ARM CART Research Articles

A narrative review of the Medtronic Hugo RAS and technical comparison with the Intuitive da Vinci robotic surgical system.

Medtronic launched the Hugo Robotic-Assisted Surgery (RAS) System in 2021, offering a modular alternative to the incumbent market leader in surgical robotics, the Intuitive da Vinci (dV) surgical system. A detailed technical review of the Hugo RAS was conducted to explore the strengths and weaknesses of this new robotic surgical system. Each component of the system-vision tower, arm cart, and surgeon console-was compared against the existing dV systems. The docking process, instrumentation, and external arm movement trajectories were analyzed. The modular Hugo RAS provides the possibility of operating using up to four arm carts. It has certain design features that are unique to itself, and others that have been implemented to address the shortcomings of the dV Si. While Medtronic's first-generation robot offers distinct advantages over the older Intuitive systems, the true test of its mettle will be its performance compared to the latest dV Xi.

Robot-Assisted Pyeloplasty with HUGO™ Robotic System: Initial Experience and Optimal Surgical Set-Up at a Tertiary Referral Robotic Center.

Background: In February 2021 Medtronic® (Minneapolis, MN) launched the HUGO™ Robot-Assisted Surgery (RAS) System in the global market. The aim of the current study is to describe the first case series and the optimal setup of robot-assisted pyeloplasty procedure, performed with HUGO RAS system in a tertiary referral robotic center. Methods: Data from consecutive patients who underwent robot-assisted pyeloplasty at Onze-Lieve-Vrouwziekenhuis Hospital (Aalst, Belgium) were recorded. Baseline characteristics, and perioperative and surgical outcomes were collected. Results: Overall, 10 robot-assisted pyeloplasties were performed (October 2022-September 2023). Based on our expertise, the following minor setting changes have been made, relative to the official setup guide: the endoscope port and, subsequently, the left and right-hand ports were positioned more laterally. Additionally, the reserve/4th port was placed more laterally and cranially, and adjusted the arm cart's tilt angle, reducing it from -30° to -15°. The median docking time was 8 (interquartile range [IQR]: 7.2-9.8) minutes, and the median active console time was 89.5 (80.0-95.8) minutes. No conversion to open/laparoscopic surgery or perioperative complications was encountered. A single technical problem was recorded in 1 (10%) procedure. Specifically, one arm was blocked, and the procedure was accomplished with three arms without compromising the procedure success. Conclusions: This study represents the first worldwide series of robot-assisted pyeloplasty performed with the HUGO RAS system and shows promising results. The procedure might be safely performed with this robotic platform achieving optimal perioperative outcomes.

