Robotic Operative Time Research Articles

Colorectal cancer surgery: by Cambridge Medical Robotics Versius Surgical Robot System-a single-institution study. Our experience.

With the previous experiences in performing laparoscopic for over a period of 15years and da Vinci colorectal surgeries from 2010 to 2013, we started operating using the CambridgeMedicalRobotics (CMR) Versius Surgical Robot System. The aim of the study is a prospective analysis and evaluation of short-term results of consecutive patients to study the technical feasibility and oncological outcome of robot-assisted low anterior resection (LAR) and ultralow anterior resection (ULAR), using the CMR Versius Surgical Robot System. This study was conducted at single minimal access surgery institute. 31 patients with colorectal adenocarcinoma underwent robot-assisted LAR and ULAR between August 2019 and March 2020. Patient characteristics, perioperative parameters and complications were evaluated. Surgical and pathological outcomes such as quality of Total Mesorectal Excision (TME), free circumferential resection margins and number of lymph nodes dissected were also evaluated. Of 31 patients, 23 were men and 8 women, with mean age of 55.6years. The mean robotic operative time was 51min and the mean blood loss was 55ml. The mean robot docking and undocking time was 17min and 5min, respectively. The mean hospital stay was 7days. The longitudinal and circumferential resection margins were negative in all patients. Histopathological reports of 27 among 31 patients showed complete TME. Splenic flexure of colon mobilization was done laparoscopically. We feel that Versius robot has the qualities in terms of dexterity, vision and intuitive movements, and to translate this technical ability into oncological safety.

Oncological, Surgical and Functional Outcomes of Transoral Robotic Cordectomy for Early Glottic Carcinoma

To investigate oncological, surgical and functional outcomes of transoral robotic surgery cordectomy (TORS-Co). A retrospective chart review of patients benefiting from TORS-Co for a cT1a vocal fold squamous cell carcinoma was conducted at a single academic medical center. TORS-Co was performed through da Vinci robot. The following outcomes were studied: preoperative and operative exposures; feasibility; conversion rate; average robotic set-up and operative times; margin status; postoperative complications; tracheotomy and feeding tube requirement. The medical record data of 12 patients were collected. Among them, two patients were excluded because the laryngeal exposition was not adequate. From the 10 included patients, TORS-Co was not performed in three patients. The tumor was not exposable regarding anatomical conditions in two patients, while the size of the robot arms did not allow an adequate exposure in another patient. TORS-Co was performed in the remaining seven patients without transient tracheotomy or feeding tube. The mean estimated blood loss was 20 mL. The average robotic set-up and operative times were 26 minutes and 30 minutes, respectively. The mean hospital stay was 2 days. The margins were not analyzable regarding the use of the monopolar. Two patients reported postoperative complications, while five required class 2 analgesics for postoperative pain. The mean duration of follow-up was 44 months (minimum duration of 36 months). One recurrence occurred 2 years post-surgery. The recurrence was successfully treated by transoral laser CO2 microsurgery. The exposure of the laryngeal surgical field is the primary limitation of TORS-Co. TORS-Co may not report better oncological and functional outcomes than transoral laser CO2 microsurgery, which remains the gold standard surgical approach for early glottic squamous cell carcinoma.

Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform.

Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.

Robotic versus laparoscopic ventral mesh rectopexy: a systematic review and meta-analysis

Ventral mesh rectopexy is frequently performed as a means of improving the quality of life for sufferers of rectal prolapse. The minimally invasive approach is highly desirable but can be technically difficult to achieve in the narrow confines of the pelvis. The robotic platform is becoming a more common means of overcoming these difficulties, but evidence of an objective benefit over standard laparoscopy is scarce. This study seeks to review and analyse the data comparing outcomes after robotic and laparoscopic ventral mesh rectopexy. We searched MEDLINE, EMBASE and the Cochrane database for papers comparing robotic to laparoscopic ventral mesh rectopexy. Comparable data was pooled for meta-analysis. Six studies compared outcomes between robotic and laparoscopic ventral mesh rectopexy. Sample sizes were relatively small, and only two of the studies were randomised. Pooled analysis was possible for data on operating time, complication rates, conversion rates and length of stay in hospital. This showed a non-significant trend towards longer operating times and a statistically significant reduction in length of stay after robotic procedures. There was no significant difference in complication and conversion rates. The frequent finding of longer operating time for robotic surgery was not confirmed in this study. Shorter length of stay in hospital was seen, with other post-operative outcomes showing no significant difference. More data is needed with cost-benefit analyses to show whether the robotic platform is justified.

