Science.gov

Sample records for robot da vinci

  1. The da Vinci robot.

    PubMed

    Moran, Michael E

    2006-12-01

    One might assume from the title of this paper that the nuances of a complex mechanical robot will be discussed, and this would be correct. On the other hand, the date of the design and possible construction of this robot was 1495, a little more than five centuries ago. The key point in the title is the lack of a trademarked name, as Leonardo was the designer of this sophisticated system. His notes from the Codex Altanticus represent the foundation of this report. English translations of da Vinci's notebooks are currently available. Beginning in the 1950s, investigators at the University of California began to ponder the significance of some of da Vinci's markings on what appeared to be technical drawings. Such markings also occur in his Codex Atlanticus (the largest single collection of da Vinci's sheets, consisting of 1119 separate pages and 481 folios) along with a large number of other mechanical devices. Continuing research at the Instituto e Museo di Storia della Scienza in Florence has yielded a great deal of information about Leonardo's intentions with regard to his mechanical knight. It is now known that da Vinci's robot would have had the outer appearance of a Germanic knight. It had a complex core of mechanical devices that probably was human powered. The robot had two independent operating systems. The first had three degree-of-freedom legs, ankles, knees, and hips. The second had four degrees of freedom in the arms with articulated shoulders, elbows, wrists, and hands. A mechanical analog-programmable controller within the chest provided the power and control for the arms. The legs were powered by an external crank arrangement driving the cable, which connected to key locations near each lower extremity's joints. Da Vinci also is known to have devised a programmable front-wheel-drive automobile with rack-and-pinion suspension mechanisms at age 26. He would recall this device again, when, at age 40, he is thought to have built a programmable automated

  2. Da Vinci Xi Robot-Assisted Penetrating Keratoplasty.

    PubMed

    Chammas, Jimmy; Sauer, Arnaud; Pizzuto, Joëlle; Pouthier, Fabienne; Gaucher, David; Marescaux, Jacques; Mutter, Didier; Bourcier, Tristan

    2017-06-01

    This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

  3. Adapter for contact force sensing of the da Vinci robot.

    PubMed

    Shimachi, Shigeyuki; Hirunyanitiwatna, Surakij; Fujiwara, Yasunori; Hashimoto, Akira; Hakozaki, Yoshinori

    2008-06-01

    At present, the da Vinci surgical robot system does not provide haptic feedback. One of the authors has proposed a contact-force sensing method called the 'overcoat method', in which the instrument/driver is supported by force sensors. In the da Vinci robot, the instrument jaws are powered by a wire-pulley mechanism; thus, in order to apply the overcoat method to the da Vinci system, we must transfer the power through a frame that is supported by force sensors. The authors have attempted to add a force-sensor function to the Sterile Adapter of the da Vinci system. In developing a sensorized adapter, a new configuration of force sensors and a new axial-force-free (AFF) joint have been devised in order to obtain an independent 'axial force effect' from the drive torque fed from the da Vinci robot arm. The force-sensing errors of the present system have been measured to have a maximum value of approximately 0.2 N while driving the jaws, and a maximum value of approximately 0.2 N when the robot arm is inclined with some excitation. Some impact reference forces applied on to the ends of the jaws agree with the outputs of the sensorized adapter to within <0.05 N. It is shown that the new adapter can be sterilized. One apprehension is that the total weight of the new adapter-approximately 1.2 kg-might unbalance the robot arm. In the case of the new adapter, the centre-line of the instrument shaft is shifted externally through approximately 3.5 mm from its original position. However, a new cannula for the da Vinci robot might solve this problem. The new configuration of force sensors and the new AFF joint work well in their basic functions. The total force-sensing error is estimated as approximately 0.5 N. One of the main reasons for the error appears to be the deformation of the adapter frame. (c) 2008 John Wiley & Sons, Ltd.

  4. Evolution of robots throughout history from Hephaestus to Da Vinci Robot.

    PubMed

    Iavazzo, Christos; Gkegke, Xanthi-Ekaterini D; Iavazzo, Paraskevi-Evangelia; Gkegkes, Ioannis D

    2014-01-01

    Da Vinci robot is increasingly used for operations adding the advantages of robots to the favor of medicine. This is a historical article with the aim to present the evolution of robots in the medical area from the time of ancient myths to Renaissance and finally to the current revolutionary applications. We endeavored to collect several elegant narratives on the topic. The use of imagination could help the reader to find similarities. A trip from the Greek myths of Hephaestus through Aristotle and Leonardo Da Vinci to the robots of Karel Capek and Isaac Asimov and finally the invention of the medical robots is presented.

  5. Mammary artery harvesting using the Da Vinci Si robotic system

    PubMed Central

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

  6. [History of robotics: from archytas of tarentum until Da Vinci robot. (Part II)].

    PubMed

    Sánchez-Martín, F M; Jiménez Schlegl, P; Millán Rodríguez, F; Salvador-Bayarri, J; Monllau Font, V; Palou Redorta, J; Villavicencio Mavrich, H

    2007-03-01

    Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXth century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery.

  7. DaVinci canvas: a telerobotic surgical system with integrated, robot-assisted, laparoscopic ultrasound capability.

    PubMed

    Leven, Joshua; Burschka, Darius; Kumar, Rajesh; Zhang, Gary; Blumenkranz, Steve; Dai, Xiangtian Donald; Awad, Mike; Hager, Gregory D; Marohn, Mike; Choti, Mike; Hasser, Chris; Taylor, Russell H

    2005-01-01

    We present daVinci Canvas: a telerobotic surgical system with integrated robot-assisted laparoscopic ultrasound capability. DaVinci Canvas consists of the integration of a rigid laparoscopic ultrasound probe with the daVinci robot, video tracking of ultrasound probe motions, endoscope and ultrasound calibration and registration, autonomous robot motions, and the display of registered 2D and 3D ultrasound images. Although we used laparoscopic liver cancer surgery as a focusing application, our broader aim was the development of a versatile system that would be useful for many procedures.

  8. [RESEARCH PROGRESS OF PERIPHERAL NERVE SURGERY ASSISTED BY Da Vinci ROBOTIC SYSTEM].

    PubMed

    Shen, Jie; Song, Diyu; Wang, Xiaoyu; Wang, Changjiang; Zhang, Shuming

    2016-02-01

    To summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. The recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. Compared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. The development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.

  9. Robotic Partial Nephrectomy with the Da Vinci Xi.

    PubMed

    Kallingal, George J S; Swain, Sanjaya; Darwiche, Fadi; Punnen, Sanoj; Manoharan, Murugesan; Gonzalgo, Mark L; Parekh, Dipen J

    2016-01-01

    Purpose. The surgical expertise to perform robotic partial nephrectomy is heavily dependent on technology. The Da Vinci Xi (XI) is the latest robotic surgical platform with significant advancements compared to its predecessor. We describe our operative technique and experience with the XI system for robotic partial nephrectomy (RPN). Materials and Methods. Patients with clinical T1 renal masses were offered RPN with the XI. We used laser targeting, autopositioning, and a novel "in-line" port placement to perform RPN. Results. 15 patients underwent RPN with the XI. There were no intraoperative complications and no operative conversions. Mean console time was 101.3 minutes (range 44-176 minutes). Mean ischemia time was 17.5 minutes and estimated blood loss was 120 mLs. 12 of 15 patients had renal cell carcinoma. Two patients had oncocytoma and one had benign cystic disease. All patients had negative surgical margins and pathologic T1 disease. Two postoperative complications were encountered, including one patient who developed a pseudoaneurysm and one readmitted for presumed urinary tract infection. Conclusions. RPN with the XI system can be safely performed. Combining our surgical technique with the technological advancements on the XI offers patients acceptable pathologic and perioperative outcomes.

  10. [History of robotics: from Archytas of Tarentum until da Vinci robot. (Part I)].

    PubMed

    Sánchez Martín, F M; Millán Rodríguez, F; Salvador Bayarri, J; Palou Redorta, J; Rodríguez Escovar, F; Esquena Fernández, S; Villavicencio Mavrich, H

    2007-02-01

    Robotic surgery is the newst technologic option in urology. To understand how new robots work is interesting to know their history. The desire to design machines imitating humans continued for more than 4000 years. There are references to King-su Tse (clasic China) making up automaton at 500 a. C. Archytas of Tarentum (at around 400 a.C.) is considered the father of mechanical engineering, and one of the occidental robotics classic referents. Heron of Alexandria, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors in the middle age, renaissance and classicism. At the XIXth century, automaton production underwent a peak and all engineering branches suffered a great development. At 1942 Asimov published the three robotics laws, based on mechanics, electronics and informatics advances. At XXth century robots able to do very complex self governing works were developed, like da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons.

  11. The First Korean Experience of Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using the da Vinci System

    PubMed Central

    Kang, Chang Moo; Chi, Hoon Sang; Hyeung, Woo Jin; Kim, Kyung Sik; Choi, Jin Sub; Kim, Byong Ro

    2007-01-01

    With the advancement of laparoscopic instruments and computer sciences, complex surgical procedures are expected to be safely performed by robot assisted telemanipulative laparoscopic surgery. The da Vinci system (Intuitive Surgical, Mountain View, CA, USA) became available at the many surgical fields. The wrist like movements of the instrument's tip, as well as 3-dimensional vision, could be expected to facilitate more complex laparoscopic procedure. Here, we present the first Korean experience of da Vinci robotic assisted laparoscopic cholecystectomy and discuss the introduction and perspectives of this robotic system. PMID:17594166

  12. Multiquadrant robotic colorectal surgery: the da Vinci Xi vs Si comparison.

    PubMed

    Protyniak, Bogdan; Jorden, Jeffrey; Farmer, Russell

    2017-03-08

    The newly introduced da Vinci Xi Surgical System hopes to address the shortcomings of its predecessor, specifically robotic arm restrictions and difficulty working in multiple quadrants. We compare the two robot platforms in multiquadrant surgery at a major colorectal referral center. Forty-four patients in the da Vinci Si group and 26 patients in the Xi group underwent sigmoidectomy or low anterior resection between 2014 and 2016. Patient demographics, operative variables, and postoperative outcomes were compared using descriptive statistics. Both groups were similar in age, sex, BMI, pelvic surgeries, and ASA class. Splenic flexure was mobilized in more (p = 0.045) da Vinci Xi cases compared to da Vinci Si both for sigmoidectomy (50 vs 15.4%) and low anterior resection (60 vs 29%). There was no significant difference in operative time (219.9 vs 224.7 min; p = 0.640), blood loss (170.0 vs 188.1 mL; p = 0.289), length of stay (5.7 vs 6 days; p = 0.851), or overall complications (26.9 vs 22.7%; p = 0.692) between the da Vinci Xi and Si groups, respectively. Single-dock multiquadrant robotic surgery, measured by splenic flexure mobilization with concomitant pelvic dissection, was more frequently performed using the da Vinci Xi platform with no increase in operative time, bleeding, or postoperative complications. The new platform provides surgeons an easier alternative to the da Vinci Si dual docking or combined robotic/laparoscopic multiquadrant surgery.

  13. Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®.

    PubMed

    Morelli, Luca; Guadagni, Simone; Di Franco, Gregorio; Palmeri, Matteo; Caprili, Giovanni; D'Isidoro, Cristiano; Cobuccio, Luigi; Marciano, Emanuele; Di Candio, Giulio; Mosca, Franco

    2017-03-01

    The aim of this study was to compare the short-term outcomes of robotic rectal resection with total mesorectal excision (TME) for rectal cancer, with the use of the new da Vinci Xi® (Xi-RobTME group) and the da Vinci Si® (Si-RobTME group). Ten patients with histologically confirmed rectal cancer underwent robot-assisted TME with the use of the new da Vinci Xi. The outcomes of Xi-RobTME group were compared with a Si-RobTME group selected using a case-matched methodology. Overall operative times and mean hospital stays were shorter in the Xi-RobTME group. Surgeries were fully robotic with a complete take-down of the splenic flexure in all Xi-RobTME cases, while only four cases of the Si-RobTME group were fully robotic, with two cases of complete take-down of the splenic flexure. The new da Vinci Xi could offer some advantages with respect to the da Vinci Si in rectal resection for cancer. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Load evaluation of the da Vinci surgical system for transoral robotic surgery.

    PubMed

    Fujiwara, Kazunori; Fukuhara, Takahiro; Niimi, Koji; Sato, Takahiro; Kitano, Hiroya

    2015-12-01

    Transoral robotic surgery, performed with the da Vinci surgical system (da Vinci), is a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a 3-dimensional magnified view and ability to see and work around curves or angles. However, the current da Vinci surgical system does not provide haptic feedback. This is problematic because the potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury and mandibular fracture. To assess the potential for intraoperative injuries, we measured the load of the endoscope and the instrument of the da Vinci Si surgical system. We pressed the endoscope and instrument of the da Vinci Si against Load cell six times each and measured the dynamic load and the time-to-maximum load. We also struck the da Vinci Si endoscope and instrument against the Load cell six times each and measured the impact load. The maximum dynamic load was 7.27 ± 1.31 kg for the endoscope and 1.90 ± 0.72 for the instrument. The corresponding time-to-maximum loads were 1.72 ± 0.22 and 1.29 ± 0.34 s, but the impact loads were significantly lower than the dynamic load. It remains possible that a major load is exerted on adjacent structures by continuous contact with the endoscope and instrument of da Vinci Si. However, there is a minor delay in reaching the maximum load. Careful monitoring by an on-site assistant may, therefore, help prevent contiguous injury.

  15. [The beginnings of robotic surgery--from the roots up to the da Vinci telemanipulator system].

    PubMed

    Dervaderics, János

    2007-12-09

    The history of the robotic surgery is only 22 years old. The article gives a short overview regarding the history of robotics, the surgical robots, the da Vinci telemanipulator system and some further commercial and experimental surgical robotic surgical simulation is also emphasized. Robotic surgery has its own place within the following concepts: 1. computer assisted surgery (CAS), 2. computer integrated surgery (CIS), 3. surgical automation, 4. surgical system integration and 5. artificial intelligence (AI). At the end of the paper there are some important sources of informations regarding robotic surgery.

  16. The Settings, Pros and Cons of the New Surgical Robot da Vinci Xi System for Transoral Robotic Surgery (TORS): A Comparison With the Popular da Vinci Si System.

    PubMed

    Kim, Da Hee; Kim, Hwan; Kwak, Sanghyun; Baek, Kwangha; Na, Gina; Kim, Ji Hoon; Kim, Se Heon

    2016-10-01

    The da Vinci system (da Vinci Surgical System; Intuitive Surgical Inc.) has rapidly developed in several years from the S system to the Si system and now the Xi System. To investigate the surgical feasibility and to provide workflow guidance for the newly released system, we used the new da Vinci Xi system for transoral robotic surgery (TORS) on a cadaveric specimen. Bilateral supraglottic partial laryngectomy, hypopharyngectomy, lateral oropharyngectomy, and base of the tongue resection were serially performed in search of the optimal procedures with the new system. The new surgical robotic system has been upgraded in all respects. The telescope and camera were incorporated into one system, with a digital end-mounted camera. Overhead boom rotation allows multiquadrant access without axis limitation, the arms are now thinner and longer with grabbing movements for easy adjustments. The patient clearance button dramatically reduces external collisions. The new surgical robotic system has been optimized for improved anatomic access, with better-equipped appurtenances. This cadaveric study of TORS offers guidance on the best protocol for surgical workflow with the new Xi system leading to improvements in the functional results of TORS.

  17. From Jacobeaus to the da Vinci: thoracoscopic applications of the robot.

    PubMed

    Al-Mufarrej, Faisal; Margolis, Marc; Tempesta, Barbara; Strother, Eric; Najam, Farzad; Gharagozloo, Farid

    2010-02-01

    With the increasing recognition of the benefits of minimally invasive surgery, surgical technology has evolved significantly since Jacobeaus' first attempt at thoracoscopy 100 years ago. Currently, video-assisted thoracic surgery occupies a significant role in the diagnosis and treatment of benign and malignant diseases of the chest. However, the clinical application of video-assisted thoracic surgery is limited by the technical shortcomings of the approach. Although the da Vinci system (Intuitive Surgical) is not the first robotic surgical system, it has been the most successful and widely applicable. After early applications in general and urologic surgery, the da Vinci robot extended its arms into the field of thoracic surgery, broadening the applicability of minimally invasive thoracic surgery. We review the available literature on robot-assisted thoracic surgery in attempt to better define the current role of the robot in pulmonary, mediastinal, and esophageal surgeries.

  18. [Applicability of the da Vinci robotic system in the skull base surgical approach. Preclinical investigation].

    PubMed

    Fernandez-Nogueras Jimenez, Francisco J; Segura Fernandez-Nogueras, Miguel; Jouma Katati, Majed; Arraez Sanchez, Miguel Ángel; Roda Murillo, Olga; Sánchez Montesinos, Indalecio

    2015-01-01

    The role of robotic surgery is well established in various specialties such as urology and general surgery, but not in others such as neurosurgery and otolaryngology. In the case of surgery of the skull base, it has just emerged from an experimental phase. To investigate possible applications of the da Vinci surgical robot in transoral skull base surgery, comparing it with the authors' experience using conventional endoscopic transnasal surgery in the same region. A transoral transpalatal approach to the nasopharynx and medial skull base was performed on 4 cryopreserved cadaver heads. We used the da Vinci robot, a 30° standard endoscope 12mm thick, dual camera and dual illumination, Maryland forceps on the left terminal and curved scissors on the right, both 8mm thick. Bone drilling was performed manually. For the anatomical study of this region, we used 0.5cm axial slices from a plastinated cadaver head. Various skull base structures at different depths were reached with relative ease with the robot terminals Transoral robotic surgery with the da Vinci system provides potential advantages over conventional endoscopic transnasal surgery in the surgical approach to this region. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  19. Does transition from the da Vinci Si to Xi robotic platform impact single-docking technique for robot-assisted laparoscopic nephroureterectomy?

    PubMed

    Patel, Manish N; Aboumohamed, Ahmed; Hemal, Ashok

    2015-12-01

    To describe our robot-assisted nephroureterectomy (RNU) technique for benign indications and RNU with en bloc excision of bladder cuff (BCE) and lymphadenectomy (LND) for malignant indications using the da Vinci Si and da Vinci Xi robotic platform, with its pros and cons. The port placement described for Si can be used for standard and S robotic systems. This is the first report in the literature on the use of the da Vinci Xi robotic platform for RNU. After a substantial experience of RNU using different da Vinci robots from the standard to the Si platform in a single-docking fashion for benign and malignant conditions, we started using the newly released da Vinci Xi robot since 2014. The most important differences are in port placement and effective use of the features of da Vinci Xi robot while performing simultaneous upper and lower tract surgery. Patient positioning, port placement, step-by-step technique of single docking RNU-LND-BCE using the da Vinci Si and da Vinci Xi robot are shown in an accompanying video with the goal that centres using either robotic system benefit from the hints and tips. The first segment of video describes RNU-LND-BCE using the da Vinci Si followed by the da Vinci Xi to highlight differences. There was no need for patient repositioning or robot re-docking with the new da Vinci Xi robotic platform. We have experience of using different robotic systems for single docking RNU in 70 cases for benign (15) and malignant (55) conditions. The da Vinci Xi robotic platform helps operating room personnel in its easy movement, allows easier patient side-docking with the help of its boom feature, in addition to easy and swift movements of the robotic arms. The patient clearance feature can be used to avoid collision with the robotic arms or the patient's body. In patients with challenging body habitus and in situations where bladder cuff management is difficult, modifications can be made through reassigning the camera to a different port with

  20. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi.

    PubMed

    Gorphe, Philippe; Von Tan, Jean; El Bedoui, Sophie; Hartl, Dana M; Auperin, Anne; Qassemyar, Quentin; Moya-Plana, Antoine; Janot, François; Julieron, Morbize; Temam, Stephane

    2017-01-07

    The latest generation Da Vinci(®) Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci(®) Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci(®) Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.

  1. From Leonardo to da Vinci: the history of robot-assisted surgery in urology.

    PubMed

    Yates, David R; Vaessen, Christophe; Roupret, Morgan

    2011-12-01

    What's known on the subject? and What does the study add? Numerous urological procedures can now be performed with robotic assistance. Though not definitely proven to be superior to conventional laparoscopy or traditional open surgery in the setting of a randomised trial, in experienced centres robot-assisted surgery allows for excellent surgical outcomes and is a valuable tool to augment modern surgical practice. Our review highlights the depth of history that underpins the robotic surgical platform we utilise today, whilst also detailing the current place of robot-assisted surgery in urology in 2011. The evolution of robots in general and as platforms to augment surgical practice is an intriguing story that spans cultures, continents and centuries. A timeline from Yan Shi (1023-957 bc), Archytas of Tarentum (400 bc), Aristotle (322 bc), Heron of Alexandria (10-70 ad), Leonardo da Vinci (1495), the Industrial Revolution (1790), 'telepresence' (1950) and to the da Vinci(®) Surgical System (1999), shows the incredible depth of history and development that underpins the modern surgical robot we use to treat our patients. Robot-assisted surgery is now well-established in Urology and although not currently regarded as a 'gold standard' approach for any urological procedure, it is being increasingly used for index operations of the prostate, kidney and bladder. We perceive that robotic evolution will continue infinitely, securing the place of robots in the history of Urological surgery. Herein, we detail the history of robots in general, in surgery and in Urology, highlighting the current place of robot-assisted surgery in radical prostatectomy, partial nephrectomy, pyeloplasty and radical cystectomy.

  2. [Minimally invasive robotic coronary bypass on the beating heart using da Vinci S system].

    PubMed

    Gao, Chang-qing; Yang, Ming; Wang, Gang; Wu, Yang; Zhao, Yue; Li, Li-xia; Wang, Jia-li; Xiao, Cang-song; Zhou, Qi

    2009-04-15

    To summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China. Fifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography. All patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical

  3. Application of da Vinci® Robot in simple or radical hysterectomy: Tips and tricks

    PubMed Central

    Iavazzo, Christos; Gkegkes, Ioannis D.

    2016-01-01

    The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon’s training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients’ safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies. PMID:27403078

  4. Development of a virtual reality robotic surgical curriculum using the da Vinci Si surgical system.

    PubMed

    Gomez, Pedro Pablo; Willis, Ross E; Van Sickle, Kent R

    2015-08-01

    This study aimed to develop a training curriculum to evaluate the basic robotic skills necessary to reach an 80 % preset proficiency score and correlate the level of surgical experience with the overall performance obtained using the da Vinci Surgical Skills simulator. Twenty-two participants (4 faculty, 4 senior, and 14 junior residents) were enrolled in a 4-week robotic training curriculum developed at our institution. A set of seven robotic skills were selected based on the manufacturer's exercise primary endpoint. During their pretesting session, participants completed one trial of each of the seven simulated exercises. In two individual sessions over a 2 week period, trainees practiced a different set of exercises that evaluated the same basic robotic skills assessed during pretesting with the objective of reaching an overall score of 80 % on two consecutive attempts. If proficiency was not achieved, then a maximum of six trials per exercise was allowed before advancing to the next skill. During their fourth week of training, participants completed a post-testing session with the same set of exercises used during pretesting. Participants' overall performance and various metrics were recorded in an online database for further analysis. A significant skills gain from pre- to post-test was observed for each of the seven basic robotic skills regardless of participant's level of training (p < .001). Interestingly, participants only achieved an overall score of 80 % or more in only five of the seven exercises. No statistical difference in gain of skills was found between groups suggesting robotic skills development is independent of level of prior surgical expertise. A dedicated virtual reality robotic training curriculum significantly improves the seven basic robotic surgical skills necessary to operate the da Vinci Si surgical console. Six training trials appear to be insufficient to reach proficiency levels on more advanced skills.

