Tremor Elimination Research Articles

Radiosurgical thalamotomy for the management of tremors: a systematic review and meta-analysis.

Medical treatment for tremors may include beta-blockers, primidone, dopaminergic, and anticholinergic drugs but it frequently leads to pharmacoresistance. Therefore, surgical treatment gained relevance as an alternative for those patients.We aim to evaluate radiosurgical thalamotomy as an effective and safe alternative to manage tremors.Pubmed (MEDLINE), Embase, Web of Science, and the Cochrane Library databases were systematically searched for potential articles that evaluated radiosurgical thalamotomy for the management of tremor.Our analysis included 12 studies with 545 patients, 226 of whom were female. Of these, 64.6% of patients were diagnosed with essential tremor (ET), 34.6% with Parkinson's disease (PD), and 0.8% with both ET and PD. The FTM-TRS global score (MD -5.46; 95% CI [-10.44]-[-0.47]; I2 = 52%) and the drawing (MD -1.40; 95% CI [-2.03]-[-0.76]; I2 = 93%), drinking (MD -1.60; 95% CI [-1.82]-[-1.37]; I2 = 40%), and writing (MD -1.51; 95% CI [-1.89]-[-1.13]; I2 = 89%) grades showed significantly lower mean differences, favoring radiosurgical thalamotomy. A pooled proportion of 12% presented with tremor unchanged, while 38% presented with total elimination of tremor. Adverse events included: major paresis, minor paresis, dysarthria, and numbness. Thus, radiosurgical thalamotomy is a safe alternative for tremors resistant to medication, particularly in high-risk patients for RF or DBS procedures. The recommended dose of 130 to 150Gy is effective and well-tolerated. However, randomized controlled trials (RCTs) are needed to understand the unpredictability of tissue response to radiation.

Robotic surgery as a driver of surgical digitalization

Classical surgery, also called analog surgery, is transmitted to us by our mentors, whose knowledge has been delegated from generation to generation throughout the history of surgery. Its main limitations are limited surgical precision and dependence on the surgeon’s skill to achieve surgical goals. So-called digital surgery incorporates the most advanced technology, with the aim of improving the results of all phases of the surgical process. Robotic platforms are currently considered to be one of the main drivers of the digital transformation of surgery. They bring considerable advances to the digitalization of surgery, including: higher quality visualization, more controlled and stable movements with elimination of tremor, minimized risk of errors, data integration throughout the patient’s surgical process, use of various systems for better surgical planning, application of virtual and augmented reality, telementoring, and artificial intelligence.

Biochemical implications of robotic surgery: a new frontier in the operating room.

Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.

Robotic distal splenopancreatectomy

AbstractAimThe use of minimally invasive approaches for pancreaticobiliary surgery has recently gained wider acceptance. Surgical arms with unparalleled flexibility, manual dexterity, 3D imaging and tremor elimination have increased anatomical access and decreased the difficulty of surgery. We describe a case of mucinous cystadenoma treated with robotic distal splenopancreatectomy.Patients and MethodsA 72‐year‐old woman presented with anorexia, nausea, constipation and weight loss of 9 kg in 3 months. Imaging and histological studies indicated it likely to be a mucinous cystadenoma of the body–tail of the pancreas. Robotic distal splenopancreatectomy was performed with intraoperative identification and splenic artery ligation.ResultsThe patient made an uneventful recovery and was discharged on postoperative day 7. A pathology study confirmed mucinous cystadenoma with focal low‐grade epithelial dysplasia and clear margins.ConclusionRobotic distal pancreatectomy is a safe and feasible approach in appropriately selected patients. Although the procedural cost is higher with the robotic approach, some argue that this is balanced by the shorter overall length of stay, thus making robotic distal pancreatectomy a cost‐effective option.

Robotic Microsurgery in Plastic and Reconstructive Surgery: A Literature Review.

Surgical robots have innovated the microsurgical field by providing advantages that improve surgical performance. These robots have been adopted by certain specialties more than others. This study discusses the potential advantages of robotics in plastic and reconstructive surgery. This study is a literature review of articles investigating "robotic microsurgery in plastic and reconstructive surgery" using the PubMed database and the Cochrane Library. A total of nineteen relevant articles were found and 5 articles performed a direct comparison between the robotic and manual approaches. Longer operating times were reported in the robotic groups featuring higher learning curves. Reported advantages to robotic use included higher accuracy, precision and flexibility, elimination of tremor and improvement of ergonomic factors. While the results provide an outlook into the outcome of robotic platforms in this field, current research is limited and further studies are required to provide a fundamental analysis.