Advantages of the Left-handed Ultrasonic Shears Technique for Robotic Gastrectomy.

The aim of this study was to investigate advantages of the left-handed ultrasonic shears technique in robotic gastrectomy for gastric cancer. We retrospectively analyzed 67 consecutive gastric cancer patients who underwent robotic gastrectomy. Fifty-six patients underwent gastrectomy with the left-handed ultrasonic shears technique (the left hand group), and 11 patients underwent surgery with the conventional approach (the conventional group). Intraoperative and postoperative outcomes were compared between the 2 groups. Operative blood loss, morbidity, and mortality were similar between the 2 groups. We observed a trend toward a shorter operation time and higher number of retrieved lymph nodes in the left hand group compared with the conventional group. Console time (docking-gastrectomy) in the left hand group was significantly shorter than in the conventional group (192.20 vs. 218.36 min, P<0.05). In robotic distal gastrectomy, both operation time and console time in the left hand group were significantly shorter than in the conventional group (276.10 vs. 354.80 min, 176.43 vs. 209.20 min, P<0.05 for both). The postoperative intra-abdominal infectious complication (Clavien Dindo≥1) rate in the left hand group was significantly lower than that in the conventional group (0% vs. 20%, P<0.05). Use of the left-handed ultrasonic shears technique is safe and provides a technically superior operative environment with satisfactory postoperative results.

Residents' Participation in Robotic Surgery and Operative Time: Does Attending Surgeons’ Volume Influence This Relationship?

Objective: This research assessed if attending surgical volume impacted the relationship between resident participation and operative time in robotic surgery for benign gynecologic conditions. Mate...

Stapled versus robot-sewn ileo-ileal anastomosis during robot-assisted radical cystectomy: a review of outcomes in urinary bladder cancer patients

Background Whereas the literature has demonstrated an acceptable safety profile of stapled anastomoses when compared to the hand-sewn alternative in open surgery, the choice of intestinal anastomosis using sutures or staples remains inadequately investigated in robotic surgery. The purpose of this study was to compare the surgical outcomes of both anastomotic techniques in robotic-assisted radical cystectomy. Methods A retrospective analysis of patients with urinary bladder cancer undergoing cystectomy with urinary diversion and with ileo-ileal intestinal anastomosis at a single tertiary centre (2012–2018) was undertaken. The robotic operating time, hospital stay and GI complications were compared between the robotic-sewn (RS) and stapled anastomosis (SA) groups. The only difference between the groups was the anastomosis technique; the other technical steps during the operation were the same. Primary outcomes were GI complications; the secondary outcome was robotic operation time. Results There were 155 patients, of which 112 (73%) were male. The median age was 71 years old. A surgical stapling device was used to create 66 (43%) separate anastomoses, while a robot-sewn method was employed in 89 (57%) anastomoses. There were no statistically significant differences in primary and secondary outcomes between RS and SA. Conclusions Compared to stapled anastomosis, a robot-sewn ileo-ileal anastomosis may serve as an alternative and cost-saving approach.

Operative Times of Robotic Hysterectomy Versus Other Modalities

Study Objective Previous studies demonstrate that robotic surgeries have significantly longer operative times with minimal difference in outcomes. This argument has led to surgeons choosing other modalities over robotic surgery. However, these studies typically examine case operative times during a robotic surgeons’ training period. The aim of this study is to compare robotic hysterectomy data from an expert robotic surgeon to historical data of non-robotic hysterectomies. Design This study pools operative times from consecutive robotic hysterectomies performed by a surgeon who has been performing robotic hysterectomies for over ten years. The data was compared to the Premiere database. No postoperative follow-up data was reviewed for this study. Setting All patients had benign indications for hysterectomy. Patients or Participants Data was collected from 200 consecutive robotic cases. Cases were excluded if the primary surgery was not a hysterectomy and if operative times were not properly documented. Out of the 200 cases, 78 cases met criteria. These cases were compared to non-robotic hysterectomies from the Premier database, which included 289,875 cases. Interventions The primary surgery performed was a robotic hysterectomy. Measurements and Main Results The primary comparison was skin-to-skin operative time. Surgical complexity was accounted for by comparing primary surgery, number concomitant surgeries, concomitant surgery type, and resident involvement. Preliminary results show significantly faster operative times with the robot. The average robotic skin-to-skin operative time was 96 minutes; whereas, the average non-robotic skin-to-skin operative time was 130 minutes for vaginal, 147 minutes for abdominal, and 164 minutes for laparoscopic. Conclusion Our study demonstrates that an expert robotic surgeon's operative times were significantly faster to other modalities. With decreased operative times, demonstrated decreased estimated blood loss, and length of hospitalization with robotic surgeries, it is fair to suggest that robotic surgeries, if available, can be considered over other modalities given the associated benefits of robotic surgery.