  5. [The benefit of the da Vinci robotic system in abdominal oncosurgery - our preliminary results].

    PubMed

    Langer, D; Pudil, J; Rudiš, J; Ryska, M

    2013-02-01

    The robotization of minimally invasive treatment in surgery has been evident since the beginning of the third Millennium. The authors present their current evaluation of the benefits of the da Vinci robotic system in the treatment of abdominal malignancy. The authors summarize published studies in the Medline and Pubmed databases that compare robotic, laparoscopic and open approaches in the treatment of abdominal malignancy. Epidemiological data, intraoperative blood loss, complications and oncological outcomes are monitored in a group of 30 patients with carcinoma of rectum. The results measured in the evaluated parameters (open conversion, perioperative and non - surgery complications, intraoperative blood loss, histological findings, lethality) are similar in the published studies, i.e. without significant differences in both groups subject to the robotic and laparoscopic treatment. The operative time in the group of robotic surgery has been is slightly longer (a non-significant difference) in most of published studies. 30 patients underwent the robotic assisted treatment of the carcinoma of the rectum (14 men and 16 women, average age of 60 years (33-80). Neoadjuvant treatment was indicated in 50% of the patients. Average blood loss was 260 ml, transfusion was administered in one case. Conversion to laparotomic treatment was performed twice, four patients had post-operative complications, no patient has died. We have not found any relapse of oncological disease in the observed set to this date. The Da Vinci robotic system is a safe manipulator in the treatment of abdominal malignancy (including HPB surgery). Randomized clinical trials (RCT) have confirmed (short-term clinical and oncological) results comparable to the laparoscopic or open approach treatment. The benefits of robotic surgery for patients in abdominal surgery (long-term results, sufficient number of patients and high-grade EBM) are yet to be evaluated, however. It is necessary to implement more

  6. Possible role of DaVinci Robot in uterine transplantation.

    PubMed

    Iavazzo, Christos; Gkegkes, Ioannis D

    2015-01-01

    Minimally invasive surgery, specifically robotic surgery, became a common technique used by gynecological surgeons over the last decade. The realization of the first human uterine transplantation commenced new perspectives in the treatment of uterine agenesia or infertility in women with history of hysterectomy at a young age. Robot-assisted technique may enhance the safety of the procedure by facilitating the microvascular anastomosis, vaginal anastomosis, and ligaments' fixation. This study proposes the formation of a multicenter collaboration group to organize a protocol with the aim to clarify the possible role of robotic surgery in uterine transplantation.

  7. Initial experience with the new da Vinci single-port robot-assisted platform.

    PubMed

    Ballestero Diego, R; Zubillaga Guerrero, S; Truan Cacho, D; Carrion Ballardo, C; Velilla Diez, G; Calleja Hermosa, P; Gutiérrez Baños, J L

    2017-06-01

    To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. The PAKY, HERMES, AESOP, ZEUS, and da Vinci robotic systems.

    PubMed

    Kim, Hyung L; Schulam, Peter

    2004-11-01

    In 1965 Gordon Moore, cofounder of Intel Corporation, made his famous observation now known as Moore's law. He predicted that computing capacity will double every 18 to 24 months. Since then, Moore's law has held true; the number of transistors per integrated computer circuit has doubled every couple of years. This relentless advance in computer technology ensures future advances in robotic technology. The ultimate goal of robotics is to allow surgeons to perform difficult procedures with a level of precision and improved clinical outcomes not possible by conventional methods. Robotics has the potential to enable surgeons with various levels of surgical skill to achieve a uniform outcome. As long as urologists continue to embrace technological advances and incorporate beneficial technology into their practice, the outlook for patients remains bright.

  9. Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands.

    PubMed

    Abrishami, Payam; Boer, Albert; Horstman, Klasien

    2014-09-01

    This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.

  10. The Da Vinci Xi and robotic radical prostatectomy-an evolution in learning and technique.

    PubMed

    Goonewardene, S S; Cahill, D

    2017-06-01

    The da Vinci Xi robot has been introduced as the successor to the Si platform. The promise of the Xi is to open the door to new surgical procedures. For robotic-assisted radical prostatectomy (RARP)/pelvic surgery, the potential is better vision and longer instruments. How has the Xi impacted on operative and pathological parameters as indicators of surgical performance? This is a comparison of an initial series of 42 RARPs with the Xi system in 2015 with a series using the Si system immediately before Xi uptake in the same calendar year, and an Si series by the same surgeon synchronously as the Xi series using operative time, blood loss, and positive margins as surrogates of surgical performance. Subjectively and objectively, there is a learning curve to Xi uptake in longer operative times but no impact on T2 positive margins which are the most reflective single measure of RARP outcomes. Subjectively, the vision of the Xi is inferior to the Si system, and the integrated diathermy system and automated setup are quirky. All require experience to overcome. There is a learning curve to progress from the Si to Xi da Vinci surgical platforms, but this does not negatively impact the outcome.

  11. Robot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience

    PubMed Central

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-01-01

    Background We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Methods Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Results Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Conclusion Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team. PMID:25883892

  12. Robot-assisted cardiac surgery using the da vinci surgical system: a single center experience.

    PubMed

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-04-01

    We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

  13. Measurements of the level of surgical expertise using flight path analysis from da Vinci robotic surgical system.

    PubMed

    Verner, Lawton; Oleynikov, Dmitry; Holtmann, Stephen; Haider, Hani; Zhukov, Leonid

    2003-01-01

    Laparoscopic surgical procedures require precise hand and eye coordination based on a 2-dimensional representation of 3-dimensional space. Currently, no metric exists to guide the educational process while surgeons are still on the learning curve. In this paper, we propose to identify and qualify the patterns of movements recorded from the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale CA) that are most consistent with mastery and can define levels of proficiency. We have recorded velocities and positions of complex movements made by both novice and expert surgeons using da Vinci system and performed geometric and statistical analysis of the data.

  14. Successful treatment of esophageal metastasis from hepatocellular carcinoma using the da Vinci robotic surgical system

    PubMed Central

    Boonnuch, Wiroon; Akaraviputh, Thawatchai; Nino, Carnivale; Yiengpruksawan, Anusak; Christiano, Arthur Andrew

    2011-01-01

    A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma (HCC) presented with progressive dysphagia. He had undergone liver transplantation for HCC three and a half years prevously. At presentation, his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus, causing a luminal stricture. We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system. Recovery was uneventful and he was been doing well 2 mo after surgery. α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively. During the follow-up period, he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation. PMID:21765971

  15. Evaluation of robotic-assisted platysmaplasty procedures in a cadaveric model using the da Vinci Surgical System.

    PubMed

    Taghizadeh, Farhan; Reiley, Carol; Mohr, Catherine; Paul, Malcolm

    2014-03-01

    We are evaluating the technical feasibility of robotic-assisted laparoscopic vertical-intermediate platysmaplasty in conjunction with an open rhytidectomy. In a cadaveric study, the da Vinci Surgical System was used to access certain angles in the lower neck that are difficult for traditional short incision, short flap procedures. Ergonomics, approach, and technical challenges were noted. To date, there are no published reports of robotic-assisted neck lifts, motivating us to assess its potential in this field of plastic surgery. Standard open technique short flap rhytidectomies with concurrent experimental robotic-assisted platysmaplasties (neck lifts) were performed on six cadavers with the da Vinci Si Surgical System(®) (Intuitive Surgical, Sunnyvale, CA, USA). The surgical procedures were performed on a diverse cadaver population from June 2011 to January 2012. The procedures included (1) submental incision and laser-assisted liposuction, (2) open rhytidectomy, and (3) robotic-assisted platysmaplasty using knot-free sutures. A variety of sutures and fat extraction techniques, coupled with 0° and 30° three-dimensional endoscopes, were utilized to optimize visualization of the platysma. An unaltered da Vinci Si Surgical System with currently available instruments was easily adaptable to neck lift surgery. Mid-neck platysma exposure was excellent, tissue handling was delicate and precise, and suturing was easily performed. Robotic-assisted surgery has the potential to improve outcomes in neck lifts by offering the ability to manipulate instruments with increased freedom of movement, scaled motion, tremor reduction, and stereoscopic three-dimensional visualization in the deep neck. Future clinical studies on live human patients can better assess subject and surgeon benefits arising from the use of the da Vinci system for neck lifts. Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in

  16. Sponsoring surgeons; an investigation on the influence of the da Vinci robot.

    PubMed

    Criss, Cory N; Gadepalli, Samir K

    2017-08-26

    The integrity of the medical literature about robotic surgery remains unclear despite wide-spread adoption. We sought to determine if payment from Intuitive Surgical Incorporated (ISI) affected quality of the research produced by surgeons. Publicly available financial data from the CMS website regarding the top-20 earners from ISI for 2015 was gathered. Studies conducted by these surgeons were identified using PubMed. Inclusion criteria consisted of publications about the da Vinci(®) robot on patient outcomes. The primary outcome of our study was if the study conclusion was positive/equivocal/negative towards the robot. Secondary outcomes included authorship, sponsorship, study controls, and disclosure. The top earners received $3,296,844 in 2015, with a median of $141,959. Sub-specialties included general surgery (55%), colorectal (20%), thoracic (15%), and obstetrics/gynecology (10%). Of the 37 studies, there was 1 RCT, with observational studies comprising the rest. The majority of the studies (n = 16, 43%) had no control population, with 11 (30%) comparing to same institution/surgeon, Though ISI sponsored only 6 (16%) studies, all with positive conclusions, 27 (73%) studies had positive conclusions for robot use, 9 (24%) equivocal, and only 1 (3%) negative. Overall, 13 earners had lead authorship and 11 senior. This initial pilot study highlights a potential bias as current literature published by benefactors demonstrates low quality and highly positive conclusions towards approval of the robot. This substantiates the need for a large, systematic review of the potential influence of sponsoring surgeons on medical literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Full Robotic Colorectal Resections for Cancer Combined With Other Major Surgical Procedures: Early Experience With the da Vinci Xi.

    PubMed

    Morelli, Luca; Di Franco, Gregorio; Guadagni, Simone; Palmeri, Matteo; Gianardi, Desirée; Bianchini, Matteo; Moglia, Andrea; Ferrari, Vincenzo; Caprili, Giovanni; D'Isidoro, Cristiano; Melfi, Franca; Di Candio, Giulio; Mosca, Franco

    2017-08-01

    The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for "left lower quadrant," with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure. All procedures were completed with the full robotic technique. Simultaneous procedures in same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-targeting operation. No external collisions or problems related to trocar positions were noted. No patient experienced postoperative surgical complications and the mean hospital stay was 6 days. The high success rate of full robotic colorectal resection combined with other surgical interventions for synchronous tumors, suggest the efficacy of the da Vinci Xi in this setting.

  18. Error reporting from the da Vinci surgical system in robotic surgery: A Canadian multispecialty experience at a single academic centre

    PubMed Central

    Rajih, Emad; Tholomier, Côme; Cormier, Beatrice; Samouëlian, Vanessa; Warkus, Thomas; Liberman, Moishe; Widmer, Hugues; Lattouf, Jean-Baptiste; Alenizi, Abdullah M.; Meskawi, Malek; Valdivieso, Roger; Hueber, Pierre-Alain; Karakewicz, Pierre I.; El-Hakim, Assaad; Zorn, Kevin C.

    2017-01-01

    Introduction The goal of the study is to evaluate and report on the third-generation da Vinci surgical (Si) system malfunctions. Methods A total of 1228 robotic surgeries were performed between January 2012 and December 2015 at our academic centre. All cases were performed by using a single, dual console, four-arm, da Vinci Si robot system. The three specialties included urology, gynecology, and thoracic surgery. Studied outcomes included the robotic surgical error types, immediate consequences, and operative side effects. Error rate trend with time was also examined. Results Overall robotic malfunctions were documented on the da Vinci Si systems event log in 4.97% (61/1228) of the cases. The most common error was related to pressure sensors in the robotic arms indicating out of limit output. This recoverable fault was noted in 2.04% (25/1228) of cases. Other errors included unrecoverable electronic communication-related in 1.06% (13/1228) of cases, failed encoder error in 0.57% (7/1228), illuminator-related in 0.33% (4/1228), faulty switch in 0.24% (3/1228), battery-related failures in 0.24% (3/1228), and software/hardware error in 0.08% (1/1228) of cases. Surgical delay was reported only in one patient. No conversion to either open or laparoscopic occurred secondary to robotic malfunctions. In 2015, the incidence of robotic error rose to 1.71% (21/1228) from 0.81% (10/1228) in 2014. Conclusions Robotic malfunction is not infrequent in the current era of robotic surgery in various surgical subspecialties, but rarely consequential. Their seldom occurrence does not seem to affect patient safety or surgical outcome. PMID:28503234

  19. The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

    PubMed

    Badalato, Gina M; Shapiro, Edan; Rothberg, Michael B; Bergman, Ari; RoyChoudhury, Arindam; Korets, Ruslan; Patel, Trushar; Badani, Ketan K

    2014-01-01

    Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference. Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance. Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (P<.05). Overall left-right ratios were found to be 1.45 versus 1.12 for the open and robot tasks, respectively (P<.05). Handedness significantly differed between robotic and open approaches for raw time scores (P<.0001) and left-right ratio (P=.03) when controlling for the prior tasks completed, starting hand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts. The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

  20. Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience.

    PubMed

    Abdel Raheem, Ali; Sheikh, Abulhasan; Kim, Dae Keun; Alatawi, Atalla; Alabdulaali, Ibrahim; Han, Woong Kyu; Choi, Young Deuk; Rha, Koon Ho

    2017-03-01

    The aims of this study were to compare the perioperative outcomes of da Vinci Xi to Si during robotic-assisted partial nephrectomy (RAPN) and to discuss the feasibility of our novel port placement scheme for the da Vinci Xi platform, to overcome the existing kinetic and technical difficulties we faced with the linear port placement in patients with a small body habitus. A retrospective data analysis of patients who underwent RPN using da Vinci Xi (n = 18) was carried out. The outcomes of the Xi group were compared with the Si group (n = 18) selected using a case-matched methodology. For da Vinci Xi, we applied the universal linear port placement in 12 patients and our modified port placement in the remaining 6 patients. The Xi group had a shorter mean docking time of 17.8 ± 2.6 min compared to the Si group of 20.5 ± 2.1 min (p = 0.002); otherwise, no significant difference was present with regard to the remaining perioperative variables (p > 0.05). The modified Xi port placement had a shorter mean console time of 70.8 ± 9.7 min compared to the universal linear port placement of 89.3 ± 17.2 min (p = 0.03). Moreover, it provided a broader field of vision with excellent robotic arms movement, minimizing collisions and allowing an easier and comfortable surgical assist. Da Vinci Xi appears to be feasible and safe during RPN with similar outcomes to Si. The novel Xi port placement makes surgery easier in patients with low BMI.

  1. Early Experience in Da Vinci Robot-Assisted Partial Nephrectomy: An Australian Single Centre Series

    PubMed Central

    Ting, Francis; Savdie, Richard; Chopra, Sam; Yuen, Carlo; Brenner, Phillip

    2015-01-01

    Introduction and Objectives. To demonstrate the safety and efficacy of the robot-assisted partial nephrectomy (RAPN) technique in an Australian setting. Methods. Between November 2010 and July 2014, a total of 76 patients underwent 77 RAPN procedures using the Da Vinci Surgical System© at our institution. 58 of these procedures were performed primarily by the senior author (PB) and are described in this case series. Results. Median operative time was 4 hours (range 1.5–6) and median warm ischaemic time (WIT) was 8 minutes (range 0–30) including 11 cases with zero ischaemic time. All surgical margins were clear with the exception of one patient who had egress of intravascular microscopic tumour outside the capsule to the point of the resection margin. Complications were identified in 9 patients (15.8%). Major complications included conversion to open surgery due to significant venous bleeding (n = 1), reperfusion injury (n = 1), gluteal compartment syndrome (n = 1), DVT/PE (n = 1), and readmission for haematuria (n = 1). Conclusion. This series demonstrates the safety and efficacy of the RAPN technique in an Australian setting when performed by experienced laparoscopic surgeons in a dedicated high volume robotic centre. PMID:26167299

  2. Accuracy of a novel photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

    NASA Astrophysics Data System (ADS)

    Gandhi, Neeraj; Kim, Sungmin; Kazanzides, Peter; Lediju Bell, Muyinatu A.

    2017-03-01

    Minimally invasive surgery carries the deadly risk of rupturing major blood vessels, such as the internal carotid arteries hidden by bone in endonasal transsphenoidal surgery. We propose a novel approach to surgical guidance that relies on photoacoustic-based vessel separation measurements to assess the extent of safety zones during these type of surgical procedures. This approach can be implemented with or without a robot or navigation system. To determine the accuracy of this approach, a custom phantom was designed and manufactured for modular placement of two 3.18-mm diameter vessel-mimicking targets separated by 10-20 mm. Photoacoustic images were acquired as the optical fiber was swept across the vessels in the absence and presence of teleoperation with a research da Vinci Surgical System. When the da Vinci was used, vessel positions were recorded based on the fiber position (calculated from the robot kinematics) that corresponded to an observed photoacoustic signal. In all cases, compounded photoacoustic data from a single sweep displayed the four vessel boundaries in one image. Amplitude- and coherence-based photoacoustic images were used to estimate vessel separations, resulting in 0.52-0.56 mm mean absolute errors, 0.66-0.71 mm root mean square errors, and 65-68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Results indicate that with further development, photoacoustic image-based measurements of anatomical landmarks could be a viable method for real-time path planning in multiple interventional photoacoustic applications.

  3. Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

    PubMed

    Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

    2014-03-01

    Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

  4. Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital

    PubMed Central

    Sait, Khalid H

    2011-01-01

    Background: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital. Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times. Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%), and none were directly related to the robotic system. Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot. PMID:21845067

  5. [First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].

    PubMed

    Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

    2008-05-01

    In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced.

  6. Leonardo da Vinci and the Downburst.

    NASA Astrophysics Data System (ADS)

    Gedzelman, Stanley David

    1990-05-01

    Evidence from the drawings, experiments, and writings of Leonardo da Vinci are presented to demonstrate that da Vinci recognized and, possibly, discovered the downburst and understood its associated airflow. Other early references to vortex flows resembling downbursts are mentioned.

  7. da Vinci decoded: does da Vinci stereopsis rely on disparity?

    PubMed

    Tsirlin, Inna; Wilcox, Laurie M; Allison, Robert S

    2012-11-01

    In conventional stereopsis, the depth between two objects is computed based on the retinal disparity in the position of matching points in the two eyes. When an object is occluded by another object in the scene, so that it is visible only in one eye, its retinal disparity cannot be computed. Nakayama and Shimojo (1990) found that a precept of quantitative depth between the two objects could still be established for such stimuli and proposed that this precept is based on the constraints imposed by occlusion geometry. They named this and other occlusion-based depth phenomena "da Vinci stereopsis." Subsequent research found quantitative depth based on occlusion geometry in several other classes of stimuli grouped under the term da Vinci stereopsis. However, Nakayama and Shimojo's findings were later brought into question by Gillam, Cook, and Blackburn (2003), who suggested that quantitative depth in their stimuli was perceived based on conventional disparity. In order to understand whether da Vinci stereopsis relies on one type of mechanism or whether its function is stimulus dependent we examine the nature and source of depth in the class of stimuli used by Nakayama and Shimojo (1990). We use three different psychophysical and computational methods to show that the most likely source for depth in these stimuli is occlusion geometry. Based on these experiments and previous data we discuss the potential mechanisms responsible for processing depth from monocular features in da Vinci stereopsis.

  8. Specific learning curve for port placement and docking of da Vinci(®) Surgical System: one surgeon's experience in robotic-assisted radical prostatectomy.

    PubMed

    Dal Moro, F; Secco, S; Valotto, C; Artibani, W; Zattoni, F

    2012-12-01

    Port placement and docking of the da Vinci(®) Surgical System is fundamental in robotic-assisted laparoscopic radical prostatectomy (RALP). The aim of our study was to investigate learning curves for port placement and docking of robots (PPDR) in RALP. This manuscript is a retrospective review of prospectively collected data looking at PPDR in 526 patients who underwent RALP in our institute from April 2005 to May 2010. Data included patient-factor features such as body mass index (BMI), and pre-, intra- and post-operative data. Intra-operative information included operation time, subdivided into anesthesia, PPDR and console times. 526 patients underwent RALP, but only those in whom PPDR was performed by the same surgeon without laparoscopic and robotic experience (F.D.M.) were studied, totalling 257 cases. The PPDR phase revealed an evident learning curve, comparable with other robotic phases. Efficiency improved until approximately the 60th case (P < 0.001), due more to effective port placement than to docking of robotic arms. In our experience, conversion to open surgery is so rare that statistical evaluation is not significant. Conversion due to robotic device failure is also very rare. This study on da Vinci procedures in RALP revealed a learning curve during PPDR and throughout the robotic-assisted procedure, reaching a plateau after 60 cases.

  9. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection.

    PubMed

    Koh, Dean Chi-Siong; Tsang, Charles Bih-Shou; Kim, Seon-Hahn

    2011-06-01

    The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vinci® system with a fourth arm extension. The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. The standard da Vinci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with short-term outcomes similar to those of

  10. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si.

    PubMed

    Morelli, Luca; Di Franco, Gregorio; Guadagni, Simone; Rossi, Leonardo; Palmeri, Matteo; Furbetta, Niccolò; Gianardi, Desirée; Bianchini, Matteo; Caprili, Giovanni; D'Isidoro, Cristiano; Mosca, Franco; Moglia, Andrea; Cuschieri, Alfred

    2017-07-21

    Robotic rectal resection with da Vinci Si has some technical limitations, which could be overcome by the new da Vinci Xi. We compare short-term surgical and functional outcomes following robotic rectal resection with total mesorectal excision for cancer, with the da Vinci Xi (Xi-RobTME group) and the da Vinci Si (Si-RobTME group). The first consecutive 30 Xi-RobTME were compared with a Si-RobTME control group of 30 patients, selected using a one-to-one case-matched methodology from our prospectively collected Institutional database, comprising all cases performed between April 2010 and September 2016 by a single surgeon. Perioperative outcomes were compared. The impact of minimally invasive TME on autonomic function and quality of life was analyzed with specific questionnaires. The docking and overall operative time were shorter in the Xi-RobTME group (p < 0.001 and p < 0.05 respectively). The mean differences of overall operative time and docking time were -33.8 min (95% CI -5.1 to -64.5) and -6 min (95% CI -4.1 to -7.9), respectively. A fully-robotic approach with complete splenic flexure mobilization was used in 30/30 (100%) of the Xi-RobTME cases and in 7/30 (23%) of the Si-RobTME group (p < 0.001). The hybrid approach in males and patients with BMI > 25 kg/m(2) was necessary in ten patients (45 vs. 0%, p < 0.001) and in six patients (37 vs. 0%, p < 0.05), in the Si-RobTME and Xi-RobTME groups, respectively. There were no differences in conversion rate, mean hospital stay, pathological data, and in functional outcomes between the two groups before and at 1 year after surgery. The technical advantages offered by the da Vinci Xi seem to be mainly associated with a shorter docking and operative time and with superior ability to perform a fully-robotic approach. Clinical and functional outcomes seem not to be improved, with the introduction of the new Xi platform.

