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1.
Surg Clin North Am ; 100(2): 461-468, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169190

RESUMO

Robotic-assisted surgery has represented a revolution for surgical practice and minimally invasive surgery. The case volume is increasing exponentially and the numbers continue to grow particularly owing to urology and general surgery subspecialties. Nonetheless, robotic surgery is not exempt from complications, which can occur during the preoperative, intraoperative, and postoperative periods, and in particular with issues related to patient preparation, team dynamics, equipment failure, complications related to the surgical act, and surgical outcomes.


Assuntos
Complicações Intraoperatórias , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Competência Clínica , Falha de Equipamento , Humanos , Procedimentos Cirúrgicos Robóticos/instrumentação
2.
Mayo Clin Proc ; 94(11): 2263-2269, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31635830

RESUMO

OBJECTIVE: To evaluate the outcomes of robotic mitral valve repair (MVr) by primary indication per American Heart Association guidelines for surgery: class I vs class IIa. PATIENTS AND METHODS: From January 1, 2008, through September 30, 2016, 603 patients underwent robotic MVr for severe primary mitral regurgitation. Medical records of 576 consenting patients were retrospectively reviewed to determine the primary indication for surgery. Patients were stratified into class I or class IIa, and preoperative, intraoperative, and postoperative variables were compared. RESULTS: Of 516 patients, 428 (83%) had class I indication and 88 (17%) had class IIa indication for surgery. Preoperatively, no significant differences were observed between both cohorts. Importantly, a significantly higher number of patients with class I indication underwent MVr for bileaflet prolapse (172 of 428 [40%] vs 21 of 88 [25%]; P=.03). Early MVr outcomes indicated recurrent mitral regurgitation (moderate or greater) in only 12 of 576 (2%), and no significant differences were observed between classes (P=.23). Apart from parameters for ventricular size, all other intraoperative and postoperative variables were comparable between both cohorts. CONCLUSION: Comparable outcomes were indicated across all classes of indications for MVr surgery. These results continue to support the use of this surgical technique, even in less sick patients. Early referral along with more extensive robotic MVr experience will likely result in further improvements in long-term outcomes.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do Tratamento
3.
World J Gastroenterol ; 25(28): 3722-3737, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391768

RESUMO

Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.


Assuntos
Pancreatectomia/métodos , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Drenagem/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Pâncreas/efeitos dos fármacos , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Pancreatectomia/instrumentação , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Suco Pancreático/efeitos dos fármacos , Suco Pancreático/metabolismo , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/instrumentação , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Stents/efeitos adversos , Resultado do Tratamento
5.
Urology ; 133: 5-10.e1, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31299326

RESUMO

Laparoendoscopic single-site surgery was developed to minimize the morbidity associated with laparoscopic surgery. Application of robotics in urologic surgery has been widely adopted given the advantages it provides over standard laparoscopy including 3-dimensional vision, improved ergonomics, enhanced precision and dexterity. The real benefit of robotic laparoendoscopic single-site surgery is still unbalanced by the limitations of this approach and the sole applicability by highly skilled surgeons. The ideal robotic platform for single-port surgery should have the possibility of being deployed through a single access site restoring intracorporeal triangulation for precise instrument maneuvers. This manuscript reviews the potential applications of R-1 new surgical robot, highlighting its added value in allowing new surgical approaches.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos , Cadáver , Humanos , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Urológicos/educação
6.
World Neurosurg ; 130: e737-e742, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284059

RESUMO

BACKGROUND: Idiopathic scoliosis is the most common spinal disorder in the pediatric population. The goals of treatment for pediatric idiopathic scoliosis are to correct deformity, prevent curve progression, restore trunk symmetry and balance, and minimize pain and morbidity. Surgical treatment has advanced significantly, from the advent of segmental pedicle screw instrumentation several decades ago to the recent development of robotic-assisted surgery and growth-modulating fusionless surgery. The objective of the present study was to review the reported data on emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. METHODS: The PubMed and Google Scholar electronic databases were used to identify studies that had examined new emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. RESULTS: Major developments in the surgical techniques for pediatric idiopathic scoliosis have included robotic-assisted pedicle screw placement, vertebral body stapling, vertebral body tethering, magnetically controlled growing rods, ApiFix (not currently approved for use in the United States by the Food and Drug Administration), and sublaminar polyester bands. Such growth-modulating fusionless surgical techniques have received increasing attention in recent years, especially for the younger pediatric scoliosis population with significant growth potential remaining. CONCLUSIONS: Various emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents have demonstrated promising results in the reported data thus far. However, longer term prospective studies with larger cohorts are necessary to better evaluate their safety and efficacy.


