Robotic Instruments Research Articles

Localization of Point-of-Interest Positions on Cardiac Surface for Robotic-Assisted Beating Heart Surgery.

One of the critical components of robotic-assisted beating heart surgery is precise localization of a point-of-interest (POI) position on cardiac surface, which needs to be tracked by the robotic instruments. This is challenging as the incoming sensor measurements, from which POI position is localized, might be noisy and incomplete. This paper presents two Bayesian filtering based localization approaches to localize POI position online from sonomicrometer measurements. Specifically, extended Kalman filter (EKF) and particle filter (PF) localization algorithms are explored to estimate the state of POI position. The estimations of upcoming heart motion generated by the generalized adaptive predictor, which is demonstrated in the authors' past work, are also incorporated to generate an improved motion model. The proposed methods are validated with prerecorded in-vivo heart motion data.

Postavení miniinvazivní a robotické chirurgie v léčbě nádorů jícnu a žaludku

Summary: Esophagectomy and gastrectomy are essential curative methods in the treatment of non-metastatic malignancies of the esophagus and stomach. Video-assisted minimally invasive resections of the esophagus and stomach have demonstrated surgical and oncological safety and can be used as part of multimodal treatment strategy. Robot-assisted surgical operations are a new technology in the field of mini-invasive upper gastrointestinal surgery. The technical advantages of robotic systems combining minimally invasive surgical approaches with the possibility of multi-element articulation of robotic instruments in the operating field lead to a worldwide expansion of robotic centers. Further technological development can be expected to enhance support and facilitation of minimally invasive surgery and to further reduction of the surgical stress while adhering to the criteria of radical oncosurgery. Key words: minimally invasive surgery – laparoscopy – robotic surgery – esophagectomy – gastrectomy

Preclinical implementation of a steerable, Da Vinci Xi® compatible CO2 -laser fibre carrier for transoral robotic surgery (TORS): A cadaveric feasibility study.

Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. We developed a steerable CO2 -laser fibre carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. One radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA-TLX questionnaires. The reported prototype successfully combines the advantages of CO2 -laser with the advantages of TORS.

Robotic Myomectomy: Five Modifications in Our Practice.

We discuss five technical modifications made over 8 years in the technique of robotic myomectomy at our institution. Universal preoperative MRI was the first modification. Precise hysterotomy incisions were planned by accurate myoma mapping. The second modification was to reduce the number of ports. We performed surgery with one 12-mm-port for the camera and one 8-mm-port on either side of the patient for scissors and fenestrated bipolar forceps. Third modification was to reduce the number of robotic instruments by using laparoscopic myoma screw instead of robotic tenaculum during enucleation and discard the use of a second needle driver and prograsp forceps. So instead of six instruments in classical technique, we now use only three instruments thus reducing the cost of instruments by 40-50%. The fourth modification was to use a single 30 or 45cm barbed suture. A single long suture efficiently managed by wristed needle driver of robot was sufficient in most cases for hysterotomy closure. This reduces the time needed for multiple needle pass and cost due to reduced number of sutures used. The fifth modification was to not use the electro mechanical morcellator and commercially available bags. We do cold knife morcellation in indigenous plastic bags. Over a period of eight years, we have made robotic myomectomy efficient and reduced the cost of instruments by 40-50% as compared to the classical technique. This has enabled wider adoption of robotic myomectomy at our institution thus reducing open myomectomy in all types of myomas.

Robotic Gynecologic Surgery: A Beginner's Guide to Becoming an Effective Bedside Assistant