V01-06 ROBOT-ASSISTED PYELOPLASTY WITH THE NOVEL HUGO TM RAS SYSTEM: SURGICAL SETUP AT A HIGH VOLUME ROBOTIC CENTER

You have accessJournal of UrologyCME1 Apr 2023V01-06 ROBOT-ASSISTED PYELOPLASTY WITH THE NOVEL HUGOTM RAS SYSTEM: SURGICAL SETUP AT A HIGH VOLUME ROBOTIC CENTER Maria Peraire Lores, Carlo Bravi, Marco Paciotti, Luca Sarchi, Luigi Nocera, Adele Piro, Eleonora Balestrazzi, Angelo Mottaran, Federico Piramide, Rui Farinha, Geert De Naeyer, Alexandre Mottrie, and Ruben De Groote Maria Peraire LoresMaria Peraire Lores More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Adele PiroAdele Piro More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Federico PiramideFederico Piramide More articles by this author , Rui FarinhaRui Farinha More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Ruben De GrooteRuben De Groote More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New surgical robots with various technical enhancements are gaining popularity in urology and may increase the use of robotics also in non-oncological fields. HUGO RAS system is a robotic platform with independent arm carts and an open console. Here, we presented our first robot-assisted pyeloplasty with HUGO RAS system with the aim to describe technical feasibility and surgical setup of this novel robotic platform for benign kidney surgery. METHODS: A 36-year-old male, without previous abdominal surgeries, was diagnosed with a left pyeloureteral junction stenosis. The CT scan showed a left kidney hydronephrosis with a pelvis diameter of 6 cm with a delayed urinary excretion. The MAG-3 scan showed left and right renal function of 27% and 73%, respectively. A robot-assisted left pyeloplasty was performed through a transperitoneal approach with the HUGO RAS system. With the patient in right lateral decubitus, a 12-mm Airseal trocar was placed 2 cm lateral to the umbilicus, on the left pararectal line. Other two 8-mm robotic ports and an 11-mm optic port were placed under vision in a diamond configuration (Figure 1), all of them 8 cm apart from each other and 2 cm away from bone prominences; lastly, an 8-mm port was placed in the left lower quadrant. In order to optimise working space, three arm carts (corresponding to surgeon’s left hand, optic and forth robotic arm, respectively) were positioned behind the operative bed, whereas one arm cart (i.e. surgeon’s right hand) was placed in front of the patient. RESULTS: The patient was classified as ASA 1 and had a preoperative creatinine of 1.16 mg/dl. Operative and console time were 95 and 70 minutes, respectively. No intraoperative complications occurred, and blood loss was <20 cc. No technical problems, instruments or arms clashes were reported. The patient was discharged the second postoperative day with a creatinine of 1.02 mg/dl. No perioperative complications were reported. CONCLUSIONS: Robot-assisted pyeloplasty using the new HUGO RAS system is safe, feasible and it guarantees optimal perioperative and early functional outcomes. Awaiting study with longer follow-up, our data showed that HUGO RAS might be considered a valuable treatment option for benign kidney surgery, providing relevant information for future adopters of this surgical platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e80 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Peraire Lores More articles by this author Carlo Bravi More articles by this author Marco Paciotti More articles by this author Luca Sarchi More articles by this author Luigi Nocera More articles by this author Adele Piro More articles by this author Eleonora Balestrazzi More articles by this author Angelo Mottaran More articles by this author Federico Piramide More articles by this author Rui Farinha More articles by this author Geert De Naeyer More articles by this author Alexandre Mottrie More articles by this author Ruben De Groote More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRA TM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES

You have accessJournal of UrologyCME1 Apr 2023MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRATM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES Amitabh Singh, Ashish Khanna, Sarbartha Kumar Pratihar, Vivek Vasudev, Nikhil Saurabh, and Sudhir Rawal Amitabh SinghAmitabh Singh More articles by this author , Ashish KhannaAshish Khanna More articles by this author , Sarbartha Kumar PratiharSarbartha Kumar Pratihar More articles by this author , Vivek VasudevVivek Vasudev More articles by this author , Nikhil SaurabhNikhil Saurabh More articles by this author , and Sudhir RawalSudhir Rawal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: SSI MantraTM is a new addition to the arsenal of robotics systems in India for clinical usage. Here, we provide the initial outcomes of patients undergoing different types of major uro-oncological procedures. METHODS: A total of 32 patients affected by various urological conditions like prostate cancer, renal cancer, bladder cancer, and vesicovaginal fistula underwent treatment with SSI MantraTM system. Study was approved by institutional board (IRB No- 765/SO/SKR-35). Clinical use of MantraTM was registered with national clinical trial registry (CTRI/2020/11/029053). This system has four independent Arms which are docked. Demography of patient and clinical outcome like docking time, console time, total operative time, complications like bleeding, bowel injury, urinary incontinence, conversion to open, total hospital stay and perioperative outcomes were reported. RESULTS: A total of thirty–two patients were included in this study. This includes radical prostatectomy (n=15), radical cystectomy with ileal conduit (n=6), radical cystectomy with neo-bladder(n=4), radical nephrectomy (n=3), partial nephrectomy (n=2), partial cystectomy (n=1) and vesico-vaginal fistula repair (n=1). Mean age, BMI, ASA, draping time, patients positioning time, arm cart positioning, docking time, surgeon console time, total surgery time, undock time of radical prostatectomy and radical cystectomy patient was 66.1 vs 57.3 yrs , 26.1 vs 22.3, 3.3 vs 2.66, 19.3 vs 13.4 mins, 3.2 vs 5.66 mins, 13.8 vs 12.7 mins 7.2 vs 5.8 mins, 3hrs 12 min vs 5 hrs 20 mins, 5 hrs 6 mins vs 6 hrs 10 min, 10.9 vs 10.2 min respectively. There were total three conversions to open (radical prostatectomy (n=1), radical nephrectomy (n=1) and radical cystectomy with ileal conduit (n=1). CONCLUSIONS: Our experience with SSI MANTRA platform confirms that it is a robust, safe and efficient platform for all major urooncological procedures and it would expand the reach of robotic platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e957 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amitabh Singh More articles by this author Ashish Khanna More articles by this author Sarbartha Kumar Pratihar More articles by this author Vivek Vasudev More articles by this author Nikhil Saurabh More articles by this author Sudhir Rawal More articles by this author Expand All Advertisement PDF downloadLoading ...

