Assistant Surgeon Research Articles

Corrected and Republished: Breast Cancer in Young Women: Experience from a Tertiary Care Hospital of Coastal India

International Journal of Medicine and Public Health,2022,12,2,91-95.DOI:10.5530/ijmedph.2022.2.18Published:April 2022Type:Original ArticleCorrected and Republished: Breast Cancer in Young Women: Experience from a Tertiary Care Hospital of Coastal IndiaShazima Sheereen, Pradipta Das, Pradipta Kishore Khuntia, Flora D Lobo, Waseemoddin Patel, Rajashree Das, and Abhishek Singh Nayyar Shazima Sheereen1, Pradipta Das2, Pradipta Kishore Khuntia2, Flora D Lobo1, Waseemoddin Patel3, Rajashree Das4, Abhishek Singh Nayyar5 1Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, INDIA. 2Department of Surgery, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, Odisha, INDIA. 3Department of Pediatrics and Neonatology, McMaster University, Hamilton, Ontario, CANADA. 4Former- Assistant Surgeon, Capital Hospital, Bhubaneswar, Odisha, INDIA. 5Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Postgraduate Research Institute, Parbhani, Maharashtra, INDIA. Abstract:Background and Aim: Breast cancers are relatively rare among young women amounting up to 6% of all breast carcinoma cases reported in that age group. In younger age groups, breast cancers, though, have a more aggressive behavior and poorer outcome in comparison to patients in the elderly age groups. The aim of the present study was to evaluate the histopathological characteristics of breast carcinomas reported in patients lesser than 40 years of age. Materials and Methods: Surgical specimens of carcinoma breast received at the Department of Pathology in a tertiary care hospital for a period of 2 years from January 2014 to December 2015 were included in the study. The histo-pathological slides were reviewed and clinical data was collected from the archival records and compared. Statistical analysis was done using IBM SPSS statistics 17 (Chicago, USA). Various tumor characteristics were correlated with the morphological features and the other clinico-pathologic data using Chi-square value (c2), paired t-test and Fischer’s test. p<0.05 was considered to be statistically significant. Results: Infiltrating Ductal Carcinoma-Not otherwise specified (IDC-NOS) was found to be the most common variant of breast carcinoma in both the younger and the elderly age groups followed by the invasive lobular carcinoma and mucinous carcinoma in the younger and invasive lobular carcinoma and mucinous carcinoma and papillary carcinoma in the elderly age groups. Also, stage II followed by stage III were the commonest stages reported in the younger and elderly age groups based on their prevalence as against stage I and IV (p=0.006). Conclusion: Breast cancers diagnosed in younger age groups present with an aggressive behavior and poorer outcome in comparison to patients in the elderly age groups. Also, such cancers often tend to present with advanced stages of the disease process and high grades of tumor with lymph nodal involvement and metastasis at the time they are first diagnosed conferring an inferior prognosis illustrating the need for more clinical trials to be conducted on younger patients with breast cancers with an aim to improve the overall outcome in this age group. Keywords:Breast cancers, Histo-pathology, Tertiary care settings, TNM staging, Younger age groupsView:PDF (297.49 KB)

Haemodynamic changes during radical nephrectomy with inferior vena cava thrombectomy: A pilot study.

Haemodynamic changes during radical nephrectomy with inferior vena cava thrombectomy: A pilot study.

Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear

Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique.

Experimental study on the exposure level of surgical staff to SARS-CoV-2 in operating rooms with mixing ventilation under negative pressure

The purpose of this study was to reveal the exposure level of surgical staff to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the patient's nose and wound during operations on COVID-19 patients. The tracer gas N2O is used to simulate SARS-CoV-2 from the patient's nose and wound. In this study, concentration levels of tracer gas were measured in the breathing zones of these surgical staff in the operating room under three pressure difference conditions: −5 pa–15 pa and −25 pa compared to the adjunction room. These influencing factors on exposure level are analyzed in terms of ventilation efficiency and the thermal plume distribution characteristics of the patient. The results show that the assistant surgeon faces 4 to 12 times higher levels of exposure to SARS-CoV-2 than other surgical staff. Increasing the pressure difference between the OR lab and adjunction room can reduce the level of exposure for the main surgeon and assistant surgeon. Turning on the cooling fan of the endoscope imager may result in a higher exposure level for the assistant surgeon. Surgical nurses outside of the surgical microenvironment are exposed to similar contaminant concentration levels in the breathing zone as in the exhaust. However, the ventilation efficiency is not constant near the surgical patient or in the rest of the room and will vary with a change in pressure difference. This may suggest that the air may not be fully mixed in the surgical microenvironment.