  11. Training in robotic surgery using the da Vinci® surgical system for left pneumonectomy and lymph node dissection in an animal model.

    PubMed

    Kajiwara, Naohiro; Kakihana, Masatoshi; Usuda, Jitsuo; Uchida, Osamu; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2011-01-01

    In Japan, as of March 2010, only 13 hospitals were using the da Vinci® system and only for selected cases. Few clinical robotic lung surgery has been done in Japan, and there are no standardized training programs, although some exist in the U.S. and are under consideration by the Japanese society for thoracic surgery. We have used the da Vinci S® Surgical System for pneumonectomy and lymph node dissection in pigs. We report and review future possibilities and problems of robotic surgery, especially concerning education, training, safety management and ethical considerations for pneumonectomy and lymph node dissection in clinical practice. The da Vinci® system consists of a surgeon's console connected to a patient-side cart, a manipulator unit with three instrument arms and a central arm to guide the endoscope. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transmit the surgeon's movements to the instrument arm. We experienced exactly the same sensation as when performing standard open thoracotomy. Visual recognition is 3-D, and the high manipulation potential allows free movement of the various accessory instruments, exceeding the capacity of a surgeon's hands in video-assisted thoracic surgery (VATS) or even standard thoracotomy. Robotic surgery achieves at least the same level of operation technique for pneumonectomy and lymph node dissection under standard open thoracotomy, and it seemed as safe and easily performed as conventional VATS. The training program using pigs was effective and holds promise as a system to train thoracic surgeons in robotic lung surgery.

  12. Placement of {sup 125}I implants with the da Vinci robotic system after video-assisted thoracoscopic wedge resection: A feasibility study

    SciTech Connect

    Pisch, Julianna . E-mail: jpisch@bethisraelny.org; Belsley, Scott J.; Ashton, Robert; Wang Lin; Woode, Rudolph; Connery, Cliff

    2004-11-01

    Purpose: To evaluate the feasibility of using the da Vinci robotic system for radioactive seed placement in the wedge resection margin of pigs' lungs. Methods and materials: Video-assisted thoracoscopic wedge resection was performed in the upper and lower lobes in pigs. Dummy {sup 125}I seeds embedded in absorbable sutures were sewn into the resection margin with the aid of the da Vinci robotic system without complications. In the 'loop technique,' the seeds were placed in a cylindrical pattern; in the 'longitudinal,' they were above and lateral to the resection margin. Orthogonal radiographs were taken in the operating room. For dose calculation, Variseed 66.7 (Build 11312) software was used. Results: With looping seed placement, in the coronal view, the dose at 1 cm from the source was 97.0 Gy; in the lateral view it was 107.3 Gy. For longitudinal seed placement, the numbers were 89.5 Gy and 70.0 Gy, respectively. Conclusion: Robotic technology allows direct placement of radioactive seeds into the resection margin by endoscopic surgery. It overcomes the technical difficulties of manipulating in the narrow chest cavity. With the advent of robotic technology, new options in the treatment of lung cancer, as well as other malignant tumors, will become available.

  13. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    PubMed

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

  14. Novel dynamic information integration during da Vinci robotic partial nephrectomy and radical nephrectomy.

    PubMed

    Bhayani, Sam B; Snow, Devon C

    2008-07-01

    With the increasing discovery of small renal neoplasms, minimally invasive excisional approaches have become more popular. Robotic partial nephrectomy is an emerging procedure. During robotic renal surgery, the console surgeon often has a need to view images or other data during the surgical dissection. Herein, we describe the preliminary use of integrative surgical imaging in the console surgical view during 20 cases of robotic partial and radical nephrectomy. Integration of this technology, termed Tilepro, allows the surgeon to view data within the robotic console and thus prevents disengagement. The success rate of transmission was 95% and the usefulness of the transmission was 89%. Complications included delayed transmission and cabling issues. This technology is useful in robotic renal surgery and may have benefits in telepresence or other surgical fields.

  15. Surgical anatomy of the supraglottic larynx using the da Vinci robot.

    PubMed

    Goyal, Neerav; Yoo, Frederick; Setabutr, Dhave; Goldenberg, David

    2014-08-01

    Transoral robotic surgery (TORS) has facilitated organ-preserving surgery of the larynx. It has also presented a change in the surgical perspective. We performed cadaveric dissections using the robot to highlight the vascular and muscular anatomy of the supraglottic larynx. Cadaveric specimens underwent injection of their vasculature, and after injection a robotic surgical system was used to perform a transoral dissection of the supraglottic region. Care was taken to preserve anatomic landmarks and microvascular structures. Five fresh frozen cadaveric human heads were injected with silicone and used for the dissection. The superior laryngeal neurovascular bundle was identified and an absent superior laryngeal vein (SLV) was noted on 1 specimen. Using the robotic endoscope allowed us to visualize and identify the microvasculature of the head and neck. These dissections revealed anatomic variations in the superior laryngeal neurovascular bundle and also highlighted the differences in view using a surgical robotic system. Copyright © 2013 Wiley Periodicals, Inc.

  16. First series of total robotic hysterectomy (TRH) using new integrated table motion for the da Vinci Xi: feasibility, safety and efficacy.

    PubMed

    Giannini, Andrea; Russo, Eleonora; Mannella, Paolo; Palla, Giulia; Pisaneschi, Silvia; Cecchi, Elena; Maremmani, Michele; Morelli, Luca; Perutelli, Alessandra; Cela, Vito; Melfi, Franca; Simoncini, Tommaso

    2017-08-01

    To present the first case series of total robotic hysterectomy (TRH), using integrated table motion (ITM), which is a new feature comprising a unique operating table by Trumpf Medical that communicates wirelessly with the da Vinci Xi surgical system. ITM has been specifically developed to improve multiquadrant robotic surgery such as that conducted in colorectal surgery. Between May and October 2015, a prospective post-market study was conducted on ITM in the EU in 40 cases from different specialties. The gynecological study group comprised 12 patients. Primary endpoints were ITM feasibility, safety and efficacy. Ten patients underwent TRH. Mean number of ITM moves was three during TRH; there were 31 instances of table moves in the ten procedures. Twenty-eight of 31 ITM moves were made to gain internal exposure. The endoscope remained inserted during 29 of the 31 table movements (94%), while the instruments remained inserted during 27 of the 31 moves (87%). No external instrument collisions or other problems related to the operating table were noted. There were no ITM safety-related observations and no adverse events. This preliminary study demonstrated the feasibility, safety and efficacy of ITM for the da Vinci Xi surgical system in TRH. ITM was safe, with no adverse events related to its use. Further studies will be useful to define the real role and potential benefit of ITM in gynecological surgery.

  17. Hidden sketches by Leonardo da Vinci revealed

    NASA Astrophysics Data System (ADS)

    Dumé, Belle

    2009-02-01

    Three drawings on the back of Leonardo da Vinci's The Virgin and Child with St Anne (circa 1508) have been discovered by researchers led by Michel Menu from the Centre de Recherche et de Restauration des Musées de France (C2RMF) and the Louvre Museum in Paris.

  18. How to Think Like Leonardo da Vinci

    ERIC Educational Resources Information Center

    Caouette, Ralph

    2008-01-01

    To be effective and relevant in twenty-first-century learning, art needs to be more inclusive. In this article, the author discusses how teachers can find a good example in Leonardo da Vinci for building an art program. His art, design, and curiosity are the perfect foundation for any art program, at any level. (Contains 3 resources and 3 online…

  19. How to Think Like Leonardo da Vinci

    ERIC Educational Resources Information Center

    Caouette, Ralph

    2008-01-01

    To be effective and relevant in twenty-first-century learning, art needs to be more inclusive. In this article, the author discusses how teachers can find a good example in Leonardo da Vinci for building an art program. His art, design, and curiosity are the perfect foundation for any art program, at any level. (Contains 3 resources and 3 online…

  20. Early clinical experience with the da Vinci Xi Surgical System in general surgery.

    PubMed

    Hagen, Monika E; Jung, Minoa K; Ris, Frederic; Fakhro, Jassim; Buchs, Nicolas C; Buehler, Leo; Morel, Philippe

    2016-12-27

    The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6 month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6 min, p = 0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1 min, p = 0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.

  1. The DaVinci Group: a second modern Ophthalmotrope.

    PubMed

    Pruehsner, William R; Enderle, John D

    2006-01-01

    A group of undergraduate students at the University of Connecticut Biomedical Engineering Program has formed a "club" in order to more fully understand and educate themselves in modeling anatomical processes. This group is called the DaVinci Robot or DaVinci Group. Experiments to mechanically model the six extraocular muscles of the eye have been performed, each meeting little success. While researching methods that would lead to better success, the concept of the Ophthalmotrope was discovered. The Ophthalmotrope is a mechanical visual aide used in teaching the function of the extraocular muscles, prevalent in the mid 1800's. The Group decided to study this device and ultimately decided to build one. The paper presented here discusses our third experiment, currently under investigation, that is, to build an Opthalmotrope. Difficulties with this task are lack of any information with regard to how to construct this device. Presented are descriptions of the Group's initial experiments and research conducted into the construction of the Ophthalmotrpe. In the main body of the presented paper is a description of how the DaVinci Group Ophthalmotrope is constructed. Concluding is a discussion of the progress of the construction of the Ophthalmotrope along with a brief listing of research conducted in order to build the device.

  2. SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA).

    PubMed

    Tsuda, Shawn; Oleynikov, Dmitry; Gould, Jon; Azagury, Dan; Sandler, Bryan; Hutter, Matthew; Ross, Sharona; Haas, Eric; Brody, Fred; Satava, Richard

    2015-10-01

    The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.

  3. [Leonardo da Vinci--a dyslectic genius?].

    PubMed

    Røsstad, Anna

    2002-12-10

    Leonardo da Vinci's texts consist almost exclusively of scientific notes. Working on a book on Leonardo's art, I studied all Leonardo's published texts carefully for any new information. In some prefaces I came to suspect that Leonardo might have suffered from dyslexia. This article considers the question of whether it is possible to find indications of dyslexia in Leonardo's texts and in the accounts of his life.

  4. A computational theory of da Vinci stereopsis.

    PubMed

    Tsirlin, Inna; Wilcox, Laurie M; Allison, Robert S

    2014-06-09

    In binocular vision, occlusion of one object by another gives rise to monocular occlusions—regions visible only in one eye. Although binocular disparities cannot be computed for these regions, monocular occlusions can be precisely localized in depth and can induce the perception of illusory occluding surfaces. The phenomenon of depth perception from monocular occlusions, known as da Vinci stereopsis, is intriguing, but its mechanisms are not well understood. We first propose a theory of the mechanisms underlying da Vinci stereopsis that is based on the psychophysical and computational literature on monocular occlusions. It postulates, among other principles, that monocular areas are detected explicitly, and depth from occlusions is calculated based on constraints imposed by occlusion geometry. Next, we describe a biologically inspired computational model based on this theory that successfully reconstructs depth in a large range of stimuli and produces results similar to those described in the psychophysical literature. These results demonstrate that the proposed neural architecture could underpin da Vinci stereopsis and other stereoscopic percepts. © 2014 ARVO.

  5. Leonardo da Vinci's studies of the heart.

    PubMed

    Shoja, Mohammadali M; Agutter, Paul S; Loukas, Marios; Benninger, Brion; Shokouhi, Ghaffar; Namdar, Husain; Ghabili, Kamyar; Khalili, Majid; Tubbs, R Shane

    2013-08-20

    Leonardo da Vinci's detailed drawings are justly celebrated; however, less well known are his accounts of the structures and functions of the organs. In this paper, we focus on his illustrations of the heart, his conjectures about heart and blood vessel function, his experiments on model systems to test those conjectures, and his unprecedented conclusions about the way in which the cardiovascular system operates. In particular, da Vinci seems to have been the first to recognize that the heart is a muscle and that systole is the active phase of the pump. He also seems to have understood the functions of the auricles and pulmonary veins, identified the relationship between the cardiac cycle and the pulse, and explained the hemodynamic mechanism of valve opening and closure. He also described anatomical variations and changes in structure and function that occurred with age. We outline da Vinci's varied career and suggest ways in which his personality, experience, skills and intellectual heritage contributed to these advances in understanding. We also consider his influence on later studies in anatomy and physiology.

  6. The real code of leonardo da vinci.

    PubMed

    Ose, Leiv

    2008-02-01

    Leonardo da Vinci was born in Italy. Among the researchers and scientists, he is favourably known for his remarkable efforts in scientific work. His investigations of atherosclerosis judiciously combine three separate fields of research. In 1506, he finished his masterpiece, painting of Mona Lisa. A careful clinical examination of the famous painting reveals a yellow irregular leather-like spot at the inner end of the left upper eyelid and a soft bumpy well-defined swelling of the dorsum of the right hand beneath the index finger about 3 cm long. This is probably the first case of familial hypercholesterolemia (FH). The FH code of Leonardo da Vinci was given immense consideration by scientists like Carl Muller, who described the xanthomas tuberosum and angina pectoris. On the contrary, Akira Endo searched for microbial metabolites that would inhibit HMG-CoA reductase, the rate-limiting enzyme in the synthesis of cholesterol and finally, Michael Brown and Joseph Goldstein published a remarkable series of elegant and insightful papers in the 70s and 80s. They established that the cellular uptake of low-density lipoprotein (LDL) essentially requires the LDL receptor. this was the real Code of Leonardo da Vinci.

  7. The Real Code of Leonardo da Vinci

    PubMed Central

    Ose, Leiv

    2008-01-01

    Leonardo da Vinci was born in Italy. Among the researchers and scientists, he is favourably known for his remarkable efforts in scientific work. His investigations of atherosclerosis judiciously combine three separate fields of research. In 1506, he finished his masterpiece, painting of Mona Lisa. A careful clinical examination of the famous painting reveals a yellow irregular leather-like spot at the inner end of the left upper eyelid and a soft bumpy well-defined swelling of the dorsum of the right hand beneath the index finger about 3 cm long. This is probably the first case of familial hypercholesterolemia (FH). The FH code of Leonardo da Vinci was given immense consideration by scientists like Carl Muller, who described the xanthomas tuberosum and angina pectoris. On the contrary, Akira Endo searched for microbial metabolites that would inhibit HMG-CoA reductase, the rate-limiting enzyme in the synthesis of cholesterol and finally, Michael Brown and Joseph Goldstein published a remarkable series of elegant and insightful papers in the 70s and 80s. They established that the cellular uptake of low-density lipoprotein (LDL) essentially requires the LDL receptor. In conclusion: this was the real Code of Leonardo da Vinci. PMID:19924278

  8. Visual tracking of da Vinci instruments for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Speidel, S.; Kuhn, E.; Bodenstedt, S.; Röhl, S.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.

    2014-03-01

    Intraoperative tracking of laparoscopic instruments is a prerequisite to realize further assistance functions. Since endoscopic images are always available, this sensor input can be used to localize the instruments without special devices or robot kinematics. In this paper, we present an image-based markerless 3D tracking of different da Vinci instruments in near real-time without an explicit model. The method is based on different visual cues to segment the instrument tip, calculates a tip point and uses a multiple object particle filter for tracking. The accuracy and robustness is evaluated with in vivo data.

  9. da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up.

    PubMed

    Kaul, Sanjeev; Laungani, Rajesh; Sarle, Richard; Stricker, Hans; Peabody, James; Littleton, Ray; Menon, Mani

    2007-01-01

    Laparoscopic partial nephrectomy is gaining acceptance as an alternative to open surgery for small renal tumours, although technical difficulty of intracorporeal suturing and concerns over warm ischemia time are limitations. Previous work has demonstrated that suturing with the robotic system is easier compared with laparoscopy. We believe the robot has an application and we report our initial experience in 10 patients undergoing robotic partial nephrectomy. Ten patients with small exophytic renal masses underwent intraperitoneal robotic partial nephrectomy. Principles of traditional open surgery were followed and intraoperative ultrasound was used to define resection margins. The renal artery was clamped with laparoscopic bulldog clamps and indigo carmine was administered intravenously to detect entry into collecting system. Suture closure and FLOSEAL were used for hemostasis. Frozen sections were obtained in all patients. Seven men and three women, mean age 59 yr, underwent robotic partial nephrectomy. Mean tumour size was 2 cm. Mean console and warm ischemia time were 158 min and 21 min, respectively. The median hospital stay was 1.5 d. Pathology revealed renal cell carcinoma in eight, oncocytoma in one, and lipoma in one. All resection margins were negative. Follow-up ranged from 6 to 28 mo. Robotic partial nephrectomy is a viable alternative to open or laparoscopic partial nephrectomy in carefully selected patients with small renal tumours. The advantages of the robotic system must be weighed against its cost. Further studies will determine if reduction in procedure complexity warrants the expense of such technology.

  10. Totally extraperitoneal (TEP) bilateral hernioplasty using the Single Site® robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results.

    PubMed

    Cestari, A; Galli, A C; Sangalli, M N; Zanoni, M; Ferrari, M; Roviaro, G

    2017-06-01

    Laparoendoscopic single site totally extraperitoneal (TEP) hernia repair showed to be a feasible alternative to conventional laparoscopic hernia repair; nevertheless single site surgery, with the loss of instruments triangulation can be a demanding procedure. To overcome those hurdles, the Single Site® (SS) platform of the da Vinci (DV) Si robotic system enables to perform surgical procedures through a 25-mm skin incision, with a stable 3D vision and restoring an adequate triangulation of the surgical instruments. We present in details the technique and the preliminary results of DV-SS TEP, to our knowledge the first cases reported in literature. In March 2016, three consecutive male patients (mean age 46.6 years-mean BMI 25.3) with bilateral symptomatic inguinal hernia were submitted to DV-SS TEP in our institutions. Feasibility, codification of the technique, operative time and perioperative outcomes were recorded. All the procedures were completed as scheduled, with no conversion to other techniques. Mean operative time was 98.6 min, ranging between 155 and 55 min, reflecting the learning curve of the operating room team on this new procedure. No intraoperative or postoperative complications were experienced and all the patients were discharged within 24 h after surgery. Patients reported satisfactory postoperative course, with no recurrence of inguinal hernia and satisfaction in cosmetic result at 6-month follow-up. DV-SS TEP inguinal hernia repair showed to be feasible and effective surgical option for bilateral groin hernia repair. Patients' outcome was uneventful, with optimal cosmetic results. Further studies comparing this innovative technique to TEP or LESS TEP should be promoted.

  11. Comparative analysis of short - term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy.

    PubMed

    García-Sánchez, Cristina; Martín, Ana A Román; Conde-Sánchez, J Manuel; Congregado-Ruíz, C Belén; Osman-García, Ignacio; Medina-López, Rafael A

    2017-01-01

    There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved. Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV Materials and Methods: Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed. ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group. 65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months. No significant differences were found in the comparative analysis of quality of life. ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months. Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months. Copyright® by the International Brazilian Journal of Urology.

  12. The Case: Bunche-Da Vinci Learning Partnership Academy

    ERIC Educational Resources Information Center

    Eisenberg, Nicole; Winters, Lynn; Alkin, Marvin C.

    2005-01-01

    The Bunche-Da Vinci case described in this article presents a situation at Bunche Elementary School that four theorists were asked to address in their evaluation designs (see EJ791771, EJ719772, EJ791773, and EJ792694). The Bunche-Da Vinci Learning Partnership Academy, an elementary school located between an urban port city and a historically…

  13. The Case: Bunche-Da Vinci Learning Partnership Academy

    ERIC Educational Resources Information Center

    Eisenberg, Nicole; Winters, Lynn; Alkin, Marvin C.

    2005-01-01

    The Bunche-Da Vinci case described in this article presents a situation at Bunche Elementary School that four theorists were asked to address in their evaluation designs (see EJ791771, EJ719772, EJ791773, and EJ792694). The Bunche-Da Vinci Learning Partnership Academy, an elementary school located between an urban port city and a historically…

  14. Leonardo da Vinci's contributions to neuroscience.

    PubMed

    Pevsner, Jonathan

    2002-04-01

    Leonardo da Vinci (1452-1519) made far-reaching contributions to many areas of science, technology and art. Leonardo's pioneering research into the brain led him to discoveries in neuroanatomy (such as those of the frontal sinus and meningeal vessels) and neurophysiology (he was the first to pith a frog). His injection of hot wax into the brain of an ox provided a cast of the ventricles, and represents the first known use of a solidifying medium to define the shape and size of an internal body structure. Leonardo developed an original, mechanistic model of sensory physiology. He undertook his research with the broad goal of providing physical explanations of how the brain processes visual and other sensory input, and integrates that information via the soul.

  15. Tree branching: Leonardo da Vinci's rule versus biomechanical models.

    PubMed

    Minamino, Ryoko; Tateno, Masaki

    2014-01-01

    This study examined Leonardo da Vinci's rule (i.e., the sum of the cross-sectional area of all tree branches above a branching point at any height is equal to the cross-sectional area of the trunk or the branch immediately below the branching point) using simulations based on two biomechanical models: the uniform stress and elastic similarity models. Model calculations of the daughter/mother ratio (i.e., the ratio of the total cross-sectional area of the daughter branches to the cross-sectional area of the mother branch at the branching point) showed that both biomechanical models agreed with da Vinci's rule when the branching angles of daughter branches and the weights of lateral daughter branches were small; however, the models deviated from da Vinci's rule as the weights and/or the branching angles of lateral daughter branches increased. The calculated values of the two models were largely similar but differed in some ways. Field measurements of Fagus crenata and Abies homolepis also fit this trend, wherein models deviated from da Vinci's rule with increasing relative weights of lateral daughter branches. However, this deviation was small for a branching pattern in nature, where empirical measurements were taken under realistic measurement conditions; thus, da Vinci's rule did not critically contradict the biomechanical models in the case of real branching patterns, though the model calculations described the contradiction between da Vinci's rule and the biomechanical models. The field data for Fagus crenata fit the uniform stress model best, indicating that stress uniformity is the key constraint of branch morphology in Fagus crenata rather than elastic similarity or da Vinci's rule. On the other hand, mechanical constraints are not necessarily significant in the morphology of Abies homolepis branches, depending on the number of daughter branches. Rather, these branches were often in agreement with da Vinci's rule.

  16. Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon's experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si.

    PubMed

    Morelli, Luca; Guadagni, Simone; Lorenzoni, Valentina; Di Franco, Gregorio; Cobuccio, Luigi; Palmeri, Matteo; Caprili, Giovanni; D'Isidoro, Cristiano; Moglia, Andrea; Ferrari, Vincenzo; Di Candio, Giulio; Mosca, Franco; Turchetti, Giuseppe

    2016-09-01

    The aim of this study is to compare surgical parameters and the costs of robotic surgery with those of laparoscopic approach in rectal cancer based on a single surgeon's early robotic experience. Data from 25 laparoscopic (LapTME) and the first 50 robotic (RobTME) rectal resections performed at our institution by an experienced laparoscopic surgeon (>100 procedures) between 2009 and 2014 were retrospectively analyzed and compared. Patient demographic, procedure, and outcome data were gathered. Costs of the two procedures were collected, differentiated into fixed and variable costs, and analyzed against the robotic learning curve according to the cumulative sum (CUSUM) method. Based on CUSUM analysis, RobTME group was divided into three phases (Rob1: 1-19; Rob2: 20-40; Rob3: 41-50). Overall median operative time (OT) was significantly lower in LapTME than in RobTME (270 vs 312.5 min, p = 0.006). A statistically significant change in OT by phase of robotic experience was detected in the RobTME group (p = 0.010). Overall mean costs associated with LapTME procedures were significantly lower than with RobTME (p < 0.001). Statistically significant reductions in variable and overall costs were found between robotic phases (p < 0.009 for both). With fixed costs excluded, the difference between laparoscopic and Rob3 was no longer statistically significant. Our results suggest a significant optimization of robotic rectal surgery's costs with experience. Efforts to reduce the dominant fixed cost are recommended to maintain the sustainability of the system and benefit from the technical advantages offered by the robot.

