(s)
- Jong-Jin Yun
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eun-Young Kim
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eun-Jung Ahn
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jeong-Ki Kim
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Ji-Hye Choi
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jong-Min Park
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Sei Hyeog Park
- Department of Surgery, National Medical Center, Seoul, Korea
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Busch C, Nakadate R, Uemura M, Obata S, Jimbo T, Hashizume M. Objective assessment of robotic suturing skills with a new computerized system: A step forward in the training of robotic surgeons. Asian J Endosc Surg 2019; 12:388-395. [PMID: 30461209 DOI: 10.1111/ases.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/05/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this study was to assess robot-assisted suturing skills on a laparoscopic intestinal anastomosis model by using a novel computerized objective assessment system. METHODS This study compared the suturing skills of 13 surgically naïve participants on an artificial intestinal anastomosis model that mimics real tissue. Each examinee sutured using da Vinci robot assistance under 2-D and 3-D visualization and with conventional laparoscopy (CL). Pressure-measuring and image-processing devices were employed to quantitatively evaluate suturing skills. Five unique criteria were used to evaluate the skills of participants. RESULTS Suturing under 3-D visualization (P < 0.01) and with CL (P < 0.05) were significantly faster than under 2-D visualization. Sutures placed under 3-D (P < 0.05) and 2-D (P < 0.01) visualization had significantly better suture tension than those placed with CL, which did not meet acceptable values for suture tension. Sutures placed with CL had significantly better air pressure leakage than those placed under 2-D visualization (P < 0.05), which did not meet acceptable values for air pressure leakage and wound opening area. One participants failed to achieve full-thickness sutures with 2-D, two participants with CL, and one participant with 3-D. CONCLUSION Using 3-D vision is necessary for complex maneuvering during robot-assisted minimally invasive surgery. Our quantitative assessment system is useful for evaluating the skill acquisition of surgeon-trainees undergoing robotic surgery training.
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Affiliation(s)
- Caleb Busch
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan
| | - Munenori Uemura
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Obata
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Jimbo
- Department of Pediatric Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Makoto Hashizume
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.,Kitakyushu Chuou Hospital, Kitakyushu, Japan
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Wehr F, Held J. Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator. APPLIED ERGONOMICS 2019; 77:40-49. [PMID: 30832777 DOI: 10.1016/j.apergo.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/18/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.
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Affiliation(s)
- Franka Wehr
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
| | - Jürgen Held
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
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9
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Bertolo R, Checcucci E, Amparore D, Autorino R, Breda A, Ramirez-Backhaus M, Dasgupta P, Fiori C, Rassweiler J, Liatsikos E, Porpiglia F, on behalf of the ESUT Laparoscopic and Research Groups. Current Status of Three-Dimensional Laparoscopy in Urology: An ESUT Systematic Review and Cumulative Analysis. J Endourol 2018; 32:1021-1027. [DOI: 10.1089/end.2018.0374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Enrico Checcucci
- Urology Department, San Luigi Hospital, University of Turin, Turin, Italy
| | - Daniele Amparore
- Urology Department, San Luigi Hospital, University of Turin, Turin, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia
| | - Alberto Breda
- Uro-Oncology Division and of Kidney Transplant Unit, Fundacio Puigvert, Barcelona, Spain
| | | | - Prokar Dasgupta
- Division of Urology, King's College and Guy's Hospital, King's Health Partners, London, United Kingdom
| | - Cristian Fiori
- Urology Department, San Luigi Hospital, University of Turin, Turin, Italy
| | - Jens Rassweiler
- Department of Urology, Klinikum Heilbronn, Heilbronn, Germany
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George EI, Brand TC, LaPorta A, Marescaux J, Satava RM. Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS 2018; 22:e2018.00039. [PMID: 30524184 PMCID: PMC6261744 DOI: 10.4293/jsls.2018.00039] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The uses of robotics in surgery were hypothesized as far back as 1967, but it took nearly 30 years and the nation's largest agency, the Department of Defense, in conjunction with innovative startups and established research agencies to complete the first fully functional multipurpose surgical robot. Currently, the most prominently available multipurpose robotic surgery system with US Food and Drug Administration approval is Intuitive Surgical Inc.'s da Vinci Surgical System, which is found in operating rooms across the globe. Although now ubiquitous for minimally invasive surgery, early surgical robot prototypes were specialty focused. Originally, multipurpose robotic systems were intended for long-distance trauma surgery in battlefield settings. While there were impressive feats of telesurgery, the marketable focus has veered from this goal. Initially developed through SRI International and Defense Advanced Research Projects Agency, surgical robotics reached private industry through two major competitors, who later merged. METHODS A thorough search of PubMed, Clinical Key, EBSCO, Ovid, ProQuest, and industry manufacturers' websites yielded 62 relevant articles, of which 51 were evaluated in this review. CONCLUSION We analyzed the literature and referred to primary sources by conducting interviews with present and historical leaders in the field to yield a detailed chronology of surgical robotics development. As minimally invasive robotic procedures are becoming the standard of care, it is crucial to comprehensively document their historical context and importance as an emerging and evolving discipline.