Assuntos
Parafusos Pediculares/tendências , Impressão Tridimensional/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Escoliose/cirurgia , Adolescente , Criança , Feminino , Humanos , Fenômenos Magnéticos , Masculino , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Escoliose/diagnóstico , Resultado do Tratamento
7.
Otolaryngol Head Neck Surg ; 161(5): 852-855, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31331246

RESUMO

Mastoidectomy is a common surgical procedure within otology. Despite being inherently well suited for implementation of robotic assistance, there are no commercially available robotic systems that have demonstrated utility in aiding with this procedure. This article describes a robotic technique for image-guided mastoidectomy with an experimental cooperatively controlled robotic system developed for use within otolaryngology-head and neck surgery. It has the ability to facilitate enhanced operative precision with dampening of tremor in simulated surgical tasks. Its kinematic design is such that the location of the attached surgical instrument is known with a high degree of fidelity at all times. This facilitates image registration and subsequent definition of virtual fixtures, which demarcate surgical workspace boundaries and prevent motion into undesired areas. In this preliminary feasibility study, we demonstrate the clinical utility of this system to facilitate performance of a cortical mastoidectomy by a novice surgeon in 5 identical temporal bone models with a mean time of 221 ± 35 seconds.


Assuntos
Mastoidectomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Assistida por Computador/instrumentação , Humanos , Mastoidectomia/métodos , Microcirurgia/métodos , Modelos Anatômicos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos
8.
Langenbecks Arch Surg ; 404(5): 615-620, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300891

RESUMO

PURPOSE: The da Vinci Surgical System family remains the most widely used surgical robotic system for laparoscopy. Data about gastric bypass surgery with the Xi Surgical System are not available yet. We compared Roux-en-Y gastric bypass surgery performed at our institution with the da Vinci Xi and the da Vinci Si Surgical System. METHODS: All robotic gastric bypass procedures performed between January 2013 and September 2016 were analyzed retrospectively. Patient demographics and operative and postoperative outcomes up to 30 days were compared for the da Vinci Xi and Si Surgical System. Robotic costs per procedure were modeled including posts for a standard set of robotic instruments, capital investment, and yearly maintenance. RESULTS: One-hundred forty-four Xi Surgical System and 195 Si Surgical System procedures were identified. Mean age (p = 0.9), gender distribution (p = 0.8), BMI (p = 0.6), and ASA scores (p > 0.5) were similar in both cohorts. Operating room times were similar in both groups (219.4 ± 58.8 vs. 227.4 ± 60.5 min for Xi vs. Si, p = 0.22). Docking times were significantly longer with the Xi compared with the Si Surgical System (9 ± 4.8 vs. 5.8 ± 4 min, p < 0.0001). There was no difference in incidence of minor (13.9 vs. 10.3%, p = 0.3) and major complications (5.6 vs. 5.1%, p = 1 for Xi vs. Si). Costs were higher for the Xi Surgical System caused by higher capital investment and yearly maintenance. CONCLUSIONS: Roux-en-Y gastric bypass surgery can be safely performed with the Xi Surgical System, while drawbacks include longer docking times and higher costs.


Assuntos
Derivação Gástrica/instrumentação , Laparoscopia/instrumentação , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Adulto , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/economia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Resultado do Tratamento
9.
Med Biol Eng Comput ; 57(9): 1999-2010, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31346947