<h3>Study Objective</h3> Learning to become an effective bedside assistant during robotic gynecologic surgery is a difficult task with many real-world nuances. The authors aim to create a video to be a guide for those individuals beginning to fill the role of the bedside assistant in robotic gynecologic surgery, such as residents, physician assistants, and operating room staff. <h3>Design</h3> Instructional video footage was filmed to demonstrate appropriate handling of the robotic system at the bedside. Additional footage was selected that illustrates concepts of best practices in robotic gynecologic surgery. <h3>Setting</h3> This video takes place within a Minimally Invasive Gynecology operating room using a standard robotic system. <h3>Patients or Participants</h3> This video is intended for those beginning to fill the role of bedside assistant in robotic gynecologic surgery (i.e., residents, physician assistants, and surgical scrub technicians/nurses). <h3>Interventions</h3> This video reviews components of the patient cart, cannulas, and instruments in a common robotic system. The video also distills the key points of docking the patient cart, mounting cannulas, and handling of robotic instruments. It highlights safe techniques with use of standard laparoscopic instruments through the assistant port. Additionally, it helps identify ways to be a helpful bedside assistant, including multiple ways to improve the surgeon's visualization of the operative field and anticipate the needs of the primary surgeon. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> The skills of being able to efficiently handle robotic equipment, optimize the surgeon's visualization, and be prepared for next steps in the surgery are illusive to the novice bedside assistant. Review of high yield concepts can help prepare those beginning to fill the role of the bedside assist in robotic gynecologic surgery. This video illustrates many of these concepts and techniques with the intention of guiding those who are new to this role.

Stepwises Technique in Robotic Assisted Notes Sacrocolpopexy

<h3>Study Objective</h3> To demonstrate stepwise techniques for the successful utilization of the single-site technique for safely performing transvaginal sacrocolpopexy for pelvic organ prolapse. <h3>Design</h3> Stepwise demonstration with narrated video footage. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> The patient is a 69-year-old G2P2002 with a history of SVD x2 who presented with symptomatic stage II anterior vaginal prolapse (Aa +1) and stage II posterior vaginal prolapse (Ap -1). The preoperative vaginal length was measured at 9 cm. <h3>Interventions</h3> Laparoscopic transvaginal single-site sacrocolpopexy has been demonstrated to be feasible and safe in the surgical management of pelvic organ prolapse. However, retroperitoneal dissection or suturing/knot tying can be technically challenging to perform, especially in the event of an anatomical variation of a deeply angled S1 vertebra. Wristed robotic instrumentation may overcome some of these obstacles and result in easier suturing and knot tying. Integration of a robotic platform for sacrocolpopexy is a novel alternative minimally invasive approach that is more cosmetic, safer and effective. <h3>Measurements and Main Results</h3> The procedure was successfully performed in approximately 227 minutes with a measured postoperative vaginal length of 7 cm. The patient's postoperative pelvic organ prolapse quantification was stage 0. <h3>Conclusion</h3> Robotic-assisted transvaginal single-site sacrocolpopexy for pelvic organ prolapse is feasible, effective, and safe in patients with pelvic organ prolapse.

Cirq robotic arm-assisted transpedicular instrumentation with intraoperative navigation: technical note and case series with 714 thoracolumbar screws

The Cirq is a surgeon-controlled robotic arm that provides a new technique for accurately placing transpedicular screws. This report aims to present a technical report and our experience with this new robotic arm combined with intraoperative navigation. Technique and workflow using the Cirq robotic arm with intraoperative navigation is described. A retrospective review was conducted of all patients undergoing elective open thoracic/lumbar fusion surgery by a single surgeon in the first year of using the novel Cirq robotic arm. Descriptive analysis of patient and operative variables was performed. A total of 84 patients underwent placement of a total 714 transpedicular screws using the Cirq robotic arm. Most (69.1%) underwent 3-6 level fusion procedures. Mean operative time was 198min total and 28min when adjusted per screw. There was a learning curve with operative time per screw decreasing from 32 to 25min from the first to second half of cases (p = 0.057). There were no intraoperative screw revisions and 2.4% (2/84) required instrumentation revision and return to the operating room. The Cirq robotic arm is seamlessly incorporated into the workflow of a transpedicular fusion. Our experience with over 700 pedicle screw placements using the Cirq robot demonstrates efficacy and safety although further comparative studies are needed.

Design of a dexterous robotic surgical instrument with a novel bending mechanism.

