Telesurgery Research Articles

Transoral Thyroidectomy Using A Flexible Robotic System: A Preclinical Cadaver Feasibility Study.

Traditionally, most thyroid surgery utilizes a curvilinear cervical incision with a resulting permanent scar. Minimally invasive and remote access thyroid surgery techniques continue to evolve. Transoral approaches through a vestibular incision have been developed at several centers throughout the world, obviating the need for a cutaneous incision and optimizing aesthetics. To date this technique has been performed using rigid endoscopes or a linear robotic platform. The goal of this study was to test the feasibility of a novel flexible robotic system to perform a transvestibular thyroidectomy in a preclinical cadaver model. Preclinical feasibility study. Right and left thyroid lobectomies were successfully performed via a transvestibular approach in four cadavers. A single vestibular incision between bilateral mental nerves allowed entrance of the flexible robot in a subplatysmal plane in both male and female cadavers. The recurrent laryngeal nerves and parathyroids were identified and preserved. The flexible three-dimensional camera allowed excellent visualization and could be easily repositioned for optimal visualization of right and left structures. The flexible and wristed instruments enabled an atraumatic approach and allowed for precise surgical technique. The transoral vestibular approach to the central neck is a promising technique for thyroidectomy with optimal cosmesis and can be successfully accomplished using this novel flexible robotic system. Improvements in visualization and access offered by this system may improve application of this technique. NA Laryngoscope, 129:1482-1487, 2019.

MICCS: A Novel Framework for Medical Image Compression Using Compressive Sensing

The vision of some particular applications such as robot-guided remote surgery where the image of a patient body will need to be captured by the smart visual sensor and to be sent on a real-time basis through a network of high bandwidth but yet limited. The particular problem considered for the study is to develop a mechanism of a hybrid approach of compression where the Region-of-Interest (ROI) should be compressed with lossless compression techniques and Non-ROI should be compressed with Compressive Sensing (CS) techniques. So the challenge is gaining equal image quality for both ROI and Non-ROI while overcoming optimized dimension reduction by sparsity into Non-ROI. It is essential to retain acceptable visual quality to Non-ROI compressed region to obtain a better reconstructed image. This step could bridge the trade-off between image quality and traffic load. The study outcomes were compared with traditional hybrid compression methods to find that proposed method achieves better compression performance as compared to conventional hybrid compression techniques on the performances parameters e.g. PSNR, MSE, and Compression Ratio.

Virtual Network Functions Routing and Placement for Edge Cloud Latency Minimization

As a new way to design, deploy, and manage network services, network functions virtualization (NFV) decouples the network functions, from one or more physical network infrastructures and black boxes so they can run in software. It therefore comes as no surprise that NFV originated from service providers, who were looking to improve the deployment of new network services to support their revenue and growth objectives. Within the NFV ecosystem, high availability, and low latency are one of the key quality of service (QoS) benefits that service providers can expect from the 5G Cloud and the NFV networks to make delay-critical services such as remote surgery a reality. Therefore, network services should be placed, chained, and routed through the network considering users/tenants stringent QoS and service-level agreement requirements. To this end, routing and placement optimization plays a major role in improving network performance and the overall network cost. In this paper, we study the problem of virtual network functions (VNFs) placement and routing across the physical hosts to minimize overall latency defined as the queuing delay within the edge clouds and in network links. In that respect, this paper takes a holistic view by considering not only VNFs chaining and placement problem but also considering the flows routing aspect since these two problems are inter-related and have a major impact on network latency.

Transoral and Submental Thyroidectomy

Abstract Introduction: There has been growing interest in minimally invasive and remote access thyroid surgery in an attempt to eliminate a visible scar in the neck. This has involved a variety of ...

Automated open wound suturing: detection and planning algorithm

Today one of the key disadvantages of robotic surgery is a lack of a haptic feedback, while in traditional surgery a surgeon uses human haptic senses in all tasks. Providing robots with a haptic feedback have a high potential of reducing time that is spent by a surgeon on suturing subtasks and helping to reduce a surgeon fatigue. Decreasing manual input of a surgeon enables remote surgery even under long communication links with significant latency. In this paper we present a framework of wound detection and suture planning. We plan to implement and test our algorithms using KUKA iiwa manipulator.

