Use Of Robotic Assistance Research Articles

Functional Outcome in Obese Patients Undergoing Image-Based Cruciate Retaining Robotic-Assisted Total Knee Arthroplasty Using the Subvastus Approach: A Short-Term Study.

Introduction Knee osteoarthritis (OA) is a prevalent degenerative joint disease that significantly affects quality of life, especially among obese and morbidly obese individuals. Total knee arthroplasty (TKA) is an effective treatment for end-stage OA, but it presents unique challenges in obese patients. The mini-subvastus approach (SA) and robotic-assisted TKA (RA-TKA) are emerging techniques that may address these challenges. This study evaluates the clinical and radiological outcomes of cruciate-retaining (CR) RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. Methods This study included 114 obese patients (215 knees) with primary OA who underwent CR RA-TKA (Maxx Meril CR knee, USA) using the Cuvis Joint® robotic system. Patients had a BMI of ≥30 kg/m² (n=101) and morbid obesity with a BMI ≥40 kg/m² (n=13). Preoperative planning involved CT scans and the J-planner for optimal implant size and positioning. Surgery was performed without tourniquets, and patients were mobilized postoperatively. Clinical outcomes were assessed using visual analog scale (VAS) scores and the American Knee Society Score (AKSS) at three and six months. Results The study included 85 females and 29 males with an average age of 61.8 years. Satisfactory knee exposure was achieved in all cases using SA, with no major complications such as wound infections, deep vein thrombosis, or component misalignment. Intraoperative challenges were managed effectively, including two cases of medial collateral ligament avulsion and one partial patellar tendon avulsion. Postoperative VAS scores showed significant pain reduction from pre-op (6.54) to post-op day 3 (1.3). AKSS improved from a pre-op average of 33.9 to 70.7 at three months and 80.9 at six months. Most patients (80%) achieved exceptional range of motion (ROM) ≥120° at six months. Discussion The mini-subvastus approach in RA-TKA offers several advantages, including reduced postoperative pain, faster recovery, and improved quadriceps strength, even in obese patients. The use of robotic assistance ensures accurate component positioning and alignment, mitigating the challenges typically associated with obese patients undergoing TKA. Conclusion The study demonstrates the feasibility and effectiveness of CR RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. This technique provides adequate exposure, reduces pain, and promotes early mobilization and recovery with satisfactory clinical and radiological outcomes. The findings support the potential for wider adoption of this approach in managing knee OA in obese populations, though further studies with longer follow-up are warranted.

Robotically assisted outflow graft anastomosis in minimally invasive left-ventricular assist device implantation: feasibility, surgeon comfort, and operative times in an anatomical study.

Upper hemi-sternotomy is a common approach for outflow graft anastomosis to the ascending aorta in minimally invasive left-ventricular assist device implantation. Right mini-thoracotomy may also be used, but use of robotic assistance has been reported only anecdotally. The aim of our study was to confirm the feasibility of robotically assisted suturing of the outflow graft anastomosis and to assess performance metrics for the robotic suturing part of the procedure. The procedure was carried out in eight cadaver studies by two surgeons. The assist device pump head was inserted through a left-sided mini-thoracotomy and the outflow graft was passed toward a right-sided second interspace mini-thoracotomy through the pericardium. After placement of a partial occlusion clamp on the ascending aorta, a longitudinal aortotomy was performed and the outflow graft to ascending aorta anastomosis was carried out robotically. The procedure was feasible in all eight attempts. The mean outflow graft anastomotic time was 20.1 (SD 6.8) min and the mean surgeon confidence and comfort levels to complete the anastomoses were 8.3 (SD 2.4) and 6.9 (SD2.2), respectively, on a ten-grade Likert scale. On open inspection of the anastomoses, there was good suture alignment in all cases. We conclude that suturing of a left-ventricular assist device outflow graft to the human ascending aorta is very feasible with good surgeon comfort. Anastomotic times are acceptable and suture placement can be performed with appropriate alignment.

Impact of Insertion Speed, Depth, and Robotic Assistance on Cochlear Implant Insertion Forces and Intracochlear Pressure: A Scoping Review.

