Clinical evaluation of autonomous robotic-assisted full-arch implant surgery: A 1-year prospective clinical study.

OBJECTIVES: This prospective clinical study aimed to evaluate the accuracy and 1-year clinical follow-up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full-arch implant surgery. MATERIALS AND METHODS: Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP-FC) were recorded. RESULTS: Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance (p > .05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations (p > .05). The periodontal parameters, the BBT, and IP-FC remained stable during 1-year follow-up. CONCLUSION: The ADIR system showed excellent positional accuracy. The 1-year follow-up after full-arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full-arch implant surgery.

A new era in surgical oncology: preliminary insights into the hinotori™ surgical robot system's role in rectal surgery using the double bipolar method.

BACKGROUND: The da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms. METHODS: The present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection. RESULTS: The study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified. CONCLUSIONS: The introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection.

Accuracy of dental implant placement with a robotic system in partially edentulous patients: A prospective, single-arm clinical trial.

OBJECTIVES: This clinical study aimed to assess the accuracy of implant positions using a robotic system in partially edentulous patients. MATERIALS AND METHODS: Twenty-eight partially edentulous patients received 31 implants using the robotic system. Deviations between the planned and placed implants were calculated after surgery. The deviations were compared with objective performance goals (OPGs) from reported studies of fully guided static computer-assisted implant surgery (CAIS) and dynamic CAIS. A multiple linear regression analysis was performed to investigate the possible effects of the type and side of the arch, implant location, and implant dimensions on the deviations. RESULTS: The evaluation of 31 implants resulted in a mean angle deviation of 2.81 ± 1.13° (95% confidence interval (CI): 2.40-3.23°), while the 3D deviations at the implant shoulder and apex were 0.53 ± 0.23 mm (95% CI 0.45-0.62 mm) and 0.53 ± 0.24 mm (95% CI 0.44-0.61 mm), respectively. The upper limits of the 95% CI of 3D deviations were lower than those of the corresponding OPGs; however, the angle deviation was similar to that of the OPG. No statistically significant differences were found for the type and side of the arch, implant location, and implant dimensions to the deviations (p > .05). CONCLUSIONS: The robotic system appears to achieve higher accuracy in implant positions than static and dynamic CAIS in partially edentulous patients (Chinese Clinical Trial Registry ChiCTR2300067587).

Integration of Virtual Reality in the Control System of an Innovative Medical Robot for Single-Incision Laparoscopic Surgery.

In recent years, there has been an expansion in the development of simulators that use virtual reality (VR) as a learning tool. In surgery where robots are used, VR serves as a revolutionary technology to help medical doctors train in using these robotic systems and accumulate knowledge without risk. This article presents a study in which VR is used to create a simulator designed for robotically assisted single-uniport surgery. The control of the surgical robotic system is achieved using voice commands for laparoscopic camera positioning and via a user interface developed using the Visual Studio program that connects a wristband equipped with sensors attached to the user's hand for the manipulation of the active instruments. The software consists of the user interface and the VR application via the TCP/IP communication protocol. To study the evolution of the performance of this virtual system, 15 people were involved in the experimental evaluation of the VR simulator built for the robotic surgical system, having to complete a medically relevant task. The experimental data validated the initial solution, which will be further developed.

Path Planning for Obstacle Avoidance of Robot Arm Based on Improved Potential Field Method.

In medical and surgical scenarios, the trajectory planning of a collaborative robot arm is a difficult problem. The artificial potential field (APF) algorithm is a classic method for robot trajectory planning, which has the characteristics of good real-time performance and low computing consumption. There are many variants of the APF algorithm, among which the most widely used variants is the velocity potential field (VPF) algorithm. However, the traditional VPF algorithm has inherent defects and problems, such as easily falling into local minimum, being unable to reach the target, poor dynamic obstacle avoidance ability, and safety and efficiency problems. Therefore, this work presents the improved velocity potential field (IVPF) algorithm, which considers direction factors, obstacle velocity factor, and tangential velocity. When encountering dynamic obstacles, the IVPF algorithm can avoid obstacles better to ensure the safety of both the human and robot arm. The IVPF algorithm also does not easily fall into a local problem when encountering different obstacles. The experiments informed the RRT* algorithm, VPF algorithm, and IVPF algorithm for comparison. Compared with the informed RRT* and VPF algorithm, the result of experiments indicate that the performances of the IVPF algorithm have significant improvements when dealing with different obstacles. The main aim of this paper is to provide a safe and efficient path planning algorithm for the robot arm in the medical field. The proposed algorithm can ensure the safety of both the human and the robot arm when the medical and surgical robot arm is working, and enables the robot arm to cope with emergencies and perform tasks better. The application of the proposed algorithm could make the collaborative robots work in a flexible and safe condition, which could open up new opportunities for the future development of medical and surgical scenarios.

A Concurrent Framework for Constrained Inverse Kinematics of Minimally Invasive Surgical Robots.

Minimally invasive surgery has undergone significant advancements in recent years, transforming various surgical procedures by minimizing patient trauma, postoperative pain, and recovery time. However, the use of robotic systems in minimally invasive surgery introduces significant challenges related to the control of the robot's motion and the accuracy of its movements. In particular, the inverse kinematics (IK) problem is critical for robot-assisted minimally invasive surgery (RMIS), where satisfying the remote center of motion (RCM) constraint is essential to prevent tissue damage at the incision point. Several IK strategies have been proposed for RMIS, including classical inverse Jacobian IK and optimization-based approaches. However, these methods have limitations and perform differently depending on the kinematic configuration. To address these challenges, we propose a novel concurrent IK framework that combines the strengths of both approaches and explicitly incorporates RCM constraints and joint limits into the optimization process. In this paper, we present the design and implementation of concurrent inverse kinematics solvers, as well as experimental validation in both simulation and real-world scenarios. Concurrent IK solvers outperform single-method solvers, achieving a 100% solve rate and reducing the IK solving time by up to 85% for an endoscope positioning task and 37% for a tool pose control task. In particular, the combination of an iterative inverse Jacobian method with a hierarchical quadratic programming method showed the highest average solve rate and lowest computation time in real-world experiments. Our results demonstrate that concurrent IK solving provides a novel and effective solution to the constrained IK problem in RMIS applications.

Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies.

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.

Basic performance of domestic surgical robot and the safety and effectiveness of integrated energy equipment. / å›½äº§æ‰‹æœ¯æœºå™¨äººåŸºæœ¬æ€§èƒ½å’Œæ•´åˆèƒ½é‡è®¾å¤‡çš„å®‰å ¨æ€§åŠæœ‰æ•ˆæ€§.

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.

Comparison of the learning curve of robot-assisted and laparoscopic-assisted gastrectomy. / æœºå™¨äººè¾ åŠ©ä¸Žè ¹è ”é•œè¾ åŠ©èƒƒåˆ‡é™¤æœ¯å­¦ä¹ æ›²çº¿çš„æ¯”è¾ƒ.

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.

[Robot-assisted linear aortofemoral bypass surgery]. / Robot-assistirovannoe lineinoe podvzdoshno-bedrennoe shuntirovanie.

Aortofemoral bypass surgery is still the «gold standard¼ for aortoiliac lesions with excellent results and long-term patency despite improvement of endovascular surgery. Extensive surgical approaches are accompanied by high risk of postoperative complications. Development of minimally invasive surgery and achievements of computerized technologies made a revolution in all surgeries and minimize trauma following complex reconstructive procedures. This also reduces perioperative risks and accelerates recovery. Computerized robotic systems in vascular surgery provide safe complex procedures on aortoiliac segment. We present robot-assisted linear iliofemoral bypass surgery in a 69-year-old patient with chronic arterial insufficiency Fontein grade IV.

[Uncalibrated Positioning Method for Puncture Robots Based on Optical Navigation].

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].

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.

[Research Progress and Prospect Analysis of Vascular Interventional Surgical Robot].

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.

Robot-assisted anorectal pull-through for anorectal malformations with rectourethral and rectovesical fistula: feasibility and short-term outcome.

BACKGROUND: Multiple structures in the anorectal area are closely related to defecation, voiding and sexual function. Although laparoscopic-assisted anorectal pull-through is widely accepted as a minimally invasive surgical technique, controversy still exists for ARMs with rectourethral fistulas. Intraoperative injuries more or less involve the perirectal sphincters and neurovascular tissue. METHODS: Seventeen selected infants with ARMs underwent robot-assisted anorectal pull-through (RAARP) between October 2016 and January 2018. The application of nerve- and sphincter-sparing technique in RAARP was detailed. The feasibility and early outcomes were evaluated. RESULTS: All procedures were completed without conversion. The robotic system facilitated clear dissections between different anatomical layers. Under direct vision, the fistula was easier to repair, and the rectal pouch was precisely placed in the center of the striated muscle complex. During the follow-up of 11.6 months, 13 patients resumed normal defecation. The other four children experienced mild constipation or fecal incontinence. Their continence and defecation functions showed favorable evolution. CONCLUSION: RAARP is a safe and effective alternative for the treatment of ARMs, which provides an advantage in further minimizing the injury to perirectal nerves and sphincters.

Safety and feasibility of robotic liver resection after previous abdominal surgeries.

BACKGROUND: While minimally invasive liver surgery has been increasingly adopted at least for minor resections, experience with robotic liver surgery is still limited to a few highly specialized centers. Due to the fear of abdominal adhesions, a history of prior surgeries is still used as an argument for open approaches. METHODS: Clinical data of all consecutive robotic resections at our center, using the da Vinci Xi surgical system, between April, 2018 and December, 2020, were collected and analyzed as part of a prospective, post-marketing observational study (DRKS00017229). Prior abdominal surgeries were specified according to the surgical approach and localization. Baseline and perioperative outcome criteria were compared between patients with prior surgeries (PS) and patients with no prior surgeries (NPS) in univariate and multivariate analyses. RESULTS: Out of the 126 patients undergoing robotic liver resections, 59% had a history of abdominal surgeries, which were most often colorectal resections (28%) followed by liver resections (20%). Patients with NPS were more likely to undergo robotic liver resection for hepatocellular carcinoma or benign tumors, and to have underlying liver cirrhosis when compared to patients with PS. Other baseline characteristics as well as the extent of resections were similar. Duration of surgery (258 min), conversion rates (6%), and postoperative complications rates (21% Clavien-Dindo ≥ 3) showed no differences between NPS and PS. A subgroup of patients with a history of prior liver surgery showed a longer duration of surgery in univariate analysis. However, this was not confirmed in multivariate analysis which instead revealed tumor entity and liver cirrhosis as independently correlated with duration of surgery. CONCLUSIONS: We propose robotic liver resection to be safe and feasible, including in patients with prior abdominal surgeries. Each patient should be evaluated for a minimally invasive procedure regardless of a history of previous operations.

Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years.

BACKGROUND: While laparoscopic liver surgery has become a standard procedure, experience with robotic liver surgery is still limited. The aim of this prospective study was to evaluate safety and feasibility of robotic liver surgery and compare outcomes with conventional laparoscopy. METHODS: We here report the results of a single-center, prospective, post-marketing observational study (DRKS00017229) investigating the safety and feasibility of robotic liver surgery. Baseline characteristics, surgical complexity (using the IWATE score), and postoperative outcomes were then compared to laparoscopic liver resections performed at our center between January 2015 and December 2020. A propensity score-based matching (PSM) was applied to control for selection bias. RESULTS: One hundred twenty nine robotic liver resections were performed using the da Vinci Xi surgical system (Intuitive) in this prospective study and were compared to 471 consecutive laparoscopic liver resections. After PSM, both groups comprised 129 cases with similar baseline characteristics and surgical complexity. There were no significant differences in intraoperative variables, such as need for red blood cell transfusion, duration of surgery, or conversion to open surgery. Postoperative complications were comparable after robotic and laparoscopic surgery (Clavien-Dindo ≥ 3a: 23% vs. 19%, p = 0.625); however, there were more bile leakages grade B-C in the robotic group (17% vs. 7%, p = 0.006). Length of stay and oncological short-term outcomes were comparable. CONCLUSIONS: We propose robotic liver resection as a safe and feasible alternative to established laparoscopic techniques. The object of future studies must be to define interventions where robotic techniques are superior to conventional laparoscopy.

The impact of robotic technology on the learning curve for robot-assisted gastrectomy in the initial clinical application stage.

OBJECTIVE: To evaluate the impact of robotic technology on the learning curve for robot-assisted gastrectomy in the initial clinical application stage and to compare RAG with laparoscopic-assisted gastrectomy using a short-term evaluation. METHODS: Between September 2016 and December 2018, 111 consecutive distal gastric cancer patients who were candidates for RAG or LAG were prospectively enrolled. Operative findings, morbidity, oncological findings, and the learning curve were analyzed. RESULTS: Thirty patients underwent RAG with the da Vinci Si robot system, and eighty-one patients underwent LAG. Blood loss was lower during RAG than during LAG (133.80 ± 95.28 vs. 178.83 ± 98.37, P = 0.046). The operative time for RAG was significantly longer (304.45 ± 42.08 vs. 281.17 ± 32.69, P = 0.015). The number of retrieved lymph nodes (LNs) was greater (37.33 ± 8.25 vs. 32.78 ± 5.98, P = 0.003) with RAG. Notably, RAG had an advantage in the dissection of No. 9 and 11p LNs (3.56 ± 1.76 vs. 2.78 ± 1.30, P = 0.038; 2.48 ± 0.93 vs. 1.99 ± 0.84, P = 0.015, respectively). Severe complications were less frequent in the RAG group (7 (8.6%) vs. 1 (3.3%), P = 0.003). No significant differences in terms of postoperative recovery were found between the two groups. The learning curve for RAG showed that the cumulative sum value decreased from the 10th case, while it decreased from the 28th case in the LAG group. CONCLUSION: By means of robotic technology, RAG is better than LAG for the dissection of No. 9 and 11p LNs and for the alleviation of surgical trauma, and the technique is learned more rapidly during the preliminary stage than the LAG technique.

Early evaluation of a next-generation surgical system in robot-assisted total laparoscopic hysterectomy: A prospective clinical cohort study.

INTRODUCTION: This study aimed to demonstrate the safe and effective use of the Versius surgical system (CMR Surgical, Cambridge, UK) in robot-assisted total laparoscopic hysterectomy. This surgical robot was developed iteratively with input from surgeons to improve surgical outcomes and end-user experience. We report data from the gynecology cohort of an early clinical trial designed in broad alignment with IDEAL-D (Idea, Development, Exploration, Assessment, Long-term follow-up - Devices) stage 2b (Exploration). MATERIAL AND METHODS: The study is registered in the Indian clinical trials register (CTRI/2019/02/017872). Adult women requiring total hysterectomy who provided informed consent and met the eligibility criteria underwent procedures at one of three hospitals in India. Five surgeons performed robot-assisted total laparoscopic hysterectomies using the device from March 2019 to September 2020. The primary endpoint was rate of unplanned conversion to conventional laparoscopic or open surgery. Adverse events were adjudicated by an independent clinical events committee using endoscope video recordings and clinical notes. RESULTS: In total, 144 women underwent surgery (median age: 44 years [range: 28-78]; median body mass index 25.8 kg/m2 [range: 14.3-47.8]). The rate of unplanned conversion to conventional laparoscopy was 2/144 (1.4%); neither conversion was device related. No surgery was converted to open. In total, 13 adverse events occurred among seven (4.9%) patients, comprising seven serious adverse events and six adverse events. One serious adverse event was deemed device-related. Two patients were readmitted to hospital within 30 days; both made a full recovery. No patients died within 90 days of surgery. CONCLUSIONS: The device provides a safe and effective option for total laparoscopic hysterectomy; these findings support its continued implementation in larger patient cohorts and expansion in other major minimal access indications.

Comparison of the short-term efficacy of two types of robotic total mesorectal excision for rectal cancer.

BACKGROUND: The advantages and disadvantages of robotic technology compared with conventional surgery for low rectal cancer have been discussed extensively. However, a few studies on the efficacy of total mesorectal excision (TME) with different robotic technologies have been reported. The aim of this study was to evaluate the efficacy of two types of robot-assisted TME (R-TME) compared with laparoscopic TME (L-TME). METHODS: A prospective comparative study was conducted comparing da Vinci R-TME, Micro Hand S R-TME, and L-TME for rectal cancer. This study was registered with "Clinicaltrials.gov" (ID: NCT02752698) and approved by the Association for the Accreditation of Human Research Protection Program (AAHRPP) (Project number: T16007). Between January 2017 and May 2019, patients with rectal cancer (cT1-3NxM0) were prospectively registered in the Third Xiangya Hospital. The integrity of the TME sample served as the primary outcome. Secondary outcomes included the involvement of the circumferential and distal resection margins (CRM and DRM), number of lymph nodes retrieved, blood loss, operative time, conversion rate, comprehensive complication index score, the International Prostate Symptom score, the International Index of Erectile Function, and the Female Sexual Function Index. RESULTS: Of 134 patients with rectal cancer (74 males, mean age [SD] 59.1 ± 8.27 years), 46 patients underwent laparoscopic TME, 45 patients underwent da Vinci R-TME, and 43 patients underwent Micro Hand S R-TME. There were no differences in results between the two types of R-TME. Compared with laparoscopic TME, significant reductions in blood loss (median 65.50 ml da Vinci; median 66.54 ml Micro Hand S vs median 95.04 ml L-TME p = 0.037 and p = 0.041, respectively) and conversion rate (2.2% da Vinci; 2.3% Micro Hand S vs 6.8% L-TME p = 0,040 for the comparison daVinci L-TME and p = 0.038 for the comparison Micro Hand S vs. L-TME) with da Vinci Si and Micro Hand S R-TME were noted, and significant increases in operation time (230.05 min da Vinci; 235.03 min Micro Hand S vs. 205.53 min L-TME p = 0.045 and p = 0.043, respectively) was observed. Additionally, more patients underwent TME with sphincter-preserving methods in the two R-TME groups based on the type of operation (da Vinci 97.7%; Micro Hand S 97.9% vs. L-TME 82% resulting in  p = 0.033 for the comparison daVinci L-TME and p = 0.035 for the comparison Micro Hand S vs. L-TME). In comparison with L-TME, there was a larger number of lymph nodes retrieved (da Vinci mean 17.54; Micro Hand S mean 17.32 vs. L-TME mean 14.96 p = 0.031 for the comparison daVinci L-TME and p = 0.033 for the comparison Micro Hand S vs L-TME) and less blood loss (da Vinci mean 65.50 ml; Micro Hand S mean 66.54 ml vs. L-TME mean 95.04 ml, p = 0.037 for the comparison daVinci L-TME and p = 0.041 for the comparison Micro Hand S vs. L-TME), and incidence of severe postoperative complications was similar among three TME groups except for the earlier recovery of urogenital function (mean IPSS score da Vinci 7.73±1.35; Micro Hand S7.75±1.47 vs L-TME 14.26±1.41 p<0.001 for the comparison da Vinci L-TME and p<0.001 for the comparison Microhand S vs L-TME) in the two R-TME groups. CONCLUSIONS: In our study, compared with laparoscopic surgery, da Vinci or Micro Hand R-TME exhibited similar superiority in the quality of oncologic resection, postoperative morbidity, and recovery of postoperative function.

Contact Compliance Based Visual Feedback for Tool Alignment in Robot Assisted Bone Drilling.

In recent decades, robot-assisted surgery has been proven superior at providing more accurate outcomes than the conventional one, particularly in minimally invasive procedures. However, there are still limitations to these kinds of surgical robots. Accurate bone drilling on the steep and hard surface of cortical bone is still challenging. The issues of slipping away from the target entry point on the bone surface and subsequently deviating from the desired path are still not completely solved. Therefore, in this paper, a force control is proposed to accompany the resolved motion rate controller in a handheld orthopedic robot system. The force control makes it possible to adjust the contact compliance of the drill to the bone surface. With the proper contact compliance, the drill can be prevented from deflecting in contact with the bone surface, and will eventually be directed to the target entry point. The experiments on test jig and vertebra phantom also show that the robot under the proposed contact compliance visual feedback control structure could produce better usability positioning accuracy under various contact disturbances than its counterpart.