Crucial Roles of the Assistant Surgeon During Laparoscopic Left Hemihepatectomy.

BackgroundAlthough left hemihepatectomy has been widely performed via the laparoscopic approach, the roles of the assistant surgeon have not been well-documented so far. We herein present our standardized procedures of laparoscopic left hemihepatectomy without Spiegel’s lobe resection, focusing on the crucial roles of the assistant surgeon.MethodsDuring laparoscopic left hemihepatectomy without Spiegel’s lobe resection, countertraction by the assistant surgeon is quite important especially during isolating the left Glissonean pedicle and transecting liver parenchyma. When securing the left hepatic pedicle using the Glissonean approach, the assistant surgeon pushes Segment 4 of the liver cranially and pulls the tape encircling the hepatoduodenal ligament caudally in the opposite way, orthogonal to the direction of the laparoscopic forceps toward the left portal triad. During liver parenchymal transection, the assistant surgeon pulls the hanging tape across the left lobe of the liver in order to provide a wide and stable liver transection plane.With this standardized technique, nine cases of laparoscopic left hemihepatectomy were performed over the last two years in our department, and the perioperative data were retrospectively analyzed.ResultsThe median age of the nine patients was 70 years (range: 58 - 84 years). Most of the patients were males (77.8%). Five of nine patients were diagnosed with colorectal liver metastasis, two with hepatocellular carcinoma (HCC), one with inflammatory pseudotumor, and the other one with hepaticolithiasis. There were no conversions to open surgery. The median operative time and estimated blood loss were 337 minutes (range: 219 - 478 minutes) and 100 ml (range: 41 - 375 ml), respectively. The median length of postoperative hospital stay was nine days (range: 7 - 16 days). Major complications (Clavien-Dindo classification grade III or more) were not encountered in our cohort postoperatively.ConclusionWe presented here our standardized assistant roles during laparoscopic left hemihepatectomy without Spiegel’s lobe resection, which was revealed to be safe and feasible in our cohort.

Human-robot-robot cooperative control using positioning robot and 1-DOF traction device for robot-assisted fracture reduction system.

While performing musculoskeletal long bone fracture reduction surgery, assistant surgeons can often suffer from physical fatigue as they provide resistance against the tension from surrounding muscles pulling on the patient's broken bones. These days, robotic systems are being actively developed to mitigate this physical workload by realigning and holding these fractured bones for surgeons. This has led to one consortium proposing the development of a robot-assisted fracture reduction system consisting of a 6-DOF positioning robot along with a 1-DOF traction device. With the introduction of the 1-DOF traction device, the positioning robot does not have to fight these contraction forces so can be compact improving its maneuverability and overall convenience; however, considering surgeon-robot interactions, this approach adds the requirement of controlling two different types of robots simultaneously. As such, an advanced cooperative control methodology is required to control the proposed bone fracture reduction robot system. In this paper, a human-robot-robot cooperative control (HRRCC) scheme is proposed for collaboration between the surgeon, the positioning robot, and the traction device. First, the mathematical background of this HRRCC scheme is provided. Next, we describe a series of experiments that show how the proposed scheme facilitates a reduction in the load placed on the positioning robot from strong muscular contraction forces making it possible to conduct fracture reduction procedures more safely despite the muscular forces.

