Research Progress and Prospect Analysis of Vascular Interventional Surgical Robot / 中国医疗器械杂志

Vascular interventional surgery is an important means to treat cardiovascular and cerebrovascular diseases, but the particularity of its working environment will bring greater radiation threat to doctors. Vascular interventional surgery robots can effectively improve the working environment of doctors and can provide more stable operations, improve the success rate of surgery. This study mainly introduces the current research status, key technologies, and future application of vascular interventional surgical robots.

Uncalibrated Positioning Method for Puncture Robots Based on Optical Navigation / 中国医疗器械杂志

Robotic puncture system has been widely used in modern minimally invasive surgery, which usually uses hand-eye calibration to calculate the spatial relationship between the robot and the optical tracking system. However, the hand-eye calibration process is time-consuming and sensitive to environmental changes, which makes it difficult to guarantee the puncture accuracy of the robot. This study proposes an uncalibrated positioning method for puncture robot based on optical navigation. The method divides the target path positioning into two stages, angle positioning and position positioning, and designs angle image features and position image features respectively. The corresponding image Jacobian matrix is constructed based on the image features and updated by online estimation with a cubature Kalman filter to drive the robot to perform target path localization. The target path positioning results show that the method is more accurate than the traditional hand-eye calibration method and saves significant preoperative preparation time by eliminating the need for calibration.

Medical Institution's Multiple Role in the Collaborative Innovation Transformation Mode of "Industry-University-Research-Medicine" on Domestic Surgical Robots / 中国医疗器械杂志

In recent years, with the rapid development of Chinese domestic surgical robot technology and the expansion of the application market, the "industry-university-research-medicine" collaborative innovation transformation mode has gradually developed and formed. Medical institutions play an important role in multi-party cooperation with enterprises, universities, and research institutes, as well as in product planning, technology research and development, achievement transformation, and personnel training. On the basis of reviewing the current situation of the development of the "industry-university-research-medicine" collaborative innovation transformation mode of domestic surgical robots, this study explores the multiple roles played by medical institutions in this mode and challenges, further putting forward corresponding recommendations.

Comparative study of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot in the treatment of lumbar disc herniation / 中华显微外科杂志

Objective:To compair the clinical effect of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot(ENSR) system in the treatment of lumbar disc herniations(LDH).Methods:From March 2021 to December 2021, 73 patients with LDH underwent endoscopic minimally invasive treatment in the Department of Spine Surgery, Limin Hospital of Weihai High District. Thirty-eight patients were treated with endoscopic spine surgery assisted by domestic ENSR system(ENSR group), and 35 patients were treated with endoscopic spine surgery alone(endoscopic group). The patients received follow up regularly by telephone or Wechat. The intraoperative fluoroscopy times, puncture times, upper facet arthroplasty times, operation time, preoperative and postoperative Visual Analogue Scale(VAS), Japanese Orthopaedic Association Scores(JOA), and the MOS item short from health survey(SF-36)were compared between the 2 groups. The early postoperative efficacy was evaluated by modified MacNab criteria at 1 week after surgery. SPSS 26.0 was used to analyse the data. P<0.05 was considered that the difference was statistically significant. Results:The age, gender, body mass index(BMI) and other general data of the 2 groups were basically the same, and there was no statistically significant difference( P>0.05). There was no significant difference in the excellent and good rate of postoperative treatment between ENSR group(97.37%) and endoscopic group(94.29%)( Z=0.90, P>0.05). In terms of operation time, intraoperative fluoroscopy times, puncture times, and plasty times, ENSR group[(67.00±17.00) min, (4±2) times, 1 time, 1 time, respectively] was compared with the endoscopic group[(82.00±16.00] min, (17±6) times, (9±5) times, (5±2) times], and the difference was statistically significant( t=3.87,12.62, 9.87, respectively, P<0.05). There were significant differences in VAS, JOA and SF-36 scores between the 2 groups between before and after surgery( F=106.42, 112.14, 26.88, respectively, P<0.05). There was no significant difference in VAS, JOA and SF-36 scores before and after surgery between the 2 groups( F=0.95, 3.54, 0.97, respectively, P>0.05). Conclusion:The endoscopic spine surgery assisted by the ENSR can achieve satisfactory clinical results and is a safe and effective surgical assistance system. For the endoscopic surgery, assisted by the ENSR has obvious advantages in reducing the times of fluoroscopy, puncture, and facet arthroplasty, and shortening the operation time.

