Search

Objective Retinal vein cannulation is a technically demanding surgical procedure and its feasibility may rely on using advanced surgical robots equipped with force-sensing microneedles. Reliable detection of the moment of venous puncture is important, to either alert or prevent the clinician from double puncturing the vessel and damaging the retinal surface beneath. This paper reports the first in-vivo retinal vein cannulation trial on rabbit eyes, using sensorized metal needles, and investigates puncture detection. Methods We utilized total of four indices including two previously demonstrated ones and two new indices, based on the velocity and force of the needle tip and the correlation between the needle-tissue and tool-sclera interaction forces. We also studied the effect of detection timespan on the performance of detecting actual punctures. Results The new indices, when used in conjunction with the previous algorithm, improved the detection rate form 75% to 92%, but slightly increased the number of false detections from 37 to 43. Increasing the detection window improved the detection performance, at the cost of adding to the delay. Conclusion The current algorithm can supplement the surgeons visual feedback and surgical judgment. To achieve automatic puncture detection, more measurements and further analysis are required. Subsequent in-vivo studies in other animals, such as pigs with their more human like eye anatomy, are required, before clinical trials. Significance The study provides promising results and the criteria developed may serve as guidelines for further investigation into puncture detection in in-vivo retinal vein cannulation.

Background A Chinese surgical robot, Micro Hand S, was introduced for clinical use as a novel robotic platform. This study aimed to comprehensively compare the early experience of the Micro Hand S robot-assisted total mesorectal excision (TME) with conventional approaches. Methods Between May 2017 and April 2018, 99 consecutive patients who underwent open, laparoscopic and Micro Hand S robot-assisted TME (O-/L-/RTME) for rectal cancer were included. Clinical and pathological outcomes were retrospectively analyzed. Surgical success as the primary endpoint was defined as the absence of (i) conversion, (ii) incomplete TME, (iii) involved circumferential and distal resection margins (CRM/DRM), (iv) severe complications. Results The rate of surgical success was similar (89.7 vs. 86.4 vs. 84.6%, p = 0.851) in the three groups and the respective incidences were as follows: conversion (not applicable, 4.5 vs. 2.3%, p = 1.000), incomplete TME (6.9 vs. 6.8 vs. 3.8%, p = 0.980), involved CRM/DRM (0 vs. 2.3 vs. 3.8%, p = 0.592), severe complications (3.4 vs. 4.5 vs. 7.7%, p = 0.844). Compared with open and laparoscopic surgery, the robotic surgery was associated with longer operative time, less blood loss, earlier first flatus time and liquid intake time, and shorter length of hospital stay (p Conclusions The Micro Hand S assisted TME is safe and feasible, showing comparable outcomes than conventional approaches, with superiority in blood loss, recovery of bowel function, length of hospital stay, but with increased operative time.

Robotic surgery bedside assistants play an important role in robotic procedures by performing intra-corporeal tasks while accommodating the physical presence of the robot. We hypothesized that an augmented reality headset enabling 3D intra-corporeal vision while facing the surgical field could decrease time and improve accuracy of robotic bedside tasks. Bedside assistants (one physician assistant, one medical student, three surgical trainees, and two attending surgeons) performed validated tasks within a mock abdominal cavity with a surgical robot docked. Tasks were performed with a bedside monitor providing 2D or 3D vision, or an optical see-through head-mounted augmented reality device with 2D or 3D vision. The effect of augmented reality device resolution on performance was also evaluated. For the simplest task of touching a straw, performance was generally high, regardless of mode of visualization. With more complex tasks, including stapling and pulling a ring along a path, 3D augmented reality decreased time and number of errors per task. 3D augmented reality allowed the physician assistant to perform at the level of an attending surgeon using 3D augmented reality (p = 0.08). All participants had improved times for the ring path task with better resolution (lower resolution 23 ± 11 s vs higher resolution 14 ± 4 s, p = 0.002). 3D augmented reality vision with high resolution decreased time and improved accuracy of more complex tasks, enabling a less experienced robotic surgical bedside assistant to function similar to attending surgeons. These data warrant further study with additional complex tasks and bedside assistants at various levels of training.