The robot-assisted minimally invasive surgery (RMIS) has developed rapidly in recent years, requiring highly articulated instruments to enable surgeons to perform complicated and precise procedures. A novel wrist-type surgical instrument was proposed for RMIS. The wrist consists of superelastic-wire-driven snake-like joints and universal joints, which could perform two deflections and one distal rotation. The bending mechanism and the kinematics of universal joints were analysed. The forward and inverse kinematics of the wrist were derived. The performances of the instrument were evaluated using a prototype by experiments. The average motion deviation of the wrist's deflection was 0.15±0.08 mm, and the maximum deviation was 0.52 mm. The maximum payload capability was 10 N. The suture task and ex vivo procedure verified the effectiveness of the instrument. The proposed instrument has high dexterity and payload capability, which contributes to improving the quality of the RMIS procedures.

Bidirectional reflectance capabilities of the NIST Robotic Optical Scattering Instrument.

The National Institute of Standards and Technology (NIST) Robotic Optical Scattering Instrument (ROSI) serves as the national reference instrument for specular and diffuse bidirectional reflectance measurements in the ultraviolet to short-wave infrared wavelength regions. This paper gives a comprehensive overview of the design, operation, and capabilities of ROSI. We describe measurement methods for diffuse and specular reflectance, identify and quantify the elements of the uncertainty budget, and validate the reflectance scale through comparison with NIST's previous reference instrument, the Spectral Tri-function Automated Reference Reflectometer. Examples of the range of ROSI's capabilities, including the limits for low-reflectance measurements and a research application using out-of-plane measurements of bidirectional reflectance for remote sensing reference reflectors, are also covered.

Road to automating robotic suturing skills assessment: Battling mislabeling of the ground truth

ObjectiveTo automate surgeon skills evaluation using robotic instrument kinematic data. Additionally, to implement an unsupervised mislabeling detection algorithm to identify potentially mislabeled samples that can be removed to improve model performance. MethodsVideo recordings and instrument kinematic data were derived from suturing exercises completed on the Mimic FlexVR robotic simulator. A structured human consensus-building process was developed to determine Robotic Anastomosis Competency Evaluation technical scores across 3 human graders. A 2-layer long short-term memory–based classification model used instrument kinematic data to automate suturing skills assessment. An unsupervised label analyzer (NoiseRank) was used to identify potential mislabeling of skills data. Performance of the long short-term memory model’s technical skill score prediction was measured by best area under the curve over the training runs. NoiseRank outputted a ranked list of rated skills assessments based on likelihood of mislabeling. Results22 surgeons performed 226 suturing attempts, which were broken down into 1,404 individual skill assessment points. Automation of needle entry angle, needle driving, and needle withdrawal technical skill scores performed better (area under the curve 0.698–0.705) than needle positioning (0.532) at baseline using all available data. Potential mislabels were subsequently identified by NoiseRank and removed, improving model performance across all domains (area under the curve 0.551–0.766). ConclusionUsing ground truth labels from human graders and robotic instrument kinematic data, machine learning models have automated assessment of detailed suturing technical skills with good performance. Further, an unsupervised mislabeling detection algorithm projected mislabeled data, allowing for their removal and subsequent improvement of model performance.

