Robotic Cart Research Articles

Single stage robotic total mesorectal excision-a stepwise approach.

The totally robotic procedure was traditionally described as a two-stage technique or a three-stage technique. The number of stages corresponds to the number of movements of the robotic cart. In this video article, we develop a stepwise approach video of robotic total mesorectal excision (TME) for mid rectal cancer (the surgery was performed by SHK) using a da Vinci® Si HD Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) at Korea University Anam Hospital, Seoul. After the induction of general anesthesia, the patient is placed in a modified lithotomy position. Six ports are used, including one 12-mm camera port, four 8-mm robotic working ports, and one 5-mm port for the assistant. The patient is tilted to the right side and placed in the Trendelenburg position. The small-bowel loops retracted out from the pelvic cavity to the right upper quadrant (RUQ) to expose the inferior mesenteric artery (IMA). The surgery is divided into three phases: (I) abdominal phase: vascular ligation, and sigmoid colon to splenic flexure mobilization; (II) pelvic dissection phase; and (III) rectal reconstruction phase. Mesorectal clearing was done at the level of rectal transection line (1-2 cm from distal tumor margin), then the rectum was transected with robotic stapler. Once this step is finished, the robotic arms are undocked and the cart is moved away from the patient. The remaining steps are performed in a conventional laparoscopic method. Robotic TME was performed in a 56-year-old man with an endoscopically define rectal mass. The lesion was moderately differentiated adenocarcinoma, 8 cm from the anal verge (AV). The rectal mass was managed with single stage robotic TME. The operative time was 160 minutes and the patient was discharge on post operative day 10. Final pathology revealed moderately differentiated adenocarcinoma. Single stage robotic TME was efficient and feasible technique for mid rectal cancer resection.

Towards the development of simultaneous two-field robotic surgery.

As technologically evolves, certain changes are predictable. For example, computer processor speeds will increase, surgical instruments will become more refined, and devices more durable. Likewise, it is conceivable that different approaches to surgery—and not the instruments themselves—will represent an important part of surgical innovation. One recent example of this is the new technique of transanal total mesorectal excision (taTME) [1, 2]. There can be more than one next step in innovation for both robotics and minimally invasive surgery, and often innovation happens in parallel. Recently, the da Vinci Xi robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was introduced into clinical practice in the USA. The system is equipped with features that streamline the experience for the console surgeon, particularly because of the ability to alter the operating table position without undocking the robotic cart so that access to the pelvis and splenic flexure (for example) can be obtained with single docking and without contending with poor exposure due to position-related variables. Robotic-assisted transanal total mesorectal excision (RATS-TME) [3] has been developed as a technique that allows for a very precise TME and is similar in approach to the taTME commonly performed with the transanal minimally invasive surgery (TAMIS) technique [4] or hybrid TEO–TAMIS platform [5]—and this has generated significant interest from the colorectal and robotic surgery community [6–8]. Key developments define the pretext of a potential ‘next step’ in robotic surgery—that is, the concept of a two-field synchronous approach, as described here. Marcos Gomez (Santander, Spain) has demonstrated that a single-team (asynchronous) robotic approach from above and from below is quite feasible [5]. Meanwhile, the two-team (synchronous) laparoscopic taTME approach has been championed by Antonio Lacy (Barcelona, Spain)—termed the ‘Cecil Approach’. This group has also described a robotic (from above) two-team approach (A. Lacy personal communication to editor). Our group has also previously described a synchronous two-team approach with RATSTME in combination with laparoscopic assistance [9]. As two-team approaches for taTME have become a focal point, moving towards a two-field, synchronous paradigm for robotics seems to follow from this natural evolution. But how could two-field robotic surgery work? Could the same robotic cart be configured such that dual-console surgeons are able to simultaneously perform the TME dissection? Using the da Vinci Xi (and with the aid of a second ‘teaching’ console), it is possible to conceive of a two-team operation performed in two fields simultaneously utilizing a singular robotic cart (Fig. 1). To do this, the teaching console must be configured to allow a second surgeon to operate autonomously. The current set-up allows for two of the four arms to be assigned to a second surgeon, seated at the teaching console. Thus, two working arms can be used via transanal access, and two working arms can be used for the pelvic dissection via conventional, transabdominal access with both surgeons working simultaneously and autonomously (Fig. 2). With the current Xi platform, it is possible to accomplish this task—with only four arms—by using a robotic camera Electronic supplementary material The online version of this article (doi:10.1007/s10151-015-1403-5) contains supplementary material, which is available to authorized users.