The acetabular component orientation in total hip arthroplasty is of critical importance to clinical results. Although navigation systems and surgical robots have been introduced, most surgeons still use acetabular component alignment guides. This study aimed to compare the accuracy between modern acetabular component alignment guides for the lateral position and those for the supine position. Thirteen alignment guides for the lateral position and 10 for the supine position were investigated. All the lateral position alignment guides indicated cup alignment in operative definition, and the supine position alignment guides indicated cup alignment in radiographic definition. For lateral position alignment guides, the anteversion actually indicated by the alignment guide itself was smaller than that indicated by the manufacturer by a mean of 6° (maximum, 9°), and the inclination actually indicated by alignment guides themselves was larger than that by the manufacturer (p

We aim to discuss the development of Revo-i, the first new robotic medical device for laparoscopic surgery made in Korea, including the history of launching Revo-i in the global market, and the success results of the progression with the clinical data after launching the system. Revo-i has been commercialized in the global and domestic market, and it has been increasing the number of the procedures at the major specialties such as obstetrics and gynecology, urology and general surgery. This shows that Revo-i is one of the competitive robots in the global market to compete with the current worldwide robotic system.

Objectives Since the introduction of the first master–slave robotic platform for surgical procedures, there have been ongoing modifications and development of new platforms, but there is still a paucity of commercially available systems. Our study aims to identify all master–slave robotic surgical platforms currently commercially available or in development around the world with applications in urologic surgery. Methods A scoping literature search was performed using PRISMA methodology to identify all relevant publications in English in PubMed, PubMed Central, and Embase, with additional information being obtained from official company websites. Results Ten robotic platforms with either proven or potential application in urologic surgery were identified: the da Vinci surgical system (Intuitive), Senhance surgical system (Transentrix), Versius Surgical (CMR Ltd), Enos surgical system (Titan Medical), Revo –I (Meere Company), MiroSurge (DLR), Avatera System (Avatera Medical), Hugo Surgical Robot (Medtronic), Ottava (J&J, Ethicon, Areus), and Hinotori (Medicaroid Corporation). Conclusions This review highlights the distinct features of emerging master–slave robotic platforms with applications in urologic surgery. Research and development are now focused on finding wider applications, improving outcomes, increasing availability, and reducing cost. Additional research is required comparing newly developed master–slave robotic platforms with those already well established.

Introduction: For the past 20 years, robotic surgical systems have been used for the Roux-en-Y gastric bypass (RYGB). The da Vinci Surgical System (Intuitive Surgical, Inc.) has been one of the mos...

Robotics technology is used widely in minimally invasive surgery (MIS) which provides high performance and accuracy. The most famous robot arm mechanisms, which are used in MIS, are tendon-driven mechanism (TDM), and concentric tube mechanism (CTM). Unfortunately, these mechanisms until now have some limitations, i.e. making friction with the tissue during extracting and retracting and strain limits, for TDM and CTM respectively. A new hybrid concentric tube-tendon driven mechanism (HCTDM) is proposed to overcome these limitations. HCTDM enables the end-effector to get close to and get away from the surgical area during the operation without harming the tissue and with more flexibility. In addition to that, the workspace increases as a result of this combination, too. This benefit serves MIS, especially endoscopic surgeries (ESs). We did an analytical study of this idea and got the forward kinematics. In the inverse kinematics, an intelligent approach which is called an adaptive neuro-fuzzy inference system (ANFIS) is used because the closed-form solution is more complicated for such these mechanisms. Finally, HCTDM is analyzed and evaluated by using a computer simulation. The simulation results show that the workspace becomes wider and has more dexterity than use TDM or CTM individually. Furthermore, various trajectories are used to test the mechanism and the kinematic analysis, which show the mechanism can follow and track the trajectories with maximum mean error 1.279, 0.7027, and [Formula: see text] for X, Y, and Z axes respectively.

In the mid- to late-1990s the cardiac surgery community began to apply limited incisions in mitral valve surgery. Ministernotomies and right-sided minithoracotomies were placed instead of the classic midline sternotomy. Adjunct technology such as videoscopy, advanced peripheral cannulation techniques, procedure specific long shafted surgical instruments, as well as surgical robots became available, and the procedures were refined in a stepwise fashion. In 2021, minimally invasive mitral valve repair is routine at many centers around the globe. We reviewed a total of 50 consecutive patient series published on the topic between 1999 and 2019. Three main versions of minimally invasive mitral valve surgery were applied in 20,539 patients. The surgical methods, their specific results, and the cumulative outcome of less invasive mitral valve surgery published over more than 20 years are reported and an integrated view on what less invasive mitral valve surgery can offer is presented.

