Robotic Approach Research Articles

From Shadows to Light: A Swarm Robotics Approach With Onboard Control for Seeking Dynamic Sources in Constrained Environments

From Shadows to Light: A Swarm Robotics Approach With Onboard Control for Seeking Dynamic Sources in Constrained Environments

Robotic Versus Laparoscopic Abdominoperineal Resection for Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy.

The usefulness of robotic surgery compared to laparoscopic surgery for rectal cancer has been reported; however, few reports exist on robotic abdominoperineal resection (APR). The aim of this study was to compare the outcomes of robotic and laparoscopic surgery to determine their usefulness in patients with locally advanced rectal cancer who had undergone preoperative chemoradiotherapy (CRT). This retrospective study included 43 patients with locally advanced rectal cancer who underwent preoperative CRT and robotic (22 patients) or laparoscopic APR (21 patients) between December 2012 and September 2022. We examined the short- and long-term outcomes in the robotic and laparoscopic groups. The median follow-up durations were 36 and 48 months for the robotic and laparoscopic groups, respectively. No significant differences in operative time, intraoperative blood loss, or overall complication rates were observed. However, the incidence of organ/space surgical site infection (SSI) was significantly lower in the robotic surgery group than in the laparoscopic group (9.1% vs. 38.1%, p=0.034) and the 3-year overall survival rate was significantly higher in the robotic surgery group than in the laparoscopic group (95% vs. 67%, p=0.029). Robotic APR was associated with a significantly lower rate of organ/space SSIs than the laparoscopic approach, indicating the usefulness of the robotic approach.

Is robotic approach for distal pancreatectomy economically detrimental to the healthcare system?

Is robotic approach for distal pancreatectomy economically detrimental to the healthcare system?

Totally robotic total gastrectomy with D2 lymphadenectomy for gastric cancer via da Vinci Xi platform: Technical details and perioperative outcomes

BackgroundThis study reported the surgical details and outcomes in a case of totally robotic total gastrectomy (TRTG) using the da Vinci Xi robotic system, aiming to share surgical experience in difficult procedures during TRTG and add evidence supporting the feasibility and safety of TRTG. MethodsA 55-year-old male patient diagnosed with adenocarcinoma of gastroesophageal junction underwent TRTG via the da Vinci Xi robotic system in Sun Yat-sen University Cancer Center on January 10, 2024. The surgical details and perioperative outcomes were summarized. ResultsWith an estimated blood loss of 100 ​ml, the operation lasted 210 ​min, including an anastomosis time of 36 ​min. During a postoperative hospital stay of 7 days, the patient started liquid diet after the removal of gastric tube on the third day. There were no perioperative complications. Postoperative radiography demonstrated no evidence of anastomotic fistulas or luminal narrowing. The final pathology revealed a 4.5∗1.5 ​cm gastric adenocarcinoma with 10/61 positive lymph nodes. The pathological stage of this patient was pT3N3aM0 IIIB. ConclusionsThis successful surgery reflected the effectiveness of minimally invasive surgery for total gastrectomy through a totally intracorporeal robotic approach. Future research is warranted to further validate the feasibility and safety of performing TRTG.

Effect of surgical risk factors on the short-term outcomes for rectal cancer surgery. Laparoscopic or robotic approach?

Effect of surgical risk factors on the short-term outcomes for rectal cancer surgery. Laparoscopic or robotic approach?

Comparison of the Learning Curve between Uniportal and Robotic Thoracoscopic Approaches in Pulmonary Segmentectomy during the Implementation Period Using Cumulative Sum Analysis.

The aim of this retrospective study was to compare the learning curve and perioperative outcomes between the two approaches uVATS and RATS during their implementation periods. The uVATS group included 77 consecutive uVATS segmentectomies performed by HI between February 2019 and June 2022, while the RATS group included 30 between July 2022 and September 2023. The patient characteristics, perioperative outcomes, and learning curves were compared between the two groups. The learning curve was evaluated using operative time and cumulative sum (CUSUMOT) analysis. Most patient characteristics and perioperative outcomes were equivalent between the two groups. In the uVATS group, after a positive slope was observed until the 14th case (initial period), a plateau was observed until the 38th case (stable period). Finally, a negative slope was observed after the 38th case (proficiency period). In the RATS group, after a positive slope was observed until the 16th case (initial period), a plateau was observed until the 22nd case (stable period). Finally, a negative slope was observed after the 22nd case (proficiency period). In segmentectomy, a surgeon reached the proficiency period earlier in RATS than in uVATS, although the trends to the stable period were similar.