Introduction: the rise of the robots in spinal surgery.

In his 1920 science fiction play R.U.R., Czech writer Karel Capek introduced the word "robot" to the English language. The play tells the story of a factory that produces roboti, which are living creatures that resemble humans and have the capacity for individual thought. While at first the roboti seem content to work for their human masters, they later rebel, ultimately leading to the extinction of the human race. 1 This play and similar depictions of robots in literature and film are probably responsible for the slightly negative reputation of robots in general. Only recently has this perception changed, thanks to the advent of robots that can vacuum our houses and perform other mundane chores. Raymond Goertz, while working for the US Atomic Energy Commission, is credited with the development of the first robotic arm in 1951. 2 It was designed to handle hazardous radioactive material. Unimation Inc. developed the first industrial robot in 1961; that robot handled molten die-castings and removed the human element from these labor-intensive, often dangerous tasks. With the development of the Programmable Universal Manipulation Arm (PUMA) in 1978, the robot was sophisticated enough to be introduced to medicine. The first working definition of the word "robot" was published, fittingly, by the Robotics Institute of America in 1980: ". . . a reprogrammable, multifunctional manipulator designed to move materials, parts, tools, or specialized devices through various programmed motions for the performance of a variety of tasks." 6 In 1988, the six-degrees-of-freedom flexible arm PUMA 560 was used to guide a needle under CT guidance into the brain. 4 With the introduction of robotic arms came the ability to use them as surgical assistants. In 1998, Okada et al. described a voice-controlled robot used to hold a thoracoscope. 5 This type of robot was also used in thoracoscopic spinal surgery. The military, having a vested interest in telepresence surgery, helped fund the development of the da Vinci Surgical System that was approved for use by the FDA in 2000 and designed to facilitate complex, minimally invasive intracavitary surgeries. 7 In 2004, the FDA cleared the first commercially available positioning device for the placement of spinal instrumentation. At present, several systems are commercially available that utilize robotics for spinal operations. In a recent review, Joseph et al. evaluated the current landscape regarding safety, accuracy, and radiation exposure with the use of these technologies. These authors concluded that "… the placement of pedicle screws with robotics appears to be safe, and accuracy appears to be superior to freehand placement, although the data are not conclusive." 3 There seems to be a significant level of interest in this technology; however, only time will tell if it will become commonplace in our field. In this issue of Neurosurgical Focus, we visually explore the expanding role of robotics and image guidance in spinal surgery. New robots used for the first time and existing robots used for novel applications graphically demonstrate how our field is evolving. The days of fearing robots are behind us as members of our specialty begin to embrace the concept of automation. Thankfully, unlike Capek's rogue roboti, surgical robots rising up against us and causing world destruction is unlikely!

The development of Smart Cyber Operating Theater (SCOT), an innovative medical robot architecture that can allow surgeons to freely select and connect master and slave telesurgical robots

Master-slave robotic technology demonstrates a distinct model of communication that allows one device or user to have unidirectional control over one or more devices. The master refers to the user or device that initiates and controls the transmission, while the slave is the unit that receives these commands and acts accordingly. The direction of control always flows from the master to the slave. This technology has found a plethora of applications in a variety of fields such as engineering, information technology as well as hydraulic and pneumatic systems. Robotic technology has become an integral part of medical applications involving telesurgery (remote surgery) owing to the profound advantages it can offer to both surgeons and patience. Not only is surgery in previously-inoperable conditions now possible through this technology, but robotics also offer additional advantages in the training of medical professionals. In laparoscopic surgery, a high level of accuracy and control are required due to the complex nature and small scale of the area involved. Here, robotically-assisted surgery is performed by the surgeon using master-slave remotely-controlled manipulators or integrating locally-operated small surgical robots in a sterilised area. However, the fundamental problem associated with this master-slave system is that the master and the slave cannot be separated and exchanged with a master or a slave of another system. Performance of the robotic systems during these operations often come across limitations due to the inability of a slave robot to match the pace and performance of the master or the need for different tools during surgery, forcing a requirement for separate master-slave pairs. This creates an inefficiency in the system that Professor Ken Masamune from the Institute of Advance Biomedical Engineering and Science at the Tokyo Women’s Medical University seeks to address. By introducing a middleware that will connect these various masters and slaves, Masamune and his team seek to allow optimal communication and evaluation between robotic units. By separating the master from the slave and using middleware to allow communication between modules, the architecture being developed by Masamune, together with a group of collaborators, provides a quick evaluation of the master-slave combination and enables a far more efficient development and use of telesurgical robots.