We performed robotic neck surgery through a transoral or retroauricular approach (RA) using the DaVinci SP and analyzed our experiences to evaluate the feasibility and safety of this system for performing RA neck surgeries. A total of 63 patients were enrolled in this study, consisting of 37 males and 26 females. All operations were successfully completed without significant complication in 63 patients with head and neck tumor. Using DaVinci SP, it is easy to insert three robotic arms into a long and narrow working space because all robotic arms and an endoscope are inserted through a single arm. Using the navigation function of the DaVinci SP, the endoscopic arm could be made into the shape of a "cobra" to secure proper visualization of the surgical site, which helps surgeons identify specific anatomic structures such as cranial nerve or vessels. We did not have any cases where robotic surgery was converted to open surgery due to severe bleeding or technical issues during surgery. The mean operative time was 207 min and the average hospital stay was 6.9 days. The time required for docking the surgical robot was within 10 min on average for DaVinci SP, which was much simpler and faster than that of the previous Si/Xi system. Based on our early experiences performing robotic head and neck surgery using the DaVinci SP, we confirmed that the system provided advanced technical advantages over the previous Si/Xi system in performing robotic surgery.

Background: Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients’ expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA. Methods: Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools. Results: The main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered “modifiable” factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered “non-modifiable” factors. Conclusion: The use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.

Background We demonstrate the first self-learning, context-sensitive, autonomous camera-guiding robot applicable to minimally invasive surgery. The majority of surgical robots nowadays are telemanipulators without autonomous capabilities. Autonomous systems have been developed for laparoscopic camera guidance, however following simple rules and not adapting their behavior to specific tasks, procedures, or surgeons. Methods The herein presented methodology allows different robot kinematics to perceive their environment, interpret it according to a knowledge base and perform context-aware actions. For training, twenty operations were conducted with human camera guidance by a single surgeon. Subsequently, we experimentally evaluated the cognitive robotic camera control. A VIKY EP system and a KUKA LWR 4 robot were trained on data from manual camera guidance after completion of the surgeon’s learning curve. Second, only data from VIKY EP were used to train the LWR and finally data from training with the LWR were used to re-train the LWR. Results The duration of each operation decreased with the robot’s increasing experience from 1704 s ± 244 s to 1406 s ± 112 s, and 1197 s. Camera guidance quality (good/neutral/poor) improved from 38.6/53.4/7.9 to 49.4/46.3/4.1% and 56.2/41.0/2.8%. Conclusions The cognitive camera robot improved its performance with experience, laying the foundation for a new generation of cognitive surgical robots that adapt to a surgeon’s needs.

In traditional nasal surgery, surgeons are prone to fatigue and jitter by holding the endoscope for a long‐time. Some complex operations require assistant surgeon to assist with holding the endoscope. To address the above problems, the authors design a remote centre of motion based nasal robot, and propose a voice‐based robot control method. First, through the operation space analysis of nasal surgery, the design scheme of the robot based on RCM mechanism is proposed. On this basis, the design parameters of the robot are analysed to complete the entire design of robot. Then, considering that the surgeon's hands are occupied by surgical instruments during complex surgical operations, a voice‐based robot control method is proposed. This method obtains direction instructions from surgeons by analysing the movement of the endoscopic image. Afterward, a commercial speech recognition interface is used to realise the offline grammar controlwords lib compatible with both Chinese and English, and the overall strategy of robot control is proposed. Finally, an experimental platform for virtual robot control is established, and the voice‐based robot control experiment is performed. The results show that the proposed voice‐based control method is feasible, and it provides guidance for the subsequent development and control of the actual robot system.

Robotic surgery (RS) has been increasingly incorporated into colorectal surgery (CRS) training. The degree to which RS has been integrated into CRS residency training is not well described. A web-based survey was sent to all 2019 accredited CRS residency programs within the United States and Canada. Program directors (PDs) were queried on how robotic surgery had been integrated into their program, specifics on RS curriculum and opinions on RS training during general surgery residency. We compared survey responses by program type (university-based, university-affiliated programs, or independent programs) and by geographic region. In addition, a chi-square test was used to evaluate differences in survey responses with respect to robotic curriculum components. Of 66 programs, 42 (64%) responded to the survey. Of the responding programs, 35 (83%) were university-based or university-affiliated, while 7 (17%) were independent. Most programs were in the Midwest (33%). Forty-one (98%) reported having a surgical robot in use at their institution, with 95% reporting active participation of CRS residents in RS. While 74% of programs have a formal RS training curriculum for CRS residents, there was considerable variability in the curriculum elements employed by each institution, and the differences in proportions of these elements were significant (χ2 99.8, p 0.05) or among the different regions (p > 0.05). This study demonstrated that almost all CRS residencies have integrated RS and have trainees operating at the robotic console. Most programs have a robotics curriculum and there are expanding indications for RS within CRS. This expansion calls for discussion on implementation of training standards such as curricular requisites, baseline competency assessments, and definitions of minimum case requirements to ensure adequate training.

