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Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being. Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement. Methods: We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration–Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed. Results: Surgeons' self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance. Conclusions: This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness. [ABSTRACT FROM AUTHOR]

Objectives: In the current clinical practice of thermal ablation treatment for liver tumors, achieving consistent and effective clinical outcomes across tumors of varying shapes, sizes and locations remains challenging. The aim of this study was to evaluate the repeatability of a novel robotic approach for configurable ablation of distinct tumor shapes and compare it to the standard ablation technique for creating ellipsoidal ablation volumes. Materials and methods: The repeatability was evaluated in terms of width variability in created ablation volumes. Using a robotic navigation platform, custom ablation profiles configured with power, time, and distance parameters were designed to create four distinct ablation shapes. The profiles were applied for microwave ablation in a tissue-mimicking liver model. For comparison of ablation shape variability, six standard ellipsoidal shapes were created using the standard ablation technique by configuring power and time parameters. For each sample, the resulting ablation area was segmented, and the resulting shape width and length were calculated at the measurement points. Width variability was calculated as the median of the absolute pairwise differences in width at each measurement point, and configurable versus standard ablation shapes were compared using the Mann–Whitney U test. Results: All tissue-mimicking samples were successfully ablated using both configurable (n = 48) and standard ablation technique (n = 35). Study findings revealed noninferiority regarding repeatability of created ablation shapes using the robotic platform for configurable ablation, compared to created standard ellipsoidal ablation shapes (p < 0.001, 95% CI ≤ -0.05 mm, Δ = -0.22 mm). Median repeatability of created configurable shapes was 1.00 mm, and for standard shapes 1.22 mm. Maximal repeatability for both groups was below 3 mm. Conclusion: The repeatability of configurable ablation shapes was observed to be noninferior to the standard ablation shapes. Achieving configurable ablation volumes underscores the potential to advance personalization of thermal ablation treatment and broaden its applicability to distinct tumor cases. In-vivo validation is needed for evaluation of the clinical implications of this novel treatment technique. [ABSTRACT FROM AUTHOR]

This article introduces a novel approach to constructing a topometric map that allows for efficient navigation and decision-making in mobile robotics applications. The method generates the topometric map from a 2D grid-based map. The topometric map segments areas of the input map into different structural-semantic classes: intersections, pathways, dead ends, and pathways leading to unexplored areas. This method is grounded in a new technique for intersection detection that identifies the area and the openings of intersections in a semantically meaningful way. The framework introduces two levels of pre-filtering with minimal computational cost to eliminate small openings and objects from the map which are unimportant in the context of high-level map segmentation and decision making. The topological map generated by GRID-FAST enables fast navigation in large-scale environments, and the structural semantics can aid in mission planning, autonomous exploration, and human-to-robot cooperation. The efficacy of the proposed method is demonstrated through validation on real maps gathered from robotic experiments: 1) a structured indoor environment, 2) an unstructured cave-like subterranean environment, and 3) a large-scale outdoor environment, which comprises pathways, buildings, and scattered objects. Additionally, the proposed framework has been compared with state-of-the-art topological mapping solutions and is able to produce a topometric and topological map with up to 92% fewer nodes than the next best solution. The method proposed in this article has been implemented in the robotics framework ROS and is open-sourced. The code is available at: . [ABSTRACT FROM AUTHOR]

The predictive brain hypothesis suggests that perception can be interpreted as the process of minimizing the error between predicted perception tokens generated via an internal world model and actual sensory input tokens. When implementing working examples of this hypothesis in the context of in-air sonar, significant difficulties arise due to the sparse nature of the reflection model that governs ultrasonic sensing. Despite these challenges, creating consistent world models using sonar data is crucial for implementing predictive processing of ultrasound data in robotics. In an effort to enable robust robot behavior using ultrasound as the sole exteroceptive sensor modality, this paper introduces EchoPT (Echo-Predicting Pretrained Transformer), a pretrained transformer architecture designed to predict 2D sonar images from previous sensory data and robot ego-motion information. We detail the transformer architecture that drives EchoPT and compare the performance of our model to several state-of-the-art techniques. In addition to presenting and evaluating our EchoPT model, we demonstrate the effectiveness of this predictive perception approach in two robotic tasks. [ABSTRACT FROM AUTHOR]