V02-09 ROBOTIC EXTRAVESICAL MULLERIAN DUCT REMNANT EXCISION

You have accessJournal of UrologyMisc. Benign Disease & Transplant & Renovascular (V02)1 Sep 2021V02-09 ROBOTIC EXTRAVESICAL MULLERIAN DUCT REMNANT EXCISION Laura Kidd, Chinonyerem Okoro, and Daniel Eun Laura KiddLaura Kidd More articles by this author , Chinonyerem OkoroChinonyerem Okoro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001979.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a 13-year-old male with history of mixed gonadal dysgenesis who presented with abdominal pain and urinary frequency. He was admitted for work-up, which revealed a negative urine culture but a 13.9 cm Mullerian duct remnant (MDR). The patient underwent cystoscopic drainage, which provided temporary relief, but seven months later his pain recurred and he developed gross hematuria. Repeat imaging showed the same MDR, now 10 cm in size. He was referred for robotic surgical repair. METHODS: Cystourethroscopy showed a mound of heaped of tissue at 6 o’clock in the prostatic urethra, corresponding to the opening of the remnant. This was not cannulated, to avoid draining the remnant prior to its dissection. The patient was placed in steep Trendelenburg and a three-port configuration was used (right, camera, left), with no assistant port. The bladder was filled and the vesicouterine plane was carefully developed, taking care to control any encountered vessels feeding the MDR. The remnant was dissected down to its neck. Near infrared fluoroscopy (NIF) and white light from the cystoscope in the urethra was used to confirm the exact insertion point. This was also visualized by the bedside assistant in the cystoscopic view, with gentle prodding from the robotic instrument. The MDR was then amputated at the insertion point and the defect was closed in a single layer. Intraoperative cystoscopy confirmed excellent closure with no luminal narrowing or back-wall suture bites. A coude catheter was placed to end the case. RESULTS: Estimated blood loss was 50cc, total operative time was 97 minutes. No complications were encountered. The patient was discharged on post-operative day 0. Pathology was consistent with Mullerian duct remnant. Catheter was removed at 2 weeks and he continues to do well at 2-month follow-up. CONCLUSIONS: Mullerian duct remnants are rare and presenting symptoms can vary. Endoscopic management can be attempted, but failure often necessitates more definitive repair. This can safely be performed robotically, and intraoperative urethroscopy can help identify the urethral insertion point if cannulation of the remnant is not, or cannot be, performed pre-operatively. In the limited literature, as well as in our experience, perioperative outcomes are favorable. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e136-e136 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Kidd More articles by this author Chinonyerem Okoro More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...

V03-12 ROBOTIC-ASSISTED LAPAROSCOPIC RPLND FOR PARATESTICULAR RHABDOMYOSARCOMA USING 5 MM INSTRUMENTS IN PEDIATRIC SETTING

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-12 ROBOTIC-ASSISTED LAPAROSCOPIC RPLND FOR PARATESTICULAR RHABDOMYOSARCOMA USING 5 MM INSTRUMENTS IN PEDIATRIC SETTING Angeline Johny, Vinaya Bhatia, Alan Hsieh, Jeffrey White, and Chester Koh Angeline JohnyAngeline Johny More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , Alan HsiehAlan Hsieh More articles by this author , Jeffrey WhiteJeffrey White More articles by this author , and Chester KohChester Koh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The primary objective of this video is to demonstrate that the robotic approach using 5 mm instruments for primary retroperitoneal lymph dissection (RPLND) in the pediatric patient population with paratesticular rhabdomyosarcoma (PT-RMS) is an effective and safe procedure with favorable oncologic outcomes. Patients greater than 10 years of age with PT-RMS are often under staged and under treated. Additionally, the incidence of micrometastases has been shown to be as high 40%. Micrometastases is not amenable to chemotherapy and as such, the current US recommendation is for patients who are ten years and older with PT-RMS to undergo an ipsilateral retroperitoneal lymph node dissection regardless of radiographic findings. Following initiation of these guidelines, studies have demonstrated that ipsilateral RPLNDs have improved overall survival to 86%. METHODS: In this video, two case presentations were discussed demonstrating both left and right unilateral RPLND templates. For our left template, the patient is an 11 year old male with unremarkable history who presented with one month history of enlarging left hemiscrotum and work-up notable for elevated LDH of 577. He underwent a left radical inguinal orchiectomy with final pathology demonstrating a spindle cell RMS variant with positive margins. For our right template, the patient is a 10 year old male with history of Wiskott-Aldrich Syndrome with associated thrombocytopenia who also presented with a large painless right scrotal mass. Work-up was notable for LDH of 1012. He underwent a right radical inguinal orchiectomy with final pathology demonstrating Embryonal RMS with spermatic cord, tunic, and epididymal. Both patients underwent a primary robotic RPLND using 5 mm instruments and tolerated the procedure well, with favorable immediate post operative and long term oncologic outcomes. RESULTS: To approach our template adequately, we planned the following port placement: an 8 mm camera port at the superior margin of the umbilicus, two 5 mm robotic ports in the midline, with one inferior to the xiphoid, and the second inferior to the umbilicus but superior to the bladder. The assistant port was placed in the right versus left lower quadrant depending on the laterality of the RPLND. This port placement permits visualization of the renal hilar vessels, the great vessels, the sympathetic nerve trunks, as well as the ureter and major pelvic vessels, and was modified from techniques already described by Cost et al. 2012. CONCLUSIONS: Robotic assisted RPLND enables urologists to easily and safely to apply the benefit of minimally invasive surgery with 5 mm instruments. The major advantages of the robotic approach include reduced morbidity and mortality with preserved oncologic outcomes, enhanced visualization, and heightened instrument precision. Barriers to wide spread utilization of this technique include steep learning curve, need for proctor to oversee procedure, as well as cost. Nonetheless, our video demonstrates that the advantages of using 5 mm robotic instrument ports during a primary RPLND in the pediatric setting are technically feasible, with enhanced clinical and oncologic outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e225-e226 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angeline Johny More articles by this author Vinaya Bhatia More articles by this author Alan Hsieh More articles by this author Jeffrey White More articles by this author Chester Koh More articles by this author Expand All Advertisement Loading ...