Cochlear implants are crucial for addressing severe-to-profound hearing loss, with the success of the procedure requiring careful electrode placement. This scoping review synthesizes the findings from 125 studies examining the factors influencing insertion forces (IFs) and intracochlear pressure (IP), which are crucial for optimizing implantation techniques and enhancing patient outcomes. The review highlights the impact of variables, including insertion depth, speed, and the use of robotic assistance on IFs and IP. Results indicate that higher insertion speeds generally increase IFs and IP in artificial models, a pattern not consistently observed in cadaveric studies due to variations in methodology and sample size. The study also explores the observed minimal impact of robotic assistance on reducing IFs compared to manual methods. Importantly, this review underscores the need for a standardized approach in cochlear implant research to address inconsistencies and improve clinical practices aimed at preserving hearing during implantation.

A case of primary total knee arthroplasty revision using CORI system

Total Knee Arthroplasty (TKA) is a common surgical procedure used to treat end-stage osteoarthritis of the knee. The increasing adoption of computer-assisted and robotic assisted techniques in total joint arthroplasty has been found to enhance the accuracy of component placement. Short-term studies have indicated improved survival rates in unicompartmental knee arthroplasty with the use of robotic assistance. While robotic technology has proven beneficial in revising procedures like converting unicompartmental knee arthroplasty to TKA, there is limited information on its application in revising primary TKA. This case report details the use of robotic-assisted technology with CORI system in the revision of TKA. The incorporation of robotic assistance during TKA revision surgeries may contribute to better alignment of components and potentially increase the longevity of the prosthetic implant. However, further research is essential to explore the impact of robotic assistance on the overall survival rates and cost-effectiveness of revision TKA procedures.

Excellent 10-Year survivorship of robotic-arm-assisted unicompartmental knee arthroplasty

IntroductionRobotic-arm-assisted unicompartmental knee arthroplasty (UKA) is an excellent solution for patients suffering from single-compartment knee arthritis. While outcomes tend to be favorable for UKAs, revision operations, commonly due to component malpositioning and malalignment resulting in accelerated wear, are a major concern. Intraoperative technologies, such as robotic assistance, can help better ensure that implants are positioned based on a patient's specific anatomy and mechanical physiology. However, long-term survivorship and patient-reported satisfaction with robotic-assisted UKAs are limited. Therefore, the purpose of this study was to assess the 10-year outcomes of patients who underwent robotic-arm-assisted unicompartmental knee arthroplasty. Specifically, we evaluated: 1) 10-year survivorships; 2) patient satisfaction scores; and 3) re-operations. MethodsFrom a single surgeon and single institution, 185 patients who had a mean age of 65 years (range, 39 to 92) and a mean body mass index of 31.6 (range, 22.4 to 39) at a mean of 10 years follow-up were evaluated (range, 9 to 11). For all patients, the same robotic-assistive device was utilized intraoperatively, and all patients underwent standardized physical therapy and received standardized pain control management. Then 10-year survivorships with Kaplan-Meir curves, patient satisfaction evaluations with a 5-point Likert scale, and re-operations were assessed as primary outcomes. ResultsOverall implant survivorship was 99%, with only two patients requiring revision surgery. There was one patient who was converted to a total knee arthroplasty, while the other patient underwent polyethylene exchange at 5 weeks for an acute infection with successful implant retention. Overall, 97% of the patients were satisfied with their postoperative outcomes, with 81% of patients reporting being very satisfied. There were two other patients who required arthroscopic intervention: one to remove a cement loose body, the other to remove adhered scar from the fat pad and the anterior cruciate ligament. ConclusionThis study is one of the first to provide longer-term (mean 10-year) survivorship and patient-reported satisfaction outcomes for robotic-assisted UKA patients. These data show strong support for utilizing this surgical technique, as nearly all patients maintained their original prostheses and reported being satisfied after a mean of 10 years. Therefore, based on these results, we recommend the use of robotic assistance when performing UKAs.

Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System

BackgroundRobotic-assisted total knee arthroplasty is increasingly used in revision total knee arthroplasty (rTKA), with imageless systems recently receiving Food and Drug Administration (FDA) approval. However, there remains a paucity of literature on the use of robotic assistance in revision total knee arthroplasty (TKA). This paper describes the imageless surgical technique for robotic revision TKA using a second-generation robotic system and details both intraoperative and 90-day outcomes. MethodsThis was a retrospective review of 115 robotic revision TKAs from March 2021 to May 2023 at 3 tertiary academic centers. Patient demographics, perioperative surgical data, and 90-day outcomes were collected. Pain and Patient-Reported Outcomes Measurement Information System scores preoperatively and postoperatively were recorded. All-cause reoperations at the final follow-up were detailed. The mean patient age was 65 years (range, 43 to 88), and 58% were women. The mean follow-up time was 13 months (range, 3 to 51). ResultsThe most common indications for rTKA were instability (n = 37, 32%) and aseptic loosening (n = 42, 37%). There were 83 rTKAs to a posterior-stabilized liner, 22 to a varus-valgus constrained liner, and 5 to a hinged construct. The median polyethylene size was 11 (interquartile range, 10 to 13), and 93% of patients had their joint line restored within 5 millimeters of the native contralateral knee. Within the 90-day postoperative window, there were 8 emergency department visits and 2 readmissions. At the final follow-up, there were 5 reoperations and 2 manipulations under anesthesia. There were 4 patients who required irrigation and debridement after superficial wound dehiscence, and one had an arthrotomy disruption after a fall. ConclusionsThis review demonstrates favorable intraoperative and 90-day outcomes and suggests that imageless robotic surgery is a promising modality in rTKA. Further studies comparing the longitudinal outcomes after robotic and conventional rTKA are warranted.

Robot assisted Laparoscopic Cholecystectomy- A Comparative study

Background- Robotic surgery has recently grown in acceptance and usefulness in general surgery, and it may offer superior results to laparoscopic surgery in some gastrointestinal operations. Objectives- To assess if the use of robot assistance during laparoscopic cholecystectomy is warranted when compared to traditional laparoscopic cholecystectomy. Methods- It was a retrospective record based study. All patients undergoing robotic or laparoscopic cholecystectomy between 2019 and 2022 at a single academic medical center were captured using institutional data. A total of 110 robotic surgeries were done and 1200 Laparoscopic cholecystectomies was done during the study period. The bulk of cases were primarily handled by two acute care general surgeons, who also conducted robotic and laparoscopic cholecystectomies. The institutional Clinical Data Repository provided the financial information. The study was approved by Institutional Ethics Committee. Age, sex, race, body mass index (BMI), and comorbid conditions of the patient were examined prior to surgery. SPSS was used for analysis. Results- A total of 1310 patients were identified who underwent robotic or laparoscopic cholecystectomy between 2019 and 2022 among them Robotic-assisted approach was used in 9.1% (n = 110) of cases. There were no demographic differences in age, sex, race, and body mass index (BMI). Type II diabetes mellitus, hypertension, and CHF disease were statistically significantly different between groups. Mean age (Robotic: 41 [29-56] vs. Laparoscopic: 43 [30-54] years, p = 0.11) and BMI (Robotic: 28.4 [26.6-32.4] vs. Laparoscopic: 29.2 [27.5-33.4]) were similar between groups. both operative duration was greater and hospital cost were greater in robotic-assisted cholecystectomy and it was statistically significant (p<0.05), but hospital duration of stay and 90-day related readmission rates were less in robotic-assisted cholecystectomy which was significant; 30-day readmission rates were similar between both groups. Conclusion- When compared to laparoscopic cholecystectomy, robotic cholecystectomy has longer operating times and higher hospital costs, but it is also related with shorter hospital stays and a lower readmission rate within 90 days after the index procedure. Before exploring robotic cholecystectomy, hospitals and surgeons must weigh the enhanced clinical outcomes against the time and money necessary.

Robotic-assisted TKA is Not Associated With Decreased Odds of Early Revision: An Analysis of the American Joint Replacement Registry.