Computer Vision-Assisted Object Detection and Handling Framework for Robotic Arm Design Using YOLOV5

In recent years, there has been a surge in scientific research using computer vision and robots for precision agriculture. Productivity has increased significantly, and the need for human labor in agriculture has been dramatically reduced owing to technological and mechanical advancements. However, most current apple identification algorithms cannot distinguish between green and red apples on a diverse agricultural field, obscured by tree branches and other apples. A novel and practical target detection approach for robots, using the YOLOV5 framework is presented, in line with the need to recognize apples automatically. Robotic end effectors have been integrated into a Raspberry Pi 4B computer, where the YOLOV5 model has been trained, tested, and deployed. The image was taken with an 8-megapixel camera that uses the camera serial interface (CSI) protocol. To speed up the model creation process, researchers use a graphical processing computer to label and preprocess test images before utilizing them. Using YOLOV5, a computer vision system-assisted framework aids in the design of robotic arms capable of detecting and manipulating objects. The deployed model has performed very well on both red and green apples, with ROC values of 0.98 and 0.9488, respectively. The developed model has achieved a high F1 score with 91.43 for green apples and 89.95 for red apples. The experimental findings showed that robotics are at the forefront of technological advancement because of the rising need for productivity, eliminating monotonous work, and protecting the operator and the environment. The same discerning can be applied to agricultural robots, which have the potential to improve productivity, safety, and profit margins for farmers while reducing their impact on the environment. The system’s potential could be seen in an assortment of fields, including sophisticated object detection, nuanced manipulation, multi-robot collaboration, and field deployment.

Adaptive passive admittance control of a compliant collaborative robot

Compliance of the collaborative robots plays an important role in human-robot interaction. Due to the complex nonlinearities caused by the compliance, and parameter uncertainties, good performance control method for the compliant collaborative robot is always a challenging task. Therefore, to overcome the challenge of the compliance, and uncertain dynamics, this paper develops an adaptive passive admittance control (APAC) approach for a novel compliant collaborative robot, whose compliant mechanism is constituted of the inerters, springs, and dampers. First, through force-current analogy between mechanical network and electrical network, the compliance of the proposed collaborative robot with the inerters, springs, and dampers, is represented by a novel and simplified admittance matrix to facilitate dynamics model of the proposed collaborative robot. Then, for the proposed compliant collaborative robot, an APAC strategy is presented to dispose of the uncertain parameters of the dynamics. The inertial matrix, Coriolis matrix, admittance matrix, and gravity vector of the compliant collaborative robot are expressed as linear representation of orthogonal basis functions by using function approximation technique (FAT). The boundedness of the robot dynamics is proved by detailed stability analysis which uses Lyapunov function. Finally, simulation results indicate that the proposed APAC of the compliant collaborative robot is effective.

Robot-assisted bladder diverticulum removal in a 10-year-old child

BACKGROUND: Bladder diverticulum are hernias of the bladder mucosa that prolapse through a detrusor defect. Diverticulectomy is the treatment of choice for this disease. Surgical methods to implement this principle include open, laparoscopic and robotic approaches. In the present study, we outline our own technique for performing robotic diverticulectomy and report its short-term results.
 CLINICAL CASE DESCRIPTION: The study reports one case of bladder diverticulectomy performed with a robot-assisted technique in a 10-year-old boy. The diagnosis of the disease was established using voiding cystourethrography, cystoscopy and X-ray computed urography. The patient had robot-assisted bladder diverticulectomy using transperitoneal extravesical access. At the final stage of the study, short-term outcomes of the robot-assisted procedure were evaluated. The duration of the operation was 100 minutes. No intraoperative and postoperative complications were observed. The urinary catheter was removed the day after the operation. The duration of the patient's stay in the hospital was 7 days. Histological examination showed signs corresponding to a false diverticulum of the bladder with the presence of single muscle fibers in its structure. The ureteral stent was removed one month after the operation. After removal of the stent, control voiding cystography was performed, which demonstrated the absence of bladder contour deformation at the site of surgical procedure.
 CONCLUSION: Robot-assisted bladder diverticulectomy is a technically feasible approach to the treatment of congenital bladder diverticulum.