Eighty consecutive complex spinal robotic cases utilizing intraoperative 3D CT imaging (E3D, Group 2) were compared to 80 age-matched controls using the Excelsius robot alone with C-arm Fluoroscopic registration (Robot Only, Group 1). The demographics between the two groups were similar—severity of deformity, ASA Score for general anesthesia, patient age, gender, number of spinal levels instrumented, number of patients with prior spinal surgery, and amount of neurologic compression. The intraoperative CT scanning added several objective factors improving patient safety. There were significantly fewer complications in the E3D group with only 3 of 80 (4%) patients requiring a return to the operating room compared to 11 of 80 (14%) patients in the Robot Only Group requiring repeat surgery for implant related problems (Chi squared analysis = 5.00, p = 0.025). There was a significant reduction the amount of fluoroscopy time in the E3D Group (36 s, range 4–102 s) compared to Robot only group (51 s, range 15–160 s) (p = 0.0001). There was also shorter mean operative time in the E3D group (257 ± 59.5 min) compared to the robot only group (306 ± 73.8 min) due to much faster registration time (45 s). A longer registration time was required in the Robot only group to register each vertebral level with AP and Lateral fluoroscopy shots. The estimated blood loss was also significantly lower in Group 2 (mean 345 ± 225 ml) vs Group 1 (474 ± 397 ml) (p = 0.012). The mean hospital length of stay was also significantly shorter for Group 2 (3.77 ± 1.86 days) compared to Group 1 (5.16 ± 3.40) (p = 0.022). There was no significant difference in the number of interbody implants nor corrective osteotomies in both groups—Robot only 52 cases vs. 42 cases in E3D group. Level of evidence: IV, Retrospective review. [ABSTRACT FROM AUTHOR]

Interventional oncology is routinely tasked with the feat of tumor characterization or destruction, via image-guided biopsy and tumor ablation, which may pose difficulties due to challenging-to-reach structures, target complexity, and proximity to critical structures. Such procedures carry a risk-to-benefit ratio along with measurable radiation exposure. To streamline the complexity and inherent variability of these interventions, various systems, including table-, floor-, gantry-, and patient-mounted (semi-) automatic robotic aiming devices, have been developed to decrease human error and interoperator and intraoperator outcome variability. Their implementation in clinical practice holds promise for enhancing lesion targeting, increasing accuracy and technical success rates, reducing procedure duration and radiation exposure, enhancing standardization of the field, and ultimately improving patient outcomes. This narrative review collates evidence regarding robotic tools and their implementation in interventional oncology, focusing on clinical efficacy and safety for nonhepatic malignancies. [ABSTRACT FROM AUTHOR]

Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes. [ABSTRACT FROM AUTHOR]

Robotic navigation has been shown to increase precision, accuracy, and safety during spinal reconstructive procedures. There is a paucity of literature describing the best techniques for robotic-assisted spine surgery for complex, multilevel cases or in cases of significant deformity correction. We present a case series of 100 consecutive multilevel posterior spinal fusion procedures performed for multilevel spinal disease and/or deformity correction. 100 consecutive posterior spinal fusions were performed for multilevel disease and/or deformity correction utilizing robotic-assisted placement of pedicle screws. The primary outcome was surgery-related failure, which was defined as hardware breakage or reoperation with removal of hardware. A total of 100 consecutive patients met inclusion criteria. Among cases included, 31 were revision surgeries with existing hardware in place. The mean number of levels fused was 5.6, the mean operative time was 303 min, and the mean estimated blood loss was 469 mL. 28 cases included robotic-assisted placement of S2 alar-iliac (S2AI) screws. In total, 1043 pedicle screws and 53 S2AI screws were placed with robotic-assistance. The failure rate using survivorship analysis was 18/1043 (1.7%) and the failure rate of S2AI screws using survivorship analysis was 3/53 (5.7%). Four patients developed postoperative wound infections requiring irrigation and debridement procedures. None of the 1043 pedicle screws nor the 53 S2AI screws required reoperation due to malpositioning or suboptimal placement. This case series of 100 multilevel posterior spinal fusion procedures demonstrates promising results with low failure rates. With 1043 pedicle screws and 53 S2AI screws, we report low failure rates of 1.7% and 5.7%, respectively with zero cases of screw malpositioning. Robotic screw placement allows for accurate screw placement with no increased rate of postoperative infection compared to historical controls. Level of evidence: IV, Retrospective review. [ABSTRACT FROM AUTHOR]

In an urban city, the daily challenges of managing cleanliness are the primary aspect of routine life, which requires a large number of resources, the manual process of labour, and budget. Street cleaning techniques include street sweepers going away to different metropolitan areas, manually verifying if the street required cleaning taking action. This research presents novel street garbage recognizing robotic navigation techniques by detecting the city's street-level images and multi-level segmentation. For the large volume of the process, the deep learning-based methods can be better to achieve a high level of classification, object detection, and accuracy than other learning algorithms. The proposed Histogram of Oriented Gradients (HOG) is used to features extracted while using the deep learning technique to classify the ground-level segmentation process's images. In this paper, we use mobile edge computing to process street images in advance and filter out pictures that meet our needs, which significantly affect recognition efficiency. To measure the urban streets' cleanliness, our street cleanliness assessment approach provides a multi-level assessment model across different layers. Besides, with ground-level segmentation using a deep neural network, a novel navigation strategy is proposed for robotic classification. Single Shot MultiBox Detector (SSD) approaches the output space of bounding boxes into a set of default boxes over different feature ratios and scales per attribute map location from the dataset. The SSD can classify and detect the garbage's accurately and autonomously by using deep learning for garbage recognition. Experimental results show that accurate street garbage detection and navigation can reach approximately the same cleaning effectiveness as traditional methods. [ABSTRACT FROM AUTHOR]