RESUMO

Interventional surgery is widely used in the treatment of cardiovascular and cerebrovascular diseases, and the development of surgical robots can greatly reduce the fatigue and radiation risks brought to surgeons during surgery. In this paper, we present a novel interventional surgical robot which allows surgeons to fully use their operating skills during remote control. Fuzzy control theory is used to guarantee control precision during the master-slave operation. The safety force feedback control is designed based on the catheter and guidewire spring model, and the force-position control is designed to decrease the potential damage due to the control delay. This study first evaluates the force-position control strategy using a vascular model experiment, and then an in vivo experiment is used to evaluate the precision of the surgical robot controlling the catheter and guidewire to the designated position. The in vivo experiment results and surgeon's feedback demonstrate that the proposed surgical robot is able to perform complex remote surgery in clinical application. Graphical abstract Surgeons perform remote interventional animal surgery using interventional surgical robots.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgiões , Procedimentos Cirúrgicos Vasculares/instrumentação , Animais , Calibragem , Competência Clínica , Desenho de Equipamento , Retroalimentação , Humanos , Suínos , Dispositivos de Acesso Vascular
10.
BMC Surg ; 19(1): 97, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337375

RESUMO

BACKGROUND: Surgical robots are increasingly being used in bariatric surgery. While several studies describe the safety of using barbed sutures in laparoscopic gastric bypass surgery, no reports are available for robotic bariatric procedures. The aim of our article is to determine whether barbed sutures can be used safely in robotic Roux-en-Y bypass (RYGB) surgery. METHODS: This was a single-center, single-surgeon case series of RYGB procedures using the da Vinci® Xi Surgical System (Intuitive Surgery, Sunnyvale, CA, USA) in combination with the use of barbed sutures (Stratafix, Ethicon, Johnson & Johnson, Cincinnati, OH, USA). RESULTS: Fifty robotic proximal and distal RYGB surgeries were performed. A linear stapled, side-to-side gastrojejunostomy was carried out, whereby the enterotomy was completed with a running resorbable unidirectional barbed suture, Stratafix 2-0. In one case after robotic proximal RYGB, revision surgery was required due to omentum necrosis. Another patient was readmitted due to gastrointestinal bleeding from anastomosis. No anastomotic insufficiencies, no stenoses, or higher-grade complications according to Clavien-Dindo 4a-5 were found. CONCLUSIONS: We found that the use of self-fixing barbed sutures in robotic RYGB is safe. The self-fixing suture enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction. Although we are the first to report this procedure, we had a low number of cases and no control group; thus, further studies with a higher level of evidence are required.


Assuntos
Derivação Gástrica/instrumentação , Obesidade/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Técnicas de Sutura/instrumentação , Suturas , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento , Perda de Peso
12.
Ann Otol Rhinol Laryngol ; 128(11): 1023-1029, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220916

RESUMO

OBJECTIVES: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. METHODS: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. RESULTS: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. CONCLUSIONS: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringoscópios , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Idoso , Cadáver , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Boca
13.
Nat Commun ; 10(1): 2536, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182714

RESUMO

Optical fiber-mediated optogenetic activation and neuronal Ca2+ recording in combination with fMRI provide a multi-modal fMRI platform. Here, we developed an MRI-guided robotic arm (MgRA) as a flexible positioning system with high precision to real-time assist optical fiber brain intervention for multi-modal animal fMRI. Besides the ex vivo precision evaluation, we present the highly reliable brain activity patterns in the projected basal forebrain regions upon MgRA-driven optogenetic stimulation in the lateral hypothalamus. Also, we show the step-wise optical fiber targeting thalamic nuclei and map the region-specific functional connectivity with whole-brain fMRI accompanied by simultaneous calcium recordings to specify its circuit-specificity. The MgRA also guides the real-time microinjection to specific deep brain nuclei, which is demonstrated by an Mn-enhanced MRI method. The MgRA represents a clear advantage over the standard stereotaxic-based fiber implantation and opens a broad avenue to investigate the circuit-specific functional brain mapping with the multi-modal fMRI platform.


Assuntos
Imagem por Ressonância Magnética/instrumentação , Optogenética/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Animais , Cálcio/metabolismo , Channelrhodopsins , Neuroimagem Funcional/instrumentação , Neuroimagem Funcional/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Fibras Ópticas , Optogenética/métodos , Ratos Sprague-Dawley
14.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 165-169, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31184070

RESUMO

At present, there still exist some limitations in the laparoscopic surgery robot represented by da Vinci surgical robot, such as the lack of force feedback function. Doctor can not feel the force feedback while operating. In this paper, a new minimally invasive laparoscopic surgery robot system is designed. Based on the master side surgeon's console, stereo vision subsystem and the slave side surgical cart, the multi-dimensional instrument force feedback technology and force feedback based safety protection strategy are introduced. The design realizes the force sensing function of full state operation. Besides, a number of different live pig experiments are carried out. The amount of bleeding in these experiments is relatively small compared with the data of the same kind of surgical robots, which effectively validates the force feedback and surgical safety protection strategies of the new robot system.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Animais , Desenho de Equipamento , Laparoscopia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Suínos
15.
Int J Med Robot ; 15(5): e2023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31215714