Using Regression Models to Predict Surgery Duration for Robotic-Assisted Total Laparoscopic Hysterectomy in Endometrial Cancer

Study Objective To develop regression models using preoperative variables that can accurately predict the operating room time of robotic surgery for endometrial cancer. Design A retrospective review using preoperative variables including age, BMI, ASA score, surgery start time, preoperative diagnosis, number of previous abdominal surgeries, parity, and uterine volume were used to develop regression models. These regression models were compared to institutional models that used preoperative estimations of operating room times based on historical averages. Setting An urban, academic hospital. Patients or Participants 348 patients undergoing robotic-assisted total laparoscopic hysterectomy with staging for endometrial cancer between 2016-2020 by six surgeons. Interventions N/A Measurements and Main Results The mean operating room time was 234 minutes (range: 130 – 484). The mean preoperative estimated operating room time was 223 minutes (range: 120 – 390). Linear, ridge, lasso, and elastic net models had relatively similar performance measures, and all models outperformed preoperative estimated operating room duration. Ultimately, the elastic net model performed the best. Elastic net had the smallest median root mean square error (RMSE) 57.97 (CI of 54.44-61.72) and greatest median R-squared 0.22 (CI 0.18-0.26). Surgery start time and preoperative diagnosis were found to be most influential variables in predicting operating room time followed by BMI, uterine volume, and number of prior surgeries. Age, ASA, parity and surgery type were not important in predicting operating room time. Conclusion Regression modeling more accurately predicted operating room time than the institutional standard that used historical averages for robotic-assisted hysterectomy with staging for endometrial cancers. This study is novel in its application to the field of robotic surgery in gynecologic oncology as it builds off of previous work from other disciplines demonstrating improved OR time predictions with regression models. Further studies are needed with expanded databases and more robust variable sets to refine the models ability to account for variance.

Regression modeling improves or scheduling for robotic surgery on endometrial cancer

Objective: Our objective was to develop a tool that can accurately predict operating room time for robotic surgery for endometrial cancer using quantifiable and qualifiable preoperative variables.

Oncologic Outcomes of Robotic Radical Hysterectomy (RRH) for Patients with Early-Stage Cervical Cancer: Experience at a Referral Cancer Center.

To evaluate oncologic outcomes of early stage cervical cancer patients who underwent robotic radical hysterectomy (RRH) in a referral center, a retrospective analysis was performed. From January 2010 to December 2018, medical records of stage IA2-IIA1 cervical cancer patients, who underwent radical hysterectomy at our institute, were retrospectively reviewed. We focused our analysis on those who underwent RRH. A total of 198 patients were included in the final analysis. Median follow up was 52months. At last follow-up, 188 (94.9%) women were disease-free, 9 (4.5%) had died, and 1 (0.5%) was alive with recurrent disease. At 4.5years, PFS was 93.1% (SE ± 2.1) and OS was 95.1% (SE ± 1.8). Stratified by tumor size, PFS for tumor < 2cm versus tumor ≥ 2cm was statistically different (96.8% ± 2.3 and 87.9% ± 4.1 respectively, p = 0.01), as well as OS (100% and 89.8% ± 40 respectively, p = 0.01).Stratified by evidence of tumor at time of robotic surgery, PFS was statistically different in women with no residual tumor after conisation versus those with residual disease (100% ± 2.5 and 90.8% ± 2.8 respectively, p = 0.04). A recurrence occurred in 11 patients (5.6%). Based on our results, we could speculate that robotic approach, along with some technical precautions to avoid spillage, might be safe as primary treatment of early-stage cervical cancer, especially for tumor < 2cm and in case of no evidence of disease at time of radical hysterectomy after previous conisation.

Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy.