Robotic-assisted TKA continues to see wider clinical use, despite limited knowledge of its impact on patient satisfaction and implant survival. Most studies to date have presented small cohorts and came from single-surgeon or single-center experiences. Therefore, a population-level comparison of revision rates between robotic-assisted and conventional TKA in the registry setting may help arthroplasty surgeons better define whether robotic assistance provides a meaningful advantage compared with the conventional technique. (1) After controlling for confounding variables, such as surgeon, location of surgery, and patient comorbidity profile, were robotic-assisted TKAs less likely than conventional TKAs to result in revision for any reason at 2 years? (2) After again controlling for confounding variables, were robotic-assisted TKAs less likely to result in any specific reasons for revision than the conventional technique at 2 years? The American Joint Replacement Registry was used to identify patients 65 years or older who underwent TKA between January 2017 and March 2020 with a minimum of 2 years of follow-up. Patients were limited to age 65 yeas or older to link TKAs to Medicare claims data. Two retrospective cohorts were created: robotic-assisted TKA and conventional TKA. Patient demographic variables included in the analysis were age, gender, BMI, and race. Additional characteristics included the Charlson comorbidity index, anesthesia type, year of the index procedure, and length of stay. A total of 10% (14,216 of 142,550) of TKAs performed during this study period used robotics. Patients with robotic-assisted TKA and those with conventional TKA were similar regarding age (73 ± 6 years versus 73 ± 6 years; p = 0.31) and gender (62% [8736 of 14,126] versus 62% [79,399 of 128,334] women; p = 0.34). A multivariable, mixed-effects logistic regression model was created to analyze the odds of all-cause revision as a factor of robot use, and a logistic regression model was created to investigate specific revision diagnoses. After controlling for potentially confounding variables, such as surgeon, location of surgery, and Charlson comorbidity index, we found no difference between the robotic-assisted and conventional TKAs in terms of the odds of revision at 2 years (OR of robotic-assisted versus conventional TKA 1.0 [95% CI 0.8 to 1.3]; p = 0.92). The reasons for revision of robotic-assisted TKA did not differ from those of conventional TKA, except for an increased odds of instability (OR 1.6 [95% CI 1.0 to 2.4]; p = 0.04) and pain (OR 2.1 [95% CI 1.4 to 3.0]; p < 0.001) in the robotic-assisted cohort. In light of these findings, surgeons should not assume that robotic assistance in TKA will lead to improved early implant survival. Our findings do not support an improvement over conventional TKA with robotic assistance with regards to common causes of early revisions such malalignment, malposition, stiffness, pain, and instability, and in some cases, suggest there is a benefit to conventional TKA. Differences in the mid-term and long-term revision risk with conventional versus robotic-assisted TKA remain unknown. Appropriate informed consent around the use of robotic assistance should not imply decreased early revision risk. Level III, therapeutic study.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

558 Comparison of Length of Post-Operative Hospital Stay Following Robot-Assisted Laparoscopic Nephrectomies with Traditional Laparoscopic Nephrectomies: A Single-Centre Retrospective Study

Abstract Aim The study aims to compare the length of post-operative hospital stay following robot-assisted laparoscopic (RAL) nephrectomies with stays following traditional laparoscopic (LAP) nephrectomies at a district general hospital. Method This study retrospectively compares the post-operative length of hospital stay using information documented on patient’s paper notes scanned onto an online system. Between January 2021 and December 2021, 25 patients underwent LAP nephrectomies in this unit. Following the introduction of RAL at our unit, all patients requiring a nephrectomy had this procedure done using RAL. Between January 2022 to November 2022, 33 patients underwent a RAL, 3 of which required conversion to open and excluded from this study. Additionally, data on age, BMI, tumour size and ASA score was collected to identify any evidence of systemic bias. Results Mean post LAP hospital stay was 3.60 (±3.24) nights, while post RAL was shorter at 2.07 (±1.44) nights to a statistically significant degree (p-value = 0.0357). There was no significant difference in any of the demographic factors between the two groups (LAP and RAL). When including data for partial nephrectomies (n = 20; LAP = 11, RAL = 9) and pyeloplasties (n = 9; LAP = 5, RAL = 4), length of post-operation hospital stay was still significantly shorter for patients who had undergone robot-assisted laparoscopy. Mean post-LAP hospital stay was 3.56 (±2.62) nights, while post-RAL was shorter at 2.21 (±1.68) nights to a statistically significant degree (p-value = 0.00666). Conclusions The use of robot-assistance during laparoscopic nephrectomies was associated with significantly shorter post-operative hospital stays over traditional laparoscopic procedures in this cohort of patients.

