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1.
Orthop Clin North Am ; 52(2): 83-92, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752841

RESUMO

The success of total knee arthroplasty (TKA) depends on restoration of the stability and biomechanical efficiency of the native knee. The emergence of robotic surgical technologies has greatly increased the precision and reproducibility. We discuss contemporary robotic TKA systems by reviewing the features of the individual platforms, their accuracy, and the clinical outcomes. While early results suggest significant gains in patient outcomes, long-term evidence is still awaited from multicenter prospective clinical trials. Moreover, advances in this technology are needed to address knee laxity while individualizing the functional performance of each patient's new joint.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Ajuste de Prótese/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Artroplastia do Joelho/métodos , Humanos , Ajuste de Prótese/métodos , Procedimentos Cirúrgicos Robóticos/métodos
2.
Medicine (Baltimore) ; 100(3): e24370, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546074

RESUMO

ABSTRACT: Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.


Assuntos
Desenho de Equipamento/normas , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas , Tireoidectomia/instrumentação , Adulto , Distribuição de Qui-Quadrado , Desenho de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Tireoidectomia/métodos , Tireoidectomia/normas , Resultado do Tratamento
3.
ACS Appl Mater Interfaces ; 13(3): 4560-4566, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33435667

RESUMO

Optical micro/nanofibers (MNFs) can be applied for ultrasensitive tactile sensing with fast response and compact size, which are attractive for restoring tactile information in minimally invasive robotic surgery and tissue palpation. Herein, we present a compact tactile sensor (CTS) with a diameter of 1.5 mm enabled by an optical MNF. The CTS provides continuous readouts for high-fidelity transduction of touch and pressure stimuli into interpretable optical signals, which permit instantaneous sensing of contact and pressure with pressure-sensing sensitivity as high as 0.108 mN-1 and a resolution of 0.031 mN. Working in pressing mode, the CTS can discriminate the difference in the hardness of two poly(dimethylsiloxane) (PDMS) slats (with shore A of 36 and 40) directly, a hardness resolving ability even beyond the human hands. Benefitting from the fast response feature, the CTS can also be operated in either scanning or tapping mode, making it feasible for hardness identification by analyzing the shape of the response curve. As a proof of concept, the hardness discrimination of a pork liver and an adductor muscle was experimentally demonstrated. Such MNF-enabled compact tactile sensors may pave the way for hardness sensing in tissue palpation, surgical robotics, and object identification.


Assuntos
Técnicas Biossensoriais/instrumentação , Fígado , Músculos , Animais , Fenômenos Biomecânicos , Desenho de Equipamento , Dureza , Humanos , Fígado/fisiologia , Músculos/fisiologia , Nanofibras/química , Pressão , Procedimentos Cirúrgicos Robóticos/instrumentação , Suínos , Tato
4.
J Surg Oncol ; 123(4): 997-1004, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33368284

RESUMO

BACKGROUND AND OBJECTIVE: Rectal cancer is often surgically treated, but it is still associated with morbidity rates. Minimally invasive techniques are increasingly being used to reduce complications, and the use of such techniques can be found in the literature. This study aims to report our experience in a reference oncology center. METHODS: A retrospective cohort study was performed on a prospective database of patients who underwent robotic surgery for rectal cancer using the single-docking technique from September 2014 to April 2018. Clinical and surgical variables, as well as morbidity and mortality rates, were analyzed. RESULTS: One hundred and two patients underwent robotic surgery. Intraoperative complications occurred in six patients (4.9%), and postoperative complications in 24 patients (23.5%), of which anastomotic fistula represented 3.9%. The conversion rate was 1.96%. Two cases (1.9%) faced death within 30 days. The median length of hospitalization was 3 days. The median number of lymph nodes dissected was 15. Clinical and surgical data were correlated with postoperative complications, and no statistically significant differences were found. CONCLUSION: Robotic surgery is a safe and feasible approach to manage rectal cancer. The method presents satisfactory results with regard to the rate of operative complications, conversion rate, oncologic outcomes, and length of hospitalization.