Introducing the New Surgical Robot HUGO™ RAS: System Description and Docking Settings for Gynecological Surgery.

This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an “open” surgical console with an HD–3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called “straight” and “bridge”; instead, the so-called “compact” and “butterfly” configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer’s point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.

MP50-13 FEASIBILITY AND OPTIMAL SETTING OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING A NOVEL MULTI-ARM, MODULAR ROBOTIC PLATFORM

You have accessJournal of UrologyCME1 May 2022MP50-13 FEASIBILITY AND OPTIMAL SETTING OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING A NOVEL MULTI-ARM, MODULAR ROBOTIC PLATFORM Carlo Andrea Bravi, Luca Sarchi, Angelo Mottaran, Pietro Piazza, Fernando Gonzalez Meza, Marco Corsetti, Sophie Knipper, Marco Paciotti, Marco Amato, Rui Farinha, Stefano Puliatti, Simone Scarcella, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Fernando Gonzalez MezaFernando Gonzalez Meza More articles by this author , Marco CorsettiMarco Corsetti More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Marco AmatoMarco Amato More articles by this author , Rui FarinhaRui Farinha More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery is a challenging procedure that requires surgical dexterity and speed of execution. Due to its technical complexity, the benefits provided by the robotic approach have led to an increasing interest in robot-assisted partial nephrectomy (RAPN). Our aim was to assess procedural feasibility and to describe our technical setting for RAPN using the novel HUGO RAS system (MedTronic ©) on a pre-clinical model. METHODS: HUGO RAS System was used to perform 3 RAPNs on human cadavers. This novel robotic system has independent robotic arms that allow for a modular configuration, an open high-definition console, 3-dimension vision goggles, and easy-grip “pistol-like” controllers. We sought to describe the optimal setup configuration for this new robotic platform, and to assess technical feasibility of all the procedural steps. All components of surgical team (console surgeon, bed-side assistant and scrub nurse) received an official technical training. Patient positioning, arm cart disposition, and trocar placement were described. Docking time, operative time, and technical errors of the system were recorded, as well as intra-operative complications such as clashing of the instruments and/or injury to abdominal organs. RESULTS: Instruments consisted of monopolar scissors, forceps bipolar, and needle driver; a 0-degree camera was used. With patients on flank position, four robotic trocars (one 11-mm optic port, and three 8-mm robotic ports) were positioned in a ‘diamond’ configuration, with three arm carts behind the back of the patient, and one arm cart positioned in front of the abdomen (Figure 1). One 12-mm assistant trocar was placed on the para-rectal line. All procedures were performed trans-peritoneally, and all cases were completed following all traditional steps. Docking time ranged between 3 and 7 minutes. Mean (standard deviation) operative time was 55 (±15) minutes. No operative complications, nor technical failure by the system occurred with our setup. CONCLUSIONS: RAPN with HUGO RAS system is feasible and safe in a pre-clinical setting. Future investigations should focus on technical standardization and optimal setting of this novel robotic platform in a clinical setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e870 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlo Andrea Bravi More articles by this author Luca Sarchi More articles by this author Angelo Mottaran More articles by this author Pietro Piazza More articles by this author Fernando Gonzalez Meza More articles by this author Marco Corsetti More articles by this author Sophie Knipper More articles by this author Marco Paciotti More articles by this author Marco Amato More articles by this author Rui Farinha More articles by this author Stefano Puliatti More articles by this author Simone Scarcella More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Simulation of the Southern Great Plains Nocturnal Boundary Layer and the Low-Level Jet with a High-Resolution Mesoscale Atmospheric Model