ThTP6.2 Comparison of length of post-operative hospital stay following robot-assisted laparoscopic nephrectomies with traditional laparoscopic nephrectomies: a single-centre retrospective study

Abstract Aim The study aims to compare the length of post-operative hospital stay following robot-assisted laparoscopic (RAL) nephrectomies with stays following traditional laparoscopic (LAP) nephrectomies at a district general hospital. Method This study retrospectively compares the post-operative length of hospital stay using information documented on patient’s paper notes scanned onto an online system. Between January 2021 and December 2021, 25 patients underwent LAP nephrectomies in this unit. Following the introduction of RAL at our unit, all patients requiring a nephrectomy had this procedure done using RAL. Between January 2022 to November 2022, 33 patients underwent a RAL, 3 of which required conversion to open and excluded from this study. Additionally, data on age, BMI, tumour size and ASA score was collected to identify any evidence of systemic bias. Results Mean post LAP hospital stay was 3.60 (±3.24) nights, while post RAL was shorter at 2.07 (±1.44) nights to a statistically significant degree (p-value=0.0357). There was no significant difference in any of the demographic factors between the two groups (LAP and RAL). When including data for partial nephrectomies (n=20; LAP=11, RAL=9) and pyeloplasties (n=9; LAP=5, RAL=4), length of post-operation hospital stay was still significantly shorter for patients who had undergone robot-assisted laparoscopy. Mean post-LAP hospital stay was 3.56 (±2.62) nights, while post-RAL was shorter at 2.21 (±1.68) nights to a statistically significant degree (p-value=0.00666). Conclusions The use of robot-assistance during laparoscopic nephrectomies was associated with significantly shorter post-operative hospital stays over traditional laparoscopic procedures in this cohort of patients.

Does Computer Navigation or Robotic Assistance Affect the Risk of Periprosthetic Joint Infection in Primary Total Knee Arthroplasty? A Propensity Score-Matched Cohort Analysis

BackgroundThe use of technology during total knee arthroplasty (TKA) has been associated with more accurate component position and less blood loss. Yet to date, the risk of developing prosthetic joint infection (PJI) associated with computer navigation (CN) or robotic assistance (RA) has not been thoroughly evaluated. This study used propensity score-matching (PSM) in a large cohort of primary TKA patients to compare the rate of PJI following conventional TKA (TKA) versus CN-TKA and RA-TKA. MethodsWe retrospectively reviewed 13,015 knees in 11,727 patients who underwent primary TKA at a single institution from 2018 to 2021. The cohort was stratified into TKA, CN-TKA, and RA-TKA groups. 1:1 PSM was applied to 11,834 patients. Propensity score-matching was performed using logistic regression accounting for age, sex, body mass index, Charlson Comorbidity Index (CCI) score, CCI components, and smoking status. Univariate and multivariable analyses were performed to evaluate differences in surgical time and PJI rate. ResultsSignificantly longer median operating times were noted in the RA-TKA group (14 minutes) compared to TKA (P < .001). The PJI rates among matched cohorts were similar among RA-TKA (0.3%), CN-TKA (0.3%), and conventional TKA (0.5%). Multivariable logistic regressions demonstrated that the use of robotic assistance (odds ratio (OR) = 0.5, P = .423) or computer navigation (OR = 0.61, P = .128) was not associated with increased risk of PJI when compared to conventional TKA. ConclusionsUse of computer navigation and robotic assistance during primary TKA are associated with longer surgical times, but no difference in PJI frequency within 90 days of surgery.

Robotics in Implant-Based and Autologous Breast Reconstruction.