5G-QoE: QoE Modelling for Ultra-HD Video Streaming in 5G Networks

Traffic on future fifth-generation (5G) mobile networks is predicted to be dominated by challenging video applications such as mobile broadcasting, remote surgery and augmented reality, demanding real-time, and ultra-high quality delivery. Two of the main expectations of 5G networks are that they will be able to handle ultra-high-definition (UHD) video streaming and that they will deliver services that meet the requirements of the end user’s perceived quality by adopting quality of experience (QoE) aware network management approaches. This paper proposes a 5G-QoE framework to address the QoE modeling for UHD video flows in 5G networks. Particularly, it focuses on providing a QoE prediction model that is both sufficiently accurate and of low enough complexity to be employed as a continuous real-time indicator of the “health” of video application flows at the scale required in future 5G networks. The model has been developed and implemented as part of the EU 5G PPP SELFNET autonomic management framework, where it provides a primary indicator of the likely perceptual quality of UHD video application flows traversing a realistic multi-tenanted 5G mobile edge network testbed. The proposed 5G-QoE framework has been implemented in the 5G testbed, and the high accuracy of QoE prediction has been validated through comparing the predicted QoE values with not only subjective testing results but also empirical measurements in the testbed. As such, 5G-QoE would enable a holistic video flow self-optimisation system employing the cutting-edge Scalable H.265 video encoding to transmit UHD video applications in a QoE-aware manner.

Remote access thyroid surgery for thyroid tumor: Initial institutional experience more than 100 surgeries from India.

e18113TITLE: Remote Access Thyroid Surgery for thyroid tumor: Initial Institutional Experience more than 100 surgeries from India ABSTRACT: Background: Endoscopic thyroidectomy allows surgeons to r...

A Medium Guardian for Enhanced Dependability in Safety-Critical Wireless Systems

According to the recent perspectives for the next generation of mobile networks (5G), future wireless communications will be able to support the operation of safety-critical systems, such as remote surgery or vehicle platooning. For that purpose, high reliability and availability values (> 99.999%), as well as low end-to-end delay (< 1 ms), are included in the requirements specification. In order to achieve these goals, novel solutions will need to be introduced both at the communications devices and at the network protocols. Fault tolerance mechanisms are good candidates to attain such dependability attributes. In this paper, a medium guardian concept is proposed to guarantee fail-silent behavior, both in time and value domains, for the nodes of a wireless network. After a generic description of the wireless medium guardian concept, its application to the case of ETSI ITS-G5-based vehicular communications is demonstrated. In this way, the design and practical implementation of a medium guardian for real-time vehicular communications is reported, together with the experimental evaluation of this first prototype. The obtained results demonstrate the low latency of the fault detection mechanism and the effectiveness of the guardian in preventing error propagation to other nodes of the network.

Development and experiment of the Internet-based telesurgery with MicroHand robot

Robot-assisted telesurgery can perform complex surgical manipulations from remote locations. Against the requirements of remote controlling for minimally invasive laparoscopic surgery robot, a prototype telesurgery system integrated on the existing “MicroHand S” robot was built. The prototype worked with the Internet, and a telesurgery communication protocol was set up based on Transmission Control Protocol/Internet Protocol. The stereo images of laparoscopy were transmitted by a hardware-based H.264 encoder/decoder. A demonstration environment of robot-assisted remote minimally invasive surgery between the medical robot laboratory of Tianjin University and the visual surgery laboratory of the PLA Rocket Force General Hospital, which is about 150 km away, was set up. Control signal and laparoscope image transmission test between these two places were conducted. After the pegboard task and knot-tying task of phantom training, the first remote gall bladder removal surgery on the sow of China was successfully performed, on the basis of remote surgery robot system integration. The experimental results show that the developed prototype telesurgery system has enough remote control performance and operability for telesurgery.