AbstractA field project over the Atmospheric Radiation Measurement–Cloud and Radiation Test Bed (ARM–CART) site during a period of several nights in September 2007 was conducted to explore the evolution of the low-level jet (LLJ). Data were collected from in situ (a multilevel tower) and remote (sodar) sensors, and the observed LLJ activity during the project was found to agree well with data from earlier studies regarding jet speed, height, and direction. To study nocturnal boundary layer (NBL) behavior, the Regional Atmospheric Modeling System was used to simulate the ARM–CART NBL field experiment and was validated against the data collected from the site. This model was run at high resolution for calculating the interactions among the various motions within the boundary layer and their influence on the surface. The model faithfully simulated the formation and dissolution of the low-level nocturnal jet during a synoptic situation in which low pressure with warm southerly advection replaced high pressure. An additional simulation at 32.5-m resolution was performed for the most stable 5.5-h period, using a turbulence scheme adjusted to allow for greater resolved turbulent kinetic energy, and the model reproduced the turbulence statistics as determined by a power spectrum. The benefit of the high-resolution simulation is evident in the much more realistically resolved model turbulent kinetic energy and the fluxes of momentum, heat, and water vapor.

Influence of Land Surface Fluxes on Precipitation: Inferences from Simulations Forced with Four ARM–CART SCM Datasets

Four different Atmospheric Radiation Measurement Program Cloud and Radiation Test Bed (ARM–CART) Single-Column Model (SCM) datasets were used to force an SCM in a number of simulations performed to study the influence of land surface fluxes on precipitation. The SCM employed Goddard Earth Observing System (GEOS-2) GCM physics, which includes a recent version of prognostic cloud scheme (Microphysics of Clouds with Relaxed Arakawa–Schubert), and a land model (Simplified Simple Biosphere Model) coupled to a highly resolved soil hydrological description in the vertical. The four ARM–CART datasets employed in these studies are referred as case 1, case 3, case 4, and case 8. The SCM simulation results broadly confirm the previous findings that an increase in the solar absorption and surface evaporation helps to increase the local rainfall, but they also reveal that the magnitude of the rainfall increase is strongly affected by the ability of the background circulation to promote moist convection. The simulated precipitation increase was as large as 50% of the evapotranspiration increase for case 1 that covered a relatively wet period. It was substantially reduced for cases 3 and 4 covering a normal rainfall period and became negligible for case 8, a dry case. A part of evaporation increase became horizontal divergence of water vapor; this would have the potential of increasing the precipitation downstream of the test region. For a particular background circulation, it was found that the evaporation–precipitation relationship, often defined as recycling ratio, is remarkably robust even for a large range of vegetation covers, soil types, and initial soil moistures. Notwithstanding the limitations of only one-way interaction (i.e., the large scale influencing the regional physics and not vice versa), the current SCM simulations show that recycling ratio is a function of the background circulation and not a regional and/or seasonal feature. Indeed, a vigorous biosphere can help to produce more rainfall under wet conditions but may do little to dislodge a large-scale drought. It is pointed out that even though these inferences are robust, they are prone to weaknesses of the SCM physics as well as the assumption of the large scale remaining unaffected by changes of moist processes.