Assuntos
Laparoscopia/mortalidade , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Retais/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
5.
Yonsei Med J ; 62(1): 68-74, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381936

RESUMO

PURPOSE: There is lack of data on direct comparison of survival outcomes between open surgery and robot-assisted staging surgery (RSS) using three robotic arms for endometrial cancer. The purpose of this study was to compare the overall survival (OS) and disease-free survival (DFS) between open surgery and RSS using three robotic arms for endometrial cancer. MATERIALS AND METHODS: Consecutive women with endometrial cancer who underwent surgery between May 2006 and May 2018 were identified. Robotic procedures were performed using the da Vinci robotic system, and the robotic approach consisted of three robotic arms including a camera arm. Propensity score matching, as well as univariate and multivariate Cox regression of OS and DFS were performed according to clinicopathologic data and surgical method. RESULTS: The study cohort included 423 unselected patients with endometrial cancer, of whom 218 underwent open surgery and 205 underwent RSS using three robotic arms. Propensity score-matched cohorts of 146 women in each surgical group showed no significant differences in survival: 5-year OS of 91% vs. 92% and DFS of 86% vs. 89% in the open and robotic cohorts, respectively (hazard ratio, 1.02; 95% confidence interval, 0.82-1.67). In the univariate analysis with OS as the endpoint, surgical method, age, stage, type II histology, grade, and lymph node metastasis were independently associated with survival. Surgical stage, grade, and type II histology were found to be significant independent predictors for OS in the multivariate analysis. CONCLUSION: RSS using three robotic arms and laparotomy for endometrial carcinoma had comparable survival outcomes.


Assuntos
Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias do Endométrio/patologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação
6.
Urol Clin North Am ; 48(1): 113-125, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218586

RESUMO

Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.


Assuntos
Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anestesia , Criança , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Reimplante , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/tendências , Obstrução Ureteral/cirurgia , Doenças Urológicas/congênito , Procedimentos Cirúrgicos Urológicos/tendências , Refluxo Vesicoureteral/cirurgia
7.
Urol Clin North Am ; 48(1): 147-150, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218589

RESUMO

"The new frontier of robotic surgery is well under way. Current research and development is rapidly progressing, allowing for the creation of many new robotic companies. Each company has its own identity and platform for what their vision for the future entails. The competition generated between these companies will shortly be forcing newer, cheaper, more accessible robotic systems worldwide."


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Urológicos/instrumentação , Inteligência Artificial/tendências , Previsões , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Robótica/instrumentação , Robótica/tendências , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/tendências
8.
Urol Clin North Am ; 48(1): 151-160, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218590

RESUMO

With the advent of electronic medical records and digitalization of health care over the past 2 decades, artificial intelligence (AI) has emerged as an enabling tool to manage complex datasets and deliver streamlined data-driven patient care. AI algorithms have the ability to extract meaningful signal from complex datasets through an iterative process akin to human learning. Through advancements over the past decade in deep learning, AI-driven innovations have accelerated applications in health care. Herein, the authors explore the development of these emerging AI technologies, focusing on the application of AI to endourology and robotic surgery.


Assuntos
Inteligência Artificial/tendências , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos/tendências , Doenças Urológicas , Procedimentos Cirúrgicos Urológicos/tendências , Algoritmos , Inteligência Artificial/história , Endoscopia , História do Século XX , História do Século XXI , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Imageamento por Ressonância Magnética Multiparamétrica , Imagem Óptica , Prognóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/cirurgia , Doenças Urológicas/diagnóstico , Doenças Urológicas/cirurgia
9.
Urol Clin North Am ; 48(1): 35-44, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218592

RESUMO

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.


Assuntos
Prostatectomia/história , Neoplasias da Próstata/história , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Laparoscopia , Masculino , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/normas , Neoplasias da Próstata/cirurgia , Melhoria de Qualidade/normas , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas
11.
Vasc Endovascular Surg ; 54(7): 598-604, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32662355

RESUMO

BACKGROUND: The bottleneck of the development of endovascular interventional robot is that it cannot fully adapt to commercialized endovascular devices, such as guidewires, catheters, and stents, and cannot complete the entire procedure of endovascular treatment, for instance, stent implantation. The purpose of this study is to evaluate whether the novel universal endovascular interventional robot can adapt to different commercialized endovascular devices and accomplish the entire procedure of endovascular treatment of peripheral vascular disease. METHODS AND MATERIAL: The novel universal endovascular interventional robot consists of 2 components: a master surgeon console and a robotic platform with 4 manipulators. An adult pig was served as the experimental animal. Bilateral iliac artery stent implantation was performed on the pig by the endovascular interventional robot using commercialized guidewires, catheters, and stent delivery systems. RESULTS: The novel universal endovascular interventional robot can adapt to commercialized endovascular devices, and most interventional procedures, such as insertion, withdrawal, and rotating, can be done through remote control. By coordinating multiple manipulators, complex actions such as superselection, crossing action, or implantation of self-expanding bare stent can be realized. The entire procedure took about 50 minutes, and the total exposure time of the surgeon was less than 1 minute. Postoperative angiography showed that the position of the stent grafts was accurate. The procedure was stable without any stent or surgical-related complications. CONCLUSION: The novel universal endovascular interventional robot can realize peripheral arterial stent-assisted angioplasty with commercialized devices. Through the design improvement, the problem related to stent implantation is solved, and the remote operation is realized throughout the endovascular procedure.