Holostream: High-Accuracy, High-Speed 3D Range Video Encoding and Streaming Across Standard Wireless Networks

Holostream is a novel platform which enables high-quality 3D video communication on mobile devices (e.g., iPhones, iPads) using existing standard wireless networks. The major contributions are: (1) a novel high-quality 3D video compression method that drastically reduces both 3D geometry and color texture data sizes in order to transmit them within the bandwidths provided by existing wireless networks; (2) a novel pipeline for 3D video recording, encoding, compression, decompression, visualization and interaction; and (3) a demonstration system which successfully delivered video-rate, photorealistic 3D video content through a standard wireless network to mobile devices. The novel platform improves the quality and expands upon the capabilities of popular applications already utilizing real-time 3D data delivery, such as teleconferencing and telepresence. This technology could also enable emerging applications which may require highresolution, high-accuracy 3D video data delivery, such as remote robotic surgery and telemedicine.

Clinical study of domestically developed technology of remote programming for movement disorders

Objective To investigate the clinical values and suggestions for use of domestically developed technology of remote programming for patients with movement disorders. Methods A total of 56 patients with movement disorders underwent implantation of domestically manufactured devices of deep brain stimulation (DBS) at Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University from February 2016 to October 2017. All patients received remote programing post surgery. The types of remote programing were summarized and the side effects were analyzed. Results Among all patients in this study, adjustment of voltage was conducted in 52 cases, authority management in 45, frequency adjustment in 30, pulse width change in 15, battery check in 8, fault detect and handing in 5, contact change in 3, remote startup and shutdown for MRI scan or other reasons in 3 and change of cycling pattern in 2 cases. Conclusions Domestically developed technology of remote programming could help resolve some problems for patients with movement disorders, which seems to be correlated with controllable side effects and thus worthy of popularization and application in clinical practice. Key words: Movement disorders; Deep brain stimulation; Remote programming; Local brain stimulator

Patient's perception of remote access vs open thyroid surgery in Singapore

Patient's perception of remote access vs open thyroid surgery in Singapore

Robots in Medicine

Robots are wide across used in several industrial applications. Robot applications are more found in medical industry in recent days. In initial days, robots were mostly used for simple surgeries and medical applications such as laparoscopic surgery and minimally invasive surgery in 1980's. At that time robotic surgeries were performed with the presence of surgeons in operation theatre. The present day technology has been so much advanced with more enhanced capabilities to perform several complicated tasks such as remote surgery and micro robotic surgery. The current paper discuss about the history and evolution of robots in medical industry and their latest technological advances, applications in various fields in medicine and limitations of robots in medical industry along with its future scope.

Case of a Large Dissecting Intramyocardial Hematoma Treated Conservatively

Case of a Large Dissecting Intramyocardial Hematoma Treated Conservatively

Remote Preconditioning and Vascular Surgery.

Remote ischemic preconditioning (RIPC) is a theoretically attractive strategy for organ protection; and phase 2 studies in a variety of settings have yielded promising results. In this article, we review the existing clinical studies on RIPC in vascular surgery. We examine aspects of design that may potentially be optimized in future vascular surgery studies and we highlight some challenges that have emerged since the publication of the Remote Ischaemic Preconditioning for Heart Surgery (RIPHeart) trial and the Effect of Remote Ischaemic Preconditioning on Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery (ERICCA) trial.

Remote motor system metabolic profile and surgery outcome in cervical spondylotic myelopathy.