  17. Phantom surfaces in da Vinci stereopsis.

    PubMed

    Wardle, Susan G; Gillam, Barbara J

    2013-02-08

    In binocular viewing of natural three-dimensional scenes, occlusion relationships between objects at different depths create regions of the background that are visible to only one eye. These monocular regions can support depth perception. There are two viewing conditions in which a monocular region can be on the nasal side of a binocular surface--(a) when a background surface is viewed through an aperture and (b) when a region is camouflaged against the background in one eye's view. We created stimuli with a monocular region using complex textures in which camouflage was not possible, and for which there was no physical aperture. For these stimuli, observers perceived a strong phantom contour in near depth at the edge of the monocular region, with the monocular texture perceived behind at the depth of the binocular surface. Depth-matching with a probe showed that the depth of the phantom occluding surface was as precise as for stimuli with regular binocular disparity. Monocular regions of texture on the opposite (temporal) side of the binocular surface were perceived behind, as predicted by occlusion geometry, and there was no phantom surface. We discuss the implications for models of da Vinci stereopsis and stereoscopic edge processing, and consider the involvement of a form of Panum's limiting case. We conclude that the visual system uses a combination of occlusion geometry and complex matching to precisely locate edges in depth that lack a luminance contour.

  18. Der Telemanipulator daVinci als mechanisches Trackingsystem

    NASA Astrophysics Data System (ADS)

    Käst, Johannes; Neuhaus, Jochen; Nickel, Felix; Kenngott, Hannes; Engel, Markus; Short, Elaine; Reiter, Michael; Meinzer, Hans-Peter; Maier-Hein, Lena

    Der Telemanipulator daVinci (Intuitive Surgical, Sunnyvale, Kalifornien) ist ein M aster-Slave System für roboterassistierte minimalinvasive Chirurgie. Da er über integrierte Gelenksensoren verfügt, kann er unter Verwendung der daVinci-API als mechanisches Trackingsystem verwendet werden. In dieser Arbeit evaluieren wir die Präzision und Genauigkeit eines daVinci mit Hilfe eines Genauigkeitsphantoms mit bekannten Maßen. Der ermittelte Positionierungsfehler liegt in der Größenordnung von 6 mm und ist somit für einen Großteil der medizinischen Fragestellungen zu hoch. Zur Reduktion des Fehlers schlagen wir daher eine Kalibrierung der Gelenksensoren vor.

  19. The role of transparency in da Vinci stereopsis.

    PubMed

    Zannoli, Marina; Mamassian, Pascal

    2011-10-15

    The majority of natural scenes contains zones that are visible to one eye only. Past studies have shown that these monocular regions can be seen at a precise depth even though there are no binocular disparities that uniquely constrain their locations in depth. In the so-called da Vinci stereopsis configuration, the monocular region is a vertical line placed next to a binocular rectangular occluder. The opacity of the occluder has been mentioned to be a necessary condition to obtain da Vinci stereopsis. However, this opacity constraint has never been empirically tested. In the present study, we tested whether da Vinci stereopsis and perceptual transparency can interact using a classical da Vinci configuration in which the opacity of the occluder varied. We used two different monocular objects: a line and a disk. We found no effect of the opacity of the occluder on the perceived depth of the monocular object. A careful analysis of the distribution of perceived depth revealed that the monocular object was perceived at a depth that increased with the distance between the object and the occluder. The analysis of the skewness of the distributions was not consistent with a double fusion explanation, favoring an implication of occlusion geometry in da Vinci stereopsis. A simple model that includes the geometry of the scene could account for the results. In summary, the mechanism responsible to locate monocular regions in depth is not sensitive to the material properties of objects, suggesting that da Vinci stereopsis is solved at relatively early stages of disparity processing. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Battle of the bots: a comparison of the standard da Vinci and the da Vinci Surgical Skills Simulator in surgical skills acquisition.

    PubMed

    Brown, Kevin; Mosley, Natalie; Tierney, James

    2016-08-29

    Virtual reality simulators are increasingly used to gain robotic surgical skills. This study compared use of the da Vinci Surgical Skills Simulator (dVSSS) to the standard da Vinci (SdV) robot for skills acquisition in a prospective randomized study. Residents from urology, gynecology, and general surgery programs performed three virtual reality tasks (thread the ring, ring rail, and tubes) on the dvSSS. Participants were then randomized to one of the two study groups (dVSSS and SdV). Each participant then practiced on either the dVSSS or the SdV (depending on randomization) for 30 min per week over a 4-week time period. The dVSSS arm was not permitted to practice ring rail (due to no similar practice scenario available for the SdV group). Following 4 weeks of practice, participants performed the same three virtual reality tasks and the results were recorded and compared to baseline. Overall and percent improvement were recorded for all participants from pre-test to post-test. Two-way ANOVA analyses were used to compare the dVSSS and SdV groups and three tasks. Initially, 30 participants were identified and enrolled in the study. Randomization resulted in 15 participants in each arm. During the course of the study, four participants were unable to complete all tasks and practice sessions and were, therefore, excluded. This resulted in a total of 26 participants (15 in the dVSSS group and 11 in the SdV group) who completed the study. Overall total improvement score was found to be 23.23 and 23.48 for the SdV and dVSSS groups, respectively (p = 0.9245). The percent improvement was 60 and 47 % for the SdV and dVSSS groups respectively, which was a statistically significant difference between the two groups and three tasks. Practicing on the standard da Vinci is comparable to practicing on the da Vinci simulator for acquiring robotic surgical skills. In spite of several potential advantages, the dVSSS arm performed no better than the SdV arm in the final

  1. Leonardo da Vinci (1452-1519)

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    Painter, inventor and polymath, born in Vinci (near Empolia), Italy. Although astronomy does not figure large in Leonardo's works, he realized the possibility of constructing a telescope (`making glasses to see the Moon enlarged'). He suggested that `… in order to observe the nature of the planets, open the roof and bring the image of a single planet onto the base of a concave mirror. The image o...

  2. Training and Health. Leonardo da Vinci Series: Good Practices.

    ERIC Educational Resources Information Center

    Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

    This document profiles programs in the fields of health and medicine that are offered through the European Commission's Leonardo da Vinci program. The following programs are profiled: (1) CYTOTRAIN (a transnational vocational training program in cervical cancer screening); (2) Apollo (a program of open and distance learning for paramedical…

  3. Leonardo da Vinci's foot: historical evidence of concept.

    PubMed

    Jastifer, James R; Toledo-Pereyra, Luis H

    2012-10-01

    Leonardo da Vinci (1452-1519), world-renowned Italian renaissance master, is known for his contributions to, and broad interests in science and art. The objective of this work is to demonstrate the extent of his science by applying the use of his concepts to current models of foot and ankle mechanics. The art and science of Leonardo Da Vinci were extensively analyzed by reviewing his original drawings and hand written notebooks as well as their English translation. Current medical journals including the topics of foot, ankle, and biomechanics were reviewed for modern evidence and application of his concepts. The library of Michigan State University and the electronic library of the Royal Library at Windsor Castle were extensively utilized. From the depths of Santa Maria Nuova Hospital in Florence and Santo Spirito Hospital in Rome, through his commentary and anatomical drawings of around 30 cadaver dissections he performed, Leonardo da Vinci expressed his concept of foot and ankle anatomy and mechanics. He laid forth concepts, which vary little from current theories including those of proportion, statics and joint stability, sesamoid biomechanics, and structural support of the foot. Leonardo da Vinci, by combining an interest in anatomy and a gift of genius and artistic ability laid a foundation of foot and ankle anatomy and mechanics that have been applied in modern clinical sciences. Leonardo in this way made important contributions to the practice of foot and ankle orthopedics.

  4. The Potential da Vinci in All of Us

    ERIC Educational Resources Information Center

    Petto, Sarah; Petto, Andrew

    2009-01-01

    The study of the human form is fundamental to both science and art curricula. For vertebrates, perhaps no feature is more important than the skeleton to determine observable form and function. As Leonard da Vinci's famous Proportions of the Human Figure (Virtruvian Man) illustrates, the size, shape, and proportions of the human body are defined by…

  5. The DaVinci Project: Multimedia in Art and Chemistry.

    ERIC Educational Resources Information Center

    Simonson, Michael; Schlosser, Charles

    1998-01-01

    Provides an overview of the DaVinci Project, a collaboration of students, teachers, and researchers in chemistry and art to develop multimedia materials for grades 3-12 visualizing basic concepts in chemistry and visual art. Topics addressed include standards in art and science; the conceptual framework for the project; and project goals,…

  6. Studying and Working Abroad. Leonardo da Vinci Series: Good Practices.

    ERIC Educational Resources Information Center

    Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

    This document profiles recent successful examples of students studying and working abroad as part of the European Commission's Leonardo da Vinci program, which is designed to give students across the European Union the opportunity to experience vocational training in a foreign country. The following examples are presented: (1) 3 Finnish students…

  7. The Potential da Vinci in All of Us

    ERIC Educational Resources Information Center

    Petto, Sarah; Petto, Andrew

    2009-01-01

    The study of the human form is fundamental to both science and art curricula. For vertebrates, perhaps no feature is more important than the skeleton to determine observable form and function. As Leonard da Vinci's famous Proportions of the Human Figure (Virtruvian Man) illustrates, the size, shape, and proportions of the human body are defined by…

  8. The DaVinci Project: Multimedia in Art and Chemistry.

    ERIC Educational Resources Information Center

    Simonson, Michael; Schlosser, Charles

    1998-01-01

    Provides an overview of the DaVinci Project, a collaboration of students, teachers, and researchers in chemistry and art to develop multimedia materials for grades 3-12 visualizing basic concepts in chemistry and visual art. Topics addressed include standards in art and science; the conceptual framework for the project; and project goals,…

  9. Women and Technical Professions. Leonardo da Vinci Series: Good Practices.

    ERIC Educational Resources Information Center

    Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

    This document profiles programs for women in technical professions that are offered through the European Commission's Leonardo da Vinci program. The following programs are profiled: (1) Artemis and Diana (vocational guidance programs to help direct girls toward technology-related careers); (2) CEEWIT (an Internet-based information and…

  10. Towards the Implementation of an Autonomous Camera Algorithm on the da Vinci Platform.

    PubMed

    Eslamian, Shahab; Reisner, Luke A; King, Brady W; Pandya, Abhilash K

    2016-01-01

    Camera positioning is critical for all telerobotic surgical systems. Inadequate visualization of the remote site can lead to serious errors that can jeopardize the patient. An autonomous camera algorithm has been developed on a medical robot (da Vinci) simulator. It is found to be robust in key scenarios of operation. This system behaves with predictable and expected actions for the camera arm with respect to the tool positions. The implementation of this system is described herein. The simulation closely models the methodology needed to implement autonomous camera control in a real hardware system. The camera control algorithm follows three rules: (1) keep the view centered on the tools, (2) keep the zoom level optimized such that the tools never leave the field of view, and (3) avoid unnecessary movement of the camera that may distract/disorient the surgeon. Our future work will apply this algorithm to the real da Vinci hardware.

  11. Comparing the da Vinci si single console and dual console in teaching novice surgeons suturing techniques.

    PubMed

    Crusco, Salvatore; Jackson, Tiffany; Advincula, Arnold

    2014-01-01

    Robot-assisted laparoscopic surgery is often taught with the surgical mentor at the surgeon console and the trainee at the patient's bedside. The da Vinci dual console (Intuitive Surgical, Sunnyvale, California) allows a surgical mentor to teach with both the mentor and the trainee working at a surgeon console simultaneously. The purpose of this study is to evaluate the effectiveness of the dual console versus the single console for teaching medical students robotic tasks. Forty novice medical students were randomized to either the da Vinci single-console or dual-console group and were taught 4 knot-tying techniques by a surgical mentor. The students were timed while performing the tasks. No statistically significant differences in mean task times were observed between the single- and dual-console groups: interrupted stitch with a 2-handed knot (300 seconds for single vs 294 seconds for dual, P=.59), interrupted stitch with a 1-handed knot (198 seconds for single vs 212 seconds for dual, P=.88), figure-of-8 stitch with a 2-handed knot (261 seconds for single vs 219 seconds for dual, P=.20), and figure-of-8 stitch with a 1-handed knot (200 seconds for single vs 199 seconds for dual, P=.53). No significant difference was observed in performance time when teaching knot-tying techniques to medical students using the da Vinci dual console compared with the single console. More research needs to be performed on the utility of the da Vinci dual console in surgical training.

  12. DaVinci-assisted laparoscopic radical prostatectomy: the learning curve

    NASA Astrophysics Data System (ADS)

    Le, Carter Q.; Ho, Khai-Linh V.; Gettman, Matthew T.

    2007-02-01

    Objective: To define the learning curve for daVinci-assisted laparoscopic radical prostatectomy (DLP) at our institution. Methods: The data from 170 patients who underwent DLP between August 2002 and December 2004 by a single surgeon (MTG) were reviewed. Operative time, hemoglobin decrease, conversion to open procedure, positive margin rates, complications, length of stay (LOS), length of catheterization, continence, and erectile function were analyzed. Results: Hemoglobin decrease (p=0.11), positive margin rates (p=0.80), and early urinary continence (p=0.17) did not significantly correlate with surgical experience. A trend towards lower complications (p=0.07) and an earlier return of erectile function (p=0.09) was noted with increased experience with DLP. Operative time, hospital stay, catheterization time, and open conversion showed significant association with patient sequence. Median operative time for the first 60 and the last 110 patients was 323.5 and 239.5 minutes (p=<0.0001), respectively. Median LOS for the aforementioned groups was 53 and 51 hours (p=0.009). Length of catheterization declined significantly between the first 60 and the remaining 110 patients, 14 as compared to 11.5 days (p=<0.0001). Eight open conversions occurred, six were in the first 30 patients (p=0.03). Conclusion: As an indicator of the learning curve, the operative time in our series showed no correlation with sequence after the 60 th patient. Thus, despite the advantages of robotics, the learning curve to efficient performance of daVinciassisted laparoscopic radical prostatectomy is long. Oncological and functional outcomes should not be affected during the learning curve.

  13. DaVinci's Mona Lisa entering the next dimension.

    PubMed

    Carbon, Claus-Christian; Hesslinger, Vera M

    2013-01-01

    For several of Leonardo da Vinci's paintings, such as The Virgin and Child with St Anne or the Mona Lisa, there exist copies produced by his own studio. In case of the Mona Lisa, a quite exceptional, rediscovered studio copy was presented to the public in 2012 by the Prado Museum in Madrid. Not only does it mirror its famous counterpart superficially; it also features the very same corrections to the lower layers, which indicates that da Vinci and the 'copyist' must have elaborated their panels simultaneously. On the basis of subjective (thirty-two participants estimated painter-model constellations) as well as objective data (analysis of trajectories between landmarks of both paintings), we revealed that both versions differ slightly in perspective. We reconstructed the original studio setting and found evidence that the disparity between both paintings mimics human binocular disparity. This points to the possibility that the two Giocondas together might represent the first stereoscopic image in world history.

  14. Da Vinci's codex and the anatomy of healthcare.

    PubMed

    Stephens-Borg, Keith

    2012-08-01

    We usually display a laid-back approach to medical jargon throughout our theatre work. The word 'perioperative' is built from the Greek word 'peri' (around) and the Latin 'operari' (to work). Latin and Greek became the prefixed language of choice for Leonardo da Vinci, and his research was pivotal in determining the way in which surgical procedures are documented. Ancient manuscripts aided the unfolding of the secrets of anatomy, and Leonardo revealed that art was the key in expressive detailed explanation.

  15. Pictorial cues constrain depth in da Vinci stereopsis.

    PubMed

    Makino, Yoshinari; Yano, Masafumi

    2006-01-01

    "da Vinci stereopsis" is defined as depth seen in a monocular object occluded by a binocular one, and the visual system must solve its depth ambiguity [Nakayama, K., & Shimojo, S. (1990). da Vinci stereopsis: Depth and subjective occluding contours from unpaired image points. Vision Research, 30, 1811-1825]. Although fused images include various pictorial features, effects of pictorial depth cues have never been systematically investigated in da Vinci stereopsis. To examine this, we created stereograms consisting of a monocular bar flanked by binocular bars with a fixed large horizontal separation, in which the monocular bar induced a subjective occluding edge. Manipulating vertical size or contrast of the bars could affect the depth of the monocular bar. Conflicting these cues revealed that the effect of vertical size was stronger than that of contrast in all our subjects. Measurements of the depth indicated that the relative vertical size of the bars quantitatively determined the perceived depth, of which levels had large inter-subject differences. All these experiments indicate that the visual system can use the pictorial depth cues as a constraint to determine the depth of monocular elements.

  16. Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

    PubMed

    Jarc, Anthony M; Curet, Myriam

    2015-08-01

    Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation. New (N = 21) and experienced (N = 6) surgeons participated in the study. New surgeons (11 Gynecology [GYN] and 10 General Surgery [GEN]) had not completed any da Vinci Single-Site cases but may have completed multiport cases using the da Vinci system. They participated in this study prior to attending a certification course focused on da Vinci Single-Site instrumentation. Experienced surgeons (5 GYN and 1 GEN) had completed at least 25 da Vinci Single-Site cases. The surgeons completed four inanimate training exercises and then rated them with a questionnaire. Raw metrics and overall normalized scores were computed using both video recordings and kinematic data collected from the surgical system. The experienced surgeons significantly outperformed new surgeons for many raw metrics and the overall normalized scores derived from video review (p < 0.05). Only one exercise did not achieve a significant difference between new and experienced surgeons (p = 0.08) when calculating an overall normalized score using both video and advanced metrics derived from kinematic data. Both new and experienced surgeons rated the training exercises as appearing, to train and measure technical skills used during da Vinci Single-Site surgery and actually testing the technical skills used during da Vinci Single-Site surgery. In summary, the four training exercises showed face, content, and construct validity. Improved overall scores could be developed using additional metrics not included in this study. The results suggest that the training exercises could be used in an overall training curriculum aimed at developing proficiency in

  17. A Creative Approach to the Common Core Standards: The Da Vinci Curriculum

    ERIC Educational Resources Information Center

    Chaucer, Harry

    2012-01-01

    "A Creative Approach to the Common Core Standards: The Da Vinci Curriculum" challenges educators to design programs that boldly embrace the Common Core State Standards by imaginatively drawing from the genius of great men and women such as Leonardo da Vinci. A central figure in the High Renaissance, Leonardo made extraordinary contributions as a…

  18. A Proposal to Build Evaluation Capacity at the Bunche-Da Vinci Learning Partnership Academy

    ERIC Educational Resources Information Center

    King, Jean A.

    2005-01-01

    The author describes potential evaluation capacity-building activities in contrast to the specifics of an evaluation design. Her response to the case of the Bunche-Da Vinci Learning Partnership Academy is developed in three parts: (1) an initial framing of the Bunche-Da Vinci situation; (2) what should be done before signing a contract; and (3)…

  19. A Creative Approach to the Common Core Standards: The Da Vinci Curriculum

    ERIC Educational Resources Information Center

    Chaucer, Harry

    2012-01-01

    "A Creative Approach to the Common Core Standards: The Da Vinci Curriculum" challenges educators to design programs that boldly embrace the Common Core State Standards by imaginatively drawing from the genius of great men and women such as Leonardo da Vinci. A central figure in the High Renaissance, Leonardo made extraordinary contributions as a…

  20. Leonardo da Vinci and Kethem-Kiveris vena.

    PubMed

    Dolezal, Antonín; Skorepova-Honzlova, Zita; Jelen, Karel

    2012-01-01

    In the drawing of coitus by Leonardo da Vinci are pictured the contemporary hypotheses regarding this act. The authors analyze the mamillaruteral connection depicted by the artist and grow up to believe that this is a hypothetical kiveris vena, female vein described by Anatomist Master Nicolai Physicus from the Salerno School. The Hebrew roots were found in the name. The connection is described also by Mondino in The Anathomia. The same connection can be found in the picture of the pregnant woman in Fasciculus Medicinæ by Johannes De Ketham.

  1. LEONARDO DA VINCI AND THE ORIGIN OF SEMEN.

    PubMed

    Noble, Denis; DiFrancesco, Dario; Zancani, Diego

    2014-12-20

    It is well known that Leonardo da Vinci made several drawings of the human male anatomy. The early drawings (before 1500) were incorrect in identifying the origin of semen, where he followed accepted teaching of his time. It is widely thought that he did not correct this mistake, a view that is reflected in several biographies. In fact, he made a later drawing (after 1500) in which the description of the anatomy is remarkably accurate and must have been based on careful dissection. In addition to highlighting this fact, acknowledged previously in only one other source, this article reviews the background to Leonardo's knowledge of the relevant anatomy.

  2. Leonardo da Vinci and the origin of semen

    PubMed Central

    Noble, Denis; DiFrancesco, Dario; Zancani, Diego

    2014-01-01

    It is well known that Leonardo da Vinci made several drawings of the human male anatomy. The early drawings (before 1500) were incorrect in identifying the origin of semen, where he followed accepted teaching of his time. It is widely thought that he did not correct this mistake, a view that is reflected in several biographies. In fact, he made a later drawing (after 1500) in which the description of the anatomy is remarkably accurate and must have been based on careful dissection. In addition to highlighting this fact, acknowledged previously in only one other source, this article reviews the background to Leonardo's knowledge of the relevant anatomy. PMID:27494016

  3. Instrument Failures for the da Vinci Surgical System: a Food and Drug Administration MAUDE Database Study.

    PubMed

    Friedman, Diana C W; Lendvay, Thomas S; Hannaford, Blake

    2013-05-01

    Our goal was to analyze reported instances of the da Vinci robotic surgical system instrument failures using the FDA's MAUDE (Manufacturer and User Facility Device Experience) database. From these data we identified some root causes of failures as well as trends that may assist surgeons and users of the robotic technology. We conducted a survey of the MAUDE database and tallied robotic instrument failures that occurred between January 2009 and December 2010. We categorized failures into five main groups (cautery, shaft, wrist or tool tip, cable, and control housing) based on technical differences in instrument design and function. A total of 565 instrument failures were documented through 528 reports. The majority of failures (285) were of the instrument's wrist or tool tip. Cautery problems comprised 174 failures, 76 were shaft failures, 29 were cable failures, and 7 were control housing failures. Of the reports, 10 had no discernible failure mode and 49 exhibited multiple failures. The data show that a number of robotic instrument failures occurred in a short period of time. In reality, many instrument failures may go unreported, thus a true failure rate cannot be determined from these data. However, education of hospital administrators, operating room staff, surgeons, and patients should be incorporated into discussions regarding the introduction and utilization of robotic technology. We recommend institutions incorporate standard failure reporting policies so that the community of robotic surgery companies and surgeons can improve on existing technologies for optimal patient safety and outcomes.