Right robotic adrenalectomy for a 8 cm pheochromocytoma (with video)

Please cite this article in press as: Sessa L, et al. Right robotic adrenalectomy for a 8 cm pheochromocytoma (with video). Journal of Visceral Surgery (2015), http://dx.doi.org/10.1016/j.jviscsurg.2015.06.010 Pheochromocytoma; Robotic surgery; Minimally invasive surgery; Robotics CT scan showed a 10 cm right adrenal tumor compatible with a pheochromocytoma. MIBG scintigraphy confirmed a right adrenal tumor single uptake. Routine biomolecular evaluation (SDHx and VHL genes) was negative for a familial disease. A totally robotic lateral transperitoneal right adrenalectomy was performed. The patient was placed in left lateral strict decubitus and flexed at the waist. An ‘‘open’’ right subcostal access was used to introduce a 12 mm optical trocar. Under laparoscopic vision (0◦ scope), 4 other trocars were introduced: two 8 mm right subcostal trocars, one 12 mm and one 10 mm trocars for the first-assistant’s left and right (liver retractor) hand, respectively. The robotic cart (da Vinci® Si Surgical System, Intuitive Surgical) was placed above the patient’s right shoulder and was docked. Intra-abdominal exploration confirmed the presence of a large retroperitoneal mass that completely modified the right suprarenal region. The right triangular ligament was divided and the liver was medially retracted. The right aspect of the vena cava was not initially accessible because of the large adrenal mass volume. Consequently, the tumor was first dissected, en bloc with the periadrenal fat, from the upper pole of the kidney and from lateral attachments to obtain an adequate mobilization of the adrenal mass allowing its rotation to better approach the right lateral and posterior aspects of the vena cava. Then, dissection was carried out progressively upward along the inferior vena cava on the medial margin of the tumor. Four large adrenal veins were consecutively dissected, clipped using nonabsorbable self-locking clips (Hem-o-lok®, Weck-Telefex Europe Ltd.), and divided. The adrenal mass was completely dissected and mobilized from its posterior aspect (iliopsoas muscle). Overall operative time was 90 minutes. No post-operative complication was observed hospitalization duration was 3 days. Pathology confirmed an adrenal pheochromocytoma, 8 cm in diameter with a PASS score 1 with R0 resection without capsular effraction.

Mobile robotic cart development to support Home Oxygen Therapy patient's going out via Force control with Inverted pendulum control

Home Oxygen Therapy (HOT) patients always need to take the conveyance cart to carry oxygen equipment when they go out. However the equipment is heavy enough to discourage the patients from their going out. Therefore we try to develop a mobile robotic cart in order to support HOT patient's going out. by applying Force control and Inverted pendulum control. In this paper, we describe the control principle of the robotic cart by several simulations using Open Dynamics Engine (ODE), and we also show the effectiveness of our proposed control method.

P089 生活道路走行機能を取り入れたHOT患者を支援するロボットの開発(メカボケーション学生研究発表セッション)

P089 生活道路走行機能を取り入れたHOT患者を支援するロボットの開発(メカボケーション学生研究発表セッション)

2A2-J09 HOT患者の外出支援のための伴走型搬送カート : 剛体ハンドルによる動作制御の検討

Home Oxygen Therapy (HOT) patients need portable oxygen equipment at the time of going out. However, the currently-used oxygen equipment is enough heavy to discourage HOT patients from their going out. Therefore we try to develop the power assist robotic cart which supports HOT patients' going out. Especially we try to develop the side-moving type cart which moves next to the users. We propose new operation interface device which has high reliability and capability of easy-understandable operation, and then we verify its validity by dynamical simulation applying Open Dynamics Engine. In this paper, we report the result and show the effectiveness of our proposed interface device.