Application and research progress of artificial intelligence technology in trauma treatment / 中国修复重建外科杂志

OBJECTIVE@#To review the application and research progress of artificial intelligence (AI) technology in trauma treatment.@*METHODS@#The recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked.@*RESULTS@#The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients' situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment.@*CONCLUSION@#There is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.

Comparison of the learning curve of robot -assisted and laparoscopic -assisted gastrectomy / 中南大学学报(医学版)

OBJECTIVES@#Da Vinci robot technology is widely used in clinic,with minimally invasive surgery development. This study aims to explore the possible influence of advanced surgical robotics on the surgery learning curve by comparing the initial clinical learning curves of 2 different surgical techniques: robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG).@*METHODS@#From September 2017 to December 2020, a chief surgeon completed a total of 108 cases of radical gastric cancer from the initial stage, including 27 cases of RAG of the Da Vinci Si robotic system (RAG group) and 81 cases of LAG (LAG group). The lymph node of gastric cancer implemented by the Japanese treatment guidelines of gastric cancer. The surgical results, postoperative complications, oncology results and learning curve were analyzed.@*RESULTS@#There was no significant difference in general data, tumor size, pathological grade and clinical stage between the 2 groups (P>0.05). The incidence of serious complications in the RAG group was lower than the LAG group (P=0.003). The intraoperative blood loss in the RAG group was lower than that in the LAG group (P=0.046). The number of lymph nodes cleaned in the RAG group was more (P=0.003), among which there was obvious advantage in lymph node cleaning in the No.9 group (P=0.038) and 11p group (P=0.015). The operation time of the RAG group was significantly longer than the LAG group (P=0.015). The analysis of learning curve found that the cumulative sum analysis (CUSUM) value of the RAG group decreased from the 10th case, while the CUSUM of the LAG group decreased from the 28th case. The learning curve of the RAG group had fewer closing cases than that of the LAG group. The unique design of the surgical robot might help to improve the surgical efficiency and shorten the surgical learning curve.@*CONCLUSIONS@#Advanced robotics helps experienced surgeons quickly learn to master RAG skills. With the help of robotics, RAG are superior to LAG in No.9 and 11p lymph node dissection and surgical trauma reduction. RAG can clear more lymph nodes than LAG, and has better perioperative effect.

Basic performance of domestic surgical robot and the safety and effectiveness of integrated energy equipment / 中南大学学报(医学版)

OBJECTIVES@#Surgical robot system has broken the limitation of traditional surgery and shown excellent performance in surgery, and has been widely used in minimally invasive treatment in most areas of surgery. This study aims to verify the basic performance of the domestic surgical robot system and the safety and effectiveness of the integrated bipolar electrocoagulation and ultrasonic knife.@*METHODS@#The basic performance of the domestic surgical robot system was evaluated by completing the square knot and surgical knot, vertical and horizontal perforation and right ring perforation and suture, as well as picking up beans. Compared with laparoscopy, the safety and effectiveness of the domestic surgical robot after integrated interconnection bipolar electrocoagulation and ultrasonic scalpel were evaluated by detecting the vascular closure performance and the degree of histopathological damage in animals.@*RESULTS@#Compared with freehand knotting, domestic robot knotting speed and circumference were slightly worse, but better than laparoscopic knotting. There was no statistical significance in the tension difference of the surgical knots among the 3 methods (P>0.05), but the tension of the square knots made by the freehand and the domestic surgical robot was greater than that of the laparoscopy (P<0.05). The space required for both the left and right forceps heads of knots was smaller than that of laparoscopy (P<0.001), which successfully completed the 4 quadrant suture tasks, and the time of picking up beans was significantly less than that of laparoscopy (P<0.05). There was no significant difference in the temperature of the liver tissue after the bipolar electrocoagulation between the interconnected domestic surgical robot and the laparoscopy (P>0.05), and the acute thermal injury was observed under the light microscope. The temperature of the liver tissue treated by the domestic robotic ultrasound knife was higher than that of the laparoscopic ultrasound knife (P<0.05).@*CONCLUSIONS@#Domestic surgical robots are obviously superior to laparoscopy in suturing, knotting, and moving objects, and domestic surgical robots' interconnect bipolar electrocoagulation and ultrasonic knife have achieved success in animal experiments, and hemostasis is considered to be safe and effective.

Intelligent medicine: a new journey for urologists / 中华泌尿外科杂志

With the rapid development of digital technologies represented by artificial intelligence, big data, and cloud computing, the concept of intelligent medicine has emerged. As an in-depth integration of the national strategies of " Healthy China" and " Made in China 2025" , intelligent medicine is widely used in the full-course management of the urological diseases, including disease screening, diagnosis, treatment strategy and follow-up. This article aims to review the application progress and prospects of intelligent medicine in urological diseases and provide references for the urologists.

Surgical robot: a tool or toy / 中华消化外科杂志

Laparoscopic surgery is a revolution in the fields of surgery in the 21st century. The concept of minimally invasive surgery has been widely accepted. Nowadays, the commercial robot-assisted laparoscopic instrument operating system, commonly known as "surgical robot", does not yet have the attributes of a real robot and still needs further optimization. We are still far from claiming that we are in the "surgical robot era". A new generation of surgical robots with more developed artificial intelligence and simulation functions are worth working on for. "Minimally invasive approach" does not necessarily mean "minimally invasive surgery". The real benefit of patients is the most important indicator for evaluating minimally invasive surgery. The essence of science is discovery but not technological fashion. In the face of rapid technological development, the Chinese surgeons should remain rational and enterprising.

Toumai® endoscopic robot-assisted thoracic surgery in three patients / 中国胸心血管外科临床杂志

@#Objective    To explore the application of Toumai® minimally invasive endoscopic robot in thoracic surgery, and to observe its safety and short-term surgical efficacy. Methods    Three patients were enrolled from October to December 2021, including 1 male (69 years) and 2 females (47 years and 22 years). All 3 patients received surgery with Toumai® endoscopic surgical robot, including radical lung cancer surgery in 2 patients and mediastinal tumor resection in 1 patient. Results    All 3 patients were successfully operated without conversion to thoracotomy, complication or death. For the male lobectomy patient, the total operation time was 120 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female lobectomy patient, the total operation time was 103 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female mediastinal tumor patient, the total operation time was 81 min, the intraoperative blood loss was 50 mL, the catheter drainage time was 3 days and the hospital stay time was 3 days. Conclusion    The Toumai® minimally invasive endoscopic surgical robot is safe and effective in thoracic surgery. Compared with Da Vinci surgical robot, Toumai® has the same 3D visual field experience and smooth operation.

Prospect and hybridization of three-channel multi-mirror robot for early lung cancer diagnosis and treatment / 中国胸心血管外科临床杂志

@#Nowadays, the development of the medical instrument industry makes rapid changes in clinical practice. Hybridization of latest technology is playing an increasingly important role in the diagnosis and treatment of disease. Especially, the trend of the integration of three-channel hybrid technology in diagnosis and treatment of early lung cancer has become increasingly obvious. This paper will focus on the technical advance of the three-channel multi- mirror robot and its application in the diagnosis and treatment of early lung cancer.

Realization and Clinical Study of Robotic Technology in Cardiovascular Interventional Surgery / 中国医疗器械杂志

The high incidence of cardiovascular diseases is a serious threat to human health, and endovascular surgery has become the standard treatment for most interventional cardiovascular diseases. The robotassisted endovascular surgery system further enhances surgeons' ability to perform minimally invasive endovascular procedures in interventional cardiology. This study presents a new robotic technique for coronary intervention from the perspective of clinical application. Aiming at clinical application scenarios, this scheme proposed an intuitive guide wire catheter mechanism design, which accurately and perfectly simulates the doctor's hand movements, realizes the positive and negative direction translation of the guide wire catheter, accurate torque control of the guide wire rotation and locking. The results of animal test showed that the R-OneTM has a high degree of dexterity, accuracy and stability,and meets the clinical needs.

Evaluation on Surgical Robotic Pose Repeatability Based on Laser Tracking Measurement / 中国医疗器械杂志

To provide accurate information for registration and safety evaluation of surgical robot, the pose repeatability measurement method was proposed. According to the terminal instrument of the master-slave surgical robot (such as high-frequency electric knife, ultrasonic knife), a suitable target ball fixture was designed. The node data at 10%, 50% and 100% rated speed were measured respectively. Through data analysis, the pose repeatability property of the tested samples at different speeds was obtained. It has high applicability and repeatability, and can meet the requirements of data traceability and registration testing.

Impacto de la anestesia intravenosa en cirugía robótica para paciente de alto riesgo sometido a cirugía oncológica de larga duración en el Centro Médico Naval / Impact of intravenous anesthesia in robotic surgery for high-risk patient undergoing long-term oncologic surgery at the Naval Medical Center

Resumen: La práctica de cirugía robótica es un proceso complejo que implica desarrollo y tecnología no sólo en el campo de la cirugía, sino también en el campo de la anestesiología. Implica un proceso multifactorial, ya que ha generado un cambio drástico multidisciplinario basado en tecnología de punta que pretende ofrecer mejores condiciones durante el manejo perioperatorio en cirugía robótica. La anestesia total intravenosa cumple objetivos específicos en relación a la posición del paciente, relajación cerebral, neuroprotección, hemodinamia, pérdida y recuperación de la conciencia, parálisis neuromuscular, parámetros ventilatorios, etc. Ofrece seguridad y calidad al paciente durante el procedimiento con una mínima interferencia con el monitoreo electrofisiológico y permite modular la profundidad anestésica desde una neurosedación hasta una anestesia general, de acuerdo a las diferentes etapas de la cirugía. Un factor atribuible a la anestesia moderna para el éxito de la cirugía robótica es usar diferentes agentes anestésicos que promuevan inducción, mantenimiento y emersión anestésica más rápida y suave, a fin de reducir el tiempo de recuperación del estado de conciencia, funciones básicas y psicomotoras como la anestesia general multimodal.

Abstract: The practice of robotic surgery is a complex process, involving development and technology; not only in the surgery field but also in the anesthesiology field. It implies a multifactorial process since it has generated a drastic multidisciplinary change based on state-of-the-art technology; which aims to offer better conditions during perioperative management in robotic surgery. Intravenous Total Anesthesia accomplishes specific objectives in relation to patient position, brain relaxation, neuroprotection, hemodynamics, loss and recovery of consciousness, neuromuscular paralysis, ventilatory parameters, providing safety and quality during the procedure; with minimal intervention during electrophysiological monitoring and enabling anesthetic depth to be modulated from neurosedation to general anesthesia, according to the different stages of the surgery. A factor attributable to modern anesthesia for robotic surgery success is to employ different anesthetic agents promoting induction, maintenance of general anesthesia, smother and faster anesthetic emersion, for the purpose of reducing recovery time of the state of consciousness), basic and psychomotor functions; as is the general multimodal anesthesia.

Application of semi-automatic spinal surgery robot system in spinal surgery / 中国组织工程研究

BACKGROUND: Spinal surgical robots are mainly imported from countries outside China. The overall level of automation is still low. Domestic robot’s core technology still has some difficulties to conquer. Domestic robots are in the ascendant. The cost of spinal surgical robots is too expensive to apply in clinic practice. Our research group has developed Orthobot spinal surgical robot system for spine surgery with Shenzhen Xinjunte Company, which may be of great significance to the development of domestic surgical robots. OBJECTIVE: To explore the safety and effectiveness of the application of Orthobot semi-automatic spine surgery robot system in spine surgery in swine lumbar experimental model by analyzing its feasibility so as to optimize surgical procedures. METHODS: Totally 12 swine lumbar samples (L1-L6) were randomly divided into 2 groups. In the experimental group (6 cases), pedicle screw path was planned under the three-dimensional CT data after matching the pre-operative CT images and intra-operative C-arm film. Orthobot spinal surgical robot system was used to locate the pedicle start point automatically and to drill a hole with Kirschner wire into the pedicle. Pedicle screw path was prepared through the Kirschner wire. In the control group (6 cases), X-ray perspective data of C-arm machine during operation were directly used, and the screw path was planned under the two-dimensional X-ray data. The surgical planning time, Kirschner wire implantation time, X-ray exposure time, and total operation time were recorded for further analysis. The accuracy and the excellent and good rate of pedicle screw implantation were evaluated by CT scan according to Abul-Kasimhierarchy grading system. RESULTS AND CONCLUSION: (1) The planning time and the total operation time of single pedicle screw path preparation were lower in the experimental group than in the control group (P 0.05). (2) Post-operation CT evaluation showed that the excellent and good rate of pedicle screw path preparation was significantly better in the experimental group 96.7% (58/60) than in the control group 85.0% (51/60) (P < 0.05). (3) Results suggested that compared with intraoperative C-arm, the application of Orthobot semi-automatic spine surgery robot system combined with preoperative CT and intraoperative C-arm has high accuracy, safeness and effectiveness. However, the registration and matching time of the system is increased and the total operation time is long.

State-of-the-art of intelligent minimally invasive surgical robots / 医学前沿

A number of developed countries are rapidly turning into super-aged societies. Consequently, the demand for reduced surgical invasiveness and enhanced efficiency in the medical field has increased due to the need to reduce the physical burden on older patients and shorten their recovery period. Intelligent surgical robot systems offer high precision, high safety, and reduced invasiveness. This paper presents a review of current intelligent surgical robot systems. The history of robots and three types of intelligent surgical robots are discussed. The problems with current surgical robot systems are then analyzed. Several aspects that should be considered in designing new surgical systems are discussed in detail. The paper ends with a summary of the work and a discussion of future prospects for surgical robot development.

Current surgical practices of robotic-assisted tissue repair and reconstruction / 中华创伤杂志(英文版)

This paper systematically reviewed and analyzed the recent publications of robotic-assisted surgeries in the field of tissue repair and reconstruction. Surgical robots can elevate skin flap more accurately and shorten the time of tissue harvest. In addition, robotic-assisted surgery has the advantage of minimal tissue trauma and thus forms minimal scar. The utilization of surgical robots reduces the occurrence of complications after oral radical tumor resection while achieving cosmetic sutures. Robotic-assisted radical mastectomy could radically remove invasive breast cancer lesions and achieve breast reconstruction in the first stage through the small incisions in the operation areas. Surgical robots enable precise microvascular anastomosis and reduce tissue edema in the surgical field. Robotic-assisted technology can help appropriately locate the target tissues at different angles during sinus and skull base surgeries and accurately place tissues during urethroplasty. The robotic-assisted technology provides a new platform for surgical innovation in the field of tissue repair and reconstruction. However, the uncertainty in the survival rate after tumor radical surgery, the increase of operating time, and the high costs are barriers for its clinical application in tissue repair and reconstructive surgery. Nevertheless, robotic-assisted technology has already demonstrated an impact on the field of tissue repair and reconstruction in a meaningful way.

Clinical phase Ⅰ study of domestic surgical robot: A report of 103 cases / 中国实用外科杂志

OBJECTIVE: To evaluate the safety and feasibility of the domestic surgical robot in clinical applications.METHODS: From March 2014 to January 2019, 103 domestic robot-assisted laparoscopic surgeries were performed in Department of General Surgery, Third Xiangya Hospital of Central South University. The clinical features, operation and postoperative results were collected and analyzed. The patients were followed up for 1 month. RESULTS: Among 103 cases, 2 cases(2%) trasfered to open surgery. Two patients(2%) required intraoperative blood transfusion and no postoperative blood transfusion. Intraoperative complications occurred in 2 cases(2%) which were bladder injury and ureteral injury respectively. Postoperative complications occurred in 2 cases(2%) which were anastomotic leakage and pelvic infection. There was no reoperation during hospitalization. All patients were discharged smoothly. There were no re-admissions and deaths within 30 days after surgery. CONCLUSION: Domestic surgical robots are safe and feasible in clinical applications,which needs further verified by multicenter, randomized controlled trials.

Structure Design and Workspace Analysis of Robotic Arm for Minimally Invasive Surgical Robot / 医用生物力学

Objective The current manipulator with double parallel quadrilateral mechanism should be connected in series with a flexible degree of freedom (DOF) mechanism, which increases the volume of the manipulator, decreases the motion flexibility and creates the interference between the mechanical arms that hold the mirror and the device. Aimed at solving this problem, a novel mechanical arm was put forward to enhance the motion flexibility and reduce the volume of the manipulator. Methods The mechanical arm was designed by using the mechanism of five-link, slider and slide rail lower pair and wire transmission to realize the telescopic movement of the end effector. The kinematics model of the manipulator was established, and the MATLAB was used as the simulation tool to verify the correctness of the D-H parameters under the specific zero joint angle, and the motion equation of the manipulator was solved. Meanwhile, the three-dimensional workspace of the end effector was obtained by using Monte Carlo algorithm, and the preoperative plan of animal experiment for 3 arms was performed. Finally, cholecystectomy and other operations were acted in pigs, to verify the rationality and maneuverability of the design of double 5-link 2-DOF manipulator. Results The working space of Monte Carlo algorithm under MATLAB environment was -650.4 mm＜x＜649 mm, 163.8 mm＜y＜1 202 mm and -254.6 mm＜z＜829.8 mm. Sixteen cases of pig cholecystectomy were successfully completed, with an average operation time of 51 minutes. Conclusions The novel double 5-link 2-DOF manipulator could successfully complete cholecystectomy and other operations in pigs, which had no other symptoms after the operation. There was no interference between the mechanical arms, which fully verified the feasibility of the design scheme of the robot manipulator for minimally invasive surgery.

Impacto de la mecatrónica en la medicina / Impact of mechatronic in medicine

Se efectuó una revisión bibliográfica para determinar el impacto de la mecatrónica en el sector de la salud. Se valoró el desarrollo de esta desde la visión de diferentes investigadores, lo cual ha permitido su inserción en dicho sector. También se comprobó que la robótica y el procesamiento digital de imágenes y señales tienen mayor incidencia en la medicina. Asimismo, se hizo un análisis de la mecatrónica aplicada a esta ciencia, el cual demostró que las áreas quirúrgica y terapéutica son las más favorecidas y se nutren de técnicas innovadoras, que resultan más fiables y menos invasivas para el paciente

A literature review was carried out to determine the impact of mechatronic in the health sector. Its development was evaluated from the point of view of different investigators, which has allowed its insertion in this sector. It was also proven that robotics and digital processing of images and signs have higher incidence in medicine. Also, an analysis of mechatronic applied to this science was carried out, which demonstrated that the surgical and therapeutical areas are the most favored and receive nourishment through innovative techniques that are more reliable and less invasive for the patient