RESUMO

BACKGROUND: Despite growth of robotic surgery, published literature lacks assessment of the cost of ownership (CoO) of a da Vinci robot by surgical service line and the associated benefit such data provides. METHODS: Based on real-world data (RWD) from 14 US hospitals and ≈6000 da Vinci robotic cases, CoO was assessed using all relevant fixed and variable cost components, calculated by surgical service line. RESULTS: At a representative hospital with an efficient robotic program (n = 424 cases), the weighted average fixed cost per case was $984. Weighted average variable cost per case was $8025 (range: $3325 for Cholecystectomy-multiport, to $16 986 for Rectal Resection). Assessing weighted average by case, main variable cost drivers were non-da Vinci supplies (49.5%), staff costs (28.6%), and da Vinci supplies (21.9%). CONCLUSIONS: Case mix, annual robotic case volumes, and cut-to-close/patient-in-room time by surgical service line represent core variables influencing robotic program CoO, which help drive profitable program management.


Assuntos
Custos e Análise de Custo , Propriedade , Procedimentos Cirúrgicos Robóticos/instrumentação , Robótica/economia , Humanos , Procedimentos Cirúrgicos Robóticos/normas
16.
Urologia ; 86(2): 52-62, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31179885

RESUMO

BACKGROUND: The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. MATERIAL AND METHODS: A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. RESULTS: From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor's features showed a significant difference in size (weighted mean difference: -0.58 cm; 95% confidence interval: [-1.06, -0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: -0.53; 95% confidence interval: [-0.81, -0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. CONCLUSION: This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.


Assuntos
Nefrectomia/instrumentação , Nefrectomia/métodos , Artéria Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Estudos de Casos e Controles , Constrição , Humanos , Instrumentos Cirúrgicos
17.
Urology ; 131: 125-129, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158353

RESUMO

OBJECTIVE: To introduce a quality improvement initiative tracking robotic instrument failures on a per case basis. It is imperative to understand rates of failure, financial implications of failures, and identify factors suggesting common mechanisms of failure. MATERIALS AND METHODS: Starting in January 1, 2014 a quality reporting system for failed robotic equipment began. Staff was instructed to submit an incident report when a robotic instrument failed and the instrument returned to central processing. Instruments were then returned to the manufacturer (Intuitive Surgical Inc, Sunnyvale, CA) for analysis and reimbursement. Results of failure analysis by the manufacturer, including reimbursement rates, were recorded and correlated with the procedure and surgical specialty. RESULTS: A total of 3935 robotic cases were performed during the study period with a reported instrument failure incidence of 6.2% (247 total instruments). Etiology of instrument failure was as follows: tip or wrist (46.9%), cable (30.0%), unknown (12.6%), control housing (5.3%), and shaft (3.2%). Highest instrument failure incidence was seen in colorectal surgery cases at 4.0%, Urology had the lowest at 2.7%. Manufacturer reimbursement rate was 57.9%; the most common reason for denial being mishandling/misuse of equipment, determined by manufacturer analysis. CONCLUSION: Herein, we have demonstrated that improved process flow of reporting is necessary to better track incidence and etiology of instrument failures. Cost savings comes from improved training of not only surgeons but operating room and central processing staff in handling equipment to prevent high rates of reimbursement denial.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas , Humanos
18.
Med Biol Eng Comput ; 57(9): 1875-1887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222531

