Advantages Of Robotic Surgery Research Articles

Robotic surgery in urology: fact or fantasy?

Advanced robotic surgery was first introduced into urology in 2000. The first studies showed the feasibility and safety of the daVinci (Intuitive Surgical Inc., Sunnyvale, CA) telemanipulator assistance in radical prostatectomy, pelvi-ureteric junction obstruction, and radical cystectomy and neobladder formation. The miniature endowristed tools offer a potential advantage over standard laparoscopy in the accuracy of preparation and suturing. Other features are a three-dimensional vision system and unimpaired hand-eye coordination. Complex laparoscopic tasks are learned faster by using the robot, which may also explain the shorter training required for radical prostatectomy than for manual laparoscopy. This new and expensive technology has spread rapidly over the last 4 years. By 2004, approximately 10% of radical prostatectomies in the USA will be robot-assisted. Data on the functional and oncological outcomes are accruing but not yet conclusive. There will be a further spread of robotic surgery, routine telesurgery, smaller and more affordable systems, the introduction of virtual reality, all developments which have the potential to urological surgeons to improve.

Robot-enhanced fetoscopic surgery

Background Fetoscopic surgery carries with it less maternal morbidity than open fetal surgery. Robotic surgery facilitates endoscopic surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. The goal of the authors was to explore using a robotic surgery platform in a fetal animal model. Methods Using the Zeus Robotic Surgery System (Computer Motion, Santa Barbara, CA), fetoscopic surgery in pregnant sheep was performed using a variety of techniques: uterus exteriorized or totally percutaneous and with liquid or gas insufflation. Using the percutaneous technique and gas insufflation, the authors created and sutured fetal skin and fascial defects. The ewes were recovered and killed 2 weeks postoperatively, and autopsies were performed on them and their fetuses. Results In the exteriorized uterus model, instrument movement was unpredictable and fluid leaked. In the fluid environment, clouding of the visual field and difficulty in immobilizing the fetus were major difficulties. In the survival model, 4 of the 6 fetuses survived to autopsy at 2 weeks and showed good healing grossly and histologically. Conclusions The Zeus Robotic Surgery System can be used for fetoscopic surgery in a sheep model. The percutaneous approach with a nitrous oxide environment is the most effective. Advantages of robotic surgery may be applicable in fetoscopic surgery, but further work in a primate model is required.

Optimizing motion scaling and magnification in robotic surgery

BackgroundMotion scaling is one possible advantage of robotic surgery. The aim of this study was to determine which scaling optimized precision and speed at different magnifications. MethodsThree levels of motion scaling were tested at each of 3 camera magnifications. Surgically naı̈ve subjects (n=12) were randomized as to the order of magnification level testing (3.5×, 6.5×, 9.5×) and motion scalings (10:1, 5:1, 1:1). The subjects were asked to pierce a needle through 6 printed microtargets; then accuracy and drill completion time were scored. ResultsAt 3.5× magnification, no differences between groups were observed. At 6.5× magnification, the 5:1 scaling was superior to the 1:1 scaling in total errors, and the 10:1 scaling was significantly slower. At 9.5× magnification, 10:1 scaling resulted in fewer errors than 1:1 with no difference in time. Overall, the 10:1 and 5:1 scalings resulted in fewer errors. The 5:1 scaling resulted in less drill completion time than the 10:1 scaling. The 9.5× magnification resulted in the fewest errors. ConclusionsMotion scaling reduces the number of errors at higher magnifications, but can increase the task completion time. It is necessary to optimize both the motion scaling and magnification components of robotic systems to balance precision and speed.

An interactive planning system for optimal trocar site placement of surgical robot da Vinci

1. IntroductionPreoperative simulation of surgical robot setup should accompany advanced robotic surgery iftheir advantages are further pursued. Surgical robot setup planning system for appropriate trocar siteplacement has been developed for abdominal surgery.2. Method and resultsThis system mainly consists of da vinci geometric model, 3D patient model and haptic device. Weadapted the PHANToMk to touch and drag the robotic arms in the virtual space. With inverse-kine-matics computation, correspondent motion of connected links is generated based on DH parameter.3. Results and conclusionThe initial pose of the surgical robot and the incision site of the robot arm in laparoscopiccholecystectomy have been be discussed and planned in this system. The arm holding the forceps ofda Vinci system could be guided in reference to the virtual laparoscopic camera views of the patientmodel as in Fig. 1. Once the trocar site is determined, the manipulator makes pivoting motion aroundthe incision point. The arm’s movable area is also shown. Fig. 2 depicts the results of laparoscopiccholecystectomy setup simulation using clinical patient data.