  4. Leonardo Da Vinci and stroke - vegetarian diet as a possible cause.

    PubMed

    Oztürk, Serefnur; Altieri, Marta; Troisi, Pina

    2010-01-01

    Leonardo da Vinci (April 15, 1452 to May 2, 1519) was an Italian Renaissance architect, musician, anatomist, inventor, engineer, sculptor, geometer, and painter. It has been gleaned from the many available historical documents that da Vinci was a vegetarian who respected and loved animals, and that he suffered from right hemiparesis in the last 5 years of his life. A vegetarian diet has both positive and negative influences on the cerebrovascular system. In this report, a possible relation between a vegetarian diet and stroke is discussed from various perspectives as related to Leonardo da Vinci's stroke. Copyright (c) 2010 S. Karger AG, Basel.

  5. Xanthelasma and lipoma in Leonardo da Vinci's Mona Lisa.

    PubMed

    Dequeker, Jan; Muls, Erik; Leenders, Kathleen

    2004-08-01

    The painting Mona Lisa in the Louvre, Paris, by Leonardo da Vinci (1503-1506), shows skin alterations at the inner end of the left upper eyelid similar to xanthelasma, and a swelling of the dorsum of the right hand suggestive of a subcutaneous lipoma. These findings in a 25-30 year old woman, who died at the age of 37, may be indicative of essential hyperlipidemia, a strong risk factor for ischemic heart disease in middle age. As far as is known, this portrait of Mona Lisa painted in 1506 is the first evidence that xanthelasma and lipoma were prevalent in the sixteenth century, long before the first description by Addison and Gall in 1851.

  6. Leonardo da Vinci: the search for the soul.

    PubMed

    Del Maestro, R F

    1998-11-01

    The human race has always contemplated the question of the anatomical location of the soul. During the Renaissance the controversy crystallized into those individuals who supported the heart ("cardiocentric soul") and others who supported the brain ("cephalocentric soul") as the abode for this elusive entity. Leonardo da Vinci (1452-1519) joined a long list of other explorers in the "search for the soul." The method he used to resolve this anatomical problem involved the accumulation of information from ancient and contemporary sources, careful notetaking, discussions with acknowledged experts, and his own personal search for the truth. Leonardo used a myriad of innovative methods acquired from his knowledge of painting, sculpture, and architecture to define more clearly the site of the "senso comune"--the soul. In this review the author examines the sources of this ancient question, the knowledge base tapped by Leonardo for his personal search for the soul, and the views of key individuals who followed him.

  7. [Regarding the Manuscript D " Dell' occhio " of Leonardo da Vinci].

    PubMed

    Heitz, Robert F

    2009-01-01

    Leonardo da Vinci's Manuscript D consists of five double pages sheets, which, folded in two, comprise ten folios. This document, in the old Tuscan dialect and mirror writing, reveals the ideas of Leonardo on the anatomy of the eye in relation to the formation of images and visual perception. Leonardo explains in particular the behavior of the rays in the eye in terms of refraction and reflection, and is very mechanistic in his conception of the eye and of the visual process. The most significant innovations found in these folios are the concept of the eye as a camera obscura and the intersection of light rays in the interior of the eye. His texts nevertheless show hesitation, doubts and a troubled confusion, reflecting the ideas and uncertainties of his era. He did not share his results in his lifetime, despite both printing and etching being readily available to him.

  8. Sine ars scientia nihil est: Leonardo da Vinci and beyond.

    PubMed

    Kickhöfel, Eduardo H P

    2009-01-01

    The aim of this article is to reflect on the relationship between art and science so far as it concerns a symposium on neurosciences. We undertake a historical overview of that relationship, paying particular attention to the sui generis case of Leonardo da Vinci, who very often is regarded as the man who worked on art and science with equal ease. We then explain why his idea of merging these two forms of knowledge failed, considering the clear-cut distinction between art and science in his time. With this clarification, we explore the matter today. We look at Raphael's The Transfiguration, in which the representation of the possessed boy is seen by neuroscientists as indicative of an epileptic seizure. We also look at the ideas of neuroscientists Semir Zeki and Vilayanur Ramachandran, who study particular aspects of brain function and suggest a new merging of art and science.

  9. A review of training research and virtual reality simulators for the da Vinci surgical system.

    PubMed

    Liu, May; Curet, Myriam

    2015-01-01

    PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.

  10. The influence of ancient Greek thought on fifteenth century anatomy: Galenic influence and Leonardo da Vinci.

    PubMed

    Tubbs, Richard Isaiah; Gonzales, Jocelyn; Iwanaga, Joe; Loukas, Marios; Oskouian, Rod J; Tubbs, R Shane

    2017-05-29

    Leonardo da Vinci (1452-1519) can be called one of the earliest contributors to the history of anatomy and, by extension, the study of medicine. He may have even overshadowed Andreas Vesalius (1514-1564), the so-called founder of human anatomy, if his works had been published within his lifetime. While some of the best illustrations of their time, with our modern knowledge of anatomy, it is clear that many of da Vinci's depictions of human anatomy are inaccurate. However, he also made significant discoveries in anatomy and remarkable predictions of facts he could not yet discover with the technology available to him. Additionally, da Vinci was largely influenced by Greek anatomists, as indicated from his ideas about anatomical structure. In this historical review, we describe da Vinci's history, influences, and discoveries in anatomical research and his depictions and errors with regards to the musculoskeletal system, cardiovascular system, nervous system, and other organs.

  11. Thinking like Leonardo da Vinci and its implications for the modern doctor.

    PubMed

    Baum, Neil

    2013-01-01

    Most people when asked to name the most creative, innovative, and multidimensional people in history would agree that Leonardo da Vinci is either at the top or very close to the number one position on that list. Wouldn't it be nice to think like da Vinci? This article shares the seven unique principles of thinking that da Vinci used that enabled him to be the greatest painter, sculptor, architect, musician, mathematician, engineer, inventor, anatomist, geologist, cartographer, botanist, and writer of his (if not of all) time. This article will take you deep into the notebooks and codices of da Vinci, and suggest ways his ideas can be used by anyone in the healthcare profession to make them a better healthcare provider.

  12. Leonardo da Vinci: engineer, bioengineer, anatomist, and artist.

    PubMed

    West, John B

    2017-03-01

    Leonardo da Vinci (1452-1519) enjoys a reputation as one of the most talented people of all time in the history of science and the arts. However, little attention has been given to his contributions to physiology. One of his main interests was engineering, and he was fascinated by structural problems and the flow patterns of liquids. He also produced a large number of ingenious designs for warfare and a variety of highly original flying machines. But of particular interest to us are his contributions to bioengineering and how he used his knowledge of basic physical principles to throw light on physiological function. For example, he produced new insights into the mechanics of breathing including the action of the ribs and diaphragm. He was the first person to understand the different roles of the internal and external intercostal muscles. He had novel ideas about the airways including the mode of airflow in them. He also worked on the cardiovascular system and had a special interest in the pulmonary circulation. But, interestingly, he was not able to completely divorce his views from those of Galen, in that although he could not see pores in the interventricular septum of the heart, one of his drawings included them. Leonardo was a talented anatomist who made many striking drawings of the human body. Finally, his reputation for many people is based on his paintings including the Mona Lisa that apparently attracts more viewers than any other painting in the world.

  13. [Project Leonardo-da-Vinci for better nursing care].

    PubMed

    Gábor, Katalin; Csanádi, Lajosné; Helembai, Kornélia; Szögi, Zoltánné; Tulkán, Ibolya; Unginé, Kántor Katalin

    2002-08-18

    The aim of the present paper is to inform physicians about the work completed by nurses and professors of baccalaureat nurses in the framework of Leonardo da Vinci project, organised and sponsored by the European Union. The goal of the project was to increase the effectiveness of chief nurses throughout their further training programme in the field of management. The team of Szeged chose the human resource management, since in this field is possible to achieve the greatest improvement with the smallest financial investment. We measured the fluctuations and the absentees of the nurses, the changes in the degree of education, the nurse' and patient' satisfaction at the beginning and at the end of the period studied. Except the patient's satisfaction all the other parameters improved by the end of tested period. The project provided a unique possibility to compare the state of the Hungarian nursing with that of the countries belonging to the European Union, to exchange the experience and to learn some new methods. In the framework of this project a book of two volumes was prepared containing the suggestions of EU. This book is widely available in English and in French.

  14. Color constrains depth in da Vinci stereopsis for camouflage but not occlusion.

    PubMed

    Wardle, Susan G; Gillam, Barbara J

    2013-12-01

    Monocular regions that occur with binocular viewing of natural scenes can produce a strong perception of depth--"da Vinci stereopsis." They occur either when part of the background is occluded in one eye, or when a nearer object is camouflaged against a background surface in one eye's view. There has been some controversy over whether da Vinci depth is constrained by geometric or ecological factors. Here we show that the color of the monocular region constrains the depth perceived from camouflage, but not occlusion, as predicted by ecological considerations. Quantitative depth was found in both cases, but for camouflage only when the color of the monocular region matched the binocular background. Unlike previous reports, depth failed even when nonmatching colors satisfied conditions for perceptual transparency. We show that placing a colored line at the boundary between the binocular and monocular regions is sufficient to eliminate depth from camouflage. When both the background and the monocular region contained vertical contours that could be fused, some observers appeared to use fusion, and others da Vinci constraints, supporting the existence of a separate da Vinci mechanism. The results show that da Vinci stereopsis incorporates color constraints and is more complex than previously assumed.

  15. Leonardo da Vinci and the first hemodynamic observations.

    PubMed

    Martins e Silva, J

    2008-02-01

    Leonardo da Vinci was a genius whose accomplishments and ideas come down to us today, five centuries later, with the freshness of innovation and the fascination of discovery. This brief review begins with a summary of Leonardo's life and a description of the most important works of art that he bequeathed us, and then concentrates on his last great challenge. There was a point at which Leonardo's passion for art gave way to the study of human anatomy, not only to improve his drawing but to go beyond what had been simply a representation of form to understand the underlying functioning. Among his many interests, we focus on his study of the heart and blood vessels, which he observed carefully in animals and human autopsies, and reproduced in drawings of great quality with annotations of astonishing acuteness. The experience that he had acquired from observing the flow of water in currents and around obstacles, and the conclusions that he drew concerning hydrodynamics, were central to his interpretation of the mechanisms of the heart and of blood flow, to which he devoted much of his time between 1508 and 1513. From these studies, immortalized in drawings of great clarity, come what are acknowledged to be the first hemodynamic records, in which Leonardo demonstrates the characteristics of blood flow in the aorta and great vessels and the importance of blood reflux and the formation of eddies in the sinus in aortic valve his assiduous and careful observations, and his subsequent deductions, Leonardo put forward detailed findings on hemodynamic questions that advanced technology has only recently enabled us to confirm.

  16. Leonardo da Vinci, One Year on...a Different Look at Vocational Training in Europe.

    ERIC Educational Resources Information Center

    Le Magazine, 1996

    1996-01-01

    Discusses the success of the Leonardo da Vinci program, a European laboratory of innovation in vocational training, a priority focus of investment in human resources and intelligence, and a way to mobilize innovative forces beyond national boundaries. Trends identified by the program focus on new information and communication technologies. (JOW)

  17. Transparency of Vocational Qualifications: The Leonardo da Vinci Approach. CEDEFOP Panorama Series.

    ERIC Educational Resources Information Center

    Bjornavold, Jens; Pettersson, Sten

    This report gives an overview of the situation of transparency of vocational qualifications by presenting measures introduced at the European Community level and by drawing attention to projects within the Leonardo da Vinci Program dealing with the issue. A 16-page executive summary appears first. Chapter 1 provides general background and aims.…

  18. Leonardo da Vinci, One Year on...a Different Look at Vocational Training in Europe.

    ERIC Educational Resources Information Center

    Le Magazine, 1996

    1996-01-01

    Discusses the success of the Leonardo da Vinci program, a European laboratory of innovation in vocational training, a priority focus of investment in human resources and intelligence, and a way to mobilize innovative forces beyond national boundaries. Trends identified by the program focus on new information and communication technologies. (JOW)

  19. Solving da Vinci stereopsis with depth-edge-selective V2 cells

    PubMed Central

    Assee, Andrew; Qian, Ning

    2007-01-01

    We propose a new model for da Vinci stereopsis based on a coarse-to-fine disparity-energy computation in V1 and disparity-boundary-selective units in V2. Unlike previous work, our model contains only binocular cells, relies on distributed representations of disparity, and has a simple V1-to-V2 feedforward structure. We demonstrate with random dot stereograms that the V2 stage of our model is able to determine the location and the eye-of-origin of monocularly occluded regions and improve disparity map computation. We also examine a few related issues. First, we argue that since monocular regions are binocularly defined, they cannot generally be detected by monocular cells. Second, we show that our coarse-to-fine V1 model for conventional stereopsis explains double matching in Panum’s limiting case. This provides computational support to the notion that the perceived depth of a monocular bar next to a binocular rectangle may not be da Vinci stereopsis per se (Gillam et al., 2003). Third, we demonstrate that some stimuli previously deemed invalid have simple, valid geometric interpretations. Our work suggests that studies of da Vinci stereopsis should focus on stimuli more general than the bar-and-rectangle type and that disparity-boundary-selective V2 cells may provide a simple physiological mechanism for da Vinci stereopsis. PMID:17698163

  20. Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery.

    PubMed

    Al Kadah, Basel; Piccoli, Micaela; Mullineris, Barbara; Colli, Giovanni; Janssen, Martin; Siemer, Stephan; Schick, Bernhard

    2015-03-01

    Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be

  1. Visual degradation in Leonardo da Vinci's iconic self-portrait: A nanoscale study

    NASA Astrophysics Data System (ADS)

    Conte, A. Mosca; Pulci, O.; Misiti, M. C.; Lojewska, J.; Teodonio, L.; Violante, C.; Missori, M.

    2014-06-01

    The discoloration of ancient paper, due to the development of oxidized groups acting as chromophores in its chief component, cellulose, is responsible for severe visual degradation in ancient artifacts. By adopting a non-destructive approach based on the combination of optical reflectance measurements and time-dependent density functional theory ab-initio calculations, we describe and quantify the chromophores affecting Leonardo da Vinci's iconic self-portrait. Their relative concentrations are very similar to those measured in modern and ancient samples aged in humid environments. This analysis quantifies the present level of optical degradation of the Leonardo da Vinci's self-portrait which, compared with future measurements, will assess its degradation rate. This is a fundamental information in order to plan appropriate conservation strategies.

  2. The Handedness of Leonardo da Vinci: A Tale of the Complexities of Lateralisation

    ERIC Educational Resources Information Center

    McManus, I. C.; Drury, Helena

    2004-01-01

    The handedness of Leonardo da Vinci is controversial. Although there is little doubt that many of his well-attributed drawings were drawn with the left hand, the hatch marks of the shading going downwards from left to right, it is not clear that he was a natural left-hander, there being some suggestion that he may have become left-handed as the…

  3. The Handedness of Leonardo da Vinci: A Tale of the Complexities of Lateralisation

    ERIC Educational Resources Information Center

    McManus, I. C.; Drury, Helena

    2004-01-01

    The handedness of Leonardo da Vinci is controversial. Although there is little doubt that many of his well-attributed drawings were drawn with the left hand, the hatch marks of the shading going downwards from left to right, it is not clear that he was a natural left-hander, there being some suggestion that he may have become left-handed as the…

  4. Solving da Vinci stereopsis with depth-edge-selective V2 cells.

    PubMed

    Assee, Andrew; Qian, Ning

    2007-09-01

    We propose a new model for da Vinci stereopsis based on a coarse-to-fine disparity energy computation in V1 and disparity-boundary-selective units in V2. Unlike previous work, our model contains only binocular cells, relies on distributed representations of disparity, and has a simple V1-to-V2 feedforward structure. We demonstrate with random-dot stereograms that the V2 stage of our model is able to determine the location and the eye-of-origin of monocularly occluded regions, and improve disparity map computation. We also examine a few related issues. First, we argue that since monocular regions are binocularly defined, they cannot generally be detected by monocular cells. Second, we show that our coarse-to-fine V1 model for conventional stereopsis explains double matching in Panum's limiting case. This provides computational support to the notion that the perceived depth of a monocular bar next to a binocular rectangle may not be da Vinci stereopsis per se [Gillam, B., Cook, M., & Blackburn, S. (2003). Monocular discs in the occlusion zones of binocular surfaces do not have quantitative depth--a comparison with Panum's limiting case. Perception 32, 1009-1019.]. Third, we demonstrate that some stimuli previously deemed invalid have simple, valid geometric interpretations. Our work suggests that studies of da Vinci stereopsis should focus on stimuli more general than the bar-and-rectangle type and that disparity-boundary-selective V2 cells may provide a simple physiological mechanism for da Vinci stereopsis.

  5. Multidisciplinary validation study of the da Vinci Skills Simulator: educational tool and assessment device.

    PubMed

    Foell, Kirsten; Furse, Alexander; Honey, R John D'A; Pace, Kenneth T; Lee, Jason Y

    2013-12-01

    Despite the increased dexterity and precision of robotic surgery, like any new surgical technology it is still associated with a learning curve that can impact patient outcomes. The use of surgical simulators outside of the operating room, in a low-stakes environment, has been shown to shorten such learning curves. We present a multidisciplinary validation study of a robotic surgery simulator, the da Vinci(®) Skills Simulator (dVSS). Trainees and attending faculty from the University of Toronto, Departments of Surgery and Obstetrics and Gynecology (ObGyn), were recruited to participate in this validation study. All participants completed seven different exercises on the dVSS (Camera Targeting 1, Peg Board 1, Peg Board 2, Ring Walk 2, Match Board 1, Thread the Rings, Suture Sponge 1) and, using the da Vinci S Robot (dVR), completed two standardized skill tasks (Ring Transfer, Needle Passing). Participants were categorized as novice robotic surgeon (NRS) and experienced robotic surgeon (ERS) based on the number of robotic cases performed. Statistical analysis was conducted using independent T test and non-parametric Spearman's correlation. A total of 53 participants were included in the study: 27 urology, 13 ObGyn, and 13 thoracic surgery (Table 1). Most participants (89 %) either had no prior console experience or had performed <10 robotic cases, while one (2 %) had performed 10-20 cases and five (9 %) had performed ≥20 robotic surgeries. The dVSS demonstrated excellent face and content validity and 97 and 86 % of participants agreed that it was useful for residency training and post-graduate training, respectively. The dVSS also demonstrated construct validity, with NRS performing significantly worse than ERS on most exercises with respect to overall score, time to completion, economy of motion, and errors (Table 2). Excellent concurrent validity was also demonstrated as dVSS scores for most exercises correlated with performance of the two standardized

  6. Development of a Classification Scheme for Examining Adverse Events Associated with Medical Devices, Specifically the DaVinci Surgical System as Reported in the FDA MAUDE Database.

    PubMed

    Gupta, Priyanka; Schomburg, John; Krishna, Suprita; Adejoro, Oluwakayode; Wang, Qi; Marsh, Benjamin; Nguyen, Andrew; Genere, Juan Reyes; Self, Patrick; Lund, Erik; Konety, Badrinath R

    2017-01-01

    To examine the Manufacturer and User Facility Device Experience Database (MAUDE) database to capture adverse events experienced with the Da Vinci Surgical System. In addition, to design a standardized classification system to categorize the complications and machine failures associated with the device. Overall, 1,057,000 DaVinci procedures were performed in the United States between 2009 and 2012. Currently, no system exists for classifying and comparing device-related errors and complications with which to evaluate adverse events associated with the Da Vinci Surgical System. The MAUDE database was queried for events reports related to the DaVinci Surgical System between the years 2009 and 2012. A classification system was developed and tested among 14 robotic surgeons to associate a level of severity with each event and its relationship to the DaVinci Surgical System. Events were then classified according to this system and examined by using Chi-square analysis. Two thousand eight hundred thirty-seven events were identified, of which 34% were obstetrics and gynecology (Ob/Gyn); 19%, urology; 11%, other; and 36%, not specified. Our classification system had moderate agreement with a Kappa score of 0.52. Using our classification system, we identified 75% of the events as mild, 18% as moderate, 4% as severe, and 3% as life threatening or resulting in death. Seventy-seven percent were classified as definitely related to the device, 15% as possibly related, and 8% as not related. Urology procedures compared with Ob/Gyn were associated with more severe events (38% vs 26%, p < 0.0001). Energy instruments were associated with less severe events compared with the surgical system (8% vs 87%, p < 0.0001). Events that were definitely associated with the device tended to be less severe (81% vs 19%, p < 0.0001). Our classification system is a valid tool with moderate inter-rater agreement that can be used to better understand device-related adverse events. The

  7. [The Vitruvian Man: an anatomical drawing for proportions by Leonardo Da Vinci].

    PubMed

    Le Floch-Prigent, P

    2008-12-01

    The aim of the study was to find out and to analyse the text by Vitruvius which inspired the famous drawing by Leonardo da Vinci (circa 1490) kept in the Galleria dell'Accademia, in Venezia, Italy: the man inscribed in one circle and in one square. The book "de Architectura" by Vitruvius Marcus Pollio was printed several times since the Renaissance when both the roman architecture of antiquity and this text became very popular. From a French translation by Claude Perrault in 1864, it became easy to find a French translation with the original text in Latin (Paris, 2003, Les Belles Lettres, French text by Pierre Gros). The drawing by Leonardo da Vinci illustrates with great accuracy and fidelity the quotation of Vitruvius (with the exception of two of the 12 main relationships). The genius of Leonardo da Vinci was to keep only one trunk, head and neck for two pairs of limbs: scapular and pelvic; to make the circle tangent to the lower edge of the square; to adjust a few features of the quotation for the equilibrium of the whole figure; and of course to bring his incredible skill as a drawer (one of the best of his century). The drawing was made on a sheet of paper 344x245mm, in black ink which became dark brown with time; several lines complete the figure above and below; a short caption and a horizontal scale appear just under the drawing. The celebrity of the drawing, a symbol of the Renaissance, of the equilibrium of man and mankind, of the universality of the artists and intellectuals of the time (Humanism) made it iconic and it has been constantly reproduced and adapted especially for advertisement and logos, not only in the medical field.

  8. OCT structural examination of Madonna dei Fusi by Leonardo da Vinci

    NASA Astrophysics Data System (ADS)

    Targowski, Piotr; Iwanicka, Magdalena; Sylwestrzak, Marcin; Kaszewska, Ewa A.; Frosinini, Cecilia

    2013-05-01

    Madonna dei Fusi (`Madonna of the Yarnwider') is a spectacular example of Italian Renaissance painting, attributed to Leonardo da Vinci. The aim of this study is to give an account of past restoration procedures. The evidence of a former retouching campaign will be presented with cross-sectional images obtained non-invasively with Optical Coherence Tomography (OCT). Specifically, the locations of overpaintings/retouchings with respect to the original paint layer and secondary varnishes will be given. Additionally, the evidence of a former transfer of the pictorial layer to the new canvas support by detecting the presence of its structure incised into paint layer will be shown.

  9. [The anatomy of a reduced skull model--visualisation of Leonardo da Vinci's anthropology].

    PubMed

    Ahner, E

    2008-04-02

    The article focuses on a rare example of a miniature skull of unknown origin. The profoundness of the anatomical details, conjoint with outstanding virtuosity, reminds of Leonardo da Vinci's anatomical skull studies and asks for additional interpretation beside the emblematic "memento mori"-character. Following the miscellaneous topics of his skull studies an anatomical-anthropological interpretation is proposed. For such a project the mergence of anthropology, history of medicine and history of art was mandatory. Concerning some discrepancies within the anatomical realism, the depiction of a pathology is discussed and beyond the visualisation of a historic concept of brain function.