The article presents the research on navigation algorithms of a wheeled mobile robot with the use of a vision mapping system and the analysis of energy consumption of selected navigation algorithms, such as RRT and A-star. Obstacle maps were made with the use of an RGBW camera, and binary occupation maps were also made, which were used to determine the traffic path. To recreate the routes in hardware, a programmed Pure Pursuit controller was used. The results of navigation were compared on the basis of the forward kinematics model and odometry measurements. Quantities such as current, except (x, y, phi), and linear and angular velocities were measured in real time. As a result of the conducted research, it was found that the RRT star algorithm consumes the least energy to reach the designated target in the designated environment. [ABSTRACT FROM AUTHOR]

Objectives: In the current clinical practice of thermal ablation treatment for liver tumors, achieving consistent and effective clinical outcomes across tumors of varying shapes, sizes and locations remains challenging. The aim of this study was to evaluate the repeatability of a novel robotic approach for configurable ablation of distinct tumor shapes and compare it to the standard ablation technique for creating ellipsoidal ablation volumes., Materials and Methods: The repeatability was evaluated in terms of width variability in created ablation volumes. Using a robotic navigation platform, custom ablation profiles configured with power, time, and distance parameters were designed to create four distinct ablation shapes. The profiles were applied for microwave ablation in a tissue-mimicking liver model. For comparison of ablation shape variability, six standard ellipsoidal shapes were created using the standard ablation technique by configuring power and time parameters. For each sample, the resulting ablation area was segmented, and the resulting shape width and length were calculated at the measurement points. Width variability was calculated as the median of the absolute pairwise differences in width at each measurement point, and configurable versus standard ablation shapes were compared using the Mann-Whitney U test., Results: All tissue-mimicking samples were successfully ablated using both configurable (n = 48) and standard ablation technique (n = 35). Study findings revealed noninferiority regarding repeatability of created ablation shapes using the robotic platform for configurable ablation, compared to created standard ellipsoidal ablation shapes (p < 0.001, 95% CI ≤ -0.05 mm, Δ = -0.22 mm). Median repeatability of created configurable shapes was 1.00 mm, and for standard shapes 1.22 mm. Maximal repeatability for both groups was below 3 mm., Conclusion: The repeatability of configurable ablation shapes was observed to be noninferior to the standard ablation shapes. Achieving configurable ablation volumes underscores the potential to advance personalization of thermal ablation treatment and broaden its applicability to distinct tumor cases. In-vivo validation is needed for evaluation of the clinical implications of this novel treatment technique., Competing Interests: SW and PT are listed as co-inventors in a patent application relevant for this publication Method and System for Pose Controlled Ablation, 16150502.9 - 1659. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest., (Copyright © 2024 Bulatović, Hermann, Tinguely, Paolucci and Weber.)

Purpose: To assess the feasibility and safety of a robotic system for percutaneous needle insertion during thermal ablation of liver tumors. Materials and Methods: This study analyzed the CT-guided percutaneous needle insertion using the EPIONE robotic device (Quantum Surgical, Montpellier, France) for radiofrequency or microwave liver ablation. The main criteria of the study were feasibility (possibility to perform the thermal ablation after needle insertion), the number of needle adjustments (reiteration of robotically assisted needle insertion when initial needle positioning is considered insufficient to perform ablation), and robotic-guided procedure safety (complications related to the needle insertion). Patients were followed up at 6 months post-intervention to assess local tumor control. Results: Twenty-one patients with 24 tumors, including 6 HCC and 18 metastases measuring 15.6 ± 7.2 mm, were enrolled. One patient (with one tumor) was excluded for protocol deviation. Robotic assisted thermal ablation was feasible for 22/23 lesions (95.7%) and 19/20 patients (95.0%), as validated by a data safety monitoring Board (95% CI [76.39%; 99.11%]) for the per-protocol population. The mean number of needle adjustments per tumor treated was 0.4 (SD: 0.7), with 70.8% of tumors requiring no adjustment. No adverse events were depicted. Rate of local tumor control was 83.3% for patients and 85.7% for tumors, at 6 months. Conclusion: This bicentric first-in-human pilot study suggests both feasibility and safety of a stereotactic CT-guided EPIONE device for the percutaneous needle insertion during liver tumor thermal ablation. [ABSTRACT FROM AUTHOR]

We present an implantable brain-computer interface surgical case assisted by robotic navigation system in an elderly patient with tetraplegia caused by cervical spinal cord injury. Left primary motor cortex was selected for implantation of microelectrode arrays based on fMRI location of motor imagery. Robotic navigation system was used during this procedure for precise and stable manipulation. A design of bipartite incision was made to reduce the risk of surgery-related infection and facilitate BCI training. At 1-year follow-up, the neural signals were robust, and this patient was able to control three-dimensional movement of a prosthetic limb without any complications. [ABSTRACT FROM AUTHOR]

