Development Of Robotic Surgery Research Articles

Anatomical and Biomechanical Features of the Lateral Compartment of the Knee and Associated Technical Aspects of Unicompartmental Knee Arthroplasty: Lecture

The frequency of lateral unicompartmental knee arthroplasty is estimated at 1% of the total volume of knee arthroplasties, according to contemporary literature. Recent studies analyzing this type of surgical intervention indicate that when performed with proper indications and technical accuracy, it is equally effective and safe as total knee arthroplasty. Potential advantages of partial knee replacement include reduced invasiveness compared to total knee arthroplasty, lower perioperative blood loss, faster patient rehabilitation, and preservation of native joint proprioception. However, it is important to consider that successful implementation of lateral unicompartmental knee arthroplasty requires not only appropriate patient selection but also technical proficiency, advanced operating room equipment, and precise surgical techniques performed by experienced surgeons. Failure to meet these conditions can negate the potential benefits and may lead to early revision surgery. It is evident that unicompartmental knee arthroplasty is not simply a half-operation of total joint replacement, and the lateral compartments partial arthroplasty only shares general similarities with the more popular and established medial unicompartmental knee arthroplasty. The differences lie primarily in the complex anatomy and biomechanics of the lateral compartment, which present a challenging task even with the use of modern anatomically designed implants. The development of robotic surgery and personalized joint implants may help overcome these challenges more effectively. However, in our current routine practice, we rely on conventional instruments and strive to optimize our techniques. The authors of this article aim to provide an overview of the contemporary understanding of the anatomy and biomechanics of the lateral compartment of the knee and the specific technical aspects related to partial lateral arthroplasty using a fixed tibial platform implant.

What is the current state of artificial intelligence applications in dentistry and orthodontics?

BackgroundThe use of Artificial Intelligence (AI) in the medical field has the potential to bring about significant improvements in patient care and outcomes. AI is being used in dentistry and more specifically in orthodontics through the development of diagnostic imaging tools, the development of treatment planning tools, and the development of robotic surgery. The aim of this study is to present the latest emerging AI softwares and applications in dental field to benefit from. Types of studies reviewedSearch strategies were conducted in three electronic databases, with no date limits in the following databases up to April 30, 2023: MEDLINE, PUBMED, and GOOGLE® SCHOLAR for articles related to AI in dentistry & orthodontics. No inclusion and exclusion criteria were used for the selection of the articles. Most of the articles included (n = 79) are reviews of the literature, retro/prospective studies, systematic reviews and meta-analyses, and observational studies. ResultsThe use of AI in dentistry and orthodontics is a rapidly growing area of research and development, with the potential to revolutionize the field and bring about significant improvements in patient care and outcomes; this can save clinicians’ chair-time and push for more individualized treatment plans. Results from the various studies reported in this review are suggestive that the accuracy of AI-based systems is quite promising and reliable. Practical implicationsAI application in the healthcare field has proven to be efficient and helpful for the dentist to be more precise in diagnosis and clinical decision-making. These systems can simplify the tasks and provide results in quick time which can save dentists time and help them perform their duties more efficiently. These systems can be of greater aid and can be used as auxiliary support for dentists with lesser experience.

Surgical management of teratoma located in pretracheal retrocaval space: from pre-operative 3D reconstruction to robotic surgery

: The late 1990s saw the development of robotic surgery with its major application in cardiac surgery; since then, robotic technique revealed its huge potential in narrow spaces, like mediastinum. Robotic system properties consent to work safely in restricted areas, thanks to the tridimensional magnified vision and movement accuracy, without conflicts between the instruments. A case of surgical treatment by the robotic approach of teratoma located in pre-tracheal retrocaval space is reported. In the pre-operative phase, a three-dimensional (3D) reconstruction of chest computed tomography (CT) scan images was obtained, to define the correct location of the tumor and its anatomic relationship with adjacent structures. Therefore, pre-operative 3D reconstruction ensures properly planning the operation, minimizing the risk of intraoperative unexpected complications. The surgical removal of the lesion was performed with a robotic 3-arms approach, without complications and with fast recovery. Over the years, robotic indications have been enlarged also to more complex cases, in parallel with the increase in surgeons’ experience. Consequently, preoperative planning of the surgical procedures appears fundamental to establish operative strategies in detail. In this regard, 3D reconstruction of CT scan images may provide an exhaustive vision of the anatomical details, which is useful to plan the surgical procedure and reduce the risk of intraoperative unexpected complications.

Artificial Intelligence in Andrology: From Semen Analysis to Image Diagnostics.

Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine.