To investigate the surgical, oncological, and functional outcomes of transoral robotic surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Retrospective chart review. The charts of patients treated by TORS supraglottic laryngectomy (SGL) in an academic medical center were reviewed. The following outcomes were studied according to the tumor location: average robotic setup and operative times, mean estimated blood loss, postoperative complications, need of tracheotomy, refeeding characteristics, mean hospital stay, need of neck dissection and adjuvant therapy, 5-year local and regional controls, overall survival (OS), and disease-free survival (DFS). Seventy-five patients underwent TORS SGL. Tumors were classified as cT1 (32%), cT2 (52%), and cT3 (16%). Average robotic setup and operative times and the mean estimated blood loss were 15 minutes, 55 minutes, and 20 mL, respectively. The mean follow-up period ranged from 2 to 5 years. The 5-year OS and DFS were 80.2% and 94.3%, respectively. Overall, 34.6% of patients received adjuvant radiotherapy. The majority of patients (92%) restarted an oral diet within 24 to 48 hours postsurgery. Transient tracheotomy was performed in 8% of patients. Postoperative hemorrhages occurred in 12 patients (16.0%), lengthening the hospital stay (mean = 6.8 days). There were no outcome differences regarding the tumor location. TORS is an effective and safe therapeutic approach for early- and intermediate-stages cancers. Oncological outcomes may be quite similar to other surgical approaches, including transoral laser and open surgeries. Future randomized controlled studies are needed for comparing TORS SGL with other surgical procedures. 4 Laryngoscope, 131:1060-1065, 2021.

Robotic-assisted laparoscopic splenectomy for recurrent ovarian cancer

PurposeRecurrent ovarian cancer frequently involves the spleen. Our aims were to describe the technique of robotic-assisted laparoscopic splenectomy and to evaluate outcomes including progression-free and overall survival in patients who...

Abstract A23: Transoral robotic surgery for primary oncologic resection: Outcomes from a rural academic medical center

Abstract Objective: to report the outcomes of oncologic transoral robotic surgery (TORS) performed by a single surgeon. Study Design: Retrospective chart review. Methods: All patients who underwent a TORS primary oncologic resection between the years of 2010-2018 were reviewed. Data regarding demographics, comorbidities, prior treatment, tumor characteristics, surgery, complications, adjuvant therapy, and survival were obtained. Results: Sixty-four patients were included in the chart review with a median age of 60.8 years. Fifty patients were male and 17 were female. Average overall robotic operating time was 137.9 minutes. Forty-one cases were presented using the Da Vinci Si while 23 cases were performed using the Da Vinci Xi. There was no significant difference between these two groups with regards to operative time, complication rate, or survival. Average robotic operative times for tonsil and tongue base primaries were 151.3 and 112.1 minutes, respectively. The difference was approaching statistical significance (p=0.053). Forty-two patients underwent ligation of external carotid artery (ECA) branches whereas 23 patients did not. One major oropharyngeal bleeding complication occurred in a patient who did not receive ECA branch ligation, which resulted in death. No major bleeding complication occurred in the ligation cohort. There was no significant difference in the overall rate of complications between low ACE 27 and high ACE 27 individuals (p = 0.22). However, the number of reported complications is significantly greater in the high ACE 27 group relative to the low ACE 27 group (0.74 vs. 1.82, p = 0.016). There was no significant difference in survival between HPV+ and HPV- tumors. Conclusion: Transoral robotic surgery represents a safe and effective means for resection of malignancies of the oropharynx. Although statistical significance cannot be demonstrated, ECA branch ligation should be considered prior to TORS given the severity of potential complications. Citation Format: Eric Eisen, Christiaan Rees, Isabelle Magro, Karissa LeClair, Joseph Paydarfar. Transoral robotic surgery for primary oncologic resection: Outcomes from a rural academic medical center [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A23.