2A1-J09 HOT患者の外出支援のための倒立振子型搬送カート : 力制御による酸素機器搬送の検討

Home Oxygen Therapy (HOT) patients need portable oxygen equipment at the time of going out. However, the currently-used oxygen equipment is heavy enough to discourage HOT patients from their going out. Therefore we try to develop the power assist robotic cart which supports HOT patients' going out. Especially we try to develop the carry-cart type mobile robot which supports HOT patients by applying inverted pendulum control and force control. In this paper, we try to verify the effectiveness of the hybrid control system via computer simulation by Open Dynamics Engine.

Escort type mobile robotic cart development to support HOT patient's going out applying new operational interface mechanism

Escort type mobile robotic cart development to support HOT patient's going out applying new operational interface mechanism

Automated robotic parking systems: real-time, concurrent and multi-robot path planning in dynamic environments

This paper presents an integrated framework for a suite of dynamic path planning algorithms for real time and concurrent movement of multiple robotic carts across a parking garage floor layout without driving lanes. Planning and search algorithms were formulated to address major aspects of automation for storage and retrieval of cars loaded onto robotic mobile carts. Path planning algorithms including A*, D* Lite and Uniform Cost Search were implemented and integrated within a unified framework to guide the robotic carts from a starting point to their destination during the storage and the retrieval processes. For the circumstances where there is no clear path for a car being stored or retrieved, a procedure was developed to unblock the obstacles in the path. A policy that minimizes obstructions was defined for assigning the parking spots on a given floor for arriving cars. Performance evaluation of the overall proposed system was done using a multithreaded software application. A variety of rectangular parking lot layouts including those with 20 × 20, 20 × 40, 30 × 40, and 40 × 40 parking spaces were considered in the simulation study. Performance metrics of path length, planning or search time and memory space requirements were monitored. Simulation results demonstrate that the proposed design facilitates near optimal paths, and is able to handle tens of concurrent requests in real time and in the presence of immobilized carts.

Robotic transanal surgery for local excision of rectal neoplasms.

Robotic transanal surgery (RTS) has been a natural evolution of transanal minimally invasive surgery. This video demonstrates how RTS is performed for the full-thickness excision of a malignant rectal polyp, with endoluminal robotic suturing of the rectal wall defect. The general approach to RTS, including the approach to docking of the robotic cart, are also illustrated in video format.

1A1-E03 力制御を用いたHOT患者の外出支援用アシストカート : 酸素機器搬送ロボットの操作性についての検証(福祉ロボティクス・メカトロニクス(1))

In this research, for the purpose of improving the operability of power assistant mobile robot to support HOT patients' going-out, we measured the human operating force as the input and the trajectories of commonly-used carry cart as the output. Then we estimate the human operating characteristics from the result and propose an operating method, and mount the method to the prototype power assistant mobile robots actually to investigate the effectiveness.

1P1-E02 力制御インターフェイスによるHOT患者の外出支援用ロボットカートの制御(福祉ロボティクス・メカトロニクス(2))

1P1-E02 力制御インターフェイスによるHOT患者の外出支援用ロボットカートの制御(福祉ロボティクス・メカトロニクス(2))

1P1-B02 力センサを用いたHOT患者の外出支援用カートの動作制御(福祉ロボティクス・メカトロニクス(2))

1P1-B02 力センサを用いたHOT患者の外出支援用カートの動作制御(福祉ロボティクス・メカトロニクス(2))

Robotic Abdominoperineal Resection for Lower Rectal Cancers: How We Do It?