TECHNOLOGY AND HEALTHCARE: DEVELOPMENT OF ROBOTIC SURGERY AND ITS APPLICATION

Modern technology has changed our daily lives in many ways such as communication, transportation, and especially in terms of medication. Such medical technologies include robotic surgery. Robotic surgery, considered as new technology as the first one, PUMA 560, was first introduced in 1985 for stereotaxic operation- inserting a needle into the brain for biopsy. Robotic surgery helped surgeons to perform complex tasks and subjects to minimize trauma errors that might occur due to imprecision. The implications of robots are still in the early stages and there are many concerns with the use of robots in the medical field, especially in surgery. Such problems are but are not limited to safety, ethics and morals, and its ability compared to humans. In this paper, we will begin with the history and general use of robot both in daily life and the medical field and we will explore laparoscopic surgery before we deeply elaborate on the use of robots, Da Vinci (the first robotic surgery approved by the Food and Drug Administration for laparoscopic surgery). Then we will illustrate the highlighted case performed by robotic surgery and compare between robots. Last but not least, we will analyze whether robots might replace surgeons in the future and how they might impact us both positively and negatively.

TECHNOLOGY AND HEALTHCARE: DEVELOPMENT OF ROBOTIC SURGERY AND ITS APPLICATION

TECHNOLOGY AND HEALTHCARE: DEVELOPMENT OF ROBOTIC SURGERY AND ITS APPLICATION

Short-term and long term morbidity in robotic pancreatic surgery: a systematic review.

Pancreatic cancer is one of the most aggressive and lethal tumours in Western society. Pancreatic surgery can be considered a challenge for open and laparoscopic surgeons, even if the accuracy of gland dissection, due to the close relationship between pancreas, the portal vein, and mesenteric vessels, besides the reconstructive phase (in pancreaticoduodenectomy), lead to significant difficulties for laparoscopic technique. Minimally invasive pancreatic surgery changed utterly with the development of robotic surgery. However, this review aims to make more clarity on the influence of robotic surgery on long-term morbidity. A systematic literature search was performed in PubMed, Cochrane Library, and Scopus to identify and analyze studies published from November 2011 to September 2020 concerning robotic pancreatic surgery. The following terms were used to perform the search: "long term morbidity robotic pancreatic surgery". Eighteen articles included in the study were published between November 2011 and September 2020. The review included 2041 patients who underwent robotic pancreatic surgery, mainly for a malignant tumour. The two most common robotic surgical procedures adopted were the robotic distal pancreatectomy (RDP) and the robotic pancreaticoduodenectomy (RPD). In two studies, patients were divided into groups; on the one hand, those who underwent a robotic pancreaticoduodenectomy (RPD), on the other hand, those who underwent robotic distal pancreatectomy (RDP). The remaining items included surgical approach such as robotic middle pancreatectomy (RMP), robotic distal pancreatectomy and splenectomy, robotic-assisted laparoscopic pancreatic dissection (RALPD), robotic enucleation of pancreatic neuroendocrine tumours. Comparison between robotic surgery and open surgery lead to evidence of different advantages of the robotic approach. A multidisciplinary team and a surgical centre at high volume are essential for better postoperative morbidity and mortality.

Usability of Indocyanine Green in Robot-Assisted Hepatic Surgery.

Recent developments in robotic surgery have led to an increasing number of robot-assisted hepatobiliary procedures. However, a limitation of robotic surgery is the missing haptic feedback. The fluorescent dye indocyanine green (ICG) may help in this context, which accumulates in hepatocellular cancers and around hepatic metastasis. ICG accumulation may be visualized by a near-infrared camera integrated into some robotic systems, helping to perform surgery more accurately. We aimed to test the feasibility of preoperative ICG application and its intraoperative use in patients suffering from hepatocellular carcinoma and metastasis of colorectal cancer, but also of other origins. In a single-arm, single-center feasibility study, we tested preoperative ICG application and its intraoperative use in patients undergoing robot-assisted hepatic resections. Twenty patients were included in the final analysis. ICG staining helped in most cases by detecting a clear lesion or additional metastases or when performing an R0 resection. However, it has limitations if applied too late before surgery and in patients suffering from severe liver cirrhosis. ICG staining may serve as a beneficial intraoperative aid in patients undergoing robot-assisted hepatic surgery. Dose and time of application and standardized fluorescence intensity need to be further determined.

Current Use of the Artificial Urinary Sphincter in Adult Females.

The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.