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Affiliation(s)
- Evalyn I George
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | - Timothy C Brand
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | | | - Jacques Marescaux
- Research Institute against Digestive Cancer, Image Guided Surgery, Strasbourg, France
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O'Leary MP, Ayabe RI, Dauphine CE, Hari DM, Ozao-Choy JJ. Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?. Am Surg 2018. [DOI: 10.1177/000313481808400223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Single-site robotic cholecystectomy (SSRC) accounts for most of the robotic surgery cases performed by general surgeons at our institution since acquiring the da Vinci Si Surgical SystemTM (Intuitive Surgical, Inc., Sunnyvale, CA) in 2014. We sought to determine whether a SSRC program is safe to start in a public teaching hospital and to determine whether resident participation in this procedure is feasible. Data on age, gender, race, BMI, total operative time, length of stay, comorbidities, and conversion from laparoscopic to open surgery were examined for elective SSRC and laparoscopic cholecystectomies (LCs) performed by two faculty surgeons between February 2015 and August 2015. Thirty-eight patients underwent elective SSRC, whereas 27 patients underwent LC. Residents participated as operating surgeons for some portion of the case in 15 SSRC cases and in all LC cases. There were no significant differences in operative time, length of stay, or 30-day readmission rates, regardless of resident involvement. Patients in the SSRC group had a significantly lower BMI (25.8 vs 33.7, P = 0.008). This study suggests that resident participation does not increase complications or total operative time and that SSRC is a safe procedure to start in a public teaching hospital after proper faculty and resident training.
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Affiliation(s)
- Michael P. O'Leary
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Reed I. Ayabe
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Christine E. Dauphine
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Danielle M. Hari
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Junko J. Ozao-Choy
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
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Schwab K, Smith R, Brown V, Whyte M, Jourdan I. Evolution of stereoscopic imaging in surgery and recent advances. World J Gastrointest Endosc 2017; 9:368-377. [PMID: 28874957 PMCID: PMC5565502 DOI: 10.4253/wjge.v9.i8.368] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
In the late 1980s the first laparoscopic cholecystectomies were performed prompting a sudden rise in technological innovations as the benefits and feasibility of minimal access surgery became recognised. Monocular laparoscopes provided only two-dimensional (2D) viewing with reduced depth perception and contributed to an extended learning curve. Attention turned to producing a usable three-dimensional (3D) endoscopic view for surgeons; utilising different technologies for image capture and image projection. These evolving visual systems have been assessed in various research environments with conflicting outcomes of success and usability, and no overall consensus to their benefit. This review article aims to provide an explanation of the different types of technologies, summarise the published literature evaluating 3D vs 2D laparoscopy, to explain the conflicting outcomes, and discuss the current consensus view.
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Abstract
Technological advancement in the operating room is evolving into a dynamic system mirroring that of the aeronautics industry. Through data visualization, information is continuously being captured, collected, and stored on a scalable informatics platform for rapid, intuitive, iterative learning. The authors believe this philosophy (paradigm) will feed into an intelligent informatics domain fully accessible to all and geared toward precision, cell-based therapy in which tissue can be targeted and interrogated in situ. In the future, the operating room will be a venue that facilitates this real-time tissue interrogation, which will guide in situ therapeutics to restore the state of health.
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14
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Owlia M, Khabbazan M, Mirbagheri MM, Mirbagheri A. Real-time tracking of laparoscopic instruments using kinect for training in virtual reality. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3945-3948. [PMID: 28269148 DOI: 10.1109/embc.2016.7591590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Training of laparoscopic surgery in Virtual Reality (VR) environment has been proved as an effective step before clinical practice. Tracking the position of instruments in realtime is an essential part of developing a VR trainer. In this study, we used Microsoft Kinect and color markers instead of using similar traditional means such as mechanical sensors. The orientation and position of instruments were determined and compared with the results obtained using the SinaSim commercial laparoscopic surgery trainer, which measures these values using encoders. The final results indicated that even though the newly developed systems possess an inferior accuracy compared to the mechanical sensors, low cost and portability makes it capable of replacing traditional methods of tracking.
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15
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Robotic-assisted laparoscopy in reproductive surgery: a contemporary review. J Robot Surg 2017; 11:97-109. [PMID: 28194637 DOI: 10.1007/s11701-017-0682-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Robotic surgery is a conceptual fusion of the conventional open surgery and the minimally invasive laparoscopic surgery. We reviewed the current role of robotic-assisted laparoscopy in the field of reproductive surgery by a literature search in PubMed database. We analyzed the reported advantages and limitations of the use of robotics in reproductive surgeries like myomectomy, tubal reanastomosis, endometriosis, ovarian tissue cryopreservation, and ovarian transposition. Overall, robotic assistance in reproductive surgery resulted in decreased blood loss, less post-operative pain, shorter hospital stay, and faster convalescence, whereas reproductive outcomes were similar to open/laparoscopic approaches. The main drawbacks of robotic surgery were higher cost and longer operating times. It is as safe and effective as the conventional laparoscopy and represents a reasonable alternate to abdominal approach. Procedures that are technically challenging with the conventional laparoscopy can be performed with robotic assistance. It has advantages of improved visualization and Endowrist™ movements allowing precise suturing. This helps to overcome the limitations of laparoscopy, especially in complicated procedures, and may shorten the steep learning curve in minimal invasive surgery. Randomized controlled trials looking at both short- and long-term outcomes are warranted to strengthen the role of robotic surgery in the field of reproductive surgery.
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Abstract
Light and optical techniques have made profound impacts on modern
medicine, with numerous lasers and optical devices being currently used in
clinical practice to assess health and treat disease. Recent advances in
biomedical optics have enabled increasingly sophisticated technologies —
in particular those that integrate photonics with nanotechnology, biomaterials
and genetic engineering. In this Review, we revisit the fundamentals of
light–matter interactions, describe the applications of light in
imaging, diagnosis, therapy and surgery, overview their clinical use, and
discuss the promise of emerging light-based technologies.