Autologous and implant-based breast reconstruction continues to evolve as new technology and mastectomy techniques become available. Robotic-assisted breast reconstruction represents a growing field within plastic surgery, with the potential to improve aesthetic and functional outcomes, as well as patient satisfaction. This article provides a review of indications, techniques, and outcome data supporting the use of robotic assistance in both implant-based and autologous breast reconstruction from surgeons around the world.

P-750 A systematic review of vasovasostomy (VV) and vasoepididymostomy (VE) techniques for Vasectomy Reversal: How far have we come?

Abstract Study question A systematic review of current literature evaluating different techniques in performing vasovasostomy (VV) and vasoepididymostomy (VE) including robotic-assisted and minimally invasive techniques and their outcomes Summary answer Macrosurgical, microsurgical and robot-assisted techniques have evidence for use in vasectomy reversal. The use of robotic assistance in may have benefit over standard techniques. What is known already While vasectomy is a common procedure worldwide, six percent of these patients request a reversal procedure. Reasons for this include change of mind, a new relationship, death of a child or wanting more children. While sperm harvest combined with in-vitro fertilisation (IVF) is an alternative, factors including timing of patency and durability of patency need to be considered prior to deciding between vasectomy reversal or sperm harvesting with IVF. In 1977, microsurgical techniques for vasovasostomy were described by Silber and Owen, and microsurgical vasectomy reversal procedures became more common following this. The evidence for differing approaches is lacking. Study design, size, duration A systematic literature review was performed using databases Medline and PubMed was performed, comprising studies between 1979 to July 30 2022. Systematic review and review articles of vasovasostomy and vasoepididymostomy were included. Original studies on robotic- assisted techniques and minimally invasive approaches were also included. Exclusion criteria included animal studies and non-English. Level of evidence was evaluated. Participants/materials, setting, methods From the eligible articles identified from the above criteria, data was extracted from review articles including techniques used for vasovasostomy and vasoepididymostomy. Surgical outcomes including pregnancy rates and postoperative patency were considered surgical outcomes and data was extracted regarding this from above articles. Data from original studies on minimally invasive techniques were also extracted from the above articles. Main results and the role of chance For vasovasostomy, techniques described in the literature include microscopic vasovasostomy, mini-incision microscopic vasovasostomy (MVV), mini incision MVV using Moon’s clamp, and robotic assisted vasovasostomy. Described by surgeons as the “most technically challenging procedure”, the early approach to vasoepididymostomy comprised a 3-4cm scrotal incision for delivery of testis to provide adequate exposure to the entire epididymis and vas deferens. When vasoepididymostomy was compared to vasovasostomy, prolonged recovery periods, increased pain and swelling were identified. The techniques described for vasovasostomy comprise end-to end, end-to side, three-suture triangulation intussusception (TIVE), two-suture longitudinal intussusception (LIVE), deferential vessel-sparing LIVE, mini-incision vasoepididymostomy, robot-assisted vasoepididymostomy (RAVE). Retrospective reviews of microsurgical vasovasostomy using a 2-layer anastomosis report patency rate of 85%, similar to reports from single layer repairs. Microsurgical techniques allow accurate apposition of narrow lumen ends, allowing unobstructed semen flow and low level evidence suggests high patency rates. Macrosurgical vasovasostomy may be more simple, less expensive and a quicker alternative. Elzanaty et al. found no clear difference between microsurgical and microsurgical vasovasostomy in terms of vasal patency. Both techniques appeared to be effective when performed by an experienced surgeon. Preliminary evidence for robotic assistance suggests a role in reduced morbidity and accuracy of repair. Limitations, reasons for caution With low level evidence for each technique, formal clinical guidelines are not forthcoming. Further evaluation and longer follow-up is required to assess clinical usage and true cost-benefit ratio. There is also a need for a standardised measurement tool to provide accurate and objective outcome measures to compare techniques. Wider implications of the findings This systematic review provides evidence for available techniques in vasovasostomy and vasoepididymostomy for vasectomy reversal. Outcome measurement tools are presented, highlighting the lack of standardised definitions of patency and failure. The current review enables surgeons performing vasectomy reversal to determine the most effective, efficient and cost-effective technique for their practice. Trial registration number ‘Not applicable'

Robot-assisted spinal augmentation procedures: is it worth the increased effort?