Роботохирургия – цифровая технология, спасающая жизни

Background. The article is dedicated to the study of native and international robotic surgery develop¬ment as a revolutionary treatment technology. The article reveals the essence and advantages of surgical treatment using robots. The data provided indicate insufficient growth of the world market for robotic surgery, segmentation by country (in favor of highly developed countries) and monopolization. Materials and methods. The article is structured in theses with infographics, giving a complete picture of the main aspects. Results and discussion. The data analysis helped to identify the main trends and problems of ro¬botic technologies market in surgery. The key issue is the difference between the number of operations that can be possibly performed in robotic surgical technologies and their actual number. Based on the results of the analysis, there were formed promising directions and tasks for the development of robotic surgery and possible approaches to their implementation. In this study there were discussed the possibilities of training doctors and the prospects of the Russian robotic-assisting complex, as well as the paradoxical situation in the world of robotic surgery. The paradox is that despite the low level of market development, growing number of research works in the field of robotic-assisted surgery, its proven therapeutic efficacy and the high demand from behalf of the population and the surgical community, still there are problems that cannot be solved for the next 5 - 10 years. With a focus on the abdominal area, these problems are: high expenses; limited functionality of the robot; the lack of qualified doctors, training problems; unprofitable implementation of robotic surgery for clinics (in the business aspect). The development and implementa¬tion of robotic surgical techniques and technologies in Russia can significantly increase the availability and quality of medical care, and greatly advance the implementation of some projects in healthcare. At the same time, Moscow can initiate the development of robotic surgery in the country and in the world. Conclusion. It is important to fit the new surgical robots into the healthcare system, especially in terms of costs, and perform a large number of surgeries to increase payback. This requires the development and launch of the federal program “Robot surgery”.

Robotic-assisted minimally invasive esophagectomy: past, present and future.

Esophagectomy for cancer of the esophagus is increasingly performed using minimally invasive techniques. After the introduction of minimally invasive esophagectomy (MIE) in the early 1990's, robotic-assisted techniques followed after the turn of the millennium. The advent of robotic platforms has allowed the development of robotic-assisted minimally invasive esophagectomy (RAMIE) over the past 15 years. Although recent trials have shown superior peri-operative morbidity and quality of life compared to open esophagectomy, no randomized trials have compared RAMIE to conventional MIE. This paper summarizes the current literature on RAMIE and provides an overview of expected future developments in robotic surgery.

Robotic surgery of the anterior skull base.

Significant advances have been made in transoral robotic surgery (TORS), yet its application in anterior skull-base surgery has yet to be defined. This work explores the history of endoscopic sinus and anterior skull-base surgery, and its advantages and disadvantages. The development of robotic surgery is then discussed as well as the advantages and disadvantages of TORS as it relates to the anterior skull base. The current applications for robotic surgery to the anterior skull base are presented with details of future applications. A structured search of the current literature using MEDLINE, PubMed, and EMBASE was performed from inception to May 2019. Search terms related to topics of robotic skull-base surgery were identified and queried to identify relevant articles. Fifty-four papers were identified from the literature search and a hand search of the references. Twenty-one other references were discovered from personal communication, websites, and books relevant to the topic. Anterior skull-base surgery has the potential for significant morbidity compared to head and neck surgery, yet the application of the robot in sinus and anterior skull-base surgery has yet to be formally defined. Currently, there are certain limitations that need to be overcome; however, research to address these barriers is currently underway and promises an exciting future for robotic sinus and anterior skull-base surgery.

Submandibular gland resection via the trans-hairline approach: A preclinical study of a novel flexible single-port surgical system and the surgical experiences of standard multiarm robotic surgical systems.

Cosmetic outcome after submandibular gland (SMG) surgery has greatly improved since the development of robotic surgery through a trans-hairline approach. However, the bulky sizes of robotic arms and the rigid design of camera and instruments in the current multiarm robotic systems increased the surgical difficulty. Clinical and preclinical studies demonstrated the surgical configuration and procedures of robotic trans-hairline SMG resection using a flexible, single-port, and multiarm systems. The surgical procedures of trans-hairline approach for SMG resection could be successfully performed using the flexible single-port (SP) robotic system in the preclinical study. The unique features include an easier docking procedure, different viewing angles, the use of the third arm, and coordination of instrument positions without a bedside assistant, which are unavailable in current multiarm robotic systems. This study demonstrates the feasibility and the advantages of applying the flexible, SP robotic system in SMG resection through the trans-hairline approach.

Robotic surgery in public hospitals of Latin-America: a castle of sand?

There is no information about the evolution of robotic programs in public hospitals of Latin-America. To describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date. We conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25-75 centiles (IQR) were estimated. Since 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs. Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

Partial splenectomy: A case series and systematic review of the literature.

Backgrounds/AimsPartial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches.MethodsData of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients.ResultsFive PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5–50%) and in 3% of cases (range, 7–10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5–25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%).ConclusionsThe present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.