Aims: Robotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures. Material and methods: In this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared. Results: AcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p

Background: Robot-assisted surgery was developed to improve accuracy and outcomes in total knee arthroplasty (TKA). One important determinant of TKA success is a well-balanced knee throughout the range of motion. The purpose of this study is to determine if robot-assisted TKA (RA-TKA) results in improved intracompartmental ligament balance compared with conventional jig-based instrumentation (CM-TKA). Methods: This retrospective cohort study included 2 cohorts—a CM-TKA (n = 49) vs RA-TKA (n = 37) cohort. Demographic and intraoperative data, including intraoperative compartment loads, were measured after final implant implantation in extension (10°), mid-flexion (45°), and full flexion (90°), using an intraoperative compartment pressure sensor. An a priori power analysis revealed our study exhibited >80% power in detecting a 5-pound (lb) difference in compartment loads in the 2 cohorts. Results: There was no difference between medial and lateral compartment loads in extension, mid-flexion, and full flexion for the conventional (15.1 lbs, 15.9 lbs, and 13.4 lbs, respectively) vs RA-TKA (14.2 lbs, 15.1 lbs, and 10.3 lbs, respectively). The percentage of patients with high load compartment pressure in flexion (>40 lbs) by the conclusion of the surgery was significantly greater for the conventional (18%) vs the robotic TKA cohort (3%, P = .025). The percentage of patients with unbalanced knees (>20 lbs differential between medial and lateral compartments) in flexion was significantly greater in the conventional (24%) vs robotic TKA cohort (5%, P = .018). Conclusions: In this series, RA-TKA resulted in improved intraoperative compartment balancing in flexion with no observed difference in mid-flexion and extension compared with CM-TKA.

Introduction: Exposure to ionizing radiation occurs during most EP procedures and is associated with increased risk of cancers and orthopedic complications associated with wearing heavy protective apparel. The use of fluoroless ablation technique has been gaining popularity over the past decade and has been shown to be safe and efficient although the data has been limited to the manual catheter ablation. Fluoroless robotic navigation (RMN) ablation procedure for atrial fibrillation has not been described previously and the impact of its adoption on procedural time and safety is unknown. Material and Methods: The impact of adoption of fluoroless AF ablation was studied in this single-operator time-series analysis. A total of 58 consecutive patients undergoing RMN AF ablation were included in this study and different components of the procedural duration were assessed before and after the introduction of fluoroless technique. A meta-analysis of previously published procedural times using manual fluoroless technique was performed and used for comparison. Results: Upon introduction of fluoroless RMN ablation, there was an increase in the access and mapping time of the procedure by 16.9±4.3 min (P<0.001). However, this increase was counteracted by a reduction in the ablation time and as a result the total procedure time was not significantly impacted (increase of 5.2±15.7 min, P=0.7). The total procedure time was comparable to previously published data on fluoroless manual AF ablation. No major intra-procedural complications occurred. Conclusion: Zero fluoroscopy using Remote Magnetic Navigation is safe and efficient. The total procedural time is not significantly impacted after adoption of fluoroless technique. [ABSTRACT FROM AUTHOR]

This paper presents a novel real-time obstacle avoidance and navigation technique called as "Free-configuration Eigenspace" (FCE). The FCE enables an autonomous robot to detect unknown obstacles and avoid collisions while simultaneously steering the robot towards the target. The methodology utilizes a two-dimensional (2D) Cartesian Eigenspace as a world model. 2D way points (in world model) are extracted by computing (through FCE model) stacked Eigenvectors of laser data at discrete time scans which manifest desired robotic trajectory. The world model is updated continuously upon obtaining discrete time laser scans sampled by on-board Light Detection and Ranging (LiDAR) sensors. The FCE technique has been implemented on Robotic Operating System and real-time robotics simulator Gazebo ® . Encouraging results are obtained and shown in this paper. The FCE has also been tested in real-time with laser scans obtained from VL6180X LiDAR sensor mounted on a custom autonomous robot. The results obtained are further compared with the state-of-the-art obstacle avoidance and path planning method called as vector field histogram (VFH). The FCE results (shown in the paper) are comparable, encouraging, and outperform VFH in path length and safe distance maintenance. [ABSTRACT FROM AUTHOR]