377 Complications of Pediatric Tethered Cord Release: Seattle Children’s Hospital Experience

INTRODUCTION: We describe six years of surgical experience at our pediatric neurosurgery center, with a wide variety of operative complexity and etiologies related to tethered cord syndrome. While complications are well-described, the risk of complications associated with complexity of the procedure needs further investigation. Based on our findings, we propose guidelines to minimize complications and give attention to certain high-risk groups of patients. METHODS: Medical records of children who underwent surgery for tethered cord release (CPT 63200) from July 2014 to December 2020 were retrospectively reviewed after approval by the Institutional Review Board at Seattle Children's Hospital. Data collected included demographics, surgical technique, follow-up, and complications. We defined surgeries as complex if they involved usage of any of the following: plastic surgeon assistance, drain placement, duraplasty, or operative laser. Univariate analysis and multivariate logistic regression were used to determine covariates that were protective or risk factors for development of complications. RESULTS: In 242 contiguous tethered cord operations (51.8% male, mean age 74.8 months), the overall complication rate of any type was 10.7% (3.45% simple, 17.46% complex). Median time until complication was 11 days. Complications were associated with usage of the operative laser, increasing hospital length of stay, and increasing operative time. Plastic surgery assistance (OR 0.357, 95% CI 0.197-0.647, p=0.0007) and placement of a drain (OR 0.314, 95% CI 0.134-0.739, p=0.008) for complex cases were protective against development of complications. CONCLUSION: Our complication rate is comparable to those of others (1-4). However, multivariate logistic regression analysis suggests that plastic surgery assistance and drain placement can be protective factors, and should be considered in complex tethered cord operations.

Operating Room Planning for Emergency Surgery: Optimization in Multiobjective Modeling and Management from the Latest Developments in Computational Intelligence Techniques.

This study presents an optimization approach for scheduling the operation room for emergency surgeries, considering the priority of surgeries. This optimization model aims to minimize the costs associated with elective and emergency surgeries and maximize the number of scheduled surgeries. In this study, surgeon assistants to perform each surgery are considered in order to achieve the goals. Since the time of each surgery varies according to the conditions of the patient, this parameter is considered as an uncertain one, and a robust optimization method is applied to deal with uncertainty. To demonstrate the effectiveness of the proposed method, a case study in one of the East Asian hospitals is presented and analyzed using GAMS software. Moreover, hybrid simulation and gray wolf optimization algorithm (GWO) have been implemented to solve the optimization model in different scenarios. The results show that increasing the risk parameters in the robust optimization model will increase the system costs. Moreover, in case of uncertainty, the solutions obtained from the GWO simulation method are on average 73.75% better than the solutions obtained from the GWO algorithm.

Effect of the Fundamentals of Laparoscopic Surgery Curriculum on Skills of Operating Room Technology Students: An Interventional Study

Background: In a laparoscopic surgery team, a surgical technologist as a skillful assistant surgeon is responsible for camera navigation and peg transfer. Objectives: We assessed the effect of the fundamentals of laparoscopic surgery curriculum on improving the skills of surgical technology students in camera navigation, pattern cutting, and peg transfer. Methods: A study was conducted on 30 surgical technology students at the Iran University of Medical Sciences based on Kern's six-step model. After assessing the needs and defining the educational goals, the course content was determined. Afterward, students were trained in a simulation-based learning environment. Then, in the evaluation stage, using the standard task completion time (TCT) tool, their competence in performing the three skills was evaluated. The results of the first comprehensive attempt to perform each skill were recorded as the pretest, and the results of the sixth and 10th repetitions were recorded as the posttest. Data were analyzed using analysis of variance with duplicate data. Results: The TCT score improved in this study. The time of camera navigation decreased from 92.14 to 56.42 s, pattern cutting from 186.07 to 118.21 s, and peg transfer from 93.03 to 54.10 s. Conclusions: This study showed that the fundamentals of laparoscopic surgery curriculum improved the surgical technologists’ competence in performing triple skills essential for performing laparoscopic surgeries. Thus, this learning method could play an essential role in laparoscopic surgery.