Robot-assisted DIEAP flap harvesting: a review of techniques

Robotic surgery has expanded the capabilities of human surgical techniques by offering tremor elimination, ergonomic positioning, 3D viewing, and improved resolution.The purpose of the study: to examine DIEAP flap harvesting techniques using minimally invasive robot-assisted techniques.Material and Methods. The PubMed, SCOPUS, ScienceDirect, and Russian scientific electronic library databases were used for the review; the search was performed using the key phrases robotic deep inferior epigastric artery perforator flap, robotic DEIAP, robotic breast surgery, robot-assisted breast reconstruction. Inclusion criteria: case reports or cadaveric studies.Results. Nine studies were found that met the inclusion parameters. Nine studies looking at DIEAP flap extraction using robot-assisted techniques included a total of 59 patients. Five studies defined the flap harvesting technique as transperitoneal or intraperitoneal. Only 1 study described extroperitoneal flap harvesting. Three studies used the same terminology: transabdominal preperitoneal and total extroperitoneal. A lack of consensus in terminology was found.Conclusion. Robot-assisted DIEAP flap harvesting can be performed using transabdominally preperitoneal and total extraperitoneal techniques, as well as using monoport and multiport accesses with different port locations. However, for a more detailed study, randomized controlled trials with control of anterior abdominal wall weakness and with comparison of complications of different techniques are needed.

Challenges and Opportunities in Thoracic Robotic Surgery

Robotic surgery is a platform for minimally invasive thoracic surgery with similar general advantages as in VATS (Video Assisted Thoracic Surgery) including small incisions, faster recovery, minimal blood loss and shorter hospital stay. The extra advantages of using a robotic platform in thoracic surgery include a three-dimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. These advantages allow more complex procedures to be performed safely and easier technically, thus leading to better outcomes and improvement in the overall result. As a new advance in thoracic surgery, it has challenges that may become the reason why this technique has difficulty being adopted by a number of surgeons including cost, advancement in VATS technique and instrumentation. Despite the challenges, robotic thoracic surgery offers the platform for the expansion and improvement of thoracic surgery. Development in instrument technologies and designs, in addition to progress and interest in other futuristic technology, are notable opportunities for thoracic robotic surgery.

An effective tremor-filtering model in teleoperation: Three-domain Wavelet Least Square Support Vector Machine

Proper elimination of hand tremors in robot-assisted minimally invasive surgery has become a key concern due to its significant impacts on control precision and surgical success. In this study, a Three-domain Wavelet Least Square Support Vector Machine with Improved Sparrow Search Algorithm (ISSA-TDWLSSVM) model is proposed to forecast and eliminate tremor signals in teleoperation. The multi-domain analysis layer is proposed for redesigning the structure of the LSSVM. The multi-domain analysis layer is divided into three parts, complex-frequency domain, frequency domain, and time domain. The functions corresponding to three domains are the Time series, Mexican hat wavelet, and Gauss–Laplace functions. The other contribution of this study is that a novel wavelet kernel-function is proposed. Meanwhile, an improved sparrow search algorithm is proposed for optimizing the wavelet kernel-function parameter to improve the forecasting accuracy. To prove the generalization ability of the proposed model, the ISSA-TDWLSSVM and existing models are used in three examples. Compared with the existing models, the result showed that the ISSA-TDWLSSVM model has the highest forecasting accuracy. The wavelet kernel function has a good mapping ability. As compared with the LSSVM used in three-axis teleoperation robot, the Accuracy index of the ISSA-TDWLSSVM model is increased by 34.52%. In a word, an effective model is proposed to eliminate tele-operated tremor signals in this study.

Safe Technical Innovation: Development and Implementation of a Robotic Breast Operation Program.

Safe Technical Innovation: Development and Implementation of a Robotic Breast Operation Program.

Is There Room for Microsurgery in Robotic Surgery?

Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms ' robotic surgery ' AND microsurgery , with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.

The Management of Clinical Varicocele: Robotic Surgery Approach.

Varicocele is a pathologic dilation of the testicular veins within the spermatic cord. Varicocele is considered the most common problem in reproductive medicine practice. It is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, and several theories have been proposed to explain it. Varicocele can impair sperm quality and fertility via various mechanisms: reflux of adrenal metabolites, increased testicular hypoxia, oxidative stress, and increased testicular temperature have been proposed. Several studies have reported the significant benefits on semen parameters with the surgical treatment of varicocele: reducing oxidatively induced sperm DNA damage and potentially improving fertility. Varicocele repair should be offered as a part of treatment option for male partners of infertile couples presenting with palpable varicoceles. Nowadays, there are several surgical approaches available for the treatment of varicocele, such as the retroperitoneal approach, inguinal approach, and the subinguinal approach. The subinguinal microscopic approach offers the best outcomes, such as shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. Currently robotic-assisted laparoscopic surgery is widely adopted in urology and surgeons began to explore the potential applications of the robotic platform to male infertility microsurgical operations. Robotic approach offers many advantages: elimination of tremor, retraction with third arm, high quality, 3-dimensional visualization and surgeon ergonomics, all contributing to the precision of surgery.