Abstract Introduction: Robotic approach has been increasingly applied to the surgical resection of distal rectal cancer. All reports from the advocators on the use of robotic assistance in rectal s...

Robotic retroperitoneal approach - a new technique for the upper urinary tract and adrenal gland

The retroperitoneal approach is generally avoided because of the reduced working space, the difficulties in robot positioning and the risk of arms conflict. A new robotic retroperitoneal approach is presented that can be applied for upper urinary tract pathology and adrenal pathology. Between November 2009 and November 2011, 34 out of 114 robotic procedures were performed by the retroperitoneal approach using a triangle shaped trocar placement and the robotic cart positioned at the patient's head. All of the 34 retroperitoneal procedures were performed using this type of approach, with no conflict between the robotic arms and no conversions. The average operating time was 50 min for simple nephrectomies and 180 min for partial nephrectomies. The blood loss was not relevant. This approach enables excellent mobility for the robotic arms, generating no conflict and providing good maneuvering space for the bedside assistant.

English

English

2A1-C11 HOT 患者の外出支援のための酸素ボンベ搬送カート : キャリーカート型I/F による搬送カートのコンプライアンス制御(福祉ロボティクス・メカトロニクス(1))

Home Oxygen Therapy (HOT) patients who are suffering from Chronic Obstructive Pulmonary Disease always need to be supplied high concentration oxygen, and they also need to carry portable oxygen cylinders. However the oxygen cylinders seem to be heavy for carrying. So we propose and develop new type of robotic cart for carrying oxygen cylinder to support HOT patients. Our proposed robotic cart applies compliance control to operate the cart itself easily by using handle shape interface which is usually attached to the popular carry cart, and then the robotic cart becomes to be able to follow the patients by carrying their portable oxygen cylinders. In this paper we describe the principle of robotic cart operation, hardware development, controller design, and their effectiveness.

2A1-C10 HOT 患者の外出支援のための酸素ボンベ搬送カート開発 ジョイスティックI/F による搬送カートの牽引制御(福祉ロボティクス・メカトロニクス(1))

HOT patients always need to carry portable oxygen cylinder when they go out. However the oxygen cylinder and its transport cart is heavy enough to become a burden for HOT patients. In this paper, we propose a new type of the oxygen cylinder conveyance robotic cart for HOT patients. Firstly, we describe the problems of Hyper-Tether type robotic cart, and then, we propose a new input device in order to solve the problem.

2A1-C07 HOT 患者の外出支援のための酸素ボンベ搬送カート開発 : 力制御による伴走型搬送カートの実現(福祉ロボティクス・メカトロニクス(1))

Home Oxygen Therapy (HOT) patients always need to be supplied high concentration oxygen, and they also need to carry portable oxygen cylinders when they go out. However the oxygen cylinders seem to be heavy, so we propose and develop new type of robotic cart for carrying oxygen cylinder to support HOT patients. Our proposed robotic cart applies side-by-side running and following style to carry oxygen cylinder by using handle shape interface which has 4 force sensors to generate the robot's moving direction and velocity. In this paper we describe the concept and principle of robotic cart operation.

2A1-C09 HOT 患者の外出支援のための酸素ボンベ搬送カート開発 : 前方支持I/F による搬送カートの力制御(福祉ロボティクス・メカトロニクス(1))

Home Oxygen Therapy (HOT) patients always need to be supplied high concentration oxygen, and they also need to carry portable oxygen cylinders when they go out. However the oxygen cylinders seem to be heavy. So we propose and develop new type of robotic cart for carrying oxygen cylinder to support HOT patients. Our proposed robotic cart applies guide and lead style to carry oxygen cylinder by using the handle of two tight and left type interfaces which has 2 force sensors to generate the robot's moving direction and velocity. In this paper we describe the concept and principle of robotic cart operation, and then we show the effectiveness of our proposed feedback control system of force-velocity impedance control.