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Affiliation(s)
- Seok Hyun Yun
- Wellman Center for Photomedicine, Massachusetts General Hospital, 65 Landsdowne Street, Cambridge, MA 02139, USA.,Department of Dermatology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.,Harvard-MIT Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Sheldon J J Kwok
- Wellman Center for Photomedicine, Massachusetts General Hospital, 65 Landsdowne Street, Cambridge, MA 02139, USA.,Harvard-MIT Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
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Ghedi A, Donarini E, Lamera R, Sgroi G, Turati L, Ercole C. 3D vs 2D laparoscopic systems: Development of a performance quantitative validation model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6884-7. [PMID: 26737875 DOI: 10.1109/embc.2015.7319975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The new technology ensures 3D laparoscopic vision by adding depth to the traditional two dimensions. This realistic vision gives the surgeon the feeling of operating in real space. Hospital of Treviglio-Caravaggio isn't an university or scientific institution; in 2014 a new 3D laparoscopic technology was acquired therefore it led to evaluation of the of the appropriateness in term of patient outcome and safety. The project aims at achieving the development of a quantitative validation model that would ensure low cost and a reliable measure of the performance of 3D technology versus 2D mode. In addition, it aims at demonstrating how new technologies, such as open source hardware and software and 3D printing, could help research with no significant cost increase. For these reasons, in order to define criteria of appropriateness in the use of 3D technologies, it was decided to perform a study to technically validate the use of the best technology in terms of effectiveness, efficiency and safety in the use of a system between laparoscopic vision in 3D and the traditional 2D. METHODS 30 surgeons were enrolled in order to perform an exercise through the use of laparoscopic forceps inside a trainer. The exercise consisted of having surgeons with different level of seniority, grouped by type of specialization (eg. surgery, urology, gynecology), exercising videolaparoscopy with two technologies (2D and 3D) through the use of a anthropometric phantom. The target assigned to the surgeon was that to pass "needle and thread" without touching the metal part in the shortest time possible. The rings selected for the exercise had each a coefficient of difficulty determined by depth, diameter, angle from the positioning and from the point of view. RESULTS The analysis of the data collected from the above exercise has mathematically confirmed that the 3D technique ensures a learning curve lower in novice and greater accuracy in the performance of the task with respect to 2D.
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3D straight-stick laparoscopy versus 3D robotics for task performance in novice surgeons: a randomised crossover trial. Surg Endosc 2016; 30:5380-5387. [DOI: 10.1007/s00464-016-4893-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 02/28/2016] [Indexed: 12/29/2022]
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Beyond 2D telestration: an evaluation of novel proctoring tools for robot-assisted minimally invasive surgery. J Robot Surg 2016; 10:103-9. [PMID: 26914650 PMCID: PMC4870300 DOI: 10.1007/s11701-016-0564-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
Experienced surgeons commonly mentor trainees as they move through their initial learning curves. During robot-assisted minimally invasive surgery, several tools exist to facilitate proctored cases, such as two-dimensional telestration and a dual surgeon console. The purpose of this study was to evaluate the utility and efficiency of three, novel proctoring tools for robot-assisted minimally invasive surgery, and to compare them to existing proctoring tools. Twenty-six proctor-trainee pairs completed validated, dry-lab training exercises using standard two-dimensional telestration and three, new three-dimensional proctoring tools called ghost tools. During each exercise, proctors mentored trainees by correcting trainee technical errors. Proctors and trainees completed post-study questionnaires to compare the effectiveness of the proctoring tools. Proctors and trainees consistently rated the ghost tools as effective proctoring tools. Both proctors and trainees preferred 3DInstruments and 3DHands over standard two-dimensional telestration (proctors p < 0.001 and p = 0.03, respectively, and trainees p < 0.001 and p = 0.002, respectively). In addition, proctors preferred three-dimensional vision of the operative field (used with ghost tools) over two-dimensional vision (p < 0.001). Total mentoring time and number of instructions provided by the proctor were comparable between all proctoring tools (p > 0.05). In summary, ghost tools and three-dimensional vision were preferred over standard two-dimensional telestration and two-dimensional vision, respectively, by both proctors and trainees. Proctoring tools—such as ghost tools—have the potential to improve surgeon training by enabling new interactions between a proctor and trainee.
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Abstract
The potential for intraoperative bleeding is inherent to the practice of thoracic surgery due to the presence of multiple vital vascular structures, complex anatomy, and constant cardiorespiratory motion. Careful and detailed preoperative evaluation and planning, comprehensive review of imaging studies, and a thorough knowledge of the operative procedure, anatomic relationships, and potential complications are of the highest importance in prevention and avoidance of bleeding complications. Preparation with a clear crisis management plan ensures an effective and expedited response when intraoperative bleeding occurs.