Robot-based facade spatial assembly optimization

Robotic involvement in construction is still in its initial stages compared to other industries. Conventionally, the facade panel picking position is done manually by trial and error. The designer chooses a place to pick up a facade piece within reach of the robot arm, and then simulates the entire pick and place process in a digital model before applying to the assembly on the construction job site. After that the designer might detect errors, collisions, or singularities, which require the designer to modify the position of picking by changing the location or orientation of the module, thus repeating the simulation cycle until they reach a satisfactory result with no errors or collisions. This work is usually considered monotonous, inefficient, and time consuming. Therefore, this research proposes an optimization process implemented in design stage of construction project via static performance criteria in order to automatically search for the best picking location within the reach of the robot arm. The goal is to automate the process of robot location finding and solve the limitations of modular robot assembly simulation processes in order to allow for effective execution during the robotic construction implementation. The proposed approach, called iFobot, consists of three modules: Facade Generative Modeling (iFobot-D), Robot Position Optimization (iFobot-B), and Culminating Feedback to BIM (iFobot-L). Specifically, the scope of the paper is limited to the robot arm and facade picking and placing location finding processes. This research allows initial assessment of the possible assembly process as regards the dimensions of modules and hence the overall dimensions of the system, which subsequently influences assembly implementation in the construction job site. A set of generative algorithms were developed using commercially developed visual programming language that automatically populate facade modules on the building envelope, find the robot and facade assembly locations with their quantity take-off, and integrate the module with the BIM environment. A case study has been developed to validate and test the proposed system. The results prove that the system generates optimized locations for the robot arm workstations with the lowest possible collision and reachability rate while addressing robot operation time reduction, thus reducing risks encountered during facade assembly and increasing productivity. Moreover, the iFobot is predicted to influence decision making during the facade assembly process on a physical construction job site.

Robotic-assisted transmaxillary approach for removal of juvenile nasopharyngeal angiofibroma of the pterygopalatine and infratemporal fossa.

Endoscopic transmaxillary approaches to remove juvenile nasopharyngeal angiofibromas (JNAs) have been described previously and are used for tumors that extend laterally in the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). There is no previous description of robotic-assisted JNA removal in the literature. The video will demonstrate the success of this technique. Robotic transmaxillary approaches to the lateral PPF and ITF are easily achieved through an extended Caldwell-Luc antrostomy. Total operative time was 519 minutes. Total robotic operative time was 283 minutes. The endoscopic approach provided no assistance in tumor dissection or removal. Robotic-assisted transmaxillary JNA removal allows the operating surgeon to control the endoscope and to operate free of collisions from the robotic console while having an active assistant surgeon at the patient bedside. A video demonstrating the technique is found on Head & Neck's web site.

V03-10 EN-BLOC ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR

You have accessJournal of UrologyUTUC & Testis Cancer (V03)1 Apr 2020V03-10 EN-BLOC ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR James Porter* and Elliot Blau James Porter*James Porter* More articles by this author and Elliot BlauElliot Blau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000849.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open retroperitoneal lymph node dissection (RPLND) has been the gold standard in both the primary and post-chemotherapy treatment of non-seminomatous germ cell tumors (NSGCT). Of recent interest has been the safety and feasibility of utilizing a robotic-assisted (RA), minimally invasive approach. Proposed advantages to RA-RPLND include decreased morbidity and pain, shorter length of stay (LOS), improved cosmesis and similar oncologic outcomes to the open approach. There have been concerns raised as to the completeness of minimally invasive RPLND with incomplete removal of some lymphatic tissue behind the great vessels. To ensure a thorough dissection, we have developed a technique based on the en bloc removal of all lymphatic tissue within the bilateral template. In this video abstract we demonstrate our approach and technique for bilateral template RPLND utilizing an en-bloc method for extirpation of the specimen. METHODS: Our patient is a 32-year-old male with a history of mixed germ cell tumor of the right testis. He presented with elevated tumor markers and mildly enlarged lymph nodes and was initially stage IIa. He underwent BEP chemotherapy x3, with normalization of serum markers. On follow-up surveillance imaging there was evidence of retroperitoneal recurrence with a growing mass in the paraaortic region. Patient was taken for bilateral robotic RPLND. The robotic approach was performed in the supine position with the patient in Trendelenberg. Four robotic ports were placed in a linear configuration 4cm below the umbilicus and 7cm apart. A 12mm assistant port was placed in the right lower quadrant. Internal suspension sutures were used to provide exposure to the retroperitoneum. Complete en bloc removal of retroperitoneal lymph nodes was performed from the renal vessels to the bifurcation of the iliac arteries bilaterally. RESULTS: Robotic operative time was 6.5 hours. Estimated blood loss was 100cc. There were no complications. The patient was discharged to home post-operative day 1 on a low-fat diet. The specimen was removed en bloc. Pathology revealed 31 lymph nodes; 5 of these with evidence of fibrosis, 1 with viable mature teratoma measuring 4.9 cm. CONCLUSIONS: We present a technique for en bloc removal of retroperitoneal lymph nodes in a patient with a post chemotherapy mass using a supine robotic approach. The en bloc technique ensures complete removal of all lymphatics within the bilateral template including the retrocaval and retroaortic tissues. This method promotes control of lymphatic channels and avoids division of lymph nodes within the template. Robotic RPLND should be attempted in select patients by surgeons with significant experience in oncology and robotic surgery. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e282-e282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Porter* More articles by this author Elliot Blau More articles by this author Expand All Advertisement PDF downloadLoading ...