75 Years of Excellence: The Story of Reconstructive Surgery

75 Years of Excellence: The Story of Reconstructive Surgery

Robotic Surgery in Rectal Cancer

AbstractRectal cancer is an important cause of morbidity and mortality worldwide. The most effective and curative treatment is surgery, and the standard procedure is total mesorectal excision, initially performed by open surgery and posteriorly by minimally invasive techniques. Robotic surgery is an emerging technology that is expected to overcome the limitations of the laparoscopic approach. It has several advantages, including a stable camera platform with high definition three-dimensional image, flexible instruments with seven degrees of freedom, a third arm for fixed retraction, fine motion scaling, excellent dexterity, ambidextrous capability, elimination of physiological tremors and better ergonomics, that facilitate a steady and precise tissue dissection. The main technical disadvantages are the loss of tactile sensation and tensile feedback and the complex installation process. The aim of the present study is to review the importance and benefits of robotic surgery in rectal cancer, particularly in comparison with the laparoscopic approach. Intraoperative estimated blood loss, short and long-term outcomes as well as pathological outcomes were similar between robotic and laparoscopic surgery. The operative time is usually longer in robotic surgery and the high costs are still its major drawback. Robotic surgery for rectal cancer demonstrated lower conversion rate to open surgery and benefits in urinary and sexual functions and has been established as a safe and feasible technique.

Robotic pancreaticoduodenectomy for pancreatic head cancer and periampullary lesions.

Pancreaticoduodenectomy, so‐called “Whipple operation,” is a time‐consuming and technically demanding complex operation. Traditionally, this procedure has been performed most usually by open approach, which results in a large and painful wound. With the introduction of laparoscopic and robotic surgery, minimally invasive surgery (MIS) has emerged as a worldwide trend to improve wound cosmesis and to minimize wound pain. Although MIS for pancreaticoduodenectomy has also been attempted at some centers, the role of MIS, either robotic or laparoscopic approach, has not been well‐established for complex pancreaticoduodenectomy. Given that laparoscopic pancreaticoduodenectomy has been limited by its technical complexity and the high level of advanced laparoscopic skills required for pancreatic reconstruction, a robotic surgical system is introduced to overcome several limitations related to the laparoscopic approach. Providing high‐quality three‐dimensional (3‐D) vision, high optical magnification, articulation of robotic instruments, greater precision with suture targeting, and elimination of surgeon tremor, robotic surgical systems innovatively perform more delicate and complex procedures involving extensive dissection and suturing techniques such as pancreaticoduodenectomy. Although associated with longer operative time, robotic pancreaticoduodenectomy (RPD) has been claimed to have the benefits of less delayed gastric emptying, less blood loss, shorter length of postoperative stay, and lower wound infection rate, as compared with the traditional open pancreaticoduodenectomy (OPD). Moreover, RPD seems to be not only technically feasible but also justified without compromising the survival outcomes for pancreatic head and ampullary adenocarcinomas. Therefore, RPD could be recommended not only to surgeons but also to patients in terms of surgical feasibility, surgical outcomes, and patient satisfaction.

Minimally invasive robotic breast reconstruction surgery

The rising popularity of robotic surgery has enabled surgeons to continue to expand the uses of robotic surgery. Robotic surgery offers minimally invasive approaches coupled with tremor elimination, up to seven degrees of freedom, ergonomic positioning, 3D magnified vision and improved resolution. We describe robotic surgery techniques for nipple-sparing mastectomies, latissimus dorsi muscle flap harvest, deep inferior epigastric perforator (DIEP) flap pedicle harvest, and robotic microsurgical anastomoses. By using a robotic system the surgeon is able to offer not only a minimally invasive approach to the patient but the surgeon's ability can be improved upon as well. This improved ability is best characterized in the robotic supermicrosurgical anastomosis where even the faintest surgeon's tremor is exploited. However, within the robotic system tremor is eliminated. We are now able to offer patients a completely minimally invasive approach to ablative breast surgery and breast reconstruction. A patient could have a robotic nipple-sparing mastectomy, followed by a robotic DIEP reconstruction with a robotic microsurgical anastomosis. The patient could even have robotic lymphovenous bypass to address lymphedema that could have arisen after an axillary dissection. A completely robotic surgical approach maximizes both utilization of the robotic system and patient benefit. By using robotic techniques in flap harvest the morbidity of traditional open surgeries is minimized and the use of robotic anastomoses expands the limits of human precision.

Robotic Liver Surgery - Current Standards and Future Perspectives.

Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis. An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery. Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes. In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.