Deep learning has proved successful in computer-aided detection in interpreting ultrasound images, COVID infections, identifying tumors from computed tomography (CT) scans for humans and animals. This paper proposes applications of deep learning in detecting cancerous cells inside patients via laparoscopic camera on da Vinci Xi surgical robots. The paper presents method for detecting tumor via object detection and classification/localizing using GRAD-CAM. Localization means heat map is drawn on the image highlighting the classified class. Analyzing images collected from publicly available partial robotic nephrectomy videos, for object detection, the final mAP was 0.974 and for classification the accuracy was 0.84.

In endoscopic endonasal transsphenoidal surgery, for the treatment of deep brain tumors, such as craniopharyngiomas, an endoscope and surgical instruments are inserted through a nasal cavity into the lesion to remove the tumor. This has recently become the preferred technique because there is less likelihood of neural damage and a low complication rate. Manually controlled rigid surgical instruments are available for this procedure, but they provide limited dexterity and field of view. Therefore, some areas remain inaccessible when these surgical instruments are used. To solve these problems, we propose a surgical robot system for endoscopic endonasal transsphenoidal surgery. We defined a target surgical space based on an analysis by a surgeon and designed surgical instruments to reach this target space. The system consists of two robot arms, end-effectors, surgical instruments, a master device, a control device, and a robot base. The robot arm has an end-effector exhibiting two degrees of freedom (DOFs) and an inner channel, into which flexible surgical instruments are inserted. The flexible surgical instrument can reach the target space by steering the robot arm and end-effector. The outer diameter of the end-effector is 4 mm, and the diameter of the instrument channel, into which commercial surgical instruments can be integrated, is 2 mm. We motorized the motion of the robot arms, end-effectors, and instruments and included motion capability with the necessary precision, and developed a master device and control device to operate them. The surgical robot base is used to place the surgical robot before the operation and allow for manual operation. In a cadaver experiment, it was confirmed that the robot system can reach a larger area than is accessible with current surgical instruments, and it can support or remove tissues in the target surgical space. We received productive feedback from the surgeon conducting the experiment, and further research is underway to improve the robot system.

PURPOSE Both safety and accuracy are of vital importance for surgical operation procedures. An efficient way to avoid the singularity of the surgical robot concerning safety issues is to maximize its manipulability in robot-assisted surgery. The goal of this work was to validate a dynamic neural network optimization method for manipulability optimization control of a 7-degree of freedom (DoF) robot in a surgical operation. METHODS Three different paths, a circle, a sinusoid and a spiral were chosen to simulate typical surgical tasks. The dynamic neural network-based manipulability optimization control was implemented on a 7-DoF robot manipulator. During the surgical operation procedures, the manipulability of the robot manipulator and the accuracy of the surgical operation are recorded for performance validation. RESULTS By comparison, the dynamic neural network-based manipulability optimization control achieved optimized manipulability but with a loss of the accuracy of trajectory tracking (the global error was 1 mm compare to the 0.5 mm error of non-optimized method). CONCLUSIONS The method validated in this work achieved optimized manipulability with a loss of error. Future works should be introduced to improve the accuracy of the surgical operation.

OBJECTIVE Robotic surgery has been increasingly incorporated into the subspecialties of colorectal (CRS), minimally invasive/bariatric (MIS/Bar), and surgical oncology/hepatobiliary (SO/HPB) surgery, yet its impact on fellowship applicant evaluation and contribution to postresidency training remains undefined. The aim of our study was to evaluate how robotic training during General Surgery (GS) residency affects an applicant's competitiveness from the perspective of fellowship programs. DESIGN A web-based survey was sent to all 235 accredited fellowship programs in CRS (n = 66), MIS/Bar (n = 122), and SO/HPB (n = 47) within the United States and Canada. Fellowship programs were queried on the import of robotic surgery training during GS residency and its impact on an applicant's match potential. RESULTS Of 235 programs, 155 (66%) responded to the survey – 42 (63.6%) CRS, 87 (71.3%) MIS/Bar, and 26 (55.3%) SO/HPB. Of responding programs, 147 (94.8%) have a surgical robot at their institution, and 131 (84.5%) have fellows actively operating at the console. Overall, 107 (69%) fellowship program directors rated robotic training during surgery residency as “somewhat” or “very” important for residents seeking fellowship. While 95 (61.3%) programs said GS residents should not prioritize robotic training, 60 (38.7%) felt they should, and 38 (24.5%) were more likely to rank an applicant higher if they had some console exposure. Still, 69.7% (n = 108) of programs expect no robotic experience for incoming fellows. CONCLUSIONS This study demonstrates that most fellowship programs have low expectations of robotic experience for incoming fellows. Still, it is notable that nearly a quarter of programs would rank an applicant more highly if they had robotic console exposure. While these findings appear reassuring to residents with limited access to robotic training, residency programs should be alerted to the growing importance of robotic exposure.