Background: The quality of catheter–tissue contact is one of the most important determinants of catheter ablation (CA) success. The absence of catheter–tissue contact feedback has been regarded a major limitation of remote magnetic navigation (RMN)–guided CA. The e-Contact module (ECM) is a novel feature designed for RMN that measures the quality of catheter–tissue contact. Objective: The purpose of this study was to describe the first clinical experience with this feature and to test its effect on procedural parameters and interference with other ablation equipment during CA procedures as well as its safety. Methods: This was a prospective, single-center, 2-phase study investigating ECM use during complex RMN procedures in 30 patients. Impact of ECM on procedural parameters was evaluated in the feasibility phase (FP), and its interference with other equipment was tested in the interference phase (IP) using pacing maneuvers at 3 randomly selected right atrial sites. Intracardiac electrograms were evaluated for disturbances by 2 independent electrophysiologists. Results: For FP, mean procedural time was 162 ± 66 minutes, fluoroscopy time 21 ± 9 minutes, and ablation time 34 ± 21 minutes. For IP, no significant differences in pacing capture or thresholds were found (ECM– vs ECM+: site 1: 2.05 vs 2.21 mA; P = .320; site 2: 2.15 vs 2.12 mA; P = .873; site 3: 2.51 vs 2.50 mA; P = .976). Electrogram disturbances did not significantly differ between ECM– and ECM+. No adverse events were reported. Conclusion: The ECM is a novel catheter–tissue contact technology designed for RMN-guided CA. Our study suggests that this feature is feasible and does not interfere with other electrophysiology equipment while maintaining an excellent safety profile.

The ability to navigate the anterior lumbar disc space may improve clinical outcomes and implant longevity. However, no robotic navigation systems are presently authorized by the U.S. Food and Drug Administration to assist with anterior retroperitoneal lumbar interbody surgery. Furthermore, no studies to date have investigated such an application of this technology. This study examines the application of robotic navigation to anterior lumbar total disc replacement surgery to improve retroperitoneal exposure and orientation of the anterior lumbar spine, enhance coronal plane centralization of the implant, optimize surgical trajectory, and mitigate radiologic exposure. Postoperative outcomes of a small cohort of patients undergoing anterior lumbar total disc replacement surgery using robotic navigation were analyzed. The results of the study revealed that a modified use of the aforementioned robot-assisted surgical technology enhances coronal plane centralization and trajectory, all while mitigating radiologic exposure, resulting in more accurate placement of the implant within the intervertebral space at each level.

Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being., Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement., Methods: We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed., Results: Surgeons' self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance., Conclusions: This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KWM reports relationships with NIH, OREF, SRS, Johnson & Johnson, GE Health, and Sustain Surgical. SQ reports relationships with Viseon, Tissue Differentiation Intelligence, HS2, Minimally Invasive Spine Study Group, Stryker, SpineGuard, Globus Medical, Surgalign, Lifelink.com, Spinal Simplicity, Contemporary Spine Surgery, NASS, Annals of Translational Medicine, HSS Journal, Society of Minimally Invasive Spine Surgery (SMISS), Lumbar Spine Research Society (LSRS), Cervical Spine Research Society (CSRS), Association of Bone and Joint Surgeons (ABJS), and International Society for the Advancement of Spine Surgery (ISASS). SI reports relationships with Innovasis, HS2, Stryker, Healthgrades, and Globus Medical. The other authors declare no potential conflicts of interest., (© The Author(s) 2024.)

Preamble: Robotic magnetic navigation (RMN)-guided catheter ablation (CA) technology has been used for the treatment of cardiac arrhythmias for almost 20 years. Various studies reported that RMN allows for high catheter stability, improved lesion formation and a superior safety profile. So far, no guidelines or recommendations on RMN-guided CA have been published., Purpose: The aim of this consensus paper was to summarize knowledge and provide recommendations on management of arrhythmias using RMN-guided CA as treatment of atrial fibrillation (AF) and ventricular arrhythmias (VA)., Methodology: An expert writing group, performed a detailed review of available literature, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Recommendations on RMN-guided CA are presented in a guideline format with three levels of recommendations to serve as a reference for best practices in RMN procedures. Each recommendation is accompanied by supportive text and references. The various sections cover the practical spectrum from system and patient set-up, EP laboratory staffing, combination of RMN with fluoroscopy and mapping systems, use of automation features and ablation settings and targets, for different cardiac arrhythmias., Conclusion: This manuscript, presenting the combined experience of expert robotic users and knowledge from the available literature, offers a unique resource for providers interested in the use of RMN in the treatment of cardiac arrhythmias., Competing Interests: The Erasmus MC has received research grants from Acutus Medical, Biosense Webster and Stereotaxis. TS-T has received an educational grant from Abbott, a contract for education and advisory activities with Biotronik and consultancy contract with Acutus Medical and Ablacon. SW has received honoraria from Biotronik en Daiichi Sankyo. S-CY has received a research grant from Medtronic and honoraria from Medtronic and Boston Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Noten, Szili-Torok, Ernst, Burkhardt, Cavaco, Chen, Cheung, de Chillou, Crystal, Cooper, Gasparini, Geczy, Goehl, Hügl, Jin, Kampus, Kazemian, Khan, Kongstad, Magga, Peress, Raatikainen, Romanov, Rossvoll, Singh, Vatasescu, Wijchers, Yamashiro, Yap and Weiss.)