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

A Cognitive Architecture for Robot-Assisted Surgical Procedures

Robot-Assisted Minimally Invasive Surgery (RAMIS) procedures typically require the presence of two expert figures in the operating room (OR): the main surgeon, sitting at the console of a teleoperated surgical robot, and the assistant surgeon, who performs secondary operations directly on the patient by means of manual tools. In this paper we propose a novel strategy to allow the execution of a RAMIS procedure by a single surgeon, robotizing the role of the assistant surgeon. In addition to the teleoperation system used by the main surgeon, the architecture is augmented with an action recognition module, that recognize the operations the surgeon is performing, and a supervisory controller, which takes decisions according to the procedure state. The autonomous robotic arm serves as an assistant surgeon and it is equipped by a surgical tool to accomplish the required tasks. The proposed solution has been validated on a simplified physical set-up, with the aim of verifying and confirming its applicability and effectiveness.

Robotic and robot-assisted skull base neurosurgery: systematic review of current applications and future directions.

The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae. A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded. A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non-TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited. Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.

Anterior lumbar spine exposure with vascular surgeon assistance

Objective:Evaluate access related complications contributing to adverse outcomes in patients undergoing retroperitoneal anterior lumbar interbody fusion (ALIF). MethodsA retrospective analysis was conducted of prospectively collected data on patients undergoing ALIF in a multidisciplinary setting at our institution from January 2007 to December 2021. Patients’ demographics, comorbidities, exposure related and postoperative complications within 30 days were included. Main outcome measures included vascular and visceral injuries requiring repair, nerve injuries, blood transfusion requirements, myocardial infarction, stroke, erectile dysfunction, retrograde ejaculation, length of stay and death. ResultsSeventy-four consecutive patients were included. Forty-seven were female and 27 male. The median body mass index was of 25.46 ± 4.76. Mean age was of 45.74 years. Twelve had a history of previous abdominal surgery and 31 a previous spinal surgery. The level operated on was L5/S1 in 58 patients (78.37%), L4/L5 in 2 patients (2.7%) and multi-level in 14 patients (18.91%). Sixteen patients had both anterior and posterior approach. There were no major intra-operative vascular injuries. Two patients had an intestine serosal tear. Seven patients had sexual dysfunction after surgery, of which 5 suffered impotence and 4 retrograde ejaculation. Two patients had both. There were no cases of disc space infections. There were no postoperative deaths. ConclusionsIn a multidisciplinary setting, ALIF can be performed safely with a reasonably low overall complication rate. Impotence and retrograde ejaculation are, even if generally temporary, important issues that have to be informed to the patient and inquired at follow up.

Modeling of Surgical Procedures Using Statecharts for Semi-Autonomous Robotic Surgery

In this paper we propose a new methodology to model surgical procedures that is specifically tailored to semi-autonomous robotic surgery. We propose to use a restricted version of statecharts to merge the bottom-up approach, based on data-driven techniques (e.g., machine learning), with the top-down approach based on knowledge representation techniques. We consider medical knowledge about the procedure and sensing of the environment in two concurrent regions of the statecharts to facilitate re-usability and adaptability of the modules. Our approach allows producing a well defined procedural model exploiting the hierarchy capability of the statecharts, while machine learning modules act as soft sensors to trigger state transitions. Integrating data driven and prior knowledge techniques provides a robust, modular, flexible and re-configurable methodology to define a surgical procedure which is comprehensible by both humans and machines. We validate our approach on the three surgical phases of a Robot-Assisted Radical Prostatectomy (RARP) that directly involve the assistant surgeon: bladder mobilization, bladder neck transection, and vesicourethral anastomosis, all performed on synthetic manikins.