Learning Curve of Robot-Assisted Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

There are few reports on the robot-assisted percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF), and we aimed to explore the learning curve of the robot-assisted PKP for treating OVCF. A total of 44 patients (71 vertebral fractures) with OVCF treated with robot-assisted PKP were divided into 4 groups, namely groups 1, 2, 3, and 4, according to the date of operation, with 11 cases in each group. Another 11patients (18 vertebral fractures) treated with PKP without robot assistance were included in group 5. The success rate of robot-assisted puncture, total operation time, robot-assisted operation time, PKP operation time, and complications were analyzed. All patients underwent operation successfully. The success rates of puncture in the robot-assisted groups were 92.9%, 94.4%, 94.7%, and 100%, respectively, with no statistical difference (P > 0.05). The success rate of puncture in group 5 was 63.2%, with a statistical difference (P < 0.05) compared with groups 1-4. The total operation time and robotic operation time reduced significantly and remained relatively stable since the third group, and groups 1 and 2 showed a statistical significance compared with groups 3 and 4 (P < 0.05), but there was no difference among groups 3, 4, and 5 (P > 0.05). The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space, with an incidence of 8.5% in the robot-assisted groups and 26.3% in group5. The puncture accuracy of robot-assisted PKP for treating OVCF does not change with the increase in the number of operations. The total operation time and robotic-assisted operation time decreases with the increase in the number of cases.

Robotic-assisted latissimus dorsi muscle flap for autologous chest reconstruction in poland syndrome

As chest reconstructions in Poland syndrome are performed for patients at young ages, patients are generally concerned about conspicuous scars. Meanwhile, a robotic-assisted latissimus dorsi (LD) muscle harvest with inconspicuous scars has been performed for autologous breast reconstruction. As our experience with robotic-assisted LD flap harvest has increased over the years, we have made improvements in surgical techniques to optimize results. The purpose of this study was to introduce and identify the role of the refined robotic-assisted LD muscle flap harvest technique in autologous chest reconstruction in patients with Poland syndrome. Autologous chest reconstruction using a robotic-assisted LD muscle flap harvest was performed for 21 patients with Poland syndrome. Subjective assessments were performed to evaluate improvement in chest deformity, patient satisfaction with overall outcomes, chest symmetry, and scars. Assessments by the operator and two independent evaluating investigators were carried out with patients' photographs. The complication rates and the time for robotic surgery were also evaluated. At the last visit, the average patient grades for improvement in chest deformity, satisfaction with overall outcomes, chest symmetry, and scars were 4.80, 4.72, 4.18, and 4.87, respectively. Assessments by the operator and two independent evaluating investigators demonstrated that improvement in chest deformity was achieved in all patients. No serious complications such as flap loss were recorded for any patient. The time for robotic surgery markedly decreased as experience accumulated. Surgical refinements for robotic-assisted LD flap harvest might be effective and reduce operative times for patients with Poland syndrome.

Design and Implementation of Dual Axis Solar Tracker PV to Increase Cleaning Robot Operating Time

This paper discusses design and implementation of dual-axis tracker for PV to supply additional power to extend the operating time of cleaning robot. The system consists of PV 3.5wp, servo motor Tower Pro G90, DC motor, motor driver L298, light sensor (LDR) and microcontroller. Dual axis solar tracker PV works with the principle of comparing light intensity on four light sensors to determine the direction of the oncoming light. PV will be directed perpendicular to the direction of the sunlight in order to maximize the energy production. From the test results obtained that PV produce the highest output voltage reaches 6.10 Volts on light intensity 110800 until 116500 LUX, when PV form the angle of 0 ° to 10 ° towards the sunlight. The average time of charging the battery using the PV, with battery condition 2.5 volt to 3.7 Volt is 94 minutes 48 second. For the average operation time of mobile robot with additional PV longer 7 minutes 17 second compared to mobile robot operation time of without additional PV.