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Affiliation(s)
- Manuel Villa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Cundy TP, Marcus HJ, Hughes-Hallett A, MacKinnon T, Najmaldin AS, Yang GZ, Darzi A. Robotic versus non-robotic instruments in spatially constrained operating workspaces: a pre-clinical randomized crossover study. BJU Int 2015; 116:415-22. [DOI: 10.1111/bju.12987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Thomas P. Cundy
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Hani J. Marcus
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Archie Hughes-Hallett
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Thomas MacKinnon
- Department of Surgery and Cancer; Imperial College London; London UK
| | | | - Guang-Zhong Yang
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
| | - Ara Darzi
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
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Velayutham V, Fuks D, Nomi T, Kawaguchi Y, Gayet B. 3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study. Surg Endosc 2015; 30:147-53. [PMID: 25805241 DOI: 10.1007/s00464-015-4174-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/14/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effect of three-dimensional (3D) visualization on operative performance during elective laparoscopic liver resection (LLR). BACKGROUND Major limitations of conventional laparoscopy are lack of depth perception and tactile feedback. Introduction of robotic technology, which employs 3D imaging, has removed only one of these technical obstacles. Despite the significant advantages claimed, 3D systems have not been widely accepted. METHODS In this single institutional study, 20 patients undergoing LLR by high-definition 3D laparoscope between April 2014 and August 2014 were matched to a retrospective control group of patients who underwent LLR by two-dimensional (2D) laparoscope. RESULTS The number of patients who underwent major liver resection was 5 (25%) in the 3D group and 10 (25%) in the 2D group. There was no significant difference in contralateral wedge resection or combined resections between the 3D and 2D groups. There was no difference in the proportion of patients undergoing previous abdominal surgery (70 vs. 77%, p = 0.523) or previous hepatectomy (20 vs. 27.5%, p = 0.75). The operative time was significantly shorter in the 3D group when compared to 2D (225 ± 109 vs. 284 ± 71 min, p = 0.03). There was no significant difference in blood loss in the 3D group when compared to 2D group (204 ± 226 in 3D vs. 252 ± 349 ml in 2D group, p = 0.291). The major complication rates were similar, 5% (1/20) and 7.5% (3/40), respectively, (p ≥ 0.99). CONCLUSION 3D visualization may reduce the operating time compared to high-definition 2D. Further large studies, preferably prospective randomized control trials are required to confirm this.
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Affiliation(s)
- Vimalraj Velayutham
- Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
- Université Paris Descartes, Paris, France.
| | - David Fuks
- Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
- Université Paris Descartes, Paris, France
| | - Takeo Nomi
- Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
- Université Paris Descartes, Paris, France
| | - Yoshikuni Kawaguchi
- Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
- Université Paris Descartes, Paris, France
| | - Brice Gayet
- Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
- Université Paris Descartes, Paris, France.
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Elhage O, Challacombe B, Shortland A, Dasgupta P. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 2015; 115:274-81. [PMID: 25756137 DOI: 10.1111/bju.12680] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. RESULTS The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P < 0.005). The number of errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P < 0.005). Limitations of the present study include the small sample size and variation in prior surgical experience of the participants. CONCLUSIONS In an in vitro model of anastomosis surgery, robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.
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Smith R, Schwab K, Day A, Rockall T, Ballard K, Bailey M, Jourdan I. Effect of passive polarizing three-dimensional displays on surgical performance for experienced laparoscopic surgeons. Br J Surg 2014; 101:1453-9. [DOI: 10.1002/bjs.9601] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/19/2014] [Accepted: 06/03/2014] [Indexed: 01/15/2023]
Abstract
Abstract
Background
Although the potential benefits of stereoscopic laparoscopy have been recognized for years, the technology has not been adopted because of poor operator tolerance. Passive polarizing projection systems, which have revolutionized three-dimensional (3D) cinema, are now being trialled in surgery. This study was designed to see whether this technology resulted in significant performance benefits for skilled laparoscopists.
Methods
Four validated laparoscopic skills tasks, each with ten repetitions, were performed by 20 experienced laparoscopic surgeons, in both two-dimensional (2D) and 3D conditions. The primary outcome measure was the performance error rate; secondary outcome measures were time for task completion, 3D motion tracking (path length, motion smoothness and grasping frequency) and workload dimension ratings of the National Aeronautics and Space Administration (NASA) Task Load Index.
Results
Surgeons demonstrated a 62 per cent reduction in the median number of errors and a 35 per cent reduction in median performance time when using the passive polarizing 3D display compared with the 2D display. There was a significant 15 per cent reduction in median instrument path length, an enhancement of median motion smoothness, and a 15 per cent decrease in grasper frequency with the 3D display. Participants reported significant reductions in subjective workload dimension ratings of the NASA Task Load Index following use of the 3D displays.
Conclusion
Passive polarizing 3D displays improved both the performance of experienced surgeons in a simulated setting and surgeon perception of the operative field. Although it has been argued that the experience of skilled laparoscopic surgeons compensates fully for the loss of stereopsis, this study indicates that this is not the case.
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Affiliation(s)
- R Smith
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
| | - K Schwab
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
| | - A Day
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
| | - T Rockall
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
| | - K Ballard
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - M Bailey
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
| | - I Jourdan
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
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Wilhelm D, Reiser S, Kohn N, Witte M, Leiner U, Mühlbach L, Ruschin D, Reiner W, Feussner H. Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surg Endosc 2014; 28:2387-97. [DOI: 10.1007/s00464-014-3487-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/14/2014] [Indexed: 02/06/2023]
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Robot-assisted laparoscopy for infertility treatment: current views. Fertil Steril 2014; 101:621-6. [DOI: 10.1016/j.fertnstert.2014.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 12/22/2022]
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Kumar A, Wang YY, Wu CJ, Liu KC, Wu HS. Stereoscopic visualization of laparoscope image using depth information from 3D model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:862-868. [PMID: 24444752 DOI: 10.1016/j.cmpb.2013.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/20/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
Laparoscopic surgery is indispensable from the current surgical procedures. It uses an endoscope system of camera and light source, and surgical instruments which pass through the small incisions on the abdomen of the patients undergoing laparoscopic surgery. Conventional laparoscope (endoscope) systems produce 2D colored video images which do not provide surgeons an actual depth perception of the scene. In this work, the problem was formulated as synthesizing a stereo image of the monocular (conventional) laparoscope image by incorporating into them the depth information from a 3D CT model. Various algorithms of the computer vision including the algorithms for the feature detection, matching and tracking in the video frames, and for the reconstruction of 3D shape from shading in the 2D laparoscope image were combined for making the system. The current method was applied to the laparoscope video at the rate of up to 5 frames per second to visualize its stereo video. A correlation was investigated between the depth maps calculated with our method with those from the shape from shading algorithm. The correlation coefficients between the depth maps were within the range of 0.70-0.95 (P<0.05). A t-test was used for the statistical analysis.