Tips and Tricks for Deep Endometriosis in the Frozen Pelvis

Study Objective The objective of this study was to describe an approach to deep endometriosis in the frozen pelvis. Given it's high complexity, these cases must be thoroughly studied by every pelvic surgeon. Design Video description of tips and tricks to navigate through the frozen pelvis. Setting N/A. Patients or Participants The surgery was performed in a 20 years oldwoman who suffered from extensive retrocervical endometriotic lesions with obliteration of the pouch of Douglas. She presented with dysmenorrhea, dyspareunia, dyschezia and tenesmus. Her diagnosis was made through physical examination, ultrasound and MRI. She had an endometrioma in her left ovary and a lesion on the intestinal wall with 1.6 cm of infiltration and 3.5cm of extension, totaling 32% of the intestinal loop diameter. Interventions We start the surgery through the development of the avascular anatomical spaces. To loosen the intestinal lesion of the uterine wall, we traction the rectum centrally and posteriorly, and dissect towards the rectovaginal septum, passing the lesion area. In cases of endometriosis with extension to the ovarian pit, we like to remove the posterior leaflet of the broad ligament in conjunction with the uterosacral ligament while the assistant surgeon keeps the ureter and hypogastric nerve apart. Finally, after circumventing all the lesion and preserving the pelvic innervation, the excess fibrotic process must be resected by shaving the intestinal wall to reduce the lesion size and allow the discoid resection. Measurements and Main Results We conclude that the surgical technique in complex frozen pelvis cases must be flawless. Usually, the anatomy is very distorted and is more demanding to the surgeon. Thus, the correct use of energy devices and the help of the surgical assistant is key for successful outcome. Conclusion In summary, describe useful tips and tricks that equip the surgeon to navigate through the complex anatomy of a frozen pelvis. The objective of this study was to describe an approach to deep endometriosis in the frozen pelvis. Given it's high complexity, these cases must be thoroughly studied by every pelvic surgeon. Video description of tips and tricks to navigate through the frozen pelvis. N/A. The surgery was performed in a 20 years oldwoman who suffered from extensive retrocervical endometriotic lesions with obliteration of the pouch of Douglas. She presented with dysmenorrhea, dyspareunia, dyschezia and tenesmus. Her diagnosis was made through physical examination, ultrasound and MRI. She had an endometrioma in her left ovary and a lesion on the intestinal wall with 1.6 cm of infiltration and 3.5cm of extension, totaling 32% of the intestinal loop diameter. We start the surgery through the development of the avascular anatomical spaces. To loosen the intestinal lesion of the uterine wall, we traction the rectum centrally and posteriorly, and dissect towards the rectovaginal septum, passing the lesion area. In cases of endometriosis with extension to the ovarian pit, we like to remove the posterior leaflet of the broad ligament in conjunction with the uterosacral ligament while the assistant surgeon keeps the ureter and hypogastric nerve apart. Finally, after circumventing all the lesion and preserving the pelvic innervation, the excess fibrotic process must be resected by shaving the intestinal wall to reduce the lesion size and allow the discoid resection. We conclude that the surgical technique in complex frozen pelvis cases must be flawless. Usually, the anatomy is very distorted and is more demanding to the surgeon. Thus, the correct use of energy devices and the help of the surgical assistant is key for successful outcome. In summary, describe useful tips and tricks that equip the surgeon to navigate through the complex anatomy of a frozen pelvis.

Unsupervised Anomaly Detection for a Smart Autonomous Robotic Assistant Surgeon (SARAS) Using a Deep Residual Autoencoder

Anomaly detection in Minimally-Invasive Surgery (MIS) traditionally requires a human expert monitoring the procedure from a console, whereas automated anomaly detection systems in this area typically rely on classical supervised learning. Anomalous surgical events, however, are rare, making it difficult to capture data to train a model in a supervised fashion. In this work we propose an unsupervised approach to anomaly detection for robotic MIS based on deep residual autoencoders. The idea is to make the autoencoder learn the `normal' distribution of the data and detect abnormal events deviating from this distribution by measuring a reconstruction error. The model is trained and validated upon both the publicly available Cholec80 dataset and a set of videos captured on procedures using artificial anatomies (`phantoms') as part of the Smart Autonomous Robotic Assistant Surgeon (SARAS) project. The system achieves recall and precision equal to 78.4%, 91.5%, respectively, on Cholec80 and of 95.6%, 88.1% on the SARAS phantom dataset. The system was developed and deployed as part of the SARAS platform for real-time anomaly detection with a processing time of 25 ms per frame.