Assuntos
Angioplastia/instrumentação , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Stents , Angioplastia/efeitos adversos , Animais , Estudos de Viabilidade , Feminino , Artéria Ilíaca/diagnóstico por imagem , Teste de Materiais , Modelos Animais , Duração da Cirurgia , Sus scrofa , Fatores de Tempo
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 605-609, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521984

RESUMO

Robotic-assisted transanal total mesorectal excision (R-TaTME) has unique advantage in low rectal cancer. Single incision plus oneport (SIPOP) laparoscopic operation can synchronously cooperate with robotic-assisted transanal operation, in order to the difficulty of operation, improve the quality of operation and shorten the time of operation. A retrospective analysis was conducted on the clinical and pathological data of one patient who underwent SIPOP synchronously combined with R-TaTME + sigmoid-anal anastomosis + ileostomy at the Department of General Surgery, Army Characteristic Medical Center on September 11, 2019. This 71-year-old patient was male with body mass index of 24.08 kg/m(2) and received preoperative chemotherapy. Rectal adenocarcinoma was confirmed by colonoscopy biopsy, and distance from tumor lower edge to anal verge was 3 cm. MRI indicated T2N1 stage. The operation was completed successfully, and the transabdominal and robotic transanal surgery totaled 117 minutes, with 15 minutes for the robotic transanal preparation step. There was about 20 ml of intraoperative blood loss and no blood transfusion was performed. The patient was discharged 6 days after operation. No intraoperative or postoperative complications occurred. The postoperative TNM staging was stage I (pyT2N0cM0). No recurrence or metastasis was found at postoperative 7 month. It is a safe, effective and feasible technique for patients with low rectal cancer.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Endoscópica Transanal/métodos , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Idoso , Canal Anal/cirurgia , Anastomose Cirúrgica , Antineoplásicos/administração & dosagem , Colo Sigmoide/cirurgia , Humanos , Ileostomia , Laparoscopia/métodos , Masculino , Mesentério/cirurgia , Terapia Neoadjuvante , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Reto/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Endoscópica Transanal/instrumentação
13.
Expert Rev Med Devices ; 17(7): 721-730, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32536224

RESUMO

OBJECTIVES: With the increase in robot-assisted cases, recording the quantifiable dexterity of surgeons is essential for proficiency evaluations. The present study employs sensor-based kinematics and recorded surgeon experience for evaluating a new haptic device. METHODS: Thirty surgeons performed a task simulating micromanipulation with neuroArmPLUSHD and two commercially available hand-controllers. The surgical performance was evaluated based on subjective measures obtained from survey and objective features derived from the sensors. Statistical analyses were performed to assess the hand-controllers and regression analysis was used to identify the key features and develop a machine learning model for surgical skill assessment. FINDINGS: MANCOVA tests on objective features demonstrated significance (α = 0.05) for time (p = 0.02), errors (p = 0.01), distance (p = 0.03), clutch incidents (p = 0.03), and forces (p = 0.00). The majority of metrics were in favor of neuroArmPLUSHD. The surgeons found it smoother, more comfortable, less tiring, and easier to maneuver with more realistic force feedback. The ensemble machine learning model trained with 5-fold cross-validation showed an accuracy (SD) of 0.78 (0.15) in surgeon skill classification. CONCLUSIONS: This study validates the importance of incorporating a superior haptic device in telerobotic surgery for standardization of surgical education and patient care.