Pedicle screw fixation in pediatric spine surgery has become common practice given the fixation stability and improved curve correction. However, due to proximity to vital structures, accuracy is paramount. Literature has reported accuracy rates from 87.5 to 90% using traditional freehand techniques. This study presents our initial experience with pedicle screw placement using the newest generation of spinal robotics for treatment of pediatric spinal deformity. A cohort of patients, aged 8–21 years, undergoing spinal fusion surgery using robotic-assisted technology was reviewed. Diagnoses, Cobb angles, surgical time, robot time, number of screws placed, and complications were recorded. Accuracy of screw placement was assessed based on analysis of successful screw execution, evaluation screw position using intraoperative fluoroscopy and post-operative radiographs, and clinical evaluation. The average age was 14.5 years. Prevalent diagnoses included idiopathic (65%) and neuromuscular scoliosis (13%). Mean preoperative curve measured 66.8°. The median time for operation was 235 minutes with medians of 8 levels fused and 5 screws placed per patient. Of the 314 screws placed, we recorded a 98.7% accuracy rate. Lateral deviation was the most common cause of malpositioning. Post-operative plain films revealed no grossly misplaced screws. There were no perioperative neurologic deficits or malpositioned screws requiring reoperation. This is the first reported series of navigated spinal robotics used for pedicle screw placement in children. Our clinical success rate was 98.7% and there were no clinically relevant screw related complications. The study shows promising initial results of combined robotic-navigation techniques in pediatric patients. [ABSTRACT FROM AUTHOR]

As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery. [ABSTRACT FROM AUTHOR]

This paper presents a novel robotic navigation system integrating a visual simultaneous localization and mapping (V-SLAM) based global planner with a deep reinforcement learning (DRL) based local planner. On one hand, map of many modern popular V-SLAM systems is inhomogeneous point cloud, which contains many outliers and is too sparse for reliable global path planning. To address this problem, we propose a novel approach to generate a topological map with both trajectories and map points of V-SLAM. On the other hand, current state-of-the-art (SOTA) DRL-based local planners have shown great efficiency in obstacle avoidance. However, the SOTA DRL-based local planners are sometimes trapped by large obstacles and would fall into some local minimum during training. To address the problems, we propose a sub-target module and a mirror experience replay approach. Test results demonstrate that, our topological map generation is robust against outliers and sparsity of map points of V-SLAM, while our local planner achieves 9.61% success rate of obstacle avoidance higher than the SOTA DRL-based approach. Tests in real environment demonstrate the feasibility of our navigation system. [ABSTRACT FROM AUTHOR]

Objective Depth electrode implantation for invasive monitoring in epilepsy surgery has become a standard procedure. We describe a new frameless stereotactic intervention using robot-guided laser beam for making precise bone channels for depth electrode placement. Methods A laboratory investigation on a head cadaver specimen was performed using a CT scan planning of depth electrodes in various positions. Precise bone channels were made by a navigated robot-driven laser beam (erbium:yttrium aluminum garnet [Er:YAG], 2.94-μm wavelength,) instead of twist drill holes. Entry point and target point precision was calculated using postimplantation CT scans and comparison to the preoperative trajectory plan. Results Frontal, parietal, and occipital bone channels for bolt implantation were made. The occipital bone channel had an angulation of more than 60 degrees to the surface. Bolts and depth electrodes were implanted solely guided by the trajectory given by the precise bone channels. The mean depth electrode length was 45.5 mm. Entry point deviation was 0.73 mm (±0.66 mm SD) and target point deviation was 2.0 mm (±0.64 mm SD). Bone channel laser time was ∼30 seconds per channel. Altogether, the implantation time was ∼10 to 15 minutes per electrode. Conclusion Navigated robot-assisted laser for making precise bone channels for depth electrode implantation in epilepsy surgery is a promising new, exact and straightforward implantation technique and may have many advantages over twist drill hole implantation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of computer-assisted and robot-assisted atlantoaxial pedicle screw implantation for the treatment of reversible atlantoaxial dislocation (AAD)., Methods: The clinical data of 42 patients with reversible AAD admitted between January 2020 and June 2023 and met the selection criteria were retrospectively analyzed, of whom 23 patients were treated with computer-assisted surgery (computer group) and 19 patients were treated with Mazor X spinal robot-assisted surgery (robot group). There was no significant difference in gender, age, T value of bone mineral density, body mass index, etiology, and preoperative Japanese Orthopaedic Association (JOA) score, Neck Dysfunction Index (NDI) between the two groups ( P >0.05). The operation time, screw implantation time, intraoperative blood loss, hand and wrist radiation exposure, and complications were recorded and compared between the two groups. Gertzbein classification was used to evaluate the accuracy of screw implantation. JOA score and NDI were used to evaluate the function before operation, at 3 days after operation, and at last follow-up. At last follow-up, the status of screws and bone fusion were observed by neck three-dimensional CT., Results: The operation time and hand and wrist radiation exposure of the computer group were significantly longer than those of the robot group ( P <0.05), and there was no significant difference in the screw implantation time and intraoperative blood loss between the two groups ( P >0.05). All patients were followed up 11-24 months, with an average of 19.6 months. There was no significant difference in the follow-up time between the two groups ( P >0.05). There was no significant difference in the accuracy of screw implantation between the two groups ( P >0.05). Except for 1 case of incision infection in the computer group, which improved after antibiotic treatment, there was no complication such as nerve and vertebral artery injury, screw loosening, or breakage in the two groups. The JOA score and NDI significantly improved in both groups at 3 days after operation and at last follow-up ( P <0.05) compared to those before operation, but there was no significant difference between the two groups ( P >0.05). At last follow-up, 21 patients (91.3%) in the computer group and 18 patients (94.7%) in the robot group achieved satisfactory atlantoaxial fusion, and there was no significant difference in the fusion rate between the two groups ( P >0.05)., Conclusion: Computer-assisted or robot-assisted atlantoaxial pedicle screw implantation is safe and effective, and robotic navigation shortens operation time and reduces radiation exposure.