Spinal augmentation procedures (SAP) are standard procedures for vertebral compression fractures. Often, SAPs are carried out in a minimally invasive, percutaneous way. Certain anatomic conditions such as small pedicles or kyphotic deformities resulting from a significant collapse of the vertebral body might render the operation more difficult and increase the risk of complications. Thus, robot assistance might be useful to optimize the trajectory and to reduce procedure-associated complications. In this study robot-assisted percutaneous SAPs are compared with conventional fluoroscopy-guided percutaneous SAP. A retrospective observational analysis was carried out. Standard demographic parameters were analyzed. Procedural data including radiation dosage records were screened. Biomechanical data were recorded. Cement volumes were analyzed. The precision of the pedicular trajectory was reviewed, and misplaced trajectories were categorized. Procedure-associated complications were analyzed and evaluated for their clinical significance. A total of 130 procedures were reviewed, and 94 patients were finally included. Osteoporotic fractures (OF) were the main indication (60.7%; OF 2-44%, OF 4-33%). Demographic parameters and clinically relevant complications were equally distributed between the two groups. Duration of surgery was significantly longer in robot-assisted procedures (p < 0.001). Intraoperative radiation exposure was equally distributed. Injected cement volume was similar in both groups. There was no significant difference in pedicle trajectory deviation. The use of robot assistance in SAP seems not to be superior with regard to accuracy, radiation exposure and the rate of complications when compared to fluoroscopy-guided SAP.

Enabling four-arm laparoscopic surgery by controlling two robotic assistants via haptic foot interfaces

Robotic surgery is a promising direction to improve surgeons and assistants’ daily life with respect to conventional surgery. In this work, we propose solo laparoscopic surgery in which two robotic arms, controlled via haptic foot interfaces, assist the task of the hands. Such a system opens the door for simultaneous control of four laparoscopic tools by the same user. Each hand controls a manipulative tool while a foot controls an endoscope/camera and another controls an actuated gripper. In this scenario, the surgeon and robots need to work collaboratively within a concurrent workspace, while meeting the precision demands of surgery. To this end, we propose a control framework for the robotic arms that deals with all the task- and safety-related constraints. Furthermore, to ease the control through the feet, two assistance modalities are proposed: adaptive visual tracking of the laparoscopic instruments with the camera and grasping assistance for the gripper. A user study is conducted on twelve subjects to highlight the ease of use of the system and to evaluate the relevance of the proposed shared control strategies. The results confirm the feasibility of four-arm surgical-like tasks without extensive training in tasks that involve visual-tracking and manipulation goals for the feet, as well as coordination with both hands. Moreover, our study characterizes and motivates the use of robotic assistance for reducing task load, improving performance, increasing fluency, and eliciting higher coordination during four-arm laparoscopic tasks.

Acetabular cup placement and offset control in robotic total hip arthroplasty performed through the modified anterolateral approach.

The modified anterolateral approach (Röttinger) for total hip arthroplasty (THA) offers great advantages over conventional approaches, especially concerning early postoperative symptoms, which are mild and well tolerated by patients. Robotic-assisted implantation might facilitate rapid adoption of the modified anterolateral approach without exposing surgeons to risks encountered during the learning curve. This study posits that the use of robotic assistance in conjunction with the modified anterolateral approach for total hip arthroplasty (THA) can provide a substantial enhancement in the accuracy of cup placement in comparison to manual surgery. Thirty-two robotic-assisted THAs met the inclusion criteria and were matched to 32 conventional cases. Acetabular cup inclination, anteversion, limb-length discrepancy, and acetabular offset were assessed using certified planning software by two independent observers using pre- and postoperative anterior-posterior radiographs. Data was analyzed for normal distribution. Chi2 test was used to determine whether implanted acetabular cups that were within Lewinnek's safe zones were influenced by type of implantation. Effect size estimates and statistical power analysis were also performed to appreciate the appropriateness of the chosen sample size. Robotic-assisted implantation was found to significantly improve acetabular cup placement in terms of inclination (p < 0.001) but not anteversion (p = 0.783). Although mean postoperative limb-length discrepancy and mean acetabular offset did not differ between groups, a significantly smaller variance was found in the robotic-assisted group (p < 0.001) and (p = 0.04), respectively. There were no significant differences between the two groups in terms of consistently implanting the acetabular cup within the Lewinnek safe zones p = 0.641 for anteversion and p = 0.230 for inclination, respectively. Our results show that although robotic-assisted acetabular cup implantation performed through the modified anterolateral approach did not significantly differ from conventional implantation, it did offer increased accuracy in cup positioning, acetabular bone preservation, and limb-length restoration.