  10. The Da Vinci European BioBank: A Metabolomics-Driven Infrastructure

    PubMed Central

    Carotenuto, Dario; Luchinat, Claudio; Marcon, Giordana; Rosato, Antonio; Turano, Paola

    2015-01-01

    We present here the organization of the recently-constituted da Vinci European BioBank (daVEB, https://www.davincieuropeanbiobank.org/it). The biobank was created as an infrastructure to support the activities of the Fiorgen Foundation (http://www.fiorgen.net/), a nonprofit organization that promotes research in the field of pharmacogenomics and personalized medicine. The way operating procedures concerning samples and data have been developed at daVEB largely stems from the strong metabolomics connotation of Fiorgen and from the involvement of the scientific collaborators of the foundation in international/European projects aimed to tackle the standardization of pre-analytical procedures and the promotion of data standards in metabolomics. PMID:25913579

  11. The uncatchable smile in Leonardo da Vinci's La Bella Principessa portrait.

    PubMed

    Soranzo, Alessandro; Newberry, Michelle

    2015-08-01

    A portrait of uncertain origin recently came to light which, after extensive research and examination, was shown to be that rarest of things: a newly discovered Leonardo da Vinci painting entitled La Bella Principessa. This research presents a new illusion which is similar to that identified in the Mona Lisa; La Bella Principessa's mouth appears to change slant depending on both the Viewing Distance and the Level of Blur applied to a digital version of the portrait. Through a series of psychophysics experiments, it was found that a perceived change in the slant of the La Bella Principessa's mouth influences her expression of contentment thus generating an illusion that we have coined the "uncatchable smile". The elusive quality of the Mona Lisa's smile has been previously reported (Science, 290 (2000) 1299) and so the existence of a similar illusion in a portrait painted prior to the Mona Lisa becomes more interesting. The question remains whether Leonardo da Vinci intended this illusion. In any case, it can be argued that the ambiguity created adds to the portrait's allure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Leonardo da Vinci and Andreas Vesalius; the shoulder girdle and the spine, a comparison.

    PubMed

    Ganseman, Y; Broos, P

    2008-01-01

    Leonardo Da Vinci and Andreas Vesalius were two important renaissance persons; Vesalius was a surgeon-anatomist who delivered innovative work on the study of the human body, Leonardo da Vinci was an artist who delivered strikingly accurate and beautiful drawings on the human body. Below we compare both masters with regard to their knowledge of the working of the muscles, their method and system of dissection and their system and presentation of the drawings. The investigation consisted of a comparison between both anatomists, in particular concerning their study on the shoulder girdle and spine, by reviewing their original work as well as already existing literature on this subject. The investigation led to the conclusion that the drawings mentioned meant a change in history, and were of high quality, centuries ahead of their time. Both were anatomists, both were revolutionary, only one changed history at the moment itself, while the other changed history centuries later. Leonardo has made beautiful drawings that are at a match with the drawings of today or are even better. Vesalius set the start for medicine as a science as it is until this day. Their lives differed as strongly as their impact. In the light of their time, the achievement they made was extraordinary.

  13. Educating in the Design and Construction of Built Environments Accessible to Disabled People: The Leonardo da Vinci AWARD Project

    ERIC Educational Resources Information Center

    Frattari, Antonio; Dalpra, Michela; Bernardi, Fabio

    2013-01-01

    An interdisciplinary partnership within an European Leonardo da Vinci project has developed a new approach aimed at educating secondary school students in the creation of built environments accessible to disabled people and at sensitizing them towards the inclusion of people with disabilities in all realms of social life. The AWARD (Accessible…

  14. Virtual Mobility in Reality: A Study of the Use of ICT in Finnish Leonardo da Vinci Mobility Projects.

    ERIC Educational Resources Information Center

    Valjus, Sonja

    An e-mail survey and interviews collected data on use of information and communications technology (ICT) in Finnish Leonardo da Vinci mobility projects from 2000-02. Findings showed that the most common ICT tools used were e-mail, digital tools, and the World Wide Web; ICT was used during all project phases; the most common problems concerned…

  15. Educating in the Design and Construction of Built Environments Accessible to Disabled People: The Leonardo da Vinci AWARD Project

    ERIC Educational Resources Information Center

    Frattari, Antonio; Dalpra, Michela; Bernardi, Fabio

    2013-01-01

    An interdisciplinary partnership within an European Leonardo da Vinci project has developed a new approach aimed at educating secondary school students in the creation of built environments accessible to disabled people and at sensitizing them towards the inclusion of people with disabilities in all realms of social life. The AWARD (Accessible…

  16. Sentinel Node Mapping Using Indocyanine Green and Near-infrared Fluorescence Imaging Technology for Uterine Malignancies: Preliminary Experience With the Da Vinci Xi System.

    PubMed

    Siesto, Gabriele; Romano, Fabrizio; Fiamengo, Barbara; Vitobello, Domenico

    2016-01-01

    Sentinel lymph node (SLN) mapping has emerged as the new frontier for the surgical staging of apparently early-stage cervical and endometrial cancer. Different colorimetric and radioactive tracers, alone and in combination, have been proposed with encouraging results. Fluorometric mapping using indocyanine green (ICG) appears to be a suitable and attractive alternative to provide reliable staging [1-4]. In this video, we present the technique of SLN mapping in 2 cases (1 endometrial and 1 cervical cancer, respectively) using ICG and the near-infrared technology provided by the newest Da Vinci Xi robotic system (Intuitive Surgical Inc., Sunnyvale, CA). Together we report the results of our preliminary experience on the first 20 cases performed. The new robotic Da Vinci Xi system was available at our institution since May 2015. Upon institutional review board/ethical committee approval, all consecutive patients with early-stage endometrial and cervical cancer who were judged suitable for robotic surgery have been enrolled for SLN mapping with ICG. We adopted the Memorial Sloan Kettering Cancer Center SLN algorithm; the tracer was delivered into the cervix in all cases. Four milliliters (1.25 mg/mL) of ICG was injected divided into the 3- and 9-o'clock positions of the cervix alone, with 1 mL deep into the stroma and 1 mL submucosally at the skin incision. Sentinel lymph nodes were examined with a protocol including both ultrastaging with immunohistochemistry [3] and 1-step nucleic acid amplification assay [5,6] under a parallel protocol of study. During the study period, 20 cases were managed; 14 and 6 patients had endometrial and cervical cancer, respectively. SLN was detected in all cases (20/20, 100%). Bilateral SLNs were detected in 17 of 20 (85.0%) cases. Based on preoperative and intraoperative findings, 13 (65.0%) patients received systematic pelvic lymphadenectomy after SLN mapping. Three (15.0%) patients had microscopic nodal metastases on SLN. No

  17. Depth of monocular elements in a binocular scene: the conditions for da Vinci stereopsis.

    PubMed

    Cook, Michael; Gillam, Barbara

    2004-02-01

    Quantitative depth based on binocular resolution of visibility constraints is demonstrated in a novel stereogram representing an object, visible to 1 eye only, and seen through an aperture or camouflaged against a background. The monocular region in the display is attached to the binocular region, so that the stereogram represents an object which is only partially visible to the eye that sees it. The results show that this feature is necessary for quantitative depth, which is not found for a fully visible monocular object in the same location, and that depth in these displays, although very precise, is not based on fusional Stereopsis. The findings provide clear support for the existence of a process of da Vinci Stereopsis, but one more sophisticated than the one proposed by K. Nakayama and S. Shimojo (1990). ((c) 2004 APA, all rights reserved)

  18. Bell's palsy: the answer to the riddle of Leonardo da Vinci's 'Mona Lisa'.

    PubMed

    Maloney, W J

    2011-05-01

    The smile of the famed portrait 'The Mona Lisa' has perplexed both art historians and researchers for the past 500 years. There has been a multitude of theories expounded to explain the nature of the model's enigmatic smile. The origin of the model's wry smile can be demonstrated through a careful analysis of both documented facts concerning the portrait--some gathered only recently through the use of modern technology--and a knowledge of the clinical presentation of Bell's palsy. Bell's palsy is more prevalent in women who are either pregnant or who have recently given birth. This paper postulates that the smile of the portrait's model was due to Leonardo da Vinci's anatomically precise representation of a new mother affected by Bell's palsy subsequent to her recent pregnancy.

  19. Urodynamics in the anatomical work of Leonardo da Vinci (1452-1519).

    PubMed

    Schultheiss, D; Grünewald, V; Jonas, U

    1999-06-01

    Leonardo da Vinci (1452-1519) incorporates the symbiosis of art and medicine and can be addressed as the founder of medical illustration in the time of the Renaissance. His anatomy studies were not published in his time, which explains why Leonardo's outstanding knowledge of anatomy, physiology, and medicine had no impact on his scientific contemporaries and is therefore primarily of retrospective importance in the history of medicine. The collection of anatomical illustrations remained unknown until their rediscovery in the eighteenth century and their wide publication at the beginning of our century. This article systematically reviews Leonardo's genitourinary drawings with regard to urodynamic aspects of the upper and lower urinary tract, highlighting topics such as vesicoureteral reflux and urinary sphincter mechanisms.

  20. Microbiological Analysis of Surfaces of Leonardo Da Vinci's Atlantic Codex: Biodeterioration Risk

    PubMed Central

    Moroni, Catia; Pasquariello, Giovanna; Maggi, Oriana

    2014-01-01

    Following the discovery of discoloration on some pages of the Atlantic Codex (AC) of Leonardo da Vinci kept in the Biblioteca Ambrosiana in Milan, some investigations have been carried out to verify the presence of microorganisms, such as bacteria and fungi. To verify the presence of microorganisms a noninvasive method of sampling has been used that was efficient and allowed us to highlight the microbial facies of the material that was examined using conventional microbiological techniques. The microclimatic conditions in the storage room as well as the water content of the volume were also assessed. The combined observations allowed the conclusion that the discoloration of suspected biological origin on some pages of AC is not related to the presence or current attack of microbial agents. PMID:25574171

  1. Microbiological Analysis of Surfaces of Leonardo Da Vinci's Atlantic Codex: Biodeterioration Risk.

    PubMed

    Tarsitani, Gianfranco; Moroni, Catia; Cappitelli, Francesca; Pasquariello, Giovanna; Maggi, Oriana

    2014-01-01

    Following the discovery of discoloration on some pages of the Atlantic Codex (AC) of Leonardo da Vinci kept in the Biblioteca Ambrosiana in Milan, some investigations have been carried out to verify the presence of microorganisms, such as bacteria and fungi. To verify the presence of microorganisms a noninvasive method of sampling has been used that was efficient and allowed us to highlight the microbial facies of the material that was examined using conventional microbiological techniques. The microclimatic conditions in the storage room as well as the water content of the volume were also assessed. The combined observations allowed the conclusion that the discoloration of suspected biological origin on some pages of AC is not related to the presence or current attack of microbial agents.

  2. A laminar cortical model of stereopsis and 3D surface perception: closure and da Vinci stereopsis.

    PubMed

    Cao, Yongqiang; Grossberg, Stephen

    2005-01-01

    A laminar cortical model of stereopsis and 3D surface perception is developed and simulated. The model describes how monocular and binocular oriented filtering interact with later stages of 3D boundary formation and surface filling-in in the LGN and cortical areas V1, V2, and V4. It proposes how interactions between layers 4, 3B, and 2/3 in V1 and V2 contribute to stereopsis, and how binocular and monocular information combine to form 3D boundary and surface representations. The model includes two main new developments: (1) It clarifies how surface-to-boundary feedback from V2 thin stripes to pale stripes helps to explain data about stereopsis. This feedback has previously been used to explain data about 3D figure-ground perception. (2) It proposes that the binocular false match problem is subsumed under the Gestalt grouping problem. In particular, the disparity filter, which helps to solve the correspondence problem by eliminating false matches, is realized using inhibitory interneurons as part of the perceptual grouping process by horizontal connections in layer 2/3 of cortical area V2. The enhanced model explains all the psychophysical data previously simulated by Grossberg and Howe (2003), such as contrast variations of dichoptic masking and the correspondence problem, the effect of interocular contrast differences on stereoacuity, Panum's limiting case, the Venetian blind illusion, stereopsis with polarity-reversed stereograms, and da Vinci stereopsis. It also explains psychophysical data about perceptual closure and variations of da Vinci stereopsis that previous models cannot yet explain.

  3. Cadaveric feasibility study of da Vinci Si-assisted cochlear implant with augmented visual navigation for otologic surgery.

    PubMed

    Liu, Wen P; Azizian, Mahdi; Sorger, Jonathan; Taylor, Russell H; Reilly, Brian K; Cleary, Kevin; Preciado, Diego

    2014-03-01

    To our knowledge, this is the first reported cadaveric feasibility study of a master-slave-assisted cochlear implant procedure in the otolaryngology-head and neck surgery field using the da Vinci Si system (da Vinci Surgical System; Intuitive Surgical, Inc). We describe the surgical workflow adaptations using a minimally invasive system and image guidance integrating intraoperative cone beam computed tomography through augmented reality. To test the feasibility of da Vinci Si-assisted cochlear implant surgery with augmented reality, with visualization of critical structures and facilitation with precise cochleostomy for electrode insertion. Cadaveric case study of bilateral cochlear implant approaches conducted at Intuitive Surgical Inc, Sunnyvale, California. Bilateral cadaveric mastoidectomies, posterior tympanostomies, and cochleostomies were performed using the da Vinci Si system on a single adult human donor cadaveric specimen. Radiographic confirmation of successful cochleostomies, placement of a phantom cochlear implant wire, and visual confirmation of critical anatomic structures (facial nerve, cochlea, and round window) in augmented stereoendoscopy. With a surgical mean time of 160 minutes per side, complete bilateral cochlear implant procedures were successfully performed with no violation of critical structures, notably the facial nerve, chorda tympani, sigmoid sinus, dura, or ossicles. Augmented reality image overlay of the facial nerve, round window position, and basal turn of the cochlea was precise. Postoperative cone beam computed tomography scans confirmed successful placement of the phantom implant electrode array into the basal turn of the cochlea. To our knowledge, this is the first study in the otolaryngology-head and neck surgery literature examining the use of master-slave-assisted cochleostomy with augmented reality for cochlear implants using the da Vinci Si system. The described system for cochleostomy has the potential to improve the

  4. VR robotic surgery: randomized blinded study of the dV-Trainer robotic simulator.

    PubMed

    Lendvay, Thomas S; Casale, Pasquale; Sweet, Robert; Peters, Craig

    2008-01-01

    This research represents a randomized blinded pilot study to evaluate the acceptability and validity of a da Vinci robotic virtual reality simulator platform tested during a pediatric robotic surgery post-graduate course during the annual American Urological Association meeting in June 2007. Course enrollees performed robotic skills tasks on the da Vinci robot and on an offline dV-Trainer and course participant demographic and performance data were analyzed. The majority of learners believed that VR simulation is useful for teaching robotic skills, they believed that the offline trainer can teach robotic skills comparable to a dry lab robotics skills station, and the offline trainer was able to discriminate between experts and novices of robotic surgery, thereby meeting criteria for face, content, and construct validities. This is the first reported acceptability study of a VR robotic surgery simulator as compared to the da Vinci robot system.

  5. Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay Recognition and Prevention Study

    DTIC Science & Technology

    2016-08-01

    Readiness, da Vinci Simulator, Virtual Reality, Simulation Curriculum, GEARS - Global Evaluative Assessment of Robotic Skills, Surgical Education 16...Curriculum GEARS - Global Evaluative Assessment of Robotic Skills Surgical Education 6 3. ACCOMPLISHMENTS: What were the major goals of the project

  6. [The art of Leonardo Da Vinci as a resource to science and the ideal of nursing care].

    PubMed

    Nascimento, Maria Aparecida de Luca; de Brito, Isabela Jorge; Dehoul, Marcelo da Silva

    2003-01-01

    Theoretical reflection whose goal is to demonstrate the art a nursing team is required to show in order to perform a technical procedure for transfer of solutions from a normal vial to a microdrops vial, based on Leonardo Da Vinci's theoretical referential, inspired by his work called "Vitruvian Man", so that body harmony is kept. The authors emphasize its relationship to nursing care, viewing it from its broadest sense, and its own motto--"Science, Art and Ideal".

  7. Realization of a single image haze removal system based on DaVinci DM6467T processor

    NASA Astrophysics Data System (ADS)

    Liu, Zhuang

    2014-10-01

    Video monitoring system (VMS) has been extensively applied in domains of target recognition, traffic management, remote sensing, auto navigation and national defence. However the VMS has a strong dependence on the weather, for instance, in foggy weather, the quality of images received by the VMS are distinct degraded and the effective range of VMS is also decreased. All in all, the VMS performs terribly in bad weather. Thus the research of fog degraded images enhancement has very high theoretical and practical application value. A design scheme of a fog degraded images enhancement system based on the TI DaVinci processor is presented in this paper. The main function of the referred system is to extract and digital cameras capture images and execute image enhancement processing to obtain a clear image. The processor used in this system is the dual core TI DaVinci DM6467T - ARM@500MHz+DSP@1GH. A MontaVista Linux operating system is running on the ARM subsystem which handles I/O and application processing. The DSP handles signal processing and the results are available to the ARM subsystem in shared memory.The system benefits from the DaVinci processor so that, with lower power cost and smaller volume, it provides the equivalent image processing capability of a X86 computer. The outcome shows that the system in this paper can process images at 25 frames per second on D1 resolution.

  8. The handedness of Leonardo da Vinci: a tale of the complexities of lateralisation.

    PubMed

    McManus, I C; Drury, Helena

    2004-07-01

    The handedness of Leonardo da Vinci is controversial. Although there is little doubt that many of his well-attributed drawings were drawn with the left hand, the hatch marks of the shading going downwards from left to right, it is not clear that he was a natural left-hander, there being some suggestion that he may have become left-handed as the result of an injury to his right hand in early adulthood. Leonardo's lateralisation may be illuminated by an obscure passage in his notebooks in which he describes crouching down to look into a dark cave, putting his left hand on his knee, and shading his eyes with his right hand. We carried out a questionnaire survey, using 33 written and photographic items, to find whether this behaviour was typical of right handers or left handers. In fact the 'Leonardo task' showed almost no direct association with handedness, meaning that it contributes little to the immediate problem of elucidating Leonardo's handedness. However, the lateralisation of the task did relate to other aspects of behavioural laterality in surprisingly complex ways. This suggests that individual differences in handedness, and behavioural laterality in general, have a structural complexity which is not fully encompassed by simple measures of direction or degree of handedness.

  9. Leonardo da Vinci's "A skull sectioned": skull and dental formula revisited.

    PubMed

    Gerrits, Peter O; Veening, Jan G

    2013-05-01

    What can be learned from historical anatomical drawings and how to incorporate these drawings into anatomical teaching? The drawing "A skull sectioned" (RL 19058v) by Leonardo da Vinci (1452-1519), hides more detailed information than reported earlier. A well-chosen section cut explores sectioned paranasal sinuses and ductus nasolacrimalis. A dissected lateral wall of the maxilla is also present. Furthermore, at the level of the foramen mentale, the drawing displays compact and spongious bony components, together with a cross-section through the foramen mentale and its connection with the canalis mandibulae. Leonardo was the first to describe a correct dental formula (6424) and made efforts to place this formula above the related dental elements. However, taking into account, the morphological features of the individual elements of the maxilla, it can be suggested that Leonardo sketched a "peculiar dental element" on the position of the right maxillary premolar in the dental sketch. The fact that the author did not make any comment on that special element is remarkable. Leonardo could have had sufficient knowledge of the precise morphology of maxillary and mandibular premolars, since the author depicted these elements in the dissected skull. The fact that the author also had access to premolars in situ corroborates our suggestion that "something went wrong" in this part of the drawing. The present study shows that historical anatomical drawings are very useful for interactive learning of detailed anatomy for students in medicine and dentistry.

  10. [The history of prostate cancer from the beginning to DaVinci].

    PubMed

    Hatzinger, M; Hubmann, R; Moll, F; Sohn, M

    2012-07-01

    For hardly any other organ can the development of medicine and technical advances in the last 150 years be so clearly illustrated as for the prostate. The history of radical prostatectomy was initially characterised by the problems in approaching this relatively difficulty accessible organ. In 1867, Theodor Billroth in Vienna performed the first partial prostatectomy via a perineal access. In 1904, Hugh Hampton Young and William Stewart Halsted at the Johns Hopkins Hospital in Baltimore / USA carried out the first successful extracapsular perineal prostatectomy and opened up a new era. In Germany, Prof. Friedrich Voelcker in Halle in 1924 developed the so-called ischiorectal prostatectomy. But it was left to Terence Millin to publish in 1945 the first series of retropubic prostatectomies. In 1952, the sacroperineal approach according to Thiermann and the sacral prostatectomy according to were introduced. Finally, in 1991 another new era in prostate surgery started with the first laparoscopic prostatectomy. This development peaked in 2011 with the presentation of the laparoscopic DaVinci prostatectomy by Binder. Originally a stepchild of urological surgery that was to be avoided whenever possible due to the fear of serious complications, the prostate has progressed in the course of time to an obscure object of lust. The stepchild has become the favorite child.

  11. Molecular studies of microbial community structure on stained pages of Leonardo da Vinci's Atlantic Codex.

    PubMed

    Principi, Pamela; Villa, Federica; Sorlini, Claudia; Cappitelli, Francesca

    2011-01-01

    In 2006, after a visual inspection of the Leonardo da Vinci's Atlantic Codex by a scholar, active molds were reported to have been present on Codex pages showing areas of staining. In the present paper, molecular methods were used to assess the current microbiological risk to stained pages of the manuscript. Bacterial and fungal communities were sampled by a non-invasive technique employing nitrocellulose membranes. Denaturing gradient gel electrophoresis of 16 S rRNA gene and internal transcribed space regions were carried out to study the structure of the bacterial and fungal communities and band patterns were analyzed by the multivariate technique of principal component analysis. Any relationship between the presence of an active microbial community and staining was excluded. The presence of potential biodeteriogens was evaluated by constructing bacterial and fungal clone libraries, analyzing them by an operational taxonomic unit (OTU) approach. Among the bacteria, some OTUs were associated with species found on floors in clean room while others were identified with human skin contamination. Some fungal OTU representatives were potential biodeteriogens that, under proper thermo-hygrometric conditions, could grow. The retrieval of these potential biodeteriogens and microorganisms related to human skin suggests the need for a continuous and rigorous monitoring of the environmental conditions, and the need to improve handling procedures.

  12. [Mechatronic in functional endoscopic sinus surgery. First experiences with the daVinci Telemanipulatory System].

    PubMed

    Strauss, G; Winkler, D; Jacobs, S; Trantakis, C; Dietz, A; Bootz, F; Meixensberger, J; Falk, V

    2005-07-01

    This study examines the advantages and disadvantages of a commercial telemanipulator system (daVinci, Intuitive Surgical, USA) with computer-guided instruments in functional endoscopic sinus surgery (FESS). We performed five different surgical FESS steps on 14 anatomical preparation and compared them with conventional FESS. A total of 140 procedures were examined taking into account the following parameters: degrees of freedom (DOF), duration , learning curve, force feedback, human-machine-interface. Telemanipulatory instruments have more DOF available then conventional instrumentation in FESS. The average time consumed by configuration of the telemanipulator is around 9+/-2 min. Missing force feedback is evaluated mainly as a disadvantage of the telemanipulator. Scaling was evaluated as helpful. The ergonomic concept seems to be better than the conventional solution. Computer guided instruments showed better results for the available DOF of the instruments. The human-machine-interface is more adaptable and variable then in conventional instrumentation. Motion scaling and indexing are characteristics of the telemanipulator concept which are helpful for FESS in our study.