Features of haptic and tactile feedback in TORS-a comparison of available surgical systems

Sustained interest and an increase of possible indications endorse the role of robot-assisted surgery of the head and neck region. However, broad clinical application is impeded by substantial extra cost, time exposure and a supposed deficit of haptic and tactile feedback. The role of haptic feedback has barely been examined in this context, and literature provides only limited objective validation. This point of criticism applies to all commercially available systems. We created an experimental setup to evaluate, quantify and compare the performance of surgical systems. The daVinci system (Intuitive Surgical), the Flex system (Medrobotics) and standard rigid instruments (23cm laryngoscopic grasper, Karl Storz) were compared with the human hand by head and neck surgeons (n=15), performing a variety of surgical tasks. Specific samples with different rigidity were sorted with all devices, and the resulting orders were analyzed by permutation analysis, indicating differences in precision and accuracy of haptic and tactile feedback. The human hand was superior in all trials, acting as reference modality. The flexible instruments of the Flex system performed better than the electro-mechanically decoupled instruments of the daVinci system for the majority of measures recorded, suggesting a benefit in terms of haptic and tactile feedback in this context. While not all aspects of haptic and tactile feedback were accessible, this first objective comparison endorses the inferiority of robot-assisted surgery in terms of haptic and tactile feedback, compared to the human sense or standard surgical tools. Furthermore, the immediate force transmission of the Flex system seems to be superior to the electro-mechanical transformation of the daVinci system, indicating an advantage in terms of haptic and tactile feedback in immediate comparison. This study is providing a basis for further experiments and the development of robotic surgery towards an implementation in clinical routine.

Advances in robotic-assisted treatments for renal cell carcinoma.

Robotic techniques and technology for renal cell carcinoma surgery are constantly evolving to improve outcomes. This article reviews new knowledge and recent developments in robotic surgery for renal cancer. The long-term oncological efficacy of robotic partial nephrectomy for small renal masses has been confirmed. The greater relative importance of volume loss vs. ischemia duration in predicting long-term renal function after partial nephrectomy is now established, and the robotic technique may facilitate volume preservation. The feasibility of robotic radical nephrectomy with inferior vena cava tumor thrombectomy is being investigated. Robotic laparoendoscopic surgery offers cosmetic benefits compared with multiport technique, but technical constraints have limited widespread adoption. Cost reduction in robotic surgery is an emerging area of interest. Lastly, new purpose-built robotic systems are being developed to optimize single-site robotic surgery. Recent advances in robotic surgery for renal cancer include optimization of renal functional outcomes after partial nephrectomy, application of robotic surgery to locally advanced disease, minimization of invasiveness, cost reduction, and new robotic single-site surgery technology.

Innovations in robotic surgery.

Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.

Design of Virtual Fixtures for Robotic Cholecystectomy.

With the ongoing developments in robotic surgery, the associated adverse events need to be carefully evaluated. Virtual fixtures (VFs), a safety design feature against unintended motion during robotic surgery, have been proposed, but the methodology for designing VFs remains experimental. In this study, we propose a novel methodology for designing VFs for robotic cholecystectomy. Laparoscopic cholecystectomy (LC) was performed in 24 patients with cholecystitis. Active working space (AWS), the distance between instrument heads (DBIH), motion speed of bilateral hands, and instrument heads were calculated and analyzed. DBIH was 14.78 ± 6.94 cm. Diameter of right and left AWS was 15.81 ± 3.69 cm and 15.33 ± 1.52 cm, respectively. DBIH was found to significantly correlate with the surgeon's experience. Bilateral AWS was found to be significantly associated with body circumference at Murphy's point level. However, no association was observed between bilateral AWS and surgeon's experience. A novel methodology to build VFs for designing VFs for robotic cholecystectomy is established. Surgeon's experience appears to play an important role in determining the DBIH during robotic laparoscopic cholecystectomy, but does not affect bilateral AWS.

The growth of computer-assisted (robotic) surgery in urology 2000–2014: The role of Asian surgeons

ObjectiveA major role in the establishment of computer-assisted robotic surgery (CARS) can be traced to the work of Mani Menon at Vattikuti Urology Institute (VUI), and of many surgeons of Asian origin. The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines, improving patient comfort and disease outcomes and helping the industrial growth. The present paper gives an overview of the progress and development of robotic surgery, especially in the field of Urology; and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world. MethodsPubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014, using algorithms based on keywords “robotic surgery”, ”prostate”, “kidney”, “adrenal”, “bladder”, “reconstruction”, and “kidney transplant”. Inclusion criteria used were published full articles, book chapters, clinical trials, prospective and retrospective series, and systematic reviews/meta-analyses written in English language. Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion, and focused on techniques of robotic surgery, relevant patient outcomes and associated demographic trends. ResultsA total of 58 articles selected for final review highlight the important strides made by robots in urology, from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014. In the hands of an experienced robotic surgeon, it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery, especially in urologic oncology and reconstructive urology. With increasing surgeon proficiency, the benefits of robotic surgery were consistently seen across different surgical disciplines, patient populations, and strata. ConclusionThe addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.