Objective: Development of surgical instrument robot (MU-LapaRobot) for assisting in conventional laparoscopic surgery. Methods: A robot was designed based on instrument movement for a conventional procedure. The mechanism mimics and constrains manipulation movement through the wire-driven transmission. It is flexible for robot end-effector, which has a lightweight and small size. The usability of the robot is passive and active robot tasks with an interconnected driving system. Three main parts of the robot are robot end-effector, transmission, and a driving system. Results: On a robot platform, a parameter for setup is robot posture. The adjustment of robot position and projection of manipulation area is influenced by the accuracy of movement. To verify movement, command and exact movements are measured. Compensation with the control system is improved in order to improve the accuracy of the system. Conclusion: MU-LapaRobot provides surgical instrument manipulation by using wire-driven transmission with an effective system and requires less interference in the conventional operation.

In robotic surgery, the load exerted on the insertion port in the patient’s abdominal wall due to misalignment of the robot’s remote center of motion and the insertion port or external forces acting on the tip of the forceps during surgery, can not only stress the patient’s body but also increase the friction between the robotic forceps and the trocar, and adversely affect fine surgical manipulations or the accuracy of force estimation. To reduce such loads on the insertion port in robotic surgery, this study proposes a control method for a surgical assist robotic arm with semi-active joints. The control method was implemented on a six-degree-of-freedom pneumatically driven vertical multi-joint robotic arm with a two-axis gimbal joint (two semi-active joints) that only executes torque control, which was previously developed by the authors, and verified through an experiment. The load on the insertion port is reduced by applying torque control on the semi-active joints to compensate for the external forces on the forceps. We constructed a control system that includes a disturbance compensator and conducted a velocity-control experiment by subjecting the forceps constrained by the insertion port to an external force. The results showed that when the torque was compensated for by the semi-active joints, the load on the insertion port was reduced by 65% and 52% when the external force on the tip of the forceps was 0 N and 3 N, respectively.

Background:Using minimally invasive neurosurgical robots is one of the most desirable ablation methods and resection of brain tumors. In this study, forward kinematics and Jacobian matrix calculated for two single-port robots for comparing the effectiveness of two types of single port minimal invasive surgical robots to ablation and resection of brain tumor Methods: The motion analysis of robots type 1 and 2 has compared to each other. Ablation manipulator in robot type 1 has five degrees of freedom, but in robot type 2, three revolute degrees of freedom of this manipulator has replaced with a revolute joint perpendicular to the previous three revolute joints. Results: Results showed that for resection surgery, in the same conditions, robot type 2 damaged 58.9 mm3 more of cerebral cortex tissue than robot type 1 to resect the brain tumors. To establish a static balance, robot type 2 needs to tolerate at least 41% more internal loading than robot type 1. The maximum velocity for robot type 1 in the contact location between the end-effector and the tumor is 1.7 times more than robot type 2. The maximum end-effector force of robot type 1 to apply the tumor for ablation surgery is more than 1.8 times in robot type 2, but the maximum moment and power for ablation surgery and resection of these two robots were the same less than 1% difference. Conclusion: Despite the more straightforward mechanism, a minimum number of joints, and better kinematics range of robot type 2, robot types 1 has the possibility for transformation, establishes the static balancing, and does a better ablation surgery with less damage to the brain.

Artificial intelligence (AI) is gradually changing every aspect of social life, and healthcare is no exception. The clinical procedures that were supposed to, and could previously only be handled by human experts can now be carried out by machines in a more accurate and efficient way. The coming era of big data and the advent of supercomputers provides great opportunities to the development of AI technology for the enhancement of diagnosis and clinical decision-making. This review provides an introduction to AI and highlights its applications in the clinical flow of diagnosing and treating valvular heart diseases (VHDs). More specifically, this review first introduces some key concepts and subareas in AI. Secondly, it discusses the application of AI in heart sound auscultation and medical image analysis for assistance in diagnosing VHDs. Thirdly, it introduces using AI algorithms to identify risk factors and predict mortality of cardiac surgery. This review also describes the state-of-the-art autonomous surgical robots and their roles in cardiac surgery and intervention.

19. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e.V., CURAC2020, Hamburg, Germany, 17 Sep 2020 - 19 Sep 2020; Current directions in biomedical engineering 6(1), 1-5 (2020). doi:10.1515/cdbme-2020-0009, Published by De Gruyter, Berlin

Artificial intelligence (AI) is gradually changing the practice of surgery with technological advancements in imaging, navigation, and robotic intervention. In this article, we review the recent successful and influential applications of AI in surgery from preoperative planning and intraoperative guidance to its integration into surgical robots. We conclude this review by summarizing the current state, emerging trends, and major challenges in the future development of AI in surgery.

Objective The aim of this study is to describe the impact of robotic-assisted surgery on team performance in the operating room. Background The introduction of surgical robots has improved the technical performance of surgical procedures but has also contributed to unexpected interactions in surgical teams, leading to new types of errors. Method A systematic literature search of Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Cochrane, Web of Science, PsycINFO, and Scopus databases using key words and MeSH terms was conducted. Screening identified studies employing qualitative and quantitative methods published between January 2000 and September 2019. Two reviewers independently appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool (2018). Discussions were held among authors to examine quality scores of the studies and emergent themes, and agreement was reached through consensus. Themes were derived using inductive content analysis. Results Combined searches identified 1,065 citations. Of these, 19 articles, 16 quantitative and 3 qualitative, were included. Robotic-assisted surgeries included urology, gynecology, cardiac, and general procedures involving surgeons, anesthetists, nurses, and technicians. Three themes emerged : Negotiating the altered physical environs and adapting team communications to manage task and technology; managing the robotic system to optimize workflow efficiency; and technical proficiency depends on experience, team familiarity, and case complexity. Conclusion Inclusion of a robot as a team member adds further complexity to the work of surgery. Application These review findings will inform training programs specifically designed to optimize teamwork, workflow efficiency, and learning needs.

Technological advances in the field of surgery and medicine have increased the demand for minimally invasive surgery manifold. Robot assisted surgery is gaining popularity, overcoming the flaws of laparoscopic techniques; with improved surgical precision. The conservative nature of anaesthesia care has to face the challenges with respect to patient positioning, bulkiness of the operating system and being positioned far and away from the patient. Anaesthesiologist's commitment to be the 'best man' for the patient during the perioperative period mandates him to familiarise with these challenges of robot assisted surgical system and provide best possible anaesthetic care and ensure patient safety. In this article, a systematic review of the development of surgical robots and the consideration of unique anaesthetic concerns thereof have been undertaken as any new technology is known to be accompanied by its risks and technical perplexity.

We compared retrograde extraperitoneal open radical cystoprostatectomy (REORC) and robot-assisted radical cystoprostatectomy with intracorporeal diversion (iRARC) and have reported the early perioperative outcomes.REORC and iRARC were each performed at a different tertiary high-volume center in 2 countries. Men aged ≥ 18 years with precystectomy clinical stage T1-T3 disease were included. Patients with previous major pelvic and/or intra-abdominal surgery, those who had undergone previous pelvic and/or abdominal irradiation, women, and patients with clinical stage T4 disease were excluded. All cases were managed according to a standardized enhanced recovery after surgery protocol, and all the patients had undergone ileal conduit urinary diversion. Bowel recovery was one of the main endpoints; thus, the intervals to passing flatus, tolerating oral feeding, and bowel opening were determined. The operative time, estimated blood loss, intraoperative complications, length of hospital stay, postcystectomy tumor type, stage, margin status, lymph node yield, and 30- and 90-day complications were analyzed.We performed a retrospective analysis of prospectively collected data from October 2016 to December 2018 of 99 patients, 50 of whom had undergone REORC and 49 iRARC. The demographic data and preoperative parameters were comparable between the 2 groups. REORC resulted in a significantly shorter mean operative time (P .001), significantly greater mean estimated blood loss (P .001), and greater percentage of patients requiring blood transfusion (98% vs. 12.24%). No significant differences in the length of stay were observed (P = .412). The rate of prolonged postoperative ileus was 16% and 18.4% in the REORC and iRARC groups, respectively (P = .3). Differences in the interval to passing flatus, tolerating solid oral intake, and bowel opening were not statistically significant between the 2 groups (P = .423, P = .770, and P = .700, respectively). No statistically significant difference was observed in the postcystectomy pathologic outcomes and overall and major complications rates at 30 and 90 days.REORC resulted in quicker bowel recovery and a shorter length of stay compared with conventional open procedures, with advantages comparable to those realized with iRARC. Thus, REORC can be adopted as the preferred open approach at institutions without surgical robots available.