Comparison of Robotic and Open Lobectomy for Lung Cancer in Marginal Pulmonary Function Patients: A Single-Centre Retrospective Study.

The treatment of non-small-cell lung cancer (NSCLC) patients with reduced respiratory function represents a challenge for thoracic surgeons. Minimally invasive surgery seems to be beneficial for these patients because it reduces tissue trauma and its impact on respiratory mechanics. Application of the robotic technique, the use of CO2 insufflation and longer surgical time are factors that could influence the outcomes of marginal pulmonary function patients. The objective of this study was to evaluate the impact of the robotic technique on the postoperative outcomes of patients with poor lung function. We retrospectively collected and analyzed data from consecutive marginal respiratory function patients who underwent robotic or open lobectomy for NSCLC. Data regarding clinical, operative and postoperative details were compared between the open and robotic approaches. The outcomes of 100 patients with reduced respiratory function were evaluated, of whom 59 underwent open lobectomies and 41 underwent robotic lobectomies. Robotic lobectomy was characterized by a longer operative time, a reduced hospital stay and a lower incidence of postoperative complications (22% vs. 33.9%), when compared to the open approach. Robotic lobectomy is a safe and feasible procedure for patients with marginal pulmonary function.

Robotic Lateral Pelvic Lymph Node Dissection in Rectal Cancer: A Feasibility Study from a European Centre.

The role of robotic lateral pelvic lymph node dissection (LPLND) for lateral pelvic nodal disease (LPND) in rectal cancer has yet to be investigated in the Western hemisphere. This study aims to investigate the safety and feasibility of robotic LPLND by utilising a well-established totally robotic TME protocol. We conducted a retrospective study on 17 consecutive patients who underwent robotic LPLND for LPND ± TME for rectal cancer between 2015 and 2021. A single docking totally robotic approach from the left hip with full splenic mobilisation was performed using the X/Xi da Vinci platform. All patients underwent a tri-compartmental robotic en bloc excision of LPND with preservation of the obturator nerve and pelvic nerve plexus, leaving a well-skeletonised internal iliac vessel and its branches. The median operative time was 280 min, which was 40 min longer than our standard robotic TME. The median BMI was 26, and there were no conversions. The median inpatient stay was 7 days with no Clavien-Dindo > 3 complications. One patient (6%) developed local recurrence and metastatic disease within 5 months. The proportion of histologically confirmed LPND was 41%, of which 94% were well to moderately differentiated adenocarcinoma. Median pre-operative lateral pelvic node size was significantly higher in positive nodes (14 mm vs. 8 mm (p = 0.01)). All patients had clear resection margins on histology. Robotic LPLND is safe and feasible with good peri-operative and short-term outcomes, with the ergonomic advantages of a robotic TME docking protocol readily transferrable in LPLND.

Controversies and future directions in the management of gallbladder cancer

Abstract Gallbladder cancer (GBC) is a rare malignancy worldwide, with 140,000 new patients each year and more than 100,000 deaths annually. The review aims to address the controversial aspects of managing GBC. Regional differences of the study worldwide remain pending, and comparative mutational profiles will provide more information on the pathogenesis of GBC. However, certain pathologic aspects are discussed, such as the staging of early GBC, outcome differences between T2 pathologically staged patients, and the necessity of a uniform pathologic report. The surgical management of GBC is still under debate. The extent of liver resection, type of lymphadenectomy, and selection of patients for extended resection are aspects of the disease that require revision. Laparoscopic and robotic approaches were initially slow to develop. However, with time, they have demonstrated their value in the surgical management of GBC. The OMEGA survey, performed to analyze the management practice of surgical treatment of GBC worldwide, demonstrated differences from the recommended guidelines. The OMEGA study, the largest cohort study, examined the outcomes of surgical intervention in 3676 patients from 133 centers. Regarding future directions, the value of collaborative efforts between centers and regions must be emphasized to better understand the different aspects of the disease and globally improve therapeutic strategies for GBC.