  13. Change of practice patterns in urology with the introduction of the Da Vinci surgical system: the Greek NHS experience in debt crisis era.

    PubMed

    Deligiannis, Dimitros; Anastasiou, Ioannis; Mygdalis, Vasileios; Fragkiadis, Evangelos; Stravodimos, Konstantinos

    2015-03-31

    To determine the attitudinal change for urologic surgery in Greece since the introduction of the da Vinci Surgical System (DVS). We describe contemporary trends at public hospital level, the initial Greek experience, while at the same time Greece is in economic crisis and funding is under austerity measures. We retrospectively analyzed annualized case log data on urologic procedures, between 2008 (installation of the DVS) and 2013, from "Laiko'' Hospital in Athens. We evaluated, using summary statistics, trends and institutional status regarding robot-assisted surgery (RAS). We also analyzed the relationship between the introduction of RAS and change in total volume of procedures performed. 1578 of the urological procedures performed at "Laiko'' Hospital were pooled, 1342 (85%) being open and 236 RAS (15%). We observed a 6-fold increase in the number of RAS performed, from 7% of the total procedural volume (14/212) in 2008 to 30% (96/331) in 2013. For radical prostatectomy, in 2008 2% were robot-assisted and 98% open while in 2013, 46% and 54% respectively. Pyeloplasty was performed more often using the robot-assisted method since 2010. RAS-dedicated surgeons increased both RAS and the total number of procedures they performed. From 86 in 2008 to 145 in 2013, with 57% of them being RAS in 2013 as compared to 13 % in 2008. Robot-assisted surgery has integrated into the armamentarium for urologic surgery in Greece at public hospital level. Surgical robot acquisition is also associated with increased volume of procedures, especially prostatectomy, despite the ongoing debate over cost-effectiveness, during economic crisis and International Monetary Fund (IFN) era.

  14. Elastography Using Multi-Stream GPU: An Application to Online Tracked Ultrasound Elastography, In-Vivo and the da Vinci Surgical System

    PubMed Central

    Deshmukh, Nishikant P.; Kang, Hyun Jae; Billings, Seth D.; Taylor, Russell H.; Hager, Gregory D.; Boctor, Emad M.

    2014-01-01

    A system for real-time ultrasound (US) elastography will advance interventions for the diagnosis and treatment of cancer by advancing methods such as thermal monitoring of tissue ablation. A multi-stream graphics processing unit (GPU) based accelerated normalized cross-correlation (NCC) elastography, with a maximum frame rate of 78 frames per second, is presented in this paper. A study of NCC window size is undertaken to determine the effect on frame rate and the quality of output elastography images. This paper also presents a novel system for Online Tracked Ultrasound Elastography (O-TRuE), which extends prior work on an offline method. By tracking the US probe with an electromagnetic (EM) tracker, the system selects in-plane radio frequency (RF) data frames for generating high quality elastograms. A novel method for evaluating the quality of an elastography output stream is presented, suggesting that O-TRuE generates more stable elastograms than generated by untracked, free-hand palpation. Since EM tracking cannot be used in all systems, an integration of real-time elastography and the da Vinci Surgical System is presented and evaluated for elastography stream quality based on our metric. The da Vinci surgical robot is outfitted with a laparoscopic US probe, and palpation motions are autonomously generated by customized software. It is found that a stable output stream can be achieved, which is affected by both the frequency and amplitude of palpation. The GPU framework is validated using data from in-vivo pig liver ablation; the generated elastography images identify the ablated region, outlined more clearly than in the corresponding B-mode US images. PMID:25541954

  15. Unfolding Leonardo DA Vinci's Globe (ad 1504) to Reveal its Historical World Map

    NASA Astrophysics Data System (ADS)

    Verhoeven, G. J.; Missinne, S. J.

    2017-08-01

    This paper reports in detail on the image-based modelling and unwrapping approach used to create a two-dimensional projected map of an astonishing ostrich egg globe from AD 1504. This miniature egg globe is not only the oldest extant engraved globe, but it is also the oldest post-Columbian globe of the world and the first ever to depict Newfoundland and many other territories. The intention of digitally recording the surface geometry and colour of this unique artefact was to portray the original layout of the world map used by the Florentine Renaissance artist to make this globe. In addition, it was expected to substantiate iconographical details, which are hard to study at its scale of 1:80,000,000. The ostrich egg globe is the prototype of the Lenox Globe kept at the New York Public Library. The latter is very beneficial to examine how the egg globe looked like before being glued together at its equator. On the other hand, unfolding the map engraved in the ostrich egg halves enables a more detailed study of the remarkable details visible on both globes, since the engravings on the quasi-white egg surface are much easier to discern than those of the highly reflective red copper Lenox Globe. Finally, a detailed study of the unwrapped 3D surface is essential to learn more about the world vision of its creator and the incredible efforts that went into making this globe. Thanks to some particular pictographic details as well as the way in which the engravings are applied (by a left-handed person), the globe artist can be identified as Leonardo da Vinci.

  16. [Leonardo da Vinci the first human body imaging specialist. A brief communication on the thorax oseum images].

    PubMed

    Cicero, Raúl; Criales, José Luis; Cardoso, Manuel

    2009-01-01

    The impressive development of computed tomography (CT) techniques such as the three dimensional helical CT produces a spatial image of the thoracic skull. At the beginning of the 16th century Leonardo da Vinci drew with great precision the thorax oseum. These drawings show an outstanding similarity with the images obtained by three dimensional helical CT. The cumbersome task of the Renaissance genius is a prime example of the careful study of human anatomy. Modern imaging techniques require perfect anatomic knowledge of the human body in order to generate exact interpretations of images. Leonardo's example is alive for anybody devoted to modern imaging studies.

  17. Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator.

    PubMed

    Robison, Weston; Patel, Sonya K; Mehta, Akshat; Senkowski, Tristan; Allen, John; Shaw, Eric; Senkowski, Christopher K

    2017-08-24

    To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS). 15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups. Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p = 0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score. Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills.

  18. The LEONARDO-DA-VINCI pilot project "e-learning-assistant" - Situation-based learning in nursing education.

    PubMed

    Pfefferle, Petra Ina; Van den Stock, Etienne; Nauerth, Annette

    2010-07-01

    E-learning will play an important role in the training portfolio of students in higher and vocational education. Within the LEONARDO-DA-VINCI action programme transnational pilot projects were funded by the European Union, which aimed to improve the usage and quality of e-learning tools in education and professional training. The overall aim of the LEONARDO-DA-VINCI pilot project "e-learning-assistant" was to create new didactical and technical e-learning tools for Europe-wide use in nursing education. Based on a new situation-oriented learning approach, nursing teachers enrolled in the project were instructed to adapt, develop and implement e- and blended learning units. According to the training contents nursing modules were developed by teachers from partner institutions, implemented in the project centers and evaluated by students. The user-package "e-learning-assistant" as a product of the project includes two teacher training units, the authoring tool "synapse" to create situation-based e-learning units, a student's learning platform containing blended learning modules in nursing and an open sourced web-based communication centre. Copyright 2009 Elsevier Ltd. All rights reserved.

  19. An efficient floating-point to fixed-point conversion process for biometric algorithm on DaVinci DSP architecture

    NASA Astrophysics Data System (ADS)

    Konvalinka, Ira; Quddus, Azhar; Asraf, Daniel

    2009-05-01

    Today there is no direct path for the conversion of a floating-point algorithm implementation to an optimized fixed-point implementation. This paper proposes a novel and efficient methodology for Floating-point to Fixed-point Conversion (FFC) of biometric Fingerprint Algorithm Library (FAL) on fixed-point DaVinci processor. A general FFC research task is streamlined along smaller tasks which can be accomplished with lower effort and higher certainty. Formally specified in this paper is the optimization target in FFC, to preserve floating-point accuracy and to reduce execution time, while preserving the majority of algorithm code base. A comprehensive eight point strategy is formulated to achieve that target. Both local (focused on the most time consuming routines) and global optimization flow (to optimize across multiple routines) are used. Characteristic phases in the FFC activity are presented using data from employing the proposed FFC methodology to FAL, starting with target optimization specification, to speed optimization breakthroughs, finalized with validation of FAL accuracy after the execution time optimization. FAL implementation resulted in biometric verification time reduction for over a factor of 5, with negligible impact on accuracy. Any algorithm developer facing the task of implementing his floating-point algorithm on DaVinci DSP is expected to benefit from this presentation.

  20. Media Images Abbott and Costello Meet the End of the World: Who Is the Enemy in "The Da Vinci Code" and "An Inconvenient Truth?"

    ERIC Educational Resources Information Center

    Beck, Bernard

    2007-01-01

    Popular culture requires readily identifiable villains. Subcultural groups often serve this role, creating controversies. Controversies based on religion are especially bitter. As a rule, religion in the movies is inoffensively sentimental, but "The Da Vinci Code" is both popular and provocative, treading on the dangerous ground of Jesus's…

  1. Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.

    PubMed

    Tokas, Theodoros; Gözen, Ali Serdar; Avgeris, Margaritis; Tschada, Alexandra; Fiedler, Marcel; Klein, Jan; Rassweiler, Jens

    2016-11-26

    Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. The study was conducted in a pelvi trainer and no patients

  2. Robotic colorectal surgery.

    PubMed

    Baik, Seung Hyuk

    2008-12-31

    Robotic colorectal surgery has gradually been performed more with the help of the technological advantages of the da Vinci system. Advanced technological advantages of the da Vinci system compared with standard laparoscopic colorectal surgery have been reported. These are a stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. However, despite these technological advantages, most studies did not report the clinical advantages of robotic colorectal surgery compared to standard laparoscopic colorectal surgery. Only one study recently implies the real benefits of robotic rectal cancer surgery. The purpose of this review article is to outline the early concerns of robotic colorectal surgery using the da Vinci system, to present early clinical outcomes from the most current series, and to discuss not only the safety and the feasibility but also the real benefits of robotic colorectal surgery. Moreover, this article will comment on the possible future clinical advantages and limitations of the da Vinci system in robotic colorectal surgery.

  3. Leonardo da Vinci's drapery studies: characterization of lead white pigments by µ-XRD and 2D scanning XRF

    NASA Astrophysics Data System (ADS)

    Gonzalez, Victor; Calligaro, Thomas; Pichon, Laurent; Wallez, Gilles; Mottin, Bruno

    2015-11-01

    This work focuses on the composition and microstructure of the lead white pigment employed in a set of paintworks, using a combination of µ-XRD and 2D scanning XRF, directly applied on five drapery studies attributed to Leonardo da Vinci (1452-1519) and conserved in the Département des Arts Graphiques, Musée du Louvre and in the Musée des Beaux- Arts de Rennes. Trace elements present in the composition as well as in the lead white highlights were imaged by 2D scanning XRF. Mineral phases were determined in a fully noninvasive way using a special µ-XRD diffractometer. Phase proportions were estimated by Rietveld refinement. The analytical results obtained will contribute to differentiate lead white qualities and to highlight the artist's technique.

  4. Realization and optimization of AES algorithm on the TMS320DM6446 based on DaVinci technology

    NASA Astrophysics Data System (ADS)

    Jia, Wen-bin; Xiao, Fu-hai

    2013-03-01

    The application of AES algorithm in the digital cinema system avoids video data to be illegal theft or malicious tampering, and solves its security problems. At the same time, in order to meet the requirements of the real-time, scene and transparent encryption of high-speed data streams of audio and video in the information security field, through the in-depth analysis of AES algorithm principle, based on the hardware platform of TMS320DM6446, with the software framework structure of DaVinci, this paper proposes the specific realization methods of AES algorithm in digital video system and its optimization solutions. The test results show digital movies encrypted by AES128 can not play normally, which ensures the security of digital movies. Through the comparison of the performance of AES128 algorithm before optimization and after, the correctness and validity of improved algorithm is verified.

  5. History of robotic surgery.

    PubMed

    Kalan, Satyam; Chauhan, Sanket; Coelho, Rafael F; Orvieto, Marcelo A; Camacho, Ignacio R; Palmer, Kenneth J; Patel, Vipul R

    2010-09-01

    Robotic surgery is one of the most advanced forms of Minimally Invasive Surgery. Although the application of robotic technology to surgical robotics started some 20 years ago, the earliest work in robotics and automation can be traced back to 400 BC. Some of the early pioneers include Archytas of Arentum, Leonardo da Vinci, Gianello Toriano, and Pierre Jaquet-Droz, and we owe to these philosophers and scientists the fact that we can offer the benefit of minimal invasion in surgery. The purpose of this review is to give a brief description of the evolution of robotic surgery from its early history to present-day surgical robotics.

  6. How did Leonardo perceive himself? Metric iconography of da Vinci's self-portraits

    NASA Astrophysics Data System (ADS)

    Tyler, Christopher W.

    2010-02-01

    Some eighteen portraits are now recognized of Leonardo in old age, consolidating the impression from his bestestablished self-portrait of an old man with long white hair and beard. However, his appearance when younger is generally regarded as unknown, although he was described as very beautiful as a youth. Application of the principles of metric iconography, the study of the quantitative analysis of the painted images, provides an avenue for the identification of other portraits that may be proposed as valid portraits of Leonardo during various stages of his life, by himself and by his contemporaries. Overall, this approach identifies portraits of Leonardo by Verrocchio, Raphael, Botticelli, and others. Beyond this physiognomic analysis, Leonardo's first known drawing provides further insight into his core motivations. Topographic considerations make clear that the drawing is of the hills behind Vinci with a view overlooking the rocky promontory of the town and the plain stretching out before it. The outcroppings in the foreground bear a striking resemblance to those of his unique composition, 'The Virgin of the Rocks', suggesting a deep childhood appreciation of this wild terrain. and an identification with that religious man of the mountains, John the Baptist, who was also the topic of Leonardo's last known painting. Following this trail leads to a line of possible selfportraits continuing the age-regression concept back to a self view at about two years of age.

  7. The mother relationship and artistic inhibition in the lives of Leonardo da Vinci and Erik H. Erikson.

    PubMed

    Capps, Donald

    2008-12-01

    In four earlier articles, I focused on the theme of the relationship of melancholia and the mother, and suggested that the melancholic self may experience humor (Capps, 2007a), play (Capps, 2007b), dreams (Capps, 2008a), and art (Capps, 2008b) as restorative resources. I argued that Erik H. Erikson found these resources to be valuable remedies for his own melancholic condition, which had its origins in the fact that he was illegitimate and was raised solely by his mother until he was three years old, when she remarried. In this article, I focus on two themes in Freud's Leonardo da Vinci and a memory of his childhood (1964): Leonardo's relationship with his mother in early childhood and his inhibitions as an artist. I relate these two themes to Erikson's own early childhood and his failure to achieve his goal as an aspiring artist in his early twenties. The article concludes with a discussion of Erikson's frustrated aspirations to become an artist and his emphasis, in his psychoanalytic work, on children's play.

  8. 2D and 3D optical diagnostic techniques applied to Madonna dei Fusi by Leonardo da Vinci

    NASA Astrophysics Data System (ADS)

    Fontana, R.; Gambino, M. C.; Greco, M.; Marras, L.; Materazzi, M.; Pampaloni, E.; Pelagotti, A.; Pezzati, L.; Poggi, P.; Sanapo, C.

    2005-06-01

    3D measurement and modelling have been traditionally applied to statues, buildings, archeological sites or similar large structures, but rarely to paintings. Recently, however, 3D measurements have been performed successfully also on easel paintings, allowing to detect and document the painting's surface. We used 3D models to integrate the results of various 2D imaging techniques on a common reference frame. These applications show how the 3D shape information, complemented with 2D colour maps as well as with other types of sensory data, provide the most interesting information. The 3D data acquisition was carried out by means of two devices: a high-resolution laser micro-profilometer, composed of a commercial distance meter mounted on a scanning device, and a laser-line scanner. The 2D data acquisitions were carried out using a scanning device for simultaneous RGB colour imaging and IR reflectography, and a UV fluorescence multispectral image acquisition system. We present here the results of the techniques described, applied to the analysis of an important painting of the Italian Reinassance: `Madonna dei Fusi', attributed to Leonardo da Vinci.

  9. Amid the possible causes of a very famous foxing: molecular and microscopic insight into Leonardo da Vinci's self-portrait.

    PubMed

    Piñar, Guadalupe; Tafer, Hakim; Sterflinger, Katja; Pinzari, Flavia

    2015-12-01

    Leonardo da Vinci's self-portrait is affected by foxing spots. The portrait has no fungal or bacterial infections in place, but is contaminated with airborne spores and fungal material that could play a role in its disfigurement. The knowledge of the nature of the stains is of great concern because future conservation treatments should be derived from scientific investigations. The lack of reliable scientific data, due to the non-culturability of the microorganisms inhabiting the portrait, prompted the investigation of the drawing using non-invasive and micro-invasive sampling, in combination with scanning electron microscope (SEM) imaging and molecular techniques. The fungus Eurotium halophilicum was found in foxing spots using SEM analyses. Oxalates of fungal origin were also documented. Both findings are consistent with the hypothesis that tonophilic fungi germinate on paper metabolizing organic acids, oligosaccharides and proteic compounds, which react chemically with the material at a low water activity, forming brown products and oxidative reactions resulting in foxing spots. Additionally, molecular techniques enabled a screening of the fungi inhabiting the portrait and showed differences when different sampling techniques were employed. Swabs samples showed a high abundance of lichenized Ascomycota, while the membrane filters showed a dominance of Acremonium sp. colonizing the drawing.

  10. The oldest anatomical handmade skull of the world c. 1508: 'the ugliness of growing old' attributed to Leonardo da Vinci.

    PubMed

    Missinne, Stefaan J

    2014-06-01

    The author discusses a previously unknown early sixteenth-century renaissance handmade anatomical miniature skull. The small, naturalistic skull made from an agate (calcedonia) stone mixture (mistioni) shows remarkable osteologic details. Dr. Saban was the first to link the skull to Leonardo. The three-dimensional perspective of and the search for the senso comune are discussed. Anatomical errors both in the drawings of Leonardo and this skull are presented. The article ends with the issue of physiognomy, his grotesque faces, the Perspective Communis and his experimenting c. 1508 with the stone mixture and the human skull. Evidence, including the Italian scale based on Crazie and Braccia, chemical analysis leading to a mine in Volterra and Leonardo's search for the soul in the skull are presented. Written references in the inventory of Salai (1524), the inventory of the Villa Riposo (Raffaello Borghini 1584) and Don Ambrogio Mazenta (1635) are reviewed. The author attributes the skull c. 1508 to Leonardo da Vinci.

  11. Amid the possible causes of a very famous foxing: molecular and microscopic insight into Leonardo da Vinci's self‐portrait

    PubMed Central

    Tafer, Hakim; Sterflinger, Katja; Pinzari, Flavia

    2015-01-01

    Summary Leonardo da Vinci's self‐portrait is affected by foxing spots. The portrait has no fungal or bacterial infections in place, but is contaminated with airborne spores and fungal material that could play a role in its disfigurement. The knowledge of the nature of the stains is of great concern because future conservation treatments should be derived from scientific investigations. The lack of reliable scientific data, due to the non‐culturability of the microorganisms inhabiting the portrait, prompted the investigation of the drawing using non‐invasive and micro‐invasive sampling, in combination with scanning electron microscope (SEM) imaging and molecular techniques. The fungus E urotium halophilicum was found in foxing spots using SEM analyses. Oxalates of fungal origin were also documented. Both findings are consistent with the hypothesis that tonophilic fungi germinate on paper metabolizing organic acids, oligosaccharides and proteic compounds, which react chemically with the material at a low water activity, forming brown products and oxidative reactions resulting in foxing spots. Additionally, molecular techniques enabled a screening of the fungi inhabiting the portrait and showed differences when different sampling techniques were employed. Swabs samples showed a high abundance of lichenized Ascomycota, while the membrane filters showed a dominance of A cremonium sp. colonizing the drawing. PMID:26111623

  12. Miniature in vivo robotics and novel robotic surgical platforms.

    PubMed

    Shah, Bhavin C; Buettner, Shelby L; Lehman, Amy C; Farritor, Shane M; Oleynikov, Dmitry

    2009-05-01

    Robotic surgical systems, such as the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California), have revolutionized laparoscopic surgery but are limited by large size, increased costs, and limitations in imaging. Miniature in vivo robots are being developed that are inserted entirely into the peritoneal cavity for laparoscopic and natural orifice transluminal endoscopic surgical (NOTES) procedures. In the future, miniature camera robots and microrobots should be able to provide a mobile viewing platform. This article discusses the current state of miniature robotics and novel robotic surgical platforms and the development of future robotic technology for general surgery and urology.

  13. Single-port robotic cholecystectomy. Initial and pioneer experience in Brazil

    PubMed Central

    Schraibman, Vladimir; Epstein, Marina Gabrielle; Maccapani, Gabriel Naman; Macedo, Antônio Luiz de Vasconcellos

    2015-01-01

    The technique of a single-port laparoscopy was developed over the last years as an attempt to lower surgical aggression and improve the aesthetic results of the minimally invasive surgery. A new robotic platform used with the da Vinci® Robotic System Single-Site System® (Intuitive Surgical, Sunnyvale, California, United States) was recently launched on the global market and is still not documented in Brazil. The authors report on the first four robotic single-port cholecystectomies performed with this da Vinci® Robotic System in Brazil. PMID:26398360

  14. Proficiency training on a virtual reality robotic surgical skills curriculum.

    PubMed

    Bric, Justin; Connolly, Michael; Kastenmeier, Andrew; Goldblatt, Matthew; Gould, Jon C

    2014-12-01

    The clinical application of robotic surgery is increasing. The skills necessary to perform robotic surgery are unique from those required in open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (Fundamentals of Laparoscopic Surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool for robotic surgery. Our research group previously developed and validated a robotic training curriculum in a virtual reality (VR) simulator. We hypothesized that novice robotic surgeons could achieve proficiency levels defined by more experienced robotic surgeons on the VR robotic curriculum, and that this would result in improved performance on the actual daVinci Surgical System™. 25 medical students with no prior robotic surgery experience were recruited. Prior to VR training, subjects performed 2 FLS tasks 3 times each (Peg Transfer, Intracorporeal Knot Tying) using the daVinci Surgical System™ docked to a video trainer box. Task performance for the FLS tasks was scored objectively. Subjects then practiced on the VR simulator (daVinci Skills Simulator) until proficiency levels on all 5 tasks were achieved before completing a post-training assessment of the 2 FLS tasks on the daVinci Surgical System™ in the video trainer box. All subjects to complete the study (1 dropped out) reached proficiency levels on all VR tasks in an average of 71 (± 21.7) attempts, accumulating 164.3 (± 55.7) minutes of console training time. There was a significant improvement in performance on the robotic FLS tasks following completion of the VR training curriculum. Novice robotic surgeons are able to attain proficiency levels on a VR simulator. This leads to improved performance in the daVinci surgical platform on simulated tasks. Training to proficiency on a VR robotic surgery simulator is an efficient and viable method for acquiring robotic surgical skills.

  15. Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients

    NASA Astrophysics Data System (ADS)

    Le, Carter Q.; Ho, Khai-Linh V.; Slezak, Jeffrey M.; Blute, Michael L.; Gettman, Matthew T.