RESUMO

Performance of robot-assisted endovascular surgery (ES) remains highly dependent on an individual surgeon's skills, due to common adoption of master-slave robotic structure. Surgeons' skill modeling and unstructured surgical state perception pose prohibitive challenges for an autonomous ES robot. In this paper, a novel convolutional neural network (CNN)-based framework is proposed to address these challenges for navigation of an ES robot based on surgeons' skill learning. An operating action probability estimator is proposed by integrating a two-dimensional CNN, with which the features of a surgical state image are extracted and then directly mapped to the action probability. A one-dimensional CNN with multi-input is developed to recognize the guide wire operating force condition. An eye-hand collaborative servoing algorithm is proposed to combine the outputs of these two networks and to control the robot under a closed-loop architecture. A real-world ES robot is employed for data collection and task performance evaluation in laboratory condition. Compared with the state of the art, the CNN-based method shows its capability of adapting to different situations and achieves similar success rate and average operating time. Robotic operation performs similar operating trajectory and maintains similar level of operating force with manual operation. The CNN-based method can be easily extended to many other surgical robots. Graphical abstract A surgeon's guide wire operating skills in endovascular surgery (ES) is learned by the proposed CNN-based method. Then, the learned model is used for autonomous control of a ES robot with surgical state input (images and operating force).


Assuntos
Procedimentos Endovasculares/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Algoritmos , Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Mãos/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Procedimentos Cirúrgicos Robóticos/instrumentação
19.
Orthop Surg ; 11(3): 373-379, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124300

RESUMO

OBJECTIVE: To evaluate the bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures. METHOD: Between January 2016 and December 2016, 60 patients with femoral neck fractures were separately treated using percutaneous cannulated screws assisted by the bi-planar robot navigation system (robot group) and conventional freehand surgery (freehand group). The fluoroscopy time, the number of drilling attempts, and the operation time were recorded during operations; the dispersion and parallelism of the cannulated screws on the posteroanterior and lateral images were measured after operations. Patients were followed up for 12-24 months and the Harris scores and the final results of the two groups were compared. RESULTS: During bi-planar robot navigation system-assisted surgery, the fluoroscopy time for acquisition of images was 2.3 seconds on average, and the time for planning screws during the operation was 2.8 min on average. The average fluoroscopy time during the placement of the guide pin was 5.7 seconds and 14.14 seconds (P = 0.00), respectively. The average time of the placement of the cannulated screws was 12.7 min and 19.4 min (P = 0.00), respectively, in the robot group and the freehand group. In the robot group, only one guide pin was replaced during the operation, and the average number of adjustments for each guide pin was 2.39 in the freehand group. The screw parallelism and dispersion measured by postoperative imaging in the robot group were significantly superior to those in the freehand group. From postoperative CT it was evident that there were 5 cases of screws exiting the posterior cortex in both groups. During the follow-up phase, 1 case of femoral head necrosis and 5 cases of femoral neck shortening of more than 10 mm occurred in the robotic navigation group; 3 cases of femoral head necrosis, 1 case of fracture nonunion, and 2 cases of shortening of more than 10 mm occurred in the freehand group. At 18 months after surgery, the average Harris scores of the patients were 85.20 and 83.45, respectively, with no significant difference. CONCLUSION: Using bi-planar robot navigation system-assisted placement of femoral neck cannulated screws can significantly reduce the time of intraoperative fluoroscopy, drilling attempts, and operation time. The placed screws are superior to the screws placed freehand in relation to parallelism and dispersion. However, it is still necessary for surgeons to have a good reduction of the femoral neck fracture before surgery and to be proficient in the operation of the robot navigation system. In summary, the bi-planar robot navigation system is an effective assistant instrument for surgery.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Thorac Cardiovasc Surg ; 67(7): 610-614, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31039586

RESUMO

Total esophagectomy for esophageal cancer is associated with high morbidity. The avoidance of a thoracic access could especially reduce the occurrence of pulmonary complications. Therefore, the combination of a high transhiatal dissection of the esophagus and a neck access with mediastinal dissection of the esophagus appears to be a possibility to reduce the pulmonary risks. However, the access to the posterior mediastinum is very limited with the conventional minimal invasive instruments. These limitations can be overcome by the use of a surgical robot.In this article, we present a novel operation technique for a complete robot-assisted (da Vinci Xi) McKeown procedure avoiding a thoracic approach and abdominal incision by using a rendezvous technique with an abdominal and cervical docking of the robot system.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Mediastinoscopia , Procedimentos Cirúrgicos Robóticos , Desenho de Equipamento , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esofagectomia/instrumentação , Humanos , Mediastinoscopia/efeitos adversos , Mediastinoscopia/instrumentação , Posicionamento do Paciente , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Equipamentos Cirúrgicos , Resultado do Tratamento
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