Artificial intelligence (AI) is coming to medicine in a big wave. From making diagnosis in various medical conditions, following the latest advancements in scientific literature, suggesting appropriate therapies, to predicting prognosis and outcome of diseases and conditions, AI is offering unprecedented possibilities to improve care for patients. Gastroenterology is a field that AI can make a significant impact. This is partly because the diagnosis of gastrointestinal conditions relies a lot on image-based investigations and procedures (endoscopy and radiology). AI-assisted image analysis can make accurate assessment and provide more information than conventional analysis. AI integration of genomic, epigenetic, and metagenomic data may offer new classifications of gastrointestinal cancers and suggest optimal personalized treatments. In managing relapsing and remitting diseases such as inflammatory bowel disease, irritable bowel syndrome, and peptic ulcer bleeding, convoluted neural network may formulate models to predict disease outcome, enhancing treatment efficacy. AI and surgical robots can also assist surgeons in conducting gastrointestinal operations. While the advancement and new opportunities are exciting, the responsibility and liability issues of AI-assisted diagnosis and management need much deliberations.

Objective: To evaluate the safety and feasibility of using the Micro Hand S surgical robot for right colectomy by comparing the short-term efficacy of robot-assisted and laparoscopic right colectom...

The results of oral and maxillofacial surgery (OMS) significantly depend on the individual capabilities of surgeons. In this article, an autonomous surgical robot is proposed to automatically perform surgery according to a preoperative plan with the assistance of a surgeon. A 3-D computed tomography image of the subject's teeth was used to build an offline shape-based model by creating a large amount of 2-D contour data. A monochrome camera was mounted on a self-developed robot to capture the real-time image of the teeth for comparison with the offline 2-D contour to verify the teeth pose without using common markers. The data of the preoperative plan and the teeth pose were integrated to guide the movement of the robot during operation. Drilling experiments were conducted on the five 3D-printed mandible models, and a statistical analysis revealed highly accurate results. This autonomous robot provides a practical solution for robotically conducted OMS and has the potential to significantly reduce the workload of surgeons.

Background A Phase I clinical study of a Chinese surgical robot, Micro Hand S, was completed recently. The purpose of this research was to evaluate the feasibility and safety of the Micro Hand S surgical robot in the clinical application of general surgery. Methods March 2014 to January 2019, 81 cases of robotic surgery were performed at Third Xiangya Hospital of Central South University. Clinical characteristics, operative outcomes, and postoperative results were collected and analyzed. Patients were followed up with for one month. Results The results of 81 patients were as follows. The range of operation times was 100–495 min. The range of blood loss was 20–1200 ml, and the docking time range was 7–54 min. The range of first flatus times was 1–7 d, the range of fluid diet times was 1–13 d, and the range of hospital stays was 4–30 d. Three patients (3.7%) required conversion to laparoscopic or open-laparotomy surgery. Two patients (2.5%) needed intraoperative blood transfusions, and one patient (1.2%) required a postoperative blood transfusion. Intraoperative complications occurred in two patients (2.5%), which were bladder injury and ureteral injury. Three patients (3.7%) had postoperative complications, including anastomotic leakage, anastomotic hemorrhage, and wound infection. There were no reoperations during hospitalization, and all 81 patients were discharged smoothly. No readmission or death occurred within 30 d after surgery. Conclusion The Micro Hand S surgical robot is reliable and safe for the clinical application of general surgery.

Robots with multiple degrees-of-freedom (DoFs) are being used in the surgical field more frequently over the last decade, not as an alternative but a main method for minimally invasive surgeries. Surgical robots allow surgeons to perform surgical procedures more steadily and more accurately. In this paper, a newly designed 6-DoF manipulator for minimally invasive scaphoid surgery is introduced with its kinematic model. Given the conditions in the operating theatre, especially for the orthopaedic surgery, a sectioned trajectory planning method is proposed in order to prevent the manipulator from colliding with wounded wrist joints. Simulation results show that this approach is well performed to generate a smooth trajectory and ready for clinical trials.

Background: Video-assisted thoracoscopic trans-subxiphoid surgery is an ideal technique for removing anterior mediastinal lesions. The diffusion of this method, however, has been limited by the complexity of surgical maneuvers to be performed in the narrow retrosternal space. Robotic surgery holds promise to overcome the technical limitations of the thoracoscopic trans-subxiphoid approach. Here, we describe a case series of patients who had undergone trans-subxiphoid robotic surgery—with a special focus on short-term outcomes. Methods: Between January 2018 and January 2019, a total of 20 patients underwent trans-subxiphoid robotic surgery for maximal thymectomy or removal of anterior mediastinal masses. A 3-cm longitudinal incision was performed below the xiphoid process, through which carbon dioxide was insufflated and a camera port was inserted. Subsequently, the lower sections of the mediastinal pleura were detached bilaterally—followed by the creation of two bilateral 1-cm skin incisions on the anterior axillary line in the sixth intercostal space for the insertion of robotic arms. Upon completion of port positioning, the surgical robot was docked. Results: All robotic surgery procedures were successfully completed. Neither conversion to open surgery nor the creation of additional ports was required. The median operating time and console time were 118 min [interquartile range (IQR): 84−147 min] and 92.5 min (IQR: 78.5−133.5 min), respectively. Drainage tube positioning was not required in 11 (55%) patients. There were no operative deaths, and the median length of postoperative hospital stay was 2.5 days (IQR: 2−3 days). One patient had postoperative chylothorax and received conservative treatment. Conclusions: The results of this case series provide initial support to the clinical feasibility, safety, and short-term positive outcomes of trans-subxiphoid robot-assisted surgery for anterior mediastinal disease.