    2007-02-01

    Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame. Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square method and least-squares method of linear regression where appropriate. Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP (p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar. Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and functional outcomes when compared to open RRP.

  16. Robotic technology in surgery: current status in 2008.

    PubMed

    Murphy, Declan G; Hall, Rohan; Tong, Raymond; Goel, Rajiv; Costello, Anthony J

    2008-12-01

    There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients.

  17. Michelangelo in Florence, Leonardo in Vinci.

    ERIC Educational Resources Information Center

    Herberholz, Barbara

    2003-01-01

    Provides background information on the lives and works of Michelangelo and Leonardo da Vinci. Focuses on the artwork of the artists and the museums where their work is displayed. Includes museum photographs of their work. (CMK)

  18. Michelangelo in Florence, Leonardo in Vinci.

    ERIC Educational Resources Information Center

    Herberholz, Barbara

    2003-01-01

    Provides background information on the lives and works of Michelangelo and Leonardo da Vinci. Focuses on the artwork of the artists and the museums where their work is displayed. Includes museum photographs of their work. (CMK)

  19. Integrating Leonardo da Vinci's principles of demonstration, uncertainty, and cultivation in contemporary nursing education.

    PubMed

    Story, Lachel; Butts, Janie

    2014-03-01

    Nurses today are facing an ever changing health care system. Stimulated by health care reform and limited resources, nursing education is being challenged to prepare nurses for this uncertain environment. Looking to the past can offer possible solutions to the issues nursing education is confronting. Seven principles of da Vincian thinking have been identified (Gelb, 2004). As a follow-up to an exploration of the curiosità principle (Butts & Story, 2013), this article will explore the three principles of dimostrazione, sfumato, and corporalita. Nursing faculty can set the stage for a meaningful educational experience through these principles of demonstration (dimostrazione), uncertainty (sfumato), and cultivation (corporalita). Preparing nurses not only to manage but also to flourish in the current health care environment that will enhance the nurse's and patient's experience.

  20. Urologic robots and future directions.

    PubMed

    Mozer, Pierre; Troccaz, Jocelyne; Stoianovici, Dan

    2009-01-01

    Robot-assisted laparoscopic surgery in urology has gained immense popularity with the daVinci system, but a lot of research teams are working on new robots. The purpose of this study is to review current urologic robots and present future development directions. Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. The final goal of robots is to allow safer and more homogeneous outcomes with less variability of surgeon performance, as well as new tools to perform tasks on the basis of medical transcutaneous imaging, in a less invasive way, at lower costs. It is expected that improvements for a remote system could be augmented in reality, with haptic feedback, size reduction, and development of new tools for natural orifice translumenal endoscopic surgery. The paradigm of image-guided robots is close to clinical availability and the most advanced robots are presented with end-user technical assessments. It is also notable that the potential of robots lies much further ahead than the accomplishments of the daVinci system. The integration of imaging with robotics holds a substantial promise, because this can accomplish tasks otherwise impossible. Image-guided robots have the potential to offer a paradigm shift.

  1. UROLOGIC ROBOTS AND FUTURE DIRECTIONS

    PubMed Central

    Mozer, Pierre; Troccaz, Jocelyne; Stoianovici, Dan

    2009-01-01

    Purpose of review Robot-assisted laparoscopic surgery in urology has gained immense popularity with the Da Vinci system but a lot of research teams are working on new robots. The purpose of this paper is to review current urologic robots and present future developments directions. Recent findings Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. Summary The final goal of robots is to allow safer and more homogeneous outcomes with less variability of surgeon performance, as well as new tools to perform tasks based on medical transcutaneous imaging, in a less invasive way, at lower costs. It is expected that improvements for remote system could be augmented reality, haptic feed back, size reduction and development of new tools for NOTES surgery. The paradigm of image-guided robots is close to a clinical availability and the most advanced robots are presented with end-user technical assessments. It is also notable that the potential of robots lies much further ahead than the accomplishments of the daVinci system. The integration of imaging with robotics holds a substantial promise, because this can accomplish tasks otherwise impossible. Image guided robots have the potential to offer a paradigm shift. PMID:19057227

  2. Technological advances in robotic-assisted laparoscopic surgery.

    PubMed

    Tan, Gerald Y; Goel, Raj K; Kaouk, Jihad H; Tewari, Ashutosh K

    2009-05-01

    In this article, the authors describe the evolution of urologic robotic systems and the current state-of-the-art features and existing limitations of the da Vinci S HD System (Intuitive Surgical, Inc.). They then review promising innovations in scaling down the footprint of robotic platforms, the early experience with mobile miniaturized in vivo robots, advances in endoscopic navigation systems using augmented reality technologies and tracking devices, the emergence of technologies for robotic natural orifice transluminal endoscopic surgery and single-port surgery, advances in flexible robotics and haptics, the development of new virtual reality simulator training platforms compatible with the existing da Vinci system, and recent experiences with remote robotic surgery and telestration.

  3. Robotic ocular surgery.

    PubMed

    Tsirbas, A; Mango, C; Dutson, E

    2007-01-01

    Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures. To examine the use of a commercially available surgical robot for ocular microsurgery. Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360 degrees -rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography. Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level. Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state-of-the-art surgical skill and technology.

  4. Robotic ocular surgery

    PubMed Central

    Tsirbas, A; Mango, C; Dutson, E

    2007-01-01

    Background Bimanual, three‐dimensional robotic surgery has proved valuable for a variety of surgical procedures. Aims To examine the use of a commercially available surgical robot for ocular microsurgery. Methods Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360°‐rotating, 8‐mm, wrested‐end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10‐0 sutures, and this was documented with still and video photography. Results Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level. Conclusions Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state‐of‐the‐art surgical skill and technology. PMID:17020903

  5. A psychoanalytic understanding of the desire for knowledge as reflected in Freud's Leonardo da Vinci and a memory of his childhood.

    PubMed

    Blass, Rachel B

    2006-10-01

    The author offers an understanding of the psychoanalytic notion of the desire for knowledge and the possibility of attaining it as it fi nds expression in Freud's Leonardo da Vinci and a memory of his childhood. This understanding has not been explicitly articulated by Freud but may be considered integral to psychoanalysis' Weltanschauung as shaped by Freud's legacy. It emerges through an attempt to explain basic shifts, contradictions, inconsistencies and tensions that become apparent from a close reading of the text of Leonardo. Articulating this implicit understanding of knowledge provides the grounds for a stance on epistemology that is integral to psychoanalysis and relevant to contemporary psychoanalytic concerns on this topic. This epistemology focuses on the necessary involvement of passion, rather than detachment, in the search for knowledge and views the psychoanalytic aim of self-knowledge as a derivative, and most immediate expression, of a broader and more basic human drive to know.

  6. [The advancement of robotic surgery--successes, failures, challenges].

    PubMed

    Haidegger, Tamás

    2010-10-10

    Computer-integrated robotic surgery systems appeared more than twenty years ago and since then hundreds of different prototypes have been developed. Only a fraction of them have been commercialized, mostly to support neurosurgical and orthopaedic procedures.Unquestionably, the most successful one is the da Vinci surgical system, primarily deployed in urology and general laparoscopic surgery. It is developed and marketed by Intuitive Surgical Inc. (Sunnyvale, CA, USA), the only profitable company of the segment. The da Vinci made robotic surgery is known and acknowledged throughout the world, and the great results delivered convinced most of the former critics of the technology. Success derived from the well chosen business development strategy, proficiency of the developers, appropriate timing and a huge pot of luck. This article presents the most important features of the da Vinci system, the history of development along with its medical, economical and financial aspects, and seeks the answer why this particular system became successful.

  7. Evolution of robotic arms.

    PubMed

    Moran, Michael E

    2007-01-01

    The foundation of surgical robotics is in the development of the robotic arm. This is a thorough review of the literature on the nature and development of this device with emphasis on surgical applications. We have reviewed the published literature and classified robotic arms by their application: show, industrial application, medical application, etc. There is a definite trend in the manufacture of robotic arms toward more dextrous devices, more degrees-of-freedom, and capabilities beyond the human arm. da Vinci designed the first sophisticated robotic arm in 1495 with four degrees-of-freedom and an analog on-board controller supplying power and programmability. von Kemplen's chess-playing automaton left arm was quite sophisticated. Unimate introduced the first industrial robotic arm in 1961, it has subsequently evolved into the PUMA arm. In 1963 the Rancho arm was designed; Minsky's Tentacle arm appeared in 1968, Scheinman's Stanford arm in 1969, and MIT's Silver arm in 1974. Aird became the first cyborg human with a robotic arm in 1993. In 2000 Miguel Nicolalis redefined possible man-machine capacity in his work on cerebral implantation in owl-monkeys directly interfacing with robotic arms both locally and at a distance. The robotic arm is the end-effector of robotic systems and currently is the hallmark feature of the da Vinci Surgical System making its entrance into surgical application. But, despite the potential advantages of this computer-controlled master-slave system, robotic arms have definite limitations. Ongoing work in robotics has many potential solutions to the drawbacks of current robotic surgical systems.

  8. Robotic-assisted double-sleeve lobectomy

    PubMed Central

    Qiu, Tong; Zhao, Yandong; Xuan, Yunpeng

    2017-01-01

    Double-sleeve lobectomy, which includes bronchoplasty and pulmonary arterial angioplasty, is required for certain cases of central-type lung cancer. It is usually done by open surgery or video-assisted thoracoscopic surgery (VATS). In recently, da Vinci system and robotic surgery have been applied in such complicated cases. Here we describe the details associated with robotic-assisted double-sleeve lobectomy. PMID:28203433

  9. New Frontiers in Robotic Surgery: The latest high-tech surgical tools allow for superhuman sensing and more.

    PubMed

    Solis, Michele

    2016-01-01

    Over the past 30 years, robots have become standard fixtures in operating rooms. During brain surgery, a NeuroMate robot may guide a neurosurgeon to a target within the pulsing cortex. In orthopedics, a Mako robot sculpts and drills bone during knee and hip replacement surgery. Dominating the general surgery field is the da Vinci robot, a multiarmed device that allows surgeons to conduct precise movements of tools through small incisions that they could not manage with their own hands.

  10. Feasibility of transoral robotic-assisted high-resolution microendoscopic imaging of oropharyngeal squamous cell carcinoma.

    PubMed

    Patsias, Alexis; Giraldez-Rodriguez, Laureano; Polydorides, Alexandros D; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila; Quang, Timothy; Sikora, Andrew G; Miles, Brett

    2015-08-01

    Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high-resolution fiber-optic microendoscope (HRME), which provides real-time histological assessment, with the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). Three patients undergoing transoral robotic surgery (TORS) were prospectively enrolled in this study. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the da Vinci robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. Transoral robotic-assisted HRME imaging of the oropharynx is a safe and technically feasible approach, providing a real-time histological assessment and may serve as a valuable aid in oncologic surgery. © 2015 Wiley Periodicals, Inc.

  11. Feasibility of Transoral Robotic-Assisted High Resolution Microendoscopic Imaging of Oropharyngeal Squamous Cell Carcinoma

    PubMed Central

    Patsias, Alexis; Giraldez-Rodriguez, Laureano A.; Polydorides, Alexandros D.; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila; Quang, Timothy; Sikora, Andrew G.; Miles, Brett A.

    2015-01-01

    Background Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high resolution fiberoptic microendoscope (HRME), which provides real time histological assessment, with the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA). Methods Three patients undergoing transoral robotic surgery were prospectively enrolled. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. Results All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the Da Vinci Robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. Conclusions Transoral robotic-assisted high resolution microendoscopic imaging of the oropharynx is a safe and technically feasible approach, providing a real time histological assessment and may serve as a valuable aid in oncologic surgery. PMID:25327825

  12. Robotically assisted endoscopic ovarian transposition.

    PubMed

    Molpus, Kelly L; Wedergren, June S; Carlson, Mark A

    2003-01-01

    Ovarian transposition is the anatomical relocation of the ovaries from the pelvis to the abdomen. Transposition is beneficial in women who are to undergo pelvic radiation, because it allows maintenance of ovarian function and preservation of assisted reproductive capacity. The da Vinci surgical system (Intuitive Surgical, Mountainview, CA, USA) was used to perform an endoscopic ovarian transposition. The ovaries were mobilized on their respective infundibulopelvic ligaments and sutured to the ipsilateral pericolic gutters. A series, of laboratory sessions using the da Vinci system was completed at our institution's training facility. Surgical experience included cadaveric pelvic dissection and abdominopelvic procedures on anesthetized porcine models. Additional didactic and laboratory training, including a certification examination, was obtained from Intuitive Surgical, Inc. The first clinical case of robotically assisted endoscopic ovarian transposition was performed. Robotically assisted endoscopy was successfully used for ovarian transposition.

  13. [Robotic colorectal surgery: current status and future developments].

    PubMed

    Jayne, D

    2013-08-01

    Robotic assistance has the potential to compensate for the limitations inherent in standard laparoscopic surgery. The daVinci® surgical system remains the only currently available commercial robotic system. It has found popularity in rectal cancer surgery where its application has consistently been shown to reduce the need to convert to open surgery. With this exception, the technological advances of the robotic system have not so far translated into any reproducible patient benefit. The first part of this manuscript presents an overview of the current daVinci® platform, its applications, the evidence base and future developments in colorectal surgery. The second part of the manuscript looks at other robot systems in development and the different innovations and strategies taken to advance minimally invasive surgery.The English full-text version of this article is available at SpringerLink (under supplemental).

  14. Robotic-assisted surgery for low rectal dissection: from better views to better outcome.

    PubMed

    Ng, K H; Lim, Y K; Ho, K S; Ooi, B S; Eu, K W

    2009-08-01

    The use of robotics in colorectal surgery is relatively new. The first few cases of colonic surgery using da Vinci Surgical System were reported in 2002. Since then, several centres had reported on their experience, with favourable outcomes. Our department started to embark on robotics in colorectal surgery in December 2007. The aim of our paper was to share our early experience with robotics in colorectal surgery and provide an update on the current status of robotics. Preparations included formal training with the da Vinci Surgical System, certification of the surgeons, and obtaining Hospital Ethics committee approval. We used a hybrid technique of laparoscopic and robotic assistance in the resection of mid- to low-rectal cancer (total mesorectal excision). Laparoscopic approach was used to isolate the inferior mesenteric artery and for mobilisation of the left colon. The da Vinci robot was used in the dissection of the rectum down to the pelvic floor. We reviewed the outcomes of our early experience with emphasis on feasibility and safety. Over a period of three months, we performed eight cases of robotic-assisted colorectal surgery for cancer. The median age of the patients was 55 (range 42-80) years. The median operating time was 192.5 (range 145-250) minutes. There were no intraoperative or postoperative complications related to the use of robotics. The median length of hospital stay was five (range 4-30) days. Robotic-assisted laparoscopic colorectal surgery is a safe and feasible procedure.

  15. The left ventricle as a mechanical engine: from Leonardo da Vinci to the echocardiographic assessment of peak power output-to-left ventricular mass.

    PubMed

    Dini, Frank L; Guarini, Giacinta; Ballo, Piercarlo; Carluccio, Erberto; Maiello, Maria; Capozza, Paola; Innelli, Pasquale; Rosa, Gian M; Palmiero, Pasquale; Galderisi, Maurizio; Razzolini, Renato; Nodari, Savina

    2013-03-01

    The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da Vinci, who was the first to apply the laws of mechanics to the function of the heart. Similar to any mechanical engine, whose performance is proportional to the power generated with respect to weight, the left ventricle can be viewed as a power generator whose performance can be related to left ventricular mass. Stress echocardiography may provide valuable information on the relationship between cardiac performance and recruited left ventricular mass that may be used in distinguishing between adaptive and maladaptive left ventricular remodeling. Peak power output-to-mass, obtained during exercise or pharmacological stress echocardiography, is a measure that reflects the number of watts that are developed by 100 g of left ventricular mass under maximal stimulation. Power output-to-mass may be calculated as left ventricular power output per 100 g of left ventricular mass: 100× left ventricular power output divided by left ventricular mass (W/100 g). A simplified formula to calculate power output-to-mass is as follows: 0.222 × cardiac output (l/min) × mean blood pressure (mmHg)/left ventricular mass (g). When the integrity of myocardial structure is compromised, a mismatch becomes apparent between maximal cardiac power output and left ventricular mass; when this occurs, a reduction of the peak power output-to-mass index is observed.

  16. Investigating the 'Uncatchable Smile' in Leonardo da Vinci's La Bella Principessa: A Comparison with the Mona Lisa and Pollaiuolo's Portrait of a Girl.

    PubMed

    Soranzo, Alessandro; Newberry, Michelle

    2016-10-04

    This paper discusses how the 'Uncatchable Smile' illusion in Leonardo da Vinci's La Bella Principessa portrait was discovered. Kemp and Cotte(1) described the expression of the Princess as ambiguous and "subtle to an inexpressible degree". A combination of three methods was used (inter-observation, structured interviews, and psychophysical experiments) to identify what may underlie this 'ambiguity'. The inter-observation and the structured interview methods were firstly applied to generate experimental hypotheses that were successively tested by a series of psychophysical experiments. The combination of these research methods minimizes the impact of the researcher's beliefs and biases in the development of the research design. It emerged that the ambiguity in La Bella Principessa is triggered by a change in the perceived level of contentment in her facial expression and that this perceptual change is attributable to a visual illusion relating to her mouth. Moreover, it was found that a similar effect can be observed in the Mona Lisa. As the smile in La Bella Principessa disappears as soon as the viewer tries to 'catch it', we named this visual illusion the 'Uncatchable Smile'. The elusive quality of the Mona Lisa's smile(2) is probably why the portrait is so famous, and so the existence of a similar ambiguity in a portrait painted by Leonardo prior to the Mona Lisa is even more interesting.

  17. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience.

    PubMed

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M

    2009-10-01

    The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant

  18. Robotic microsurgery: corneal transplantation.

    PubMed

    Bourges, J-L; Hubschman, J-P; Burt, B; Culjat, M; Schwartz, S D

    2009-12-01

    Robotic ocular microsurgery including corneal suturing has been proven to be feasible in porcine eyes. To determine whether or not bimanual teleoperated robotic penetrating keratoplasty (PK) can be performed in porcine and human eyes. Three arms of the da Vinci surgical robot were loaded with a dual-channel video and two, 360 degrees -rotating, 8 mm, wrested-end effector instruments and placed over porcine eyes or over a human cadaver head. The surgeon remotely performed mechanical trephination, cardinal sutures, continuous 10.0 nylon sutures and suture adjustments on both eyes. The procedures were documented with still and video photography. Using the da Vinci robot, penetrating keratoplasty procedures were successfully performed on both porcine eyes and human eyes in natural anatomical conditions. The precise placement of continuous sutures was facilitated by the wrested-end forceps. Orbital rims and nose did not limit surgical motions. Teleoperated robotic penetrating keratoplasty is technically feasible in humans. Further studies are pending to implement the procedure with femtosecond laser and other automated steps.

  19. Contribution of laparoscopic training to robotic proficiency.

    PubMed

    Angell, Jordan; Gomez, Michael S; Baig, Mirza M; Abaza, Ronney

    2013-08-01

    Robotic surgical technology has been adopted by surgeons with and without previous standard laparoscopic experience. The necessity or benefit of prior training and experience in laparoscopic surgery is unknown. We hypothesized that laparoscopic training enhances performance in robotic surgery. Fourteen medical students with no surgical experience were instructed to incise a spiral using the da Vinci(®) surgical robot with time to completion and errors recorded. Each student was then trained for 1 month in standard laparoscopy, but with no further robotic exposure. Training included a validated laparoscopic training program, including timed and scored parameters. After completion of the month-long training, the students repeated the cutting exercise using the da Vinci robot as well as with standard laparoscopic instruments and were scored within the same parameters. The mean time to completely incise the spiral robotically before training was 16.72 min with a mean of 6.21 errors. After 1 month of validated laparoscopic training, the mean robotic time fell to 9:03 min (p=0.0002) with 3.57 errors (p=0.02). Laparoscopic performance after 1 month of validated laparoscopic training was 13.95 min with 6.14 errors, which was no better than pretraining robotic performance (p=0.20) and worse than post-training robotic performance (p=0.01). Formal laparoscopic training improved the performance of a complex robotic task. The initial robotic performance without any robotic or laparoscopic training was equivalent to standard laparoscopic performance after extensive training. Additionally, after laparoscopic training, the robot allowed significantly superior speed and precision of the task. Laparoscopic training may improve the proficiency in operation of the robot. This may explain the perceived ease with which robotics is adopted by laparoscopically trained surgeons and may be important in training future robotic surgeons.

  20. Augmented reality to the rescue of the minimally invasive surgeon. The usefulness of the interposition of stereoscopic images in the Da Vinci™ robotic console.

    PubMed

    Volonté, Francesco; Buchs, Nicolas C; Pugin, François; Spaltenstein, Joël; Schiltz, Boris; Jung, Minoa; Hagen, Monika; Ratib, Osman; Morel, Philippe

    2013-09-01

    Computerized management of medical information and 3D imaging has become the norm in everyday medical practice. Surgeons exploit these emerging technologies and bring information previously confined to the radiology rooms into the operating theatre. The paper reports the authors' experience with integrated stereoscopic 3D-rendered images in the da Vinci surgeon console. Volume-rendered images were obtained from a standard computed tomography dataset using the OsiriX DICOM workstation. A custom OsiriX plugin was created that permitted the 3D-rendered images to be displayed in the da Vinci surgeon console and to appear stereoscopic. These rendered images were displayed in the robotic console using the TilePro multi-input display. The upper part of the screen shows the real endoscopic surgical field and the bottom shows the stereoscopic 3D-rendered images. These are controlled by a 3D joystick installed on the console, and are updated in real time. Five patients underwent a robotic augmented reality-enhanced procedure. The surgeon was able to switch between the classical endoscopic view and a combined virtual view during the procedure. Subjectively, the addition of the rendered images was considered to be an undeniable help during the dissection phase. With the rapid evolution of robotics, computer-aided surgery is receiving increasing interest. This paper details the authors' experience with 3D-rendered images projected inside the surgical console. The use of this intra-operative mixed reality technology is considered very useful by the surgeon. It has been shown that the usefulness of this technique is a step toward computer-aided surgery that will progress very quickly over the next few years. Copyright © 2012 John Wiley & Sons, Ltd.

  1. Validation study of a virtual reality robotic simulator--role as an assessment tool?

    PubMed

    Lee, Jason Y; Mucksavage, Phillip; Kerbl, David C; Huynh, Victor B; Etafy, Mohamed; McDougall, Elspeth M

    2012-03-01

    Virtual reality simulators are often used for surgical skill training since they facilitate deliberate practice in a controlled, low stakes environment. However, to be considered for assessment purposes rigorous construct and criterion validity must be demonstrated. We performed face, content, construct and concurrent validity testing of the dV-Trainer™ robotic surgical simulator. Urology residents, fellows and attending surgeons were enrolled in this institutional review board approved study. After a brief introduction to the dV-Trainer each subject completed 3 repetitions each of 4 virtual reality tasks on it, including pegboard ring transfer, matchboard object transfer, needle threading of rings, and the ring and rail task. One week later subjects completed 4 similar tasks using the da Vinci® robot. Subjects were assessed on total task time and total errors using the built-in scoring algorithm and manual scoring for the dV-Trainer and the da Vinci robot, respectively. Seven experienced and 13 novice robotic surgeons were included in the study. Experienced surgeons were defined by greater than 50 hours of clinical robotic console time. Of novice robotic surgeons 77% ranked the dV-Trainