Role of oxygen reserve index monitoring in patients undergoing robot-assisted radical prostatectomy: a retrospective study.

PURPOSE: Robot-assisted radical prostatectomy (RARP) is a common surgical procedure for the treatment of prostate cancer. Although beneficial, it can lead to intraoperative hypoxia due to high-pressure pneumoperitoneum and Trendelenburg position. This study explored the use of oxygen reserve index (ORi) to monitor and predict hypoxia during RARP. METHODS: A retrospective analysis was conducted on 329 patients who underwent RARP at the Seoul National University Bundang Hospital between July 2021 and March 2023. Various pre- and intraoperative variables were collected, including ORi values. The relationship between ORi values and hypoxia occurrence was assessed using receiver operating characteristic curves and logistic regression analysis. RESULTS: Intraoperative hypoxia occurred in 18.8% of the patients. The receiver operating characteristic curve showed a satisfactory area under the curve of 0.762, with the ideal ORi cut-off value for predicting hypoxia set at 0.16. Sensitivity and specificity were 64.5% and 75.7%, respectively. An ORi value of < 0.16 and a higher body mass index were identified as independent risk factors of hypoxia during RARP. CONCLUSIONS: ORi monitoring provides a non-invasive approach to predict intraoperative hypoxia during RARP, enabling early management. Additionally, the significant relationship between a higher body mass index and hypoxia underscores the importance of individualized patient assessment.

On the relationship between various anticoagulants and robot-assisted radical prostatectomy: a single-surgeon serial analysis.

Prostate cancer patients often have other health conditions and take anticoagulants. It was believed that surgery under anticoagulants could worsen surgical results. This study aims to explore the safety of robot-assisted prostatectomy in anticoagulated patients, without any exclusion criteria. The study included 500 patients who underwent RARP by a single surgeon between April 2019 and August 2022. Patients were divided into two groups: Group 1, consisting of 376 men (75.2%), did not receive any anticoagulation, while Group 2, with 124 patients (24.8%), received different forms of anticoagulation. Then, the anticoagulation group was divided into 4 subgroups according to their definite anticoagulation: the aspirin 15.6%, new oral anticoagulants (NOAC) 5.4%, Vitamin K antagonist (VKA) 2%, and dual-antiplatelet therapy (DAPT) 1.8% subgroup. Postoperative complications and readmission rates were compared between the two study groups and subgroups. Patients in the combined group 2 were older and they also carried more comorbidities compared to men in group 1 (p = 0.03, p = 0.001).The study groups had similar oncological results, with 40.4% of patients having locally advanced cancers. Catheter days were longer in the anticoagulation group (4.5 vs 4 days, p = 0.001). No significant differences were observed between study groups for overall, minor, and major complications (p = 0.160, 0.100, and 0.915, respectively). In addition, readmissions were low (5.6%) and similar between the study groups (p = 0.635). Under cautious management, RARP under diverse anticoagulation regimes is safe and has comparable results to men with no medications. Further prospective studies must be conducted to confirm our findings.

Single-port robotic-assisted laparoscopic synchronous surgery in pediatric patent processus vaginalis.

PURPOSE: Patent processus vaginalis (PPV) is usually observed in pediatric abdominal surgery; however, robotic single-port surgery in repairing processus vaginalis has not been reported in children. Herein, we present our clinical experiences in single-port robotic surgeries for PPV repair to evaluate both efficacy and safety. METHODS: Retrospective analysis of patients underwent single-port robotic-assisted laparoscopic surgery for genitourinary diseases from May 2020 and May 2023 in our center. Among these patients, 21 children had PPV repaired at the same time. The case characteristics and follow-up data were recorded. RESULTS: Twenty-one of the 53 children were found to have PPV during genitourinary surgery. The simultaneous treatment of the primary disease and PPV with a single-port robotic-assisted platform was both convenient and safe. There was no significant increase in total operation time, and no excessive intraoperative hemorrhage was observed in any of the operations. There were no complications observed on follow-up. CONCLUSION: With a high incidence of PPV in children, a single-port robotic-assisted procedure is feasible and effective if simultaneously performed when addressing a primary abdominal disease.

Assessing the perioperative outcomes of abdominal drain omission after robot-assisted partial nephrectomy.

The study aimed to evaluate the impact of abdominal drain placement (vs. omission) on perioperative outcomes of robot-assisted partial nephrectomy (RAPN), focusing on complications, time to canalization, deambulation, and pain management. A prospectively-maintained institutional database was queried to get data of patients who underwent RAPN for renal masses between January 2018 and May 2023 at our Institution. Baseline, surgical, and postoperative data were collected. Retrieved patients were stratified based upon placement of abdominal drain (Y/N). Descriptive analyses comparing the two groups were conducted as appropriate.77 After adjusting for potential confounders, a logistic regression analysis was conducted to evaluate significant predictors of any grade and "major" complications. 342 patients were included: 192 patients in the "drain group" versus 150 patients in the "no-drain" group. Renal masses were larger (p < 0.001) and at higher complexity (RENAL score, p = 0.01), in the drain group. Procedures in the drain group had statistically significantly longer operative time, ischemia time, and higher blood loss (all p-values < 0.001). The urinary collecting system was more likely involved compared to the no-drain group (p = 0.01). At multivariate analysis, abdominal drainage was not a significant predictor of any grade (OR 0.79, 95%CI 0.33-1.87) and major postoperative complications (OR 3.62, 95%CI 0.53-9.68). Patients in the drain group experienced a statistically significantly higher hemoglobin drop (p < 0.01). Moreover, they exhibited statistically significant higher paracetamol consumption (p < 0.001) and need for additional opioids (p = 0.02). In summary, the study results suggest the safety of omitting drain placement and remark on the need for personalized decision-making, which considers patient and procedural factors.

Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression.

Lymphocele is one of the most common complications after radical prostatectomy. Multiple authors have proposed the use of vessel sealants or peritoneal interposition techniques as preventive interventions. This study aimed to aggregate and analyze the available literature on different interventions which seek to prevent lymphocele through a Bayesian Network. A systematic review was performed to identify prospective studies evaluating strategies for lymphocele prevention after robot assisted laparoscopic prostatectomy + pelvic lymph node dissection. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was then used to build a network in R Studio. These networks were used to model 200,000 Markov Chains via MonteCarlo sampling. The results are expressed as odds ratios (OR) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for pelvic lymph node dissection extent. Ten studies providing data from 2211 patients were included. 1097 patients received an intervention and 1114 patients served as controls. Interposition with fenestration had the lowest risk of developing a lymphocele (OR 0.14 [0.04, 0.50], p = 0.003). All interventions, except sealants or patches, had significant decreased odds of lymphocele rates. Meta-analysis of all the included studies showed a decreased risk of developing a lymphocele (OR 0.42 [0.33, 0.53], p < 0.00001) for the intervention group. Perivesical fixation and interposition with fenestration appear to be effective interventions for reducing the overall incidence of lymphocele.

Does the presence of abdominal wall adhesions make gynecologic robotic surgery difficult?

This study aimed to assess the status of abdominal wall adhesions resulting from prior surgeries and their impact on the outcomes of robotic surgery. We retrospectively reviewed clinical information, surgical outcomes, and the status of abdominal wall adhesions in patients who underwent gynecologic robotic surgery at Yamanashi Central Hospital, between April 2018 and March 2023. Abdominal wall adhesions were classified into seven locations and their presence was assessed at each site. Among the 768 cases examined, 196 showed the presence of abdominal wall adhesions. Notably, patients with a history of abdominal surgery exhibited a significantly higher incidence of abdominal wall adhesions than those without such surgical history, although no significant difference was observed in the frequency of adhesions in the upper left abdomen. Patients with a history of gynecologic, gastrointestinal, or biliopancreatic surgeries were more likely to have adhesions at the umbilicus or upper abdomen sites where trocars are typically inserted during robotic surgery. Although cases with abdominal wall adhesions experienced longer operative times than those without, there was no significant difference in estimated blood loss. In 13 cases (1.7%), adjustments in trocar placement were necessary due to abdominal wall adhesions, although none of the cases required conversion to open or conventional laparoscopic surgery. Abdominal wall adhesions pose challenges to minimally invasive procedures, emphasizing the importance of predicting these adhesions based on a patient's surgical history to safely perform robotic surgery. These results suggest that the robot's flexibility proves effective in managing abdominal wall adhesions.

Purely robotic ileocystoplasty in children: why not? First case in Spain. / Ampliación vesical pediátrica mediante abordaje robótico puro: ¿por qué no? Primer caso en España.

INTRODUCTION: We present the first case of pediatric ileocystoplasty using a purely robotic approach in Spain. CASE REPORT: 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladder augmentation with ileum patch was decided upon. Surgery was carried out using a purely robotic approach with 4 robotic and 2 accessory ports. Surgery duration was 380 minutes in total, without intraoperative complications. He was discharged 2 weeks after cystographic control. During 32-months follow-up, he has remained continent. DISCUSSION: The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgical techniques. Given the little availability of the robot and the low pediatric volume, its standardization is a challenge. Our accumulated experience is consistent with the current literature and shows promising surgical and esthetic results. We hope this case report will contribute to the divulgation and progressive introduction of robotic surgery in our daily lives.

INTRODUCCION: Presentamos el primer caso de abordaje robótico pediátrico puro en España. CASO CLINICO: Varón de 12 años con vejiga neurógena de escasa capacidad y altas presiones sin respuesta al tratamiento conservador, abogando por una ileocistoplastia de aumento. Se lleva a cabo un abordaje robótico puro con 4 puertos robóticos y 2 accesorios, de 380 minutos de duración total sin complicaciones intraoperatorias. Es dado de alta a las 2 semanas previo control cistográfico. Tras 32 meses de seguimiento continúa continente. COMENTARIOS: La mínima invasión, mayor precisión y ergonomía del abordaje robótico, hacen de éste una opción óptima para técnicas quirúrgicas complejas. Dada la difícil disponibilidad del robot y el escaso volumen pediátrico, resulta un reto su normalización en este campo. Nuestra experiencia coincide con la literatura, mostrando resultados quirúrgicos y estéticos prometedores. Esperamos este reporte contribuya a la difusión e introducción progresiva de la cirugía robótica en nuestra rutina.

Patient's Healthy-Limb Motion Characteristic-Based Assist-As-Needed Control Strategy for Upper-Limb Rehabilitation Robots.

The implementation of a progressive rehabilitation training model to promote patients' motivation efforts can greatly restore damaged central nervous system function in patients. Patients' active engagement can be effectively stimulated by assist-as-needed (AAN) robot rehabilitation training. However, its application in robotic therapy has been hindered by a simple determination method of robot-assisted torque which focuses on the evaluation of only the affected limb's movement ability. Moreover, the expected effect of assistance depends on the designer and deviates from the patient's expectations, and its applicability to different patients is deficient. In this study, we propose a control method with personalized treatment features based on the idea of estimating and mapping the stiffness of the patient's healthy limb. This control method comprises an interactive control module in the task-oriented space based on the quantitative evaluation of motion needs and an inner-loop position control module for the pneumatic swing cylinder in the joint space. An upper-limb endpoint stiffness estimation model was constructed, and a parameter identification algorithm was designed. The upper limb endpoint stiffness which characterizes the patient's ability to complete training movements was obtained by collecting surface electromyographic (sEMG) signals and human-robot interaction forces during patient movement. Then, the motor needs of the affected limb when completing the same movement were quantified based on the performance of the healthy limb. A stiffness-mapping algorithm was designed to dynamically adjust the rehabilitation training trajectory and auxiliary force of the robot based on the actual movement ability of the affected limb, achieving AAN control. Experimental studies were conducted on a self-developed pneumatic upper limb rehabilitation robot, and the results showed that the proposed AAN control method could effectively estimate the patient's movement needs and achieve progressive rehabilitation training. This rehabilitation training robot that simulates the movement characteristics of the patient's healthy limb drives the affected limb, making the intensity of the rehabilitation training task more in line with the patient's pre-morbid limb-use habits and also beneficial for the consistency of bilateral limb movements.

Innovative Metaheuristic Optimization Approach with a Bi-Triad for Rehabilitation Exoskeletons.

The present work proposes a comprehensive metaheuristic methodology for the development of a medical robot for the upper limb rehabilitation, which includes the topological optimization of the device, kinematic models (5 DOF), human-robot interface, control and experimental tests. This methodology applies two cutting-edge triads: (1) the three points of view in engineering design (client, designer and community) and (2) the triad formed by three pillars of Industry 4.0 (autonomous machines and systems, additive manufacturing and simulation of virtual environments). By applying the proposed procedure, a robotic mechanism was obtained with a reduction of more than 40% of its initial weight and a human-robot interface with three modes of operation and a biomechanically viable kinematic model for humans. The digital twin instance and its evaluation through therapeutic routines with and without disturbances was assessed; the average RMSEs obtained were 0.08 rad and 0.11 rad, respectively. The proposed methodology is applicable to any medical robot, providing a versatile and effective solution for optimizing the design and development of healthcare devices. It adopts an innovative and scalable approach to enhance their processes.

A Multistage Hemiplegic Lower-Limb Rehabilitation Robot: Design and Gait Trajectory Planning.

Most lower limb rehabilitation robots are limited to specific training postures to adapt to stroke patients in multiple stages of recovery. In addition, there is a lack of attention to the switching functions of the training side, including left, right, and bilateral, which enables patients with hemiplegia to rehabilitate with a single device. This article presents an exoskeleton robot named the multistage hemiplegic lower-limb rehabilitation robot, which has been designed to do rehabilitation in multiple training postures and training sides. The mechanism consisting of the thigh, calf, and foot is introduced. Additionally, the design of the multi-mode limit of the hip, knee, and ankle joints supports delivering therapy in any posture and training sides to aid patients with hemiplegia in all stages of recovery. The gait trajectory is planned by extracting the gait motion trajectory model collected by the motion capture device. In addition, a control system for the training module based on adaptive iterative learning has been simulated, and its high-precision tracking performance has been verified. The gait trajectory experiment is carried out, and the results verify that the trajectory tracking performance of the robot has good performance.

MSK-TIM: A Telerobotic Ultrasound System for Assessing the Musculoskeletal System.

The aim of this paper is to investigate technological advancements made to a robotic tele-ultrasound system for musculoskeletal imaging, the MSK-TIM (Musculoskeletal Telerobotic Imaging Machine). The hardware was enhanced with a force feedback sensor and a new controller was introduced. Software improvements were developed which allowed the operator to access ultrasound functions such as focus, depth, gain, zoom, color, and power Doppler controls. The device was equipped with Wi-Fi network capability which allowed the master and slave stations to be positioned in different locations. A trial assessing the system to scan the wrist was conducted with twelve participants, for a total of twenty-four arms. Both the participants and radiologist reported their experience. The images obtained were determined to be of satisfactory quality for diagnosis. The system improvements resulted in a better user and patient experience for the radiologist and participants. Latency with the VPN configuration was similar to the WLAN in our experiments. This research explores several technologies in medical telerobotics and provides insight into how they should be used in future. This study provides evidence to support larger-scale trials of the MSK-TIM for musculoskeletal imaging.

Towards humanlike grasp in robotic hands: mechanical implementation of force synergies.

In the field of robotic hands, finger force coordination is usually achieved by complex mechanical structures and control systems. This study presents the design of a novel transmission system inspired from the physiological concept of force synergies, aiming to simplify the control of multifingered robotic hands. To this end, we collected human finger force data during six isometric grasping tasks, and force synergies (i.e. the synergy weightings and the corresponding activation coefficients) were extracted from the concatenated force data to explore their potential for force modulation. We then implemented two force synergies with a cable-driven transmission mechanism consisting of two spring-loaded sliders and five V-shaped bars. Specifically, we used fixed synergy weightings to determine the stiffness of the compression springs, and the displacements of sliders were determined by time-varying activation coefficients. The derived transmission system was then used to drive a five-finger robotic hand named SYN hand. We also designed a motion encoder to selectively activate desired fingers, making it possible for two motors to empower a variety of hand postures. Experiments on the prototype demonstrate successful grasp of a wide range of objects in everyday life, and the finger force distribution of SYN hand can approximate that of human hand during six typical tasks. To our best knowledge, this study shows the first attempt to mechanically implement force synergies for finger force modulation in a robotic hand. In comparison to state-of-the-art robotic hands with similar functionality, the proposed hand can distribute humanlike force ratios on the fingers by simple position control, rather than resorting to additional force sensors or complex control strategies. The outcome of this study may provide alternatives for the design of novel anthropomorphic robotic hands, and thus show application prospects in the field of hand prostheses and exoskeletons.

Acute kidney injury after robot-assisted laparoscopic prostatectomy: A meta-analysis.

BACKGROUND: We investigated the rates of acute kidney injury (AKI) post robot-assisted laparoscopic prostatectomy (RALP). METHODS: A comprehensive search was conducted to identify studies that reported the rates of AKI post-RALP. A random effects model was used, and the pooled rates of AKI were calculated. RESULTS: We identified 10 studies with 60,937 patients to be included. The mean age was 65.1 years. The mean anaesthesia time was 234.3 min (95% CI: 177.8-290.9). The mean operation time was 212.2 min (95% CI: 188.7-235.6). The mean estimated blood loss was 314.1 mL (95% CI: 153-475.3). The mean intraoperative IV fluids administered were 1985 mL (95% CI: 1516.3-2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19-23.9). CONCLUSIONS: The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post-RALP.

Outcomes of robot-assisted radical prostatectomy in men after trans-urethral resection of the prostate: a matched-pair analysis.

Prior history of transurethral resection of the prostate (TURP) can complicate Robot-assisted radical prostatectomy (RARP). Very few studies analyse the outcomes of RARP in men with a prior history of TURP. We analysed the oncological and functional outcomes of RARP in post-TURP men from our prospectively maintained database. We included the RARP data from January 2016 to January 2022. Thirty men who had RARP with a prior history of TURP were identified (Group 2). They were matched using R software and propensity score matching to 90 men with no previous TURP (Group-1). The groups were matched for age, body mass index (BMI), Gleason score, stage, PSA and D'Amico risk category in a 1:3 ratio. The two-year oncological and functional outcomes were compared. Overall, the study found no significant difference between the groups in the preoperative parameters, such as BMI, age, Gleason grade, clinical stage, PSA, prostate volume, and D'amico risk grouping. There was no difference in the estimated blood loss. The TURP group had a lower chance of having a nerve spare (p = 0.03). The median console time was longer in the TURP group (140 min (120,180) versus 168 (129,190) p = 0.058). The postoperative complications (Clavien-Dindo 3a 2% versus 6.7%) and hospital stay (median of 2 days), positive surgical margins, continence, and biochemical recurrence rates at 3, 12, and 24 months were not statistically different between the groups. In high-volume centres, the oncological and continence outcomes of RARP post-TURP are not inferior to that of men without prior TURP.

Environmental impact of hybrid (reusable/single-use) ports versus single-use equivalents in robotic surgery.

Given the rise in robotic surgery, and parallel movement towards net zero carbon, sustainable healthcare systems, it is important that the environmental impact of robotic approaches is minimised. The majority of greenhouse gas emissions associated with robotic surgery have previously been associated with single-use items. Whilst switching from single-use products to hybrid equivalents (predominantly reusable, with a small single-use component) has previously been found to reduce the environmental impact of a range of products used for laparoscopic surgery, the generalisability of this to robotic surgery has not previously been demonstrated. In this life cycle assessment, use of hybrid 5 mm ports compatible with emerging robotic systems (143 g CO2e) was found to reduce the carbon footprint by 83% compared with using single-use equivalents (816 g CO2e), accompanied by reductions in fifteen out of eighteen midpoint environmental impact categories. For endpoint categories, there was an 81% reduction in impact on human health and species loss, and 82% reductions in resource depletion associated with using hybrid robotic 5 mm ports. Whilst the carbon footprint of 5 mm hybrid ports compatible with emerging robotic equipment was 70% higher than previous estimates of ports appropriate for conventional laparoscopic approaches, the six-fold reductions seen with hybrids in this analysis point to the generalisability of the finding that reusable or hybrid products have a lower carbon footprint when compared with single-use equivalents. Surgeons, procurement teams, and policy makers should encourage innovation towards clinically safe and effective robotic instruments with maximal reusable components.

Is the robotic approach the future of distal pancreatectomy with splenectomy? A propensity score matched analysis.

Our study provides a comparative analysis of the Laparo-Endoscopic Single Site (LESS) and robotic surgical approaches for distal pancreatectomy and splenectomy, examining their cosmetic advantages, patient outcomes, and operative efficiencies through propensity score matching (PSM). We prospectively followed 174 patients undergoing either the LESS or robotic procedure, matched by cell type, tumor size, age, sex, and BMI from 2012 to 2023. Propensity score matching (PSM) was utilized for data adjustment, with results presented as median (mean ± SD). Post-PSM analysis showed no significant differences in age or BMI between the two groups. LESS approach exhibited a shorter operative duration (180(180 ± 52.0) vs. 248(262 ± 78.5) minutes, p = 0.0002), but increased estimated blood loss (200(317 ± 394.4) vs. 100 (128 ± 107.2) mL, p = 0.04). Rates of intraoperative and postoperative complications, length of hospital stay, readmissions within 30 days, in-hospital mortalities, and costs were comparably similar between the two procedures. While the robotic approach led to lower blood loss, LESS was more time-efficient. Patient outcomes were similar in both methods, suggesting that the choice between these surgical techniques should balance cosmetic appeal with technical considerations.

The fluidic memristor as a collective phenomenon in elastohydrodynamic networks.

Fluid flow networks are ubiquitous and can be found in a broad range of contexts, from human-made systems such as water supply networks to living systems like animal and plant vasculature. In many cases, the elements forming these networks exhibit a highly non-linear pressure-flow relationship. Although we understand how these elements work individually, their collective behavior remains poorly understood. In this work, we combine experiments, theory, and numerical simulations to understand the main mechanisms underlying the collective behavior of soft flow networks with elements that exhibit negative differential resistance. Strikingly, our theoretical analysis and experiments reveal that a minimal network of nonlinear resistors, which we have termed a 'fluidic memristor', displays history-dependent resistance. This new class of element can be understood as a collection of hysteresis loops that allows this fluidic system to store information, and it can be directly used as a tunable resistor in fluidic setups. Our results provide insights that can inform other applications of fluid flow networks in soft materials science, biomedical settings, and soft robotics, and may also motivate new understanding of the flow networks involved in animal and plant physiology.

The evolution of robotics: research and application progress of dental implant robotic systems.

The use of robots to augment human capabilities and assist in work has long been an aspiration. Robotics has been developing since the 1960s when the first industrial robot was introduced. As technology has advanced, robotic-assisted surgery has shown numerous advantages, including more precision, efficiency, minimal invasiveness, and safety than is possible with conventional techniques, which are research hotspots and cutting-edge trends. This article reviewed the history of medical robot development and seminal research papers about current research progress. Taking the autonomous dental implant robotic system as an example, the advantages and prospects of medical robotic systems would be discussed which would provide a reference for future research.