Assuntos
Ciência de Dados , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Tato , Adulto , Humanos , Microcirurgia/educação , Pessoa de Meia-Idade , Neurocirurgia/educação , Procedimentos Cirúrgicos Robóticos/educação , Cirurgiões , Fatores de Tempo , Adulto Jovem
14.
Int J Comput Assist Radiol Surg ; 15(7): 1157-1165, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32506349

RESUMO

PURPOSE: Concentric tube robots are composed of multiple concentric, pre-curved, super-elastic, telescopic tubes that are compliant and have a small diameter suitable for interventions that must be minimally invasive like fetal surgery. Combinations of rotation and extension of the tubes can alter the robot's shape but the inverse kinematics are complex to model due to the challenge of incorporating friction and other tube interactions or manufacturing imperfections. We propose a model-free reinforcement learning approach to form the inverse kinematics solution and directly obtain a control policy. METHOD: Three exploration strategies are shown for deep deterministic policy gradient with hindsight experience replay for concentric tube robots in simulation environments. The aim is to overcome the joint to Cartesian sampling bias and be scalable with the number of robotic tubes. To compare strategies, evaluation of the trained policy network to selected Cartesian goals and associated errors are analyzed. The learned control policy is demonstrated with trajectory following tasks. RESULTS: Separation of extension and rotation joints for Gaussian exploration is required to overcome Cartesian sampling bias. Parameter noise and Ornstein-Uhlenbeck were found to be optimal strategies with less than 1 mm error in all simulation environments. Various trajectories can be followed with the optimal exploration strategy learned policy at high joint extension values. Our inverse kinematics solver in evaluation has 0.44 mm extension and [Formula: see text] rotation error. CONCLUSION: We demonstrate the feasibility of effective model-free control for concentric tube robots. Directly using the control policy, arbitrary trajectories can be followed and this is an important step towards overcoming the challenge of concentric tube robot control for clinical use in minimally invasive interventions.


Assuntos
Aprendizado Profundo , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Fenômenos Biomecânicos , Humanos
15.
Neuron ; 107(2): 351-367.e19, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32433908

RESUMO

To advance the measurement of distributed neuronal population representations of targeted motor actions on single trials, we developed an optical method (COSMOS) for tracking neural activity in a largely uncharacterized spatiotemporal regime. COSMOS allowed simultaneous recording of neural dynamics at ∼30 Hz from over a thousand near-cellular resolution neuronal sources spread across the entire dorsal neocortex of awake, behaving mice during a three-option lick-to-target task. We identified spatially distributed neuronal population representations spanning the dorsal cortex that precisely encoded ongoing motor actions on single trials. Neuronal correlations measured at video rate using unaveraged, whole-session data had localized spatial structure, whereas trial-averaged data exhibited widespread correlations. Separable modes of neural activity encoded history-guided motor plans, with similar population dynamics in individual areas throughout cortex. These initial experiments illustrate how COSMOS enables investigation of large-scale cortical dynamics and that information about motor actions is widely shared between areas, potentially underlying distributed computations.


Assuntos
Córtex Cerebral/fisiologia , Neuroimagem/instrumentação , Neuroimagem/métodos , Observação/métodos , Algoritmos , Animais , Comportamento Animal/fisiologia , Mapeamento Encefálico , Condicionamento Operante , Craniotomia , Camundongos , Neocórtex/citologia , Neocórtex/fisiologia , Neurônios , Optogenética/métodos , Desempenho Psicomotor , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Razão Sinal-Ruído
16.
Nat Protoc ; 15(6): 1992-2023, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32405052

RESUMO

Cranial microsurgery is an essential procedure for accessing the brain through the skull that can be used to introduce neural probes that measure and manipulate neural activity. Neuroscientists have typically used tools such as high-speed drills adapted from dentistry to perform these procedures. As the number of technologies available for neuroscientists has increased, the corresponding cranial microsurgery procedures to deploy them have become more complex. Using a robotic tool that automatically performs these procedures could standardize cranial microsurgeries across neuroscience laboratories and democratize the more challenging procedures. We have recently engineered a robotic surgery platform that utilizes principles of computer numerical control (CNC) machining to perform a wide variety of automated cranial procedures. Here, we describe how to adapt, configure and use an inexpensive desktop CNC mill equipped with a custom-built surface profiler for performing CNC-guided microsurgery on mice. Detailed instructions are provided to utilize this 'Craniobot' for performing circular craniotomies for coverslip implantation, large craniotomies for implanting transparent polymer skulls for cortex-wide imaging access and skull thinning for intact skull imaging. The Craniobot can be set up in <2 weeks using parts that cost <$1,500, and we anticipate that the Craniobot could be easily adapted for use in other small animals.