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Affiliation(s)
- Atul Kumar
- Medical Imaging Research Laboratory, IRCAD, Taiwan; Department of General Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan.
| | - Yen-Yu Wang
- Medical Imaging Research Laboratory, IRCAD, Taiwan; Department of General Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan
| | - Ching-Jen Wu
- Medical Imaging Research Laboratory, IRCAD, Taiwan; Department of General Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan
| | - Kai-Che Liu
- Medical Imaging Research Laboratory, IRCAD, Taiwan; Department of General Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan
| | - Hurng-Sheng Wu
- Medical Imaging Research Laboratory, IRCAD, Taiwan; Department of General Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan
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Bilgen K, Ustün M, Karakahya M, Işik S, Sengül S, Cetinkünar S, Küçükpinar TH. Comparison of 3D imaging and 2D imaging for performance time of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2013; 23:180-3. [PMID: 23579515 DOI: 10.1097/sle.0b013e3182827e17] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the effect of the Viking 3-dimensional (3D) system on performance time of laparoscopic cholecystectomy. METHODS Twenty-two patients were included in the study. The groups were standardized using a multiparameters filter (MPF) depending on preoperative ultrasonography and perioperative exploration findings. The 11 patients operated with the Viking 3D system (group A) were compared with 11 patients operated with the Olympus 2D/HD system (group B). RESULTS The mean performance time was 20.63 ± 5.66 and 30.0 ± 6.03 minutes in the group A (3D) and group B (2D), respectively (P<0.01). CONCLUSIONS The 3D imaging systems may cause a significant reduction in the performance time of laparoscopic cholecystectomy.
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Affiliation(s)
- Köksal Bilgen
- Department of General Surgery, Medical Faculty, Ordu University, Ordu, Turkey.
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Kim JH, Baek NH, Li G, Choi SH, Jeong IH, Hwang JC, Kim JH, Yoo BM, Kim WH. Robotic cholecystectomy with new port sites. World J Gastroenterol 2013; 19:3077-3082. [PMID: 23716987 PMCID: PMC3662947 DOI: 10.3748/wjg.v19.i20.3077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 01/08/2013] [Accepted: 03/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To introduce robotic cholecystectomy (RC) using new port sites on the low abdominal area.
METHODS: From June 2010 to June 2011, a total of 178 RCs were performed at Ajou University Medical Center. We prospectively collected the set-up time (working time and docking time) and console time in all robotic procedures.
RESULTS: Eighty-three patients were male and 95 female; the age ranged from 18 to 72 years of age (mean 54.6 ± 15.0 years). All robotic procedures were successfully completed. The mean operation time was 52.4 ± 17.1 min. The set-up time and console time were 11.9 ± 5.4 min (5-43 min) and 15.1 ± 8.0 min (4-50 min), respectively. The conversion rate to laparoscopic or open procedures was zero. The complication rate was 0.6% (n = 1, bleeding). There was no bile duct injury or mortality. The mean hospital stay was 1.4 ± 1.1 d. There was a significant correlation between the console time and white blood cell count (r = 0.033, P = 0.015). In addition, the higher the white blood cell count (more than 10000), the longer the console time.
CONCLUSION: Robotic cholecystectomy using new port sites on the low abdominal area can be safely and efficiently performed, with sufficient patient satisfaction.
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Park JY, Jo MJ, Nam BH, Kim Y, Eom BW, Yoon HM, Ryu KW, Kim YW, Lee JH. Surgical stress after robot-assisted distal gastrectomy and its economic implications. Br J Surg 2012; 99:1554-61. [PMID: 23027072 DOI: 10.1002/bjs.8887] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a lack of reports evaluating the outcomes of robotic gastrectomy and conventional laparoscopic surgery. The aim of this study was to compare the surgical stress response and costs of robot-assisted distal gastrectomy (RADG) with those of laparoscopy-assisted distal gastrectomy (LADG). METHODS This prospective study compared a cohort of patients who had RADG with a cohort that underwent conventional LADG for early gastric cancer between March 2010 and May 2011. The surgical outcomes including Eastern Cooperative Oncology Group performance status and complications, surgical stress response and overall costs were compared between the two groups. RESULTS Thirty patients were enrolled in the RADG group and 120 in the LADG group. There were no conversions. Median duration of operation was longer in the RADG group (218 (interquartile range 200-254) versus 140 (118-175) min; P < 0·001). Postoperative abdominal drain production was less (P = 0·001) and postoperative performance status was worse (P < 0·001) in the RADG group. C-reactive protein (CRP) levels on postoperative days 1 and 3, and interleukin (IL) 6 level on the third postoperative day, were lower in the LADG compared with the RADG group (CRP: P = 0·002 and P = 0·014 respectively; IL-6: P < 0·001). Costs for robotic surgery were much higher than for laparoscopic surgery (difference €3189). CONCLUSION RADG did not reduce surgical stress compared with LADG. The substantial RADG costs due to robotic system expenses may not be justified.
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Affiliation(s)
- J Y Park
- Gastric Cancer Branch, National Cancer Centre, Goyang-si, Gyeonggi-do, Korea
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Khoshabeh R, Juang J, Talamini MA, Nguyen TQ. Multiview glasses-free 3-D laparoscopy. IEEE Trans Biomed Eng 2012; 59:2859-65. [PMID: 22893369 DOI: 10.1109/tbme.2012.2212192] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Numerous attempts have been made to introduce three-dimensional (3-D) video systems into clinical routine, particularly for surgeries. The drawback with all of them thus far has been the fact that they require users to wear cumbersome glasses in order to receive the advantage of stereoscopy. In this study, we present, to our best knowledge, the world's very first laparoscopic surgical system that delivers glasses-free multiview 3-D in high-definition (HD) resolution. In addition to quantitative evaluations of the individual video processing components in our previous studies, we perform an initial subjective study with laparoscopically experienced surgeons, yielding very promising results. This study is still preliminary and requires further evaluation before the system may be introduced into standard surgical routine. Yet, we have developed a fully functioning prototype and successfully demonstrated its potential to numerous surgeons.
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Affiliation(s)
- Ramsin Khoshabeh
- Department of Electrical and Computer Engineering, University of California, San Diego, CA 92093, USA.
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Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA. Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc 2012; 26:2961-8. [PMID: 22580874 DOI: 10.1007/s00464-012-2295-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/02/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. METHODS In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. RESULTS Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P < 0.0001-0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001-0.015). CONCLUSIONS The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical method.
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Affiliation(s)
- O J Wagner
- Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
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van Beurden MHPH, IJsselsteijn WA, Juola JF. Effectiveness of stereoscopic displays in medicine: A review. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/3dres.01(2012)3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Advanced stereoscopic projection technology significantly improves novice performance of minimally invasive surgical skills. Surg Endosc 2012; 26:1522-7. [PMID: 22234585 DOI: 10.1007/s00464-011-2080-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/11/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Three-dimensional (3D) surgical imaging systems provide stereoscopic depth cues that are lost in conventional two-dimensional (2D) display systems. Recent improvements in stereoscopic projection technology using passive polarising displays may improve performance of minimally invasive surgical skills. This study aims to identify the effect of passive polarising stereoscopic displays on novice surgeon performance of minimally invasive surgical skills. METHODS 20 novice surgeons performed 10 repetitions of 4 surgical skills tasks using a new passive polarising stereoscopic display under 3D and 2D conditions. The previously validated tasks used were rope pass, paper cut, needle capping and knot tying. Outcome measures included total error rate and time for task completion. RESULTS Novice surgeons demonstrated a significant reduction in error rates for sequential repetitions of each task using the passive polarising stereoscopic display compared with the 2D display. Mean errors for the 3D versus the 2D mode were 2.0 versus 4.3 for rope pass (P ≤ 0.001), 0.8 versus 1.6 for paper cut (P = 0.001), 1.3 versus 4.2 for needle capping (P ≤ 0.001) and 2.8 versus 8.0 for knot tying (P ≤ 0.001). Novice surgeons demonstrated a significant improvement in mean time for completion for all four tasks when using the 3D system. Mean time (in seconds) for 3D versus 2D were 106.5 versus 134.4 for rope pass (P ≤ 0.001), 116.1 versus 176.3 for paper cut (P ≤ 0.001), 76.3 versus 141.6 for needle capping (P ≤ 0.001) and 153.4 versus 252.6 for knot tying (P ≤ 0.001). CONCLUSION Passive polarising stereoscopic displays significantly improve novice surgeon performance during acquisition of minimally invasive surgical skills.
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Wakabayashi G, Sasaki A, Nishizuka S, Furukawa T, Kitajima M. Our initial experience with robotic hepato-biliary-pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:481-7. [PMID: 21487755 DOI: 10.1007/s00534-011-0388-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The authors performed Asia's first robotic surgery in March 2000 and a clinical trial was launched in the following year in order to obtain governmental approval for the da Vinci(®) Surgical System. METHODS Fifty-two robotic surgeries were performed at Keio University Hospital, of which the authors performed 28 hepato-biliary-pancreatic surgeries. RESULTS In robotic laparoscopic cholecystectomy, articulated monopolar electrocautery scalpels are flexible, enabling precise dissection around the gall bladder and clipless ligation of the cystic artery and cystic ducts. For laparoscopic hepatectomy, hepatic parenchyma was safely resected without hemorrhage by Glisson's pedicles ligation and bipolar hemostatic forceps. CONCLUSIONS We review robotic laparoscopic cholecystectomy and hepatectomy and discuss the potential and future outlook for robotic hepato-biliary-pancreatic surgery.
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Affiliation(s)
- Go Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
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Veronesi G, Agoglia BG, Melfi F, Maisonneuve P, Bertolotti R, Bianchi PP, Rocco B, Borri A, Gasparri R, Spaggiari L. Experience with Robotic Lobectomy for Lung Cancer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Giulia Veronesi
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | | | - Franca Melfi
- Division of Thoracic Surgery, Cisanello Hospital, Pisa, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | | | - Paolo P. Bianchi
- Unit of Minimally Invasive Surgery, Division of General Surgery, European Institute of Oncology, Milan, Italy
| | - Bernardo Rocco
- Institute of Urology, University of Milan, Fondazione Ca’ Granda Policlinico, Mangiagalli, Regina Elena, Milan, Italy
| | - Alessandro Borri
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
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Experience with Robotic Lobectomy for Lung Cancer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:355-60. [DOI: 10.1097/imi.0b013e3182490093] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation. Methods Ninety-one patients with suspected or proven clinical stage I–III lung cancer underwent robotic lobectomy. Selection criteria included lesion ≤5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy. Results Median duration of operation was 239 (range 85–411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P = 0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P = 0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease. Conclusions Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery.