Spine surgery has evolved from the advent of imaging and navigation guidance, particularly with the rise of robotic surgical assistance. Navigation guidance has demonstrated potential for increased accuracy of transpedicular screw placement and resecting primary and metastatic spinal tumors. Robotic surgery is widely accepted in other surgical fields because laparoscopic techniques applied to robots can increase operator dexterity and improve visualization. Robotic assistance with spinal tumors has enjoyed rising interest owing to the potential for safe and minimally traumatic resection. We discuss available robots used for navigation-guided transpedicular screw placement and state-of-the-art robotic techniques for spinal or paraspinal tumor resection.

In robot-assisted endoscopic nasal surgery, due to the slender and complicated nasal cavity and sinus anatomical structure, the nasal endoscope of robot end-effector is prone to injure surrounding tissues during surgical approaches. In order to improve the movement safety of the endoscope in robot-assisted endoscopic nasal surgery, a path planning method for endoscopic surgical approaches based on medical image pixel map searching is proposed in this paper, and safe surgical paths from the nasal entrance point to the operating areas are obtained. Firstly, through the trajectory analysis of nasal endoscope tip during surgery, the path planning requirements of endoscope tip are analyzed and obtained. Then, considering the slender and complicated anatomy of the nasal cavity, a binarized three-dimensional grid map containing the spatial anatomy of the nasal cavity is constructed based on the patient's CT medical image sequence. The endoscopic surgical approaches are searched and optimized by introducing the A-star algorithm, and safe surgical paths from the nasal entrance point to the operating areas are obtained. Finally, a virtual nasal endoscopy system is developed and tested on a head model containing nasal tissue, and the effectiveness of the planned surgical paths is verified by automatic virtual nasal endoscopy browsing experiment.

The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.

Continuum manipulators have been widely used in minimally invasive surgery due to their high dexterity. However, different surgeries have different stiffness and dexterity requirements. This paper describes a continuum manipulator for robot-assisted surgery. The flexible part is a joint that can be 3D-printed using various materials. The flexible joints made of each material are of the same size but have different stiffness and dexterity. In this way, the appropriate stiffness can be preset by selecting a suitable manufacturing material according to specific surgical needs. Kinematic and static models of the proposed flexible joints were designed. A finite element analysis method was used to calculate the correction factors. We analyzed the workspace and stiffness differences between flexible joints made of different materials quantitatively and qualitatively, respectively. We conducted experiments to verify the accuracy of the static model and the stiffness differences between the flexible joints. Finally, several design variations were introduced, which demonstrate the unique advantages of these flexible joints in the field of surgical robotics.

Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal tumors. This study compared the implementation of NSS in the United States and Germany. Data were derived from the National Inpatient Sample and from the Nationwide German Hospital Billing Database. All cases of NSS and radical nephrectomy from 2006 to 2014 were analyzed. To assess tumor stage distribution, data from the Surveillance, Epidemiology, and End Results database (United States) and from German cancer registries were used. The study identified 74,663 cases in the United States and 130,051 cases in Germany. The proportion of NSS for T1 tumors increased from 30.6 to 57% in the United States compared with 38.5 to 72.9% (estimation) in Germany (p

Image-based surgical instrument tracking in robot-assisted surgery is an active and challenging research area. Having a real-time knowledge of surgical instrument location is an essential part of a computer-assisted intervention system. Tracking can be used as visual feedback for servo control of a surgical robot or transformed as haptic feedback for surgeon–robot interaction. In this Letter, the authors apply a multi-domain convolutional neural network for fast 2D surgical instrument tracking considering the application for multiple surgical tools and use a focal loss to decrease the effect of easy negative examples. They further introduce a new dataset based on m2cai16-tool and their cadaver experiments due to the lack of established public surgical tool tracking dataset despite significant progress in this field. Their method is evaluated on the introduced dataset and outperforms the state-of-the-art real-time trackers.