Assuntos
Craniotomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Crânio/cirurgia , Animais , Craniotomia/métodos , Desenho de Equipamento , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos
17.
Am J Obstet Gynecol ; 223(2): 258.e1-258.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413431

RESUMO

BACKGROUND: Vaginal mesh attachment can be one of the most time-consuming components of a minimally invasive sacrocolpopexy. OBJECTIVE: To assess the impact on the duration vaginal mesh attachment of using absorbable anchors compared to interrupted sutures for vaginal mesh attachment in robotic-assisted sacrocolpopexy. STUDY DESIGN: This was a single-masked, randomized clinical trial of women with pelvic organ prolapse that underwent a robotic-assisted sacrocolpopexy at 2 clinical sites. The participants were randomized to receive either interrupted delayed absorbable anchors or sutures during the vaginal mesh attachment portion of the surgery. The participants completed validated questionnaires at baseline and at 6 weeks, 6 months, and 12 months after the surgery. A certified examiner, masked to the attachment technique that was used, performed a clinical examination using the Pelvic Organ Prolapse Quantification system and also assessed for mesh exposure and the overall appearance of the vaginal walls using a 10-cm visual analog scale at each follow-up visit. The primary outcome was the vaginal mesh attachment time. The categorical variables were compared using chi-square or Fischer's Exact test, whereas the continuous variables were compared using Student's t-test or Mann-Whitney U test where appropriate. An intention-to-treat analysis was performed. RESULTS: Fifty-three participants were randomized, 26 to mesh attachment with anchor, 27 to mesh attachment with suture, and 81% (21/26) and 93% (25/27) had 12-month follow up respectively. There were no significant differences between the groups with regard to age (P=.12), body mass index (P=.23), stage of prolapse (P=.97), or other preoperative factors. Mesh attachment interval time was faster in the anchor compared to suturing study arm (12.2±7.8 vs 21.2±5.2 minutes; P<.001), while sacrocolpopexy times (107.6±33.2 vs 109.8±21.2 minutes; P=.774) were not different. The ease of placement for the surgeon based on a visual analog scale (P=.16), the appearance of the mesh attachment (P=.07), and the overall satisfaction with the use of the specific attachment type (P=.65) were similar for the arms. There was no difference in perioperative adverse events rates between arms and by 12 months follow-up there were no sacrocolpopexy mesh, anchor, or suture exposures. There was no difference in outcomes at 12 months including composite failure (10% vs 12%; P=.79), patient global impression of improvement (1.06 vs 1.19; P=.27), or patient pelvic pain (9.81 vs 9.67; P=.56). CONCLUSION: In patients undergoing a robotic-assisted sacrocolpopexy, the anchor vaginal mesh attachment technique required significantly less time than suturing. There was no difference between techniques in complications, failure, surgeon, or patient-reported outcomes through 12 months of follow-up. Mesh attachment during sacrocolpopexy can be performed in less time by using the anchor technique, providing surgeons with an alternative surgical technique for this procedure.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Duração da Cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Sacro/cirurgia , Telas Cirúrgicas , Suturas , Vagina/cirurgia , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/instrumentação , Técnicas de Sutura , Resultado do Tratamento
18.
Mo Med ; 117(2): 149-153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308241

RESUMO

Use of robotic surgery is increasing in multiple surgical specialties including colorectal. We argue that the improved visualization and better instrumentation outweigh the increased cost and operating room time. However, the indications for its use are not clearly defined. This is especially true in complex pathologies such as rectal cancer and complicated diverticulitis. We explore the limited clinical data on the subject to support or dismiss the use of this currently developing technology.


Assuntos
Colectomia/métodos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Colectomia/instrumentação , Neoplasias Colorretais/economia , Neoplasias Colorretais/patologia , Humanos , Laparoscopia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/instrumentação
19.
Acta Cir Bras ; 35(2): e202000206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348403

RESUMO

Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.


Assuntos
Endoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Animais , Endoscópios/classificação , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/métodos , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Modelos Animais , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos
20.
Epilepsia ; 61(5): 841-855, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32227349

RESUMO

This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.


Assuntos
Epilepsia/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/instrumentação , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Fotocoagulação a Laser/instrumentação , Fotocoagulação a Laser/métodos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Imagem por Ressonância Magnética Intervencionista/instrumentação , Imagem por Ressonância Magnética Intervencionista/métodos , Neuronavegação/instrumentação , Neuronavegação/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica
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