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A guide to stereoscopic 3D displays in medicine. Acad Radiol 2011; 18:1035-48. [PMID: 21652229 DOI: 10.1016/j.acra.2011.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/08/2011] [Accepted: 04/22/2011] [Indexed: 01/21/2023]
Abstract
Stereoscopic displays can potentially improve many aspects of medicine. However, weighing the advantages and disadvantages of such displays remains difficult, and more insight is needed to evaluate whether stereoscopic displays are worth adopting. In this article, we begin with a review of monocular and binocular depth cues. We then apply this knowledge to examine how stereoscopic displays can potentially benefit diagnostic imaging, medical training, and surgery. It is apparent that the binocular depth information afforded by stereo displays 1) aid the detection of diagnostically relevant shapes, orientations, and positions of anatomical features, especially when monocular cues are absent or unreliable; 2) help novice surgeons orient themselves in the surgical landscape and perform complicated tasks; and 3) improve the three-dimensional anatomical understanding of students with low visual-spatial skills. The drawbacks of stereo displays are also discussed, including extra eyewear, potential three-dimensional misperceptions, and the hurdle of overcoming familiarity with existing techniques. Finally, we list suggested guidelines for the optimal use of stereo displays. We provide a concise guide for medical practitioners who want to assess the potential benefits of stereo displays before adopting them.
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Silvestri M, Simi M, Cavallotti C, Vatteroni M, Ferrari V, Freschi C, Valdastri P, Menciassi A, Dario P. Autostereoscopic three-dimensional viewer evaluation through comparison with conventional interfaces in laparoscopic surgery. Surg Innov 2011; 18:223-30. [PMID: 21742655 DOI: 10.1177/1553350611411491] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the near future, it is likely that 3-dimensional (3D) surgical endoscopes will replace current 2D imaging systems given the rapid spreading of stereoscopy in the consumer market. In this evaluation study, an emerging technology, the autostereoscopic monitor, is compared with the visualization systems mainly used in laparoscopic surgery: a binocular visor, technically equivalent from the viewer's point of view to the da Vinci 3D console, and a standard 2D monitor. A total of 16 physicians with no experience in 3D interfaces performed 5 different tasks, and the execution time and accuracy of the tasks were evaluated. Moreover, subjective preferences were recorded to qualitatively evaluate the different technologies at the end of each trial. This study demonstrated that the autostereoscopic display is equally effective as the binocular visor for both low- and high-complexity tasks and that it guarantees better performance in terms of execution time than the standard 2D monitor. Moreover, an unconventional task, included to provide the same conditions to the surgeons regardless of their experience, was performed 22% faster when using the autostereoscopic monitor than the binocular visor. However, the final questionnaires demonstrated that 60% of participants preferred the user-friendliness of the binocular visor. These results are greatly heartening because autostereoscopic technology is still in its early stages and offers potential improvement. As a consequence, the authors expect that the increasing interest in autostereoscopy could improve its friendliness in the future and allow the technology to be widely accepted in surgery.
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Affiliation(s)
- Michele Silvestri
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
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Zacharopoulou C, Sananes N, Baulon E, Garbin O, Wattiez A. Chirurgie robotique en gynécologie : état des connaissances. Revue de la littérature. ACTA ACUST UNITED AC 2010; 39:444-52. [DOI: 10.1016/j.jgyn.2010.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 06/14/2010] [Accepted: 06/16/2010] [Indexed: 11/28/2022]
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Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc 2009; 24:1132-43. [PMID: 19911222 DOI: 10.1007/s00464-009-0740-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 10/12/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. METHODS In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. RESULTS The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. CONCLUSION The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.
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Doarn CR, Anvari M, Low T, Broderick TJ. Evaluation of teleoperated surgical robots in an enclosed undersea environment. Telemed J E Health 2009; 15:325-35. [PMID: 19441950 DOI: 10.1089/tmj.2008.0123] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The ability to support surgical care in an extreme environment is a significant issue for both military medicine and space medicine. Telemanipulation systems, those that can be remotely operated from a distant site, have been used extensively by the National Aeronautics and Space Administration (NASA) for a number of years. These systems, often called telerobots, have successfully been applied to surgical interventions. A further extension is to operate these robotic systems over data communication networks where robotic slave and master are separated by a great distance. NASA utilizes the National Oceanographic and Atmospheric Administration (NOAA) Aquarius underwater habitat as an analog environment for research and technology evaluation missions, known as NASA Extreme Environment Mission Operations (NEEMO). Three NEEMO missions have provided an opportunity to evaluate teleoperated surgical robotics by astronauts and surgeons. Three robotic systems were deployed to the habitat for evaluation during NEEMO 7, 9, and 12. These systems were linked via a telecommunications link to various sites for remote manipulation. Researchers in the habitat conducted a variety of tests to evaluate performance and applicability in extreme environments. Over three different NEEMO missions, components of the Automated Endoscopic System for Optimal Positioning (AESOP), the M7 Surgical System, and the RAVEN were deployed and evaluated. A number of factors were evaluated, including communication latency and semiautonomous functions. The M7 was modified to permit a remote surgeon the ability to insert a needle into simulated tissue with ultrasound guidance, resulting in the world's first semi-autonomous supervisory-controlled medical task. The deployment and operation of teleoperated surgical systems and semi-autonomous, supervisory-controlled tasks were successfully conducted.