Objective: Spinal metastases can significantly affect quality of life in patients with cancer and present complex neurosurgical challenges for surgeons. Surgery with instrumentation is often indicated to alleviate pain, preserve neurological function, and ensure mechanical stability. However, distortions in the bony anatomy due to oncological disease can decrease the accuracy of pedicle screw placement. Robotic-assisted surgery may offer an opportunity to increase screw accuracy and improve navigation of spinal lesions compared to conventional techniques. Therefore, we presented our institutional experience evaluating robotic-assisted surgical fixation for spinal metastases., Methods: Patients undergoing robotic-assisted surgery at a large tertiary care center between January 2019 - January 2023 for the treatment of spinal metastases were identified. Patient characteristics, including demographics, tumor pathology, surgical complications, and post-operative outcomes were extracted. The Gertzbein Robbins classification system (GRS) was used to assess pedicle screw placement accuracy in patients with post-operative computed tomography., Results: Twenty patients were identified, including 7 females (35 %), with an overall median age of 66 years (range: 39-80 years) and median BMI of 25 kg/m 2 (range: 17-34 kg/m 2 ). An average of four spinal levels were instrumented, with metastases located primarily in the thoracic (n=17, 85 %) spine. Common primary tumor types included prostate (n=4), lung (n=2), and plasma cell (n=2) cancers. Most pedicle screws (92 %) were classified as GRS A in patients with postoperative imaging. Post-operative complications were unrelated to the use of the robot, and included pulmonary embolism (n=1), deep vein thrombosis (n=2), and gastric symptoms (n=3). Three patients were readmitted at 30 days, with one reoperation due to tumor recurrence. Four patients were deceased within 6 months of surgery., Conclusions: Despite the inherent high-risk nature of these surgeries, this study underscores the safety and efficacy of robotic-assisted surgery in the management of spinal metastases. Robots can be helpful in ensuring accuracy of pedicle screw placement in patients with metastatic disease., Competing Interests: Conflict of Interest Nicholas Theodore has received royalties from, holds stock ownership in, has consulted for, and has served on the scientific advisory board/other office for Globus Medical. Dr. Lubelski reported serving as a consultant for Icotec, Carbofix, and Mindset Medical. Dr. Lubelski receives research support from Dilon Technologies. The other authors have no conflicts of interest to disclose. No generative artificial intelligence (AI) or AI-assisted technologies were utilized in the writing of this manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Preoperative computed tomography (CT)-guided localization of small pulmonary nodules (SPNs) is the major approach for accurate intraoperative visualization in video-assisted thoracoscopic surgery (VATS). However, this interventional procedure has certain risks and may challenge to less experienced junior doctors. This study aims to evaluate the feasibility and efficacy of robotic-assisted CT-guided preoperative pulmonary nodules localization with the modified hook-wire needles before VATS., Methods: A total of 599 patients with 654 SPNs who preoperatively accepted robotic-assisted CT-guided percutaneous pulmonary localization were respectively enrolled and compared to 90 patients with 94 SPNs who underwent the conventional CT-guided manual localization. The clinical and imaging data including patients' basic information, pulmonary nodule features, location procedure findings, and operation time were analyzed., Results: The localization success rate was 96.64% (632/654). The mean time required for marking was 22.85±10.27 min. Anchor of dislodgement occurred in 2 cases (0.31%). Localization-related complications included pneumothorax in 163 cases (27.21%), parenchymal hemorrhage in 222 cases (33.94%), pleural reaction in 3 cases (0.50%), and intercostal vascular hemorrhage in 5 cases (0.83%). Localization and VATS were performed within 24 hours. All devices were successfully retrieved in VATS. Histopathological examination revealed 166 (25.38%) benign nodules and 488 (74.62%) malignant nodules. For patients who received localizations, VATS spent a significantly shorter time, especially the segmentectomy group (93.61±35.72 vs. 167.50±40.70 min, P<0.001). The proportion of pneumothorax in the robotic-assisted group significantly decreased compared with the conventional manual group (27.21% vs. 43.33%, P=0.002)., Conclusions: Robotic-assisted CT-guided percutaneous pulmonary nodules hook-wire localization could be effectively helpful for junior less experienced interventional physicians to master the procedure and potentially increase precision., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-198/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