Robot assisted laparoscopic Duhamel pull through

Abstract Aim This case report is to discuss the first ever reported case in the literature of Robotic Duhamel procedure for Hirschsprung's disease. Material and method A 3-year old female child, diagnosed case of Hirschsprung's disease underwent a Robot Assisted Laparoscopic Duhamel Pull through [RALDP] procedure for the same. Conclusion Robot Assistance has a unique set of advantages like 3D view, depth perception, elimination of physiological tremors and enhanced degree of freedom in movements. These advantages in combination give a very precise dissection with minimal blood loss and greatly reduced chances of injury to surrounding vital structures especially during dissection in deep spaces like the pelvis. In view of these benefits we decided to utilize the Da Vinci Xi system for a Duhamel pull through procedure in a case of Hirschsprung's disease.

Essure removal: comparison of two minimally invasive approaches

To study differences between robotic and laparoscopic approach in Essure device removal. Demonstration video of two different surgical approaches. Clinico San Carlos University Hospital in Madrid, Spain. A total of 737 Essure devices were implanted until June 2017 in Clinico San Carlos Hospital. Nineteen of them were removed. Fourteen (73.7%) were removed using the laparoscopic approach, 4 (21%) using the robotic approach, and 1 (5.3%) using hysteroscopy. We show two cases, one performed using the robotic approach and one using the laparoscopic approach. The first patient was 49 years old and the indication for Essure removal was nickel allergy. The second patient was 52 years old and she had chronic pelvic pain. We performed two cases of Essure device removal and bilateral salpingectomy operated using the laparoscopic and robotic approaches to compare both procedures. The first step was coagulation of the antimesenteric edge of the fallopian tube with bipolar forceps 2 cm from the uterine horn. The second step was cutting of the coagulated tissue and dissection to visualize the metallic spiral. The third step was pulling gently to extract one of the spirals of the device. The fourth step was salpingectomy and extraction of the proximal part of the Essure. After Essure removal and bilateral salpingectomy, we performed X-ray of the pelvis to ensure complete removal of the device in both patients. We recorded intraoperative and postoperative complications, total operative time and blood loss. We did not have intraoperative or postoperative complications in any of the surgical approaches. Total operative time was 30 minutes in the robotic surgery (total time in the operating room, 60 minutes) and 45 minutes in the laparoscopic approach (total time in the operating room, 65 minutes). Estimated blood loss was 10 mL in the robotic surgery and 25 mL in the laparoscopic surgery. Both patients were asymptomatic after 3 months of follow-up. The same results could be extrapolated to our series; we observed a median of total operating time of 45 minutes, no complications, length of stay of 2 days, and total resolution of symptoms after 3 months of follow-up. Our results are similar to the results reported by other authors who consider laparoscopic salpingectomy for removal of Essure inserts to be safe and feasible. Robotic and laparoscopic approaches allow complete removal of Essure devices in symptomatic patients without major complications. On the other hand, robotic surgery provides advantages to the surgeon, such as greater precision, elimination of tremor, three-dimensional visualization of surgical field, and ease of minimally invasive suturing. But robotic surgery has the disadvantages of increased cost and increased case time in some circumstances.

The Recent Advances in Robotic Transoral Thyroidectomy

Transoral robotic thyroidectomy (TORT) is one of the latest approaches in remote-access thyroid surgery. This review presents the current indications for TORT, an in-depth description of the surgical procedure, and discusses the advantages, disadvantages, potential complications, and latest advances for this procedure. TORT has the advantages of excellent cosmesis, short distance from oral vestibule to the neck, and midline approach which allows easy access to bilateral thyroid glands and central compartment. In addition, the use of robotic arms ensures wristed instruments, tremor elimination, and reduced clashing of instruments with endoscope. Complication rates are low; however, the use of robotic systems is costly and there may be a steep learning curve. TORT can be performed safely with careful patient selection and with an experienced robotic surgeon and it is an acceptable alternative for the treatment of certain thyroid conditions.

Robotics in Cleft Surgery: Origins, Current Status and Future Directions.

The field of robotic surgery is an exciting and growing field that has bolstered its way to become a mainstream application in a number of surgical disciplines. The application of robotic surgery in cleft surgery is novel and has captivated many with the benefit it provides: the slender and small arms with wrist articulation at the instrument tip; motion scaling; tremor elimination; and high fidelity, three-dimensional visualization make the robot a very attractive platform for use in confined spaces with small surgical targets. The story of the origin of robotic surgery in cleft surgery is an interesting one, and one that has arisen from other allied surgical specialities to render robotic cleft surgery as its own specialised field. A field that has coined its own terms and has demonstrated a number of applications for its use. This review details the origins of robotic cleft surgery, its evolution and its current status and elaborates on future directions to enhance its application.