OBJECTIVE In patients with cervical spondylotic myelopathy (CSM), the motor system may undergo progressive functional/structural changes rostral to the lesion, and these changes may be associated with clinical disability. The extent to which these changes have a prognostic value in the clinical recovery after surgical treatment is not yet known. In this study, magnetic resonance spectroscopy (MRS) was used to test 2 primary hypotheses. 1) Based on evidence of corticospinal and spinocerebellar, rubro-, or reticulospinal tract degeneration/dysfunction during chronic spinal cord compression, the authors hypothesized that the metabolic profile of the primary motor cortices (M1s) and cerebellum, respectively, would be altered in patients with CSM, and these alterations would be associated with the extent of the neurological disabilities. 2) Considering that damage and/or plasticity in the remote motor system may contribute to clinical recovery, they hypothesized that M1 and cerebellar metabolic profiles would predict, at least in part, surgical outcome. METHODS The metabolic profile, consisting of N-acetylaspartate (NAA; marker of neuronal integrity), myoinositol (glial marker), choline (cell membrane synthesis and turnover), and glutamate-glutamine (glutamatergic system), of the M1 hand/arm territory in each hemisphere and the cerebellum vermis was investigated prior to surgery in 21 patients exhibiting weakness of the upper extremities and/or gait abnormalities. Age- and sex-matched controls (n = 16) were also evaluated to estimate the pre-CSM metabolic profile of these areas. Correlation and regression analyses were performed between preoperative metabolite levels and clinical status 6 months after surgery. RESULTS Relative to controls, patients exhibited significantly higher levels of choline but no difference in the levels of other metabolites across M1s. Cerebellar metabolite levels were indistinguishable from control levels. Certain metabolites-myo-inositol and choline across M1s, NAA and glutamate-glutamine in the left M1, and myo-inositol and glutamate-glutamine in the cerebellum-were significantly associated with postoperative clinical status. These associations were greatly improved by including preoperative clinical metrics into the models. Likewise, these models improved the predictive value of preoperative clinical metrics alone. CONCLUSIONS These preliminary findings demonstrate relationships between the preoperative metabolic profiles of two remote motor areas and surgical outcome in CSM patients. Including preoperative clinical metrics in the models significantly strengthened the predictive value. Although further studies are needed, this investigation provides an important starting point to understand how the changes upstream from the injury may influence the effect of spinal cord decompression.

Toward the Art of Robotic-assisted Vitreoretinal Surgery.

New technological progress in robotics has brought many beneficial clinical applications. Currently, computer integrated robotic surgery has gained clinical acceptance for several surgical procedures. Robotically assisted eye surgery is envisaged as a promising solution to overcome the shortcomings inherent to conventional surgical procedures as in vitreoretinal surgeries. Robotics by its high precision and fine mechanical control can improve dexterity, cancel tremor, and allow highly precise remote surgical capability, delicate vitreoretinal manipulation capabilities. Combined with magnified three-dimensional imaging of the surgical site, it can enhance surgical precision. Tele-manipulation can provide the ability for tele-surgery or haptic feedback of forces generated by the manipulation of intraocular tissues. It presents new solutions for some sight-threatening conditions such as retinal vein cannulation where, due to physiological limitations of the surgeon's hand, the procedure cannot be adequately performed. In this paper, we provide an overview of the research and advances in robotically assisted vitreoretinal eye surgery. Additionally the barriers to the integration of this method in the field of ocular surgery are summarized. Finally, we discuss the possible applications of the method in the area of vitreoretinal surgery.

IEEE Access Special Section Editorial: Health Informatics for the Developing World

We live in a world with growing disparity in the quality of life available to people in the developed and developing countries. Healthcare in the developing world is fraught with numerous problems such as the lack of health infrastructure, and human resources, which results in very limited health coverage. The field of health informatics has made great strides in recent years towards improving public health systems in the developing world by augmenting them with state-of-the-art information and communication technologies (ICT). Through real-world deployment of these technologies, there is real hope that the health industry in the developing world will progress from its current, largely dysfunctional state to one that is more effective, personalized, and cost effective. Health informatics can usher a new era of personalized health analytics, with the potential to transform healthcare in the developing world. In conjunction with mHealth and eHealth, many other important health informatics trends—such as artificial intelligence (AI), machine learning (ML), big data, crowdsourcing, cloud computing—are also emerging. Exponentially growing heterogeneous data, with the help of big data analytics, has the potential to provide descriptive, predictive, and prescriptive health insights as well as enable new applications such as telemedicine and remote diagnostics and surgery. Such systems could enhance the overall process of monitoring, diagnosis, and prognosis of diseases.