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Affiliation(s)
- Charles R Doarn
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Barry GP, Simon JW, Auringer D, Dunnican W, Zobal-Ratner J. Performance of strabismic subjects using a validated surgical training module: a pilot study. J AAPOS 2009; 13:350-3, 353.e1-2. [PMID: 19683186 DOI: 10.1016/j.jaapos.2009.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 04/28/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the performance of patients with strabismus to that of age-matched controls in a validated surgical training module. METHODS A prospective experimental study was conducted of 14 adult patients with strabismus since childhood and absent stereopsis and of 14 age-matched controls with normal stereopsis. Each participant received instruction in the task of peg transfer on a validated surgical training device and then completed 10 consecutive timed trials. The means of the best 5 scores were compared using the 2-sample Wilcoxon rank-sum test. RESULTS The average age of cases was 34.8 years (range, 15-51 years) compared with 37.8 years (range, 14-56 years) for controls. The scores for the strabismic patients ranged from 50.8 to 151.4 seconds, with a mean of 82.5 +/- 26.7 seconds. Controls ranged from 43.2 to 129 seconds, with a mean of 64.7 +/- 23.9 seconds. The Wilcoxon rank-sum test showed significantly better performance among controls (p = 0.022). CONCLUSIONS Patients with strabismus performed more poorly than did age-matched controls in this model of hand-eye coordination. However, there was significant overlap between groups and several patients with strabismus performed better than the mean of the control group. Further investigation is required to elucidate the impact of strabismus on surgical performance.
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Affiliation(s)
- Gerard P Barry
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
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Kenngott HG, Müller‐Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: Technique and benefit in advanced laparoscopic surgery. MINIM INVASIV THER 2009; 17:160-7. [DOI: 10.1080/13645700802103381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Ann Surg 2008; 247:987-93. [PMID: 18520226 DOI: 10.1097/sla.0b013e318172501f] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare safety and costs of robotic-assisted and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis. BACKGROUND Technical benefits of robotic-assisted surgery are well documented. However, pressure is currently applied to decrease costs, leading to restriction of development, and implementation of new technologies. So far, no convincing data are available comparing outcome or costs between computer assisted and conventional laparoscopic cholecystectomy. METHODS A prospective case-matched study was conducted on 50 consecutive patients, who underwent robotic-assisted cholecystectomy (Da Vinci Robot, Intuitive Surgical) between December 2004 and February 2006. These patients were matched 1:1 to 50 patients with conventional laparoscopic cholecystectomy, according to age, gender, American Society of Anesthesiologists score, histology, and surgical experience. Endpoints were complications after surgery (mean follow-up of 12.3 months [SD 1.2]), conversion rates, operative time, and hospital costs (ClinicalTrial.gov ID: NCT00562900). RESULTS No minor, but 1 major complication occurred in each group (2%). No conversion to open surgery was needed in either group. Operation time (skin-to-skin, 55 minutes vs. 50 minutes, P < 0.85) and hospital stay (2.6 days vs. 2.8 days) were similar. Overall hospital costs were significantly higher for robotic-assisted cholecystectomy $7985.4 (SD 1760.9) versus $6255.3 (SD 1956.4), P < 0.001, with a raw difference of $1730.1(95% CI 991.4-2468.7) and a difference adjusted for confounders of $1606.4 (95% CI 1076.7-2136.2). This difference was mainly related to the amortization and consumables of the robotic system. CONCLUSIONS Robotic-assisted cholecystectomy is safe and, therefore, a valuable approach. Costs of robots, however, are high and do not justify the use of this technology considering the lack of benefits for patients. A reduction of acquisition and maintenance costs for the robotic system is a prerequisite for large-scale adoption and implementation.
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Perez M, Quiaios F, Andrivon P, Husson D, Dufaut M, Felblinger J, Hubert J. Paradigms and experimental set-up for the determination of the acceptable delay in telesurgery. ACTA ACUST UNITED AC 2008; 2007:453-6. [PMID: 18001987 DOI: 10.1109/iembs.2007.4352321] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this work was to develop an experimental set-up and realistic paradigms to study the effect of delay on video flux transmission and surgical performance. Four exercises were performed by 15 surgeons with 5 different simulated transmission delays. Large standard deviation of the duration of an exercise was found. Even with a short transmission delay of 150ms, some surgeon found that the surgical procedure was not possible. Further work has to be done to have a better evaluation of the surgical precision.
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Affiliation(s)
- M Perez
- INSERM ERI13, and department of Chirurgie Générale & Urgences, Pr Grosdidier, Hôpital Central, Nancy, France.
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Ali MR, Loggins JP, Fuller WD, Miller BE, Hasser CJ, Yellowlees P, Vidovszky TJ, Rasmussen JJ, Pierce J. 3-D Telestration: A Teaching Tool for Robotic Surgery. J Laparoendosc Adv Surg Tech A 2008; 18:107-12. [DOI: 10.1089/lap.2007.0051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohamed R. Ali
- Department of Surgery, University of California, Davis, Sacramento, California
| | - Jamie P. Loggins
- Department of Surgery, University of California, Davis, Sacramento, California
| | - William D. Fuller
- Department of Surgery, University of California, Davis, Sacramento, California
| | | | | | - Peter Yellowlees
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | - Tamas J. Vidovszky
- Department of Surgery, University of California, Davis, Sacramento, California
| | - Jason J. Rasmussen
- Department of Surgery, University of California, Davis, Sacramento, California
| | - Jonathan Pierce
- Department of Surgery, University of California, Davis, Sacramento, California
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Robotic urology in the United Kingdom: experience and overview of robotic-assisted cystectomy. J Robot Surg 2008; 1:235-42. [PMID: 25484970 PMCID: PMC4247427 DOI: 10.1007/s11701-007-0049-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 12/05/2007] [Indexed: 01/30/2023]
Abstract
In this article we look at the evolution of robotic technology in operative urology and the significant early contribution of Mr John Wickham. We explore the ergonomics of robotic technology and discuss financial issues from a British perspective. We share our clinical experience, describe the authors’ robotic-assisted cystectomy technique, and conclude by exploring the patients’ perception of this new treatment modality.
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