Anastomotic Leakage after Gastrectomy for Gastric Cancer.

Anastomotic leakage (AL) constitutes a prominent cause of significant morbidity following gastrectomy for gastric cancer. The manifestation of AL typically occurs within 7 to 10 days post-surgery, with reported incidence rates of 5.8-6.7% for open gastrectomy and 3.3-4.1% for laparoscopic gastrectomy. Various predisposing risk factors have been identified, including the individual nutritional status (excluding obesity) and preoperative corticotherapy. Interestingly, the administration of neoadjuvant therapies appears to reduce the AL occurrence. In the context of distal gastrectomies, the rates of AL are comparable between laparoscopic, robotic, and open approaches. The total gastrectomies have higher AL rate compared to distal gastrectomies, which are considered the preferred approach. Prophylactic drainage measures have not demonstrated efficacy in preventing AL. As for postoperative management, conservative treatment is indicated for patients presenting with mild clinical symptoms and increased inflammatory blood tests. This approach involves fasting, enteral or parenteral nutrition, administration of antibiotics, and percutaneous drainage. For small AL, endoscopic therapies such as stents, vacuum therapy, clips, suturing devices, and injections are appropriate treatment options. In cases of high-volume fistulas, severe sepsis or failure of previous therapies, surgical reoperation becomes the ultimate solution.

Comparison of Surgical Outcomes of Laparoscopic and Robotic Surgery in Adult Choledochal Cysts.

Background: Minimally invasive surgery (MIS) for cyst excision and Roux-en-Y hepaticojejunostomy (HJ) is widely performed for adult choledochal cysts. Few articles compared the robotic and laparoscopic approaches for choledochal cysts. Methods: Between 2014 and 2022, 157 patients who underwent MIS for choledochal cysts were retrospectively analyzed. Perioperative outcomes of patients who underwent totally robotic surgery, robot-assisted surgery, and laparoscopic surgery were compared, respectively. Also, postoperative outcomes of patients with robotic reconstruction and laparoscopic reconstruction during HJ were compared. Results: Perioperative outcomes were comparable between robotic and laparoscopic groups. The suturing technique for the anterior and posterior walls of the HJ differed significantly between the robotic and laparoscopic reconstruction groups (P = .001). However, there were no significant differences in postoperative outcomes, including total complications (P = .304), major complications (P = .411), and postoperative interventions (P = .411), between the two groups. Conclusions: The robotic and laparoscopic approaches for adult choledochal cysts have comparable surgical outcomes. In the MIS era, robotic surgery could be an alternative surgical option for adult choledochal cysts.

Robotic-assisted versus laparoscopic repair of type II, III and IV hiatal hernias: A retrospective study comparing adverse outcomes

ObjectiveRobotic-assisted surgery (RAS) is continuing to expand in use in surgical specialties, including foregut surgery. The available data on its use in large hiatal hernia (HH) repair are limited and conflicting. This study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs. a laparoscopic approach. This study was limited to outcomes in patients with type II, III, and IV HHs, as these hernias are typically more challenging to repair. MethodsA retrospective analysis was performed from data obtained from TriNetX, a large deidentified clinical database, over a 10-year period. Adult patients who underwent type II, III, or IV HH repair were included in the study. HH with robotic repair was compared to laparoscopic repair. Cohorts were propensity score matched for demographic information and comorbidities. Risk ratios, risk differences (RDs) with 95% confidence intervals (CIs), and t test for each examined adverse outcome were used to estimate the effects of robotic repair vs. laparoscopic repair. ResultsIn total, 20,016 patients who met the inclusion criteria were identified; 1,515 patients utilized RAS, and 18,501 used laparoscopy. Prior to matching, there were significant differences in age, sex, comorbidity, and BMI between the two cohorts. After 1:1 propensity score matching, analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or comorbidities. Patients who underwent robotic repair were more likely to experience major complications, including venous thromboembolism (RD: 0.007, 95% CI: 0.003, 0.011; p = 0.002), critical care (RD: 0.023, 95% CI: 0.007, 0.039; p = 0.004), urinary/renal complications (RD: 0.027, 95% CI: 0.014, 0.041; p < 0.001), and respiratory complications (RD: 0.046, 95% CI: 0.028, 0.064; p < 0.001). RAS was associated with a significantly shorter length of stay (32.4 ± 27.5 h vs. 35.7 ± 50.1 h, p = 0.031), although this finding indicated a reduction in the length of stay of less than 4 hours. No statistically significant differences in risk of esophageal perforation, infection, postprocedural shock, bleeding, mortality, additional emergency room visits, cardiac complications, or wound disruption were found. ConclusionsPatients who undergo robotic-assisted large HH repair are at increased risk of venous thromboembolism, need critical care, urinary or renal complications and respiratory complications. Due to variations in RAS technique, experience, and surgical volumes, further study of this surgical approach and complication rates is warranted.