V08-03 FULL-TEMPLATE PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION WITH DAVINCI SINGLE PORT ROBOT

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-03 FULL-TEMPLATE PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION WITH DAVINCI SINGLE PORT ROBOT John Sheng, Chrystal Chang, Gregory Lovallo, and Mutahar Ahmed John ShengJohn Sheng More articles by this author , Chrystal ChangChrystal Chang More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) can be employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND has long been the standard approach but is associated with significant morbidity. Laparoscopic RPLND was developed to mitigate the morbidity associated with the open procedure, but is technically challenging requiring significant experience with laparoscopic dissection and suturing. Robotic RPLND has gained traction in recent years as an alternative, with better instrument dexterity and visualization compared to laparoscopic RPLND. The DaVinci single port robot, released by Intuitive in 2018, further advances minimally invasive surgery through one 25mm port. Here, we demonstrate the feasibility of using the single port robot technology to perform a full template RPLND for testis cancer through a single small incision. METHODS: 21 year old male with no significant past medical history underwent a left radical orchiectomy for a testicular mass. The final pathology showed mixed germ cell tumor with lymphovascular invasion. His CT scan showed subcentimeter lymphadenopathy in the retroperitoneum. Given his options of surveillance, chemotherapy or primary retroperitoneal lymph node dissection (RPLND), the patient elected to undergo primary RPLND with the single port robot. RESULTS: Patient underwent single port robotic assisted laparoscopic bilateral retroperitoneal lymph node issection. A single 25mm incision was made infraumbilically for the robotic instruments. No assistant port was used, making this a true single port procedure. The remotely operated suction irrigation system (ROSI) was used not only for suction but for dissection as well. The operative time for this case was 202 minutes. Estimated blood loss was 50cc. The patient was discharged within 18 hours of surgery with no need for post op narcotic use. CONCLUSIONS: The single port, in our experience, appears to show excellent mobility, visibility and control and allows us to perform this complex procedure in an even more minimally invasive way. Performing a robotic RPLND with the single port may allow for better cosmesis and less post operative pain which are important to many patients in this younger demographic affected by testis cancer. While there is a learning curve with the SP robot, we show that it is possible to be done safely and effectively. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e601-e602 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sheng More articles by this author Chrystal Chang More articles by this author Gregory Lovallo More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

Malfunction Events in the US FDA MAUDE Database: How Does Robotic Gynecologic Surgery Compare with Other Specialties?

To review malfunction events (MEs) related to the use of the da Vinci robot reported to the United States Food and Drug Administration Manufacturer and User Facility Device Experience in the last 10 years and compare gynecologic surgery with other surgical specialties. A retrospective review. Manufacturer and User Facility Device Experience database. Reports from 2010 to 2020 with keywords "Davinci" and "Intuitive". Report review. There were 679 reports included in the final analysis. Most MEs occurred intraoperatively (81.7%) and were related to robotic instrument malfunction (84.5%), and 30% required an instrument switch to complete the procedure. Conversion to open and laparoscopic surgery was required in 3.1% and 1.3% of MEs, respectively. Injury to the patient occurred in 15.6% of MEs. Of the reported injuries to patients, 6.6% were related to robotic malfunction, 49.2% to instrument malfunction, and 18% to surgeon or staff misuse of the robotic system, and 15.6% were complications inherent to the procedure, not related to the robotic system. Of all the reported MEs, 4.4% were related to robot malfunction, 1.5% to console malfunction, 73.3% to Intuitive accessory malfunction, 11.2% to other accessory malfunction, 4% to surgeon or staff misuse of robotic system, and 3% to complications inherent to the procedure. Comparison between gynecologic surgery and other surgical specialties showed that 14.4% of issues were solved intraoperatively in gynecologic surgery vs 13.7% in other specialties (p=.185). The procedure was completed robotically in 85.2% in gynecologic surgery vs 84% in other specialties, laparoscopically 4.6% vs 3.7%, and open in 10.2% vs 12.4%, respectively (p=.883). In gynecologic surgery, reported MEs were made by patients in 14.8% vs 4.8% in other specialties, manufacturer in 78.4% vs 74.2%, and operating room staff in 2.3% vs 16.1%, respectively (p=.007). Injury to patient was similar in gynecologic surgery compared with other specialties (35.1% vs 23.4%, p=.122). Gynecologic and other specialty MEs did not state the need for procedure rescheduling (0% vs 0%). Most reported robotic MEs occurred intraoperatively, were related to robotic instrument malfunctions, and required an instrument switch. Most surgeries are completed robotically, but conversion to either an open or laparoscopic approach was reported in 4.4%. Of the 114 reported injuries, 47.4% were Clavien-Dindo grade III+. There were no differences noted in patient injury between gynecologic surgery and other specialties.

Robotic-assisted left lower-lobe pulmonary lobectomy: Eleven steps.

Robotic-assisted left lower-lobe pulmonary lobectomy: Eleven steps.

Robotic surgery costs: Revealing the real villains.

This study aimed to evaluate the main drivers of robot assisted radical prostatectomy (RARP) hospitalization costs, in addition to assess perioperative predictors that impact costs. Overall, 474 RARP were analyzed between February 2018 and December 2019. The association between perioperative variables and total direct costs was analyzed by simple and multiple linear regression. The main drivers of RARP hospitalization costs were robotic surgical supplies. Costs increased with American Society of Anesthesiologists score 3, a one-hour increase in OR time, increased utilization of polymeric clip packs and longer length of hospital stay. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five. Costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.

Augmented-Reality-Assisted K-Wire Placement for Glenoid Component Positioning in Reversed Shoulder Arthroplasty: A Proof-of-Concept Study.

The accuracy of the implant’s post-operative position and orientation in reverse shoulder arthroplasty is known to play a significant role in both clinical and functional outcomes. Whilst technologies such as navigation and robotics have demonstrated superior radiological outcomes in many fields of surgery, the impact of augmented reality (AR) assistance in the operating room is still unknown. Malposition of the glenoid component in shoulder arthroplasty is known to result in implant failure and early revision surgery. The use of AR has many promising advantages, including allowing the detailed study of patient-specific anatomy without the need for invasive procedures such as arthroscopy to interrogate the joint’s articular surface. In addition, this technology has the potential to assist surgeons intraoperatively in aiding the guidance of surgical tools. It offers the prospect of increased component placement accuracy, reduced surgical procedure time, and improved radiological and functional outcomes, without recourse to the use of large navigation or robotic instruments, with their associated high overhead costs. This feasibility study describes the surgical workflow from a standardised CT protocol, via 3D reconstruction, 3D planning, and use of a commercial AR headset, to AR-assisted k-wire placement. Post-operative outcome was measured using a high-resolution laser scanner on the patient-specific 3D printed bone. In this proof-of-concept study, the discrepancy between the planned and the achieved glenoid entry point and guide-wire orientation was approximately 3 mm with a mean angulation error of 5°.

Cost-Effectiveness Analysis of Robotic-assisted Lobectomy for Non-Small Cell Lung Cancer

BackgroundRobot-assisted thoracic surgery has emerged as an alternative to video-assisted thoracic surgery (VATS) for treating patients with resectable non-small cell lung cancer. The objective of this study was to evaluate the cost effectiveness of robotic-assisted lobectomy (RAL) compared with VATS and open lobectomy for adults with NSCLC. MethodsA decision analysis model was employed to compare the cost effectiveness of RAL, VATS, and open lobectomy with 1-year time horizon from both health care and societal perspectives. Health care costs (2020$) and quality-adjusted life-years were compared between the approaches. The incremental cost-effectiveness ratio was calculated in terms of cost per quality-adjusted life-years gained. Sensitivity analyses were performed to identify variables driving cost effectiveness across several willingness-to-pay thresholds. ResultsOpen thoracotomy was not cost effective compared with both RAL and VATS lobectomy. From the health care sector perspective, RAL was $394.97 more expensive per case than VATS resulting in an incremental cost-effectiveness ratio of $180 755.10 per quality-adjusted life-year. From the societal perspective, RAL was $247.77 more expensive per case than VATS, resulting in an incremental cost-effectiveness ratio of $113 388.80 per quality-adjusted life-years. Robotic-assisted lobectomy becomes cost effective with marginally lower robotic instrument costs, shorter operating room times, lower conversion rates, shorter lengths of stay, higher hospital volumes, and improved quality of life. Robotic-assisted lobectomy is also cost effective if surgeons can increase the proportion of minimally invasive lobectomies using robotic technology. ConclusionsCompared with VATS, RAL is not cost effective for lung cancer lobectomy at lower willingness-to-pay thresholds. However, several factors may drive RAL to emerge as the more cost-effective approach for minimally invasive lung cancer resection.

Semantic Segmentation of Surgical Instruments based on Enhanced Multi-scale Receptive Field

With the rapid development of robot assisted surgery, the segmentation of surgical instruments becomes more and more important. However, compared with the natural scene segmentation, surgical instrument segmentation is more difficult. To solve this problem, we improve a high and low resolution fusion module, which aims to extract detail information and context information from the fusion feature map of high and low resolution. Then, in the last layer of the encoder, we propose the Enhanced Multi-scale Receptive Field module to generate more available receptive fields. Our method is validated on 2017 MICCAI EndoVis Robotic Instrument Segmentation Challenge dataset, and the result is better than the other methods. The extended experiment is carried out on the dataset of our surgical soft robot which has a content implementation.

Research progress and development trend of surgical robot and surgical instrument arm.

In recent years, surgical robots have become an indispensable part of the medical field. Surgical robots are increasingly being used in the areas of gynaecological surgery, urological surgery, orthopaedic surgery, general surgery and so forth. In this paper, the development of surgical robots in different operations is reviewed and analysed. In the type of master-slave surgical robotic system, the robotic surgical instrument arms were located in the execution terminal of a surgical robot system, as one of the core components, and directly contact with the patient during the operation, which plays an important role in the efficiency and safety of the operation. In clinical, the arm function and design in different systems varies. Furtherly, the current research progress of robotic surgical instrument arms used in different operations is analysed and summarised. Finally, the challenge and trend are concluded. According to the classification of surgical types, the development of surgical robots for laparoscopic surgery, neurosurgery, orthopaedics and microsurgery are analysed and summarised. Then, focusing on the research of robotic surgical instrument arms, according to structure type, the research and application of straight-rod surgical instrument arm, joint surgical instrument arm and continuous surgical instrument arm are analysed respectively. According to the discussion and summary of the characteristics of the existing surgical robots and instrument arms, it is concluded that they still have a lot of room for development in the future. Therefore, the development trends of the surgical robot and instrument arm are discussed and analysed in the five aspects of structural materials, modularisation, telemedicine, intelligence and human-machine collaboration. Surgical robots have shown the development trend of miniaturisation, intelligence, autonomy and dexterity. Thereby, in the field of science and technology, the research on the next generation of minimally invasive surgical robots will usher in a peak period of development.