Mercenary gentlemen? The transnational service of foreign quarterdeck officers in the Royal Navy of the American and French wars, 1775–1815

Abstract In the late eighteenth century, like most European fleets, the British Royal Navy still employed some foreign officers. This phenomenon, almost completely unexplored, seemingly embodies a contradiction between the national and the transnational meanings of honour. Using archival and printed sources, this article examines the foreign presence, or lack thereof, in four distinct categories of ‘quarterdeck’ officer: commissioned officers, ‘young gentlemen’ (aspirant officers), surgeons and assistant surgeons, and a final miscellaneous group fulfilling special tasks, sometimes ashore. The peculiar values attached to the officer class, and the relative social and occupational positioning of these four categories, serve to test the real motives behind ‘national’ acceptance and exclusion: beyond the opposing discourses of gentlemanly and professional cosmopolitanism on the one hand, and patriotic duty, loyalty and emerging anti-mercenarism on the other, the levels of foreign presence among navy officers should be explained mainly with reference to supply and demand on the international labour migration market. The distinction between natives and foreigners was culturally and politically meaningful in a wartime context, and strategically deployed by various actors to regulate access and exclusion, but it can also operate as a red herring for the social historian. This has broader implications for the way in which we conceptualize honour, patriotism and the nation at the turn of the nineteenth century.

A Digital Twin Approach for Contextual Assistance for Surgeons During Surgical Robotics Training.

Minimally invasive robotic surgery copes with some disadvantages for the surgeon of minimally invasive surgery while preserving the advantages for the patient. Most commercially available robotic systems are telemanipulated with haptic input devices. The exploitation of the haptics channel, e.g., by means of Virtual Fixtures, would allow for an individualized enhancement of surgical performance with contextual assistance. However, it remains an open field of research as it is non-trivial to estimate the task context itself during a surgery. In contrast, surgical training allows to abstract away from a real operation and thus makes it possible to model the task accurately. The presented approach exploits this fact to parameterize Virtual Fixtures during surgical training, proposing a Shared Control Parametrization Engine that retrieves procedural context information from a Digital Twin. This approach accelerates a proficient use of the robotic system for novice surgeons by augmenting the surgeon’s performance through haptic assistance. With this our aim is to reduce the required skill level and cognitive load of a surgeon performing minimally invasive robotic surgery. A pilot study is performed on the DLR MiroSurge system to evaluate the presented approach. The participants are tasked with two benchmark scenarios of surgical training. The execution of the benchmark scenarios requires basic skills as pick, place and path following. The evaluation of the pilot study shows the promising trend that novel users profit from the haptic augmentation during training of certain tasks.

Vascular Surgeon Assistance Is an Invaluable Resource for Elective Surgical Care

Vascular surgeons are often called upon to intervene in nonvascular operative procedures to prevent or manage vascular compromise or injury. A vascular surgeon must be capable of fulfilling this additional assistive role in nonvascular operations wherever they practice. This study assesses vascular surgery (VS) operative assistance and intraoperative consultation in elective procedures.

Monocular tissue reconstruction via remote center motion for robot-assisted minimally invasive surgery

In minimally invasive surgery, the primary surgeon requires an assistant to hold an endoscope to obtain visual information from the body cavity. However, the two-dimensional images acquired by endoscopy lack depth information. Future automatic robotic surgeries need three-dimensional information of the target area. This paper presents a method to reconstruct a 3D model of soft tissues from image sequences acquired from a robotic camera holder. In this algorithm, a sparse reconstruction module based on the SIFT and SURF features is designed, and a multilevel feature matching strategy is proposed to improve the algorithm efficiency. To recover the realistic effect of the soft-tissue model, a complete 3D reconstruction algorithm is implemented, including densification, meshing of the point cloud and texture mapping reconstruction. During the texture reconstruction stage, a mathematical model is proposed to achieve the repair of texture seams. To verify the feasibility of the proposed method, we use a collaborative manipulator (AUBO i5) with a mounted camera to mimic an assistant surgeon holding an endoscope. To satisfy a pivotal constraint imposed by the remote center of motion (RCM), a kinematic algorithm of the manipulator is implemented, and the primary surgeon is provided with a voice control interface to control the directions of the camera with. We conducted an experiment to show a 3D reconstruction of soft tissue by the proposed method and the manipulator, which indicates that the manipulator works as a robotic assistant which can hold a camera to provide abundant information in the surgery.