First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019).

The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the association of FAs and OT variations within and between groups. We used logistic regression to examine the relationship between the type of FA and 30-day outcomes across all procedures and approaches. A total of 691,789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included. The percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) compared to the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). There was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures. The FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates. These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures.

Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial

BackgroundImproving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. ObjectiveTo conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. MethodThirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. ResultsAfter the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). ConclusionTwo weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection.

Resistive versus active assisted robotic training for the upper limb after a stroke: A randomized controlled study

BackgroundSelection of a suitable training modality according to the status of upper limb function can maximize the effects of robotic rehabilitation; therefore, it is necessary to identify the optimal training modality. ObjectivesThis study aimed to compare robotic rehabilitation approaches incorporating either resistance training (RET) or active-assisted training (AAT) using the same rehabilitation robot in people with stroke and moderate impairment. MethodsIn this randomized controlled trial, we randomly allocated 34 people with stroke who had moderate impairment to either the experimental group (RET, n = 18) or the control group (AAT, n = 16). Both groups performed robot-assisted therapy for 30 min, 5 days per week, for 4 weeks. The same rehabilitation robot provided resistance to the RET group and assistance to the AAT group. Body function and structure, activity, and participation outcomes were evaluated before, during, and after the intervention. ResultsRET led to greater improvements than AAT in terms of smoothness (p = 0.006). The Fugl-Meyer Assessment (FMA)-upper extremity (p < 0.001), FMA-proximal (p < 0.001), Action Research Arm Test-gross movement (p = 0.011), and kinematic variables of joint independence (p = 0.017) and displacement (p = 0.011) also improved at the end of intervention more in the RET group. ConclusionsRobotic RET was more effective than AAT in improving upper limb function, structure, and activity among participants with stroke who had moderate impairment.

Robotic parathyroidectomy is a feasible technique for primary hyperparathyroidism

PurposeFocused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center.MethodsWe assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time.ResultsOf the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15–65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively.ConclusionsRobotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.

Artificial neural network-based ground reaction force estimation and learning for dynamic-legged robot systems.

Legged robots have become popular in recent years due to their ability to locomote on rough terrains; these robots are able to walk on narrow stepping-stones, go upstairs, and explore soft ground such as sand. Ground reaction force (GRF) is the force exerted on the body by the ground when they are in contact. This is a key element and is widely used for programming the locomotion of the legged robots. Being capable of estimating the GRF is advantageous over measuring it with the actual sensor system. Estimating allows one to simplify the system, and it is meant to be capable of prediction, and so on. In this article, we present a neural network approach for GRF estimation for the legged robot system. In order to fundamentally study the GRF estimation of the robot leg, we demonstrate our approach for a single-legged robot with a degree of freedom (DoF) of two with hip and knee joints on a flat-surface. The first joint is directly driven from the actuator, and another joint is belt-pulley driven from the second actuator to take advantage of the long range of motion. The neural network is designed to estimate GRF without attaching force sensors such as load cells, and the encoder is the only sensor used for the estimation. We propose a two-staged multi-layer perceptron (MLP) solution based on supervised learning to estimate GRF in the physical-world. The first stage of the MLP model is trained using datasets from the simulation, enabling it to estimate the simulation-staged GRF. The second stage of the MLP model is trained in the physical world using the simulation-staged GRF obtained from the first stage MLP as the input. This approach enables the second stage MLP to bridge the simulation to the physical world. The root mean squared error (RMSE) is 0.9949 N on the validation datasets in the best case. The performance of the trained network is evaluated when the robot follows trajectories that are not used in training the two-stage GRF estimation network.