In the field of robotics, it is essential to know the work area in which the agent is going to develop, for that reason, different methods of mapping and spatial location have been developed for different applications. In this article, a machine vision algorithm is proposed, which is responsible for identifying objects of interest within a work area and determining the polar coordinates to which they are related to the observer, applicable either with a fixed camera or in a mobile agent such as the one presented in this document. The developed algorithm was evaluated in two situations, determining the position of six objects in total around the mobile agent. These results were compared with the real position of each of the objects, reaching a high level of accuracy with an average error of 1.3271% in the distance and 2.8998% in the angle. [ABSTRACT FROM AUTHOR]

Objective: Computed tomography is considered the gold-standard imaging tool to evaluate spinal implant accuracy. However, there are no studies that evaluate the accuracy of robotic sacroiliac joint (SIJ) implant placement using CT to date. The aim of this study was to compare the accuracy of implant placement on CT between robotic and fluoroscopic navigation for SIJ fusion and the subsequent complications and clinical outcomes of suboptimally placed screws., Methods: A retrospective analysis of SIJ fusions utilizing either robotic or fluoroscopic guidance at a single institution was conducted from 2014 to 2023. Implant placement accuracy was evaluated on intra- or postoperative CT. Primary endpoints were SIJ screw placement accuracy and complications. Secondary endpoints were pain status at the first and second follow-ups and rates of 2-year revision surgery. Statistical analysis was performed using chi-square tests., Results: Sixty-nine patients who underwent 78 SIJ fusions were included, of which 63 were robotic and 15 were fluoroscopic. The mean age of the cohort at the time of surgery was 55.9 ± 14.2 years, and 35 patients (50.7%) were female. There were 135 robotically placed and 34 fluoroscopically placed implants. A significant difference was found in implant placement accuracy between robotic and fluoroscopic fusion (97.8% vs 76.5%, p < 0.001). When comparing optimal versus suboptimal implant placement, no difference was found in the presence of 30-day complications (p = 0.98). No intraoperative complications were present in this cohort. No difference was found in subjective pain status at the first (p = 0.69) and second (p = 0.45) follow-ups between optimal and suboptimal implant placement. No patients underwent 2-year revision surgery., Conclusions: Use of robotic navigation was significantly more accurate than the use of fluoroscopic navigation for SIJ implant placement. Complications overall were low and not different between optimally and suboptimally placed implants. Suboptimally placed implants did not differ in degree of subjective pain improvement or rates of revision surgery postoperatively.

Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Board of Journal of Sichuan University (Medical Sciences).)

Vision navigation technique, especially the vision-based simultaneous localization and mapping (V-SLAM), plays a critical role in robotic navigation. As a relative positioning technique, V-SLAM often suffers from drift and scale uncertainty problems which incur bias increasing over time. To overcome these drawbacks and to improve the robustness and accuracy of localization, an effective way is to fuse global navigation satellite system (GNSS) with V-SLAM. In this paper, we propose a novel GNSS and SLAM fusion algorithm, which provides ego-motion estimation through tightly coupling GNSS pseudo-range measurements and camera feature points. It first decomposes the pose state into basic motion vectors, based on which an asynchronous tracking is performed. Then, a 10-DoF joint-optimization formulation on manifold is proposed to achieve tight fusion of the raw measurement from camera and GNSS. Finally, this formulation is solved to calculate the ego-motion state. The proposed algorithm is verified on an autonomous ground vehicle in two typical environments. The results demonstrated that, the new algorithm can amend the bias in vision SLAM and constrain the GNSS solution, which achieves a better localization result than the traditional methods. [ABSTRACT FROM AUTHOR]

In Eikonal equations, rarefaction is a common phenomenon known to degrade the rate of convergence of numerical methods. The "factoring" approach alleviates this difficulty by deriving a PDE for a new (locally smooth) variable while capturing the rarefaction-related singularity in a known (non-smooth) "factor". Previously this technique was successfully used to address rarefaction fans arising at point sources. In this paper we show how similar ideas can be used to factor the 2D rarefactions arising due to nonsmoothness of domain boundaries or discontinuities in PDE coefficients. Locations and orientations of such rarefaction fans are not known in advance and we construct a "just-in-time factoring" method that identifies them dynamically. The resulting algorithm is a generalization of the Fast Marching Method originally introduced for the regular (unfactored) Eikonal equations. We show that our approach restores the first-order convergence and illustrate it using a range of maze navigation examples with non-permeable and "slowly permeable" obstacles. [ABSTRACT FROM AUTHOR]