Simultaneous Retrieval of Diurnal to Seasonal Surface Temperatures and Emissivities over SGP ARM–CART Site Using GOES Split Window

Abstract GOES-8 thermal infrared split window measurements have been used with a simultaneous land surface temperature (LST)–spectral emissivity retrieval algorithm to examine the potential of a combined retrieval methodology cast into a variational solution for temperatures at multiple but short-term 6- to 24-h time intervals and emissivities at multiple spectral bands assumed to be invariant over the selected time intervals. Retrieved LST and emissivity quantities under differing atmospheric conditions over an annual cycle are validated and analyzed in regard to their underlying diurnal and seasonal variations over the Department of Energy’s Atmospheric Radiation Measurement–Cloud and Radiation Test Bed (ARM–CART) site in Kansas and Oklahoma. It is shown that the accuracy of the retrieval algorithm depends primarily on GOES infrared channel detector noise and uncertainties in columnar water vapor path, in which retrieval accuracy increases as pathlength decreases. A detailed analysis is given of the cha...

A Cloud Climatology of the Southern Great Plains ARM CART

Cloud amount statistics from three different sources were processed and compared. Surface observations from a National Centers for Environmental Prediction dataset were used. The data (Edited Cloud Report; ECR) consist of synoptic weather reports that have been edited to facilitate cloud analysis. Two stations near the Southern Great Plains (SGP) Cloud and Radiation Test Bed (CART) in north-central Oklahoma (Oklahoma City, Oklahoma and Wichita, Kansas) were selected. The ECR data span a 10-yr period from December 1981 to November 1991. The International Satellite Cloud Climatology Project (ISCCP) provided cloud amounts over the SGP CART for an 8-yr period (1983–91). Cloud amounts were also obtained from Micro Pulse Lidar (MPL) and Belfort Ceilometer (BLC) cloud-base height measurements made at the SGP CART over a 1-yr period. The annual and diurnal cycles of cloud amount as a function of cloud height and type were analyzed. The three datasets closely agree for total cloud amount. Good agreement was found in the ECR and MPL–BLC monthly low cloud amounts. With the exception of summer and midday in other seasons, the ISCCP low cloud amount estimates are generally 5%–10% less than the others. The ECR high cloud amount estimates are typically 10%–15% greater than those obtained from either the ISCCP or MPL–BLC datasets. The observed diurnal variations of altocumulus support the authors’ model results of radiatively induced circulations.

Regional Flux Estimation in a Convective Boundary Layer Using a Conservation Approach

Abstract During the Southern Great Plains 1997 Hydrology Experiment, a tethersonde system was deployed at the U.S. Department of Energy’s Atmospheric Radiation Measurement Cloud and Radiation Test Bed (ARM CART) central facility. Additional measurements included several surface flux stations at the central facility and radiosondes at the ARM CART central and boundary facilities. Combined, these data support an examination of regional flux estimates obtained via the atmospheric boundary layer conservation approach. Because the tethersonde was deployed successfully only under light to moderate wind conditions, the effects of advection on estimation of regional fluxes generally are found to be small. Consistent with previous studies, direct estimation of the sensible heat flux yields more accuracy than direct estimation of the latent heat flux. Use of available energy measured at surface flux stations along with the direct sensible heat flux estimates yields latent heat estimates of similar accuracy to those...

An Air–Soil Layer Coupled Scheme for Computing Surface Heat Fluxes

Abstract An air–soil layer coupled scheme is developed to compute surface fluxes of sensible heat and latent heat from data collected at the Oklahoma Atmospheric Radiation Measurement–Cloud and Radiation Testbed (ARM–CART) stations. This new scheme extends the previous variational method of Xu and Qiu in two aspects: 1) it uses observed standard deviations of wind and temperature together with their similarity laws to estimate the effective roughness length, so the computed fluxes are nonlocal; that is, they contain the contributions of large-eddy motions over a nonlocal area of O(100 km2); and 2) it couples the atmospheric layer with the soil–vegetation layer and uses soil data together with the atmospheric measurements (even at a single level), so the computed fluxes are much less sensitive to measurement errors than those computed by the previous variational method. Surface skin temperature and effective roughness length are also retrieved as by-products by the new method.