The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes

The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.

Development of a novel body weight support system for gait rehabilitation

AbstractModern rehabilitation processes for neurological patients have been widely assisted by robotic structures, with continuous research and improvements. The use of robotic assistance in rehabilitation is a consolidated technique for upper limb training sessions. However, human gait robotic rehabilitation still needs further research and development. Based on that, this paper deals with the development of a novel active body weight support (BWS) system integrated with a serious game for poststroke patients. This paper starts with a brief review of the state of the art of applied technologies for gait rehabilitation. Next, it presents the obtained mathematical model followed by multibody synthesis techniques and meta-heuristic optimization to the proposed device. The control of the structure is designed using proportional integral derivative (PID) controllers tuned with meta-heuristic optimization and associated with a suppression function to perform assist-as-needed actions. Then, the prototype is integrated with a serious game designed specifically for this application. Finally, a pilot study is conducted with the structure and healthy volunteers. The results obtained show that the mobility of the novel BWS is as expected and the proposed system potentially offers a novel tool for gait training.

Surgical outcomes of robotic-assisted cyst excisions and hepaticojejunostomies in patients with perforated choledochal cysts: a single-centerretrospective study.

Perforated choledochal cysts is usually treated by open approach through a one- or two-stage procedure. Laparoscopic procedures are gradually being used more commonly with advancements in minimally invasive technology, while the level of difficulty and conversion rate are still high due to adhesions and deranged anatomy. Robot-assisted choledochal cyst excisions have been proposed as another minimally invasive procedure that is thought to improve operability and precision compared with laparoscopic surgery. However, there is still a lack about the use of robotic assistance for bilio-enteric reconstruction in pediatric patients with perforated choledochal cyst excisions. The aim of this current study was to investigate the safety and effectiveness of robotic-assisted procedures in pediatric perforated choledochal cyst excisions. Patients suffering from perforated choledochal cysts and treated with surgical procedures including open, laparoscopic, and robotic procedures between January 2009 and December 2021 were retrospectively analyzed. Robotic cyst excisions and hepaticojejunostomies were mainly used to a one-stage procedure (the pseudocyst formation or intra-mural perforation) or in stage 2 of two-stage procedures (complete perforation). Data collection included patient characteristics, intraoperative outcomes, and postoperative complications. There were a total of 64 patients suffering from perforated choledochal cysts were treated at our institution. Thirty-one cases of cyst excisions and hepaticojejunostomies were completed by open procedures. Twenty-two cases of cyst excisions and hepaticojejunostomies were completed by laparoscopic procedures and 11 cases were completed by robotic procedures. The operating times were significantly longer in the laparoscopic procedures group (214.32 ± 51.33min) than found with either the open procedures group (130.55 ± 10.51min) or the robot-assisted procedures group (188.82 ± 16.55min) (p < 0.001). The time to oral intake, total complication, and hospital stay were similar among all three groups (3.53 ± 0.28days vs 3.47 ± 0.30days vs 3.46 ± 0.29days, 19.35% vs 27.27% vs 18.18%, 11.48 ± 1.29days vs 11.95 ± 2.75days vs 11.55 ± 2.38days, respectively) (p > 0.05). The number of biliary complications was higher in the laparoscopic procedures group (18.18%) than in both the open procedures and robot-assisted procedures groups (0.00%) (p = 0.016). Robotic-assisted cyst excision and hepaticojejunostomy procedures in patients with perforated choledochal cysts are both safe and feasible. What is more, they can achieve the same results as open procedures and also reduce the level of difficulty of operations and bring fewer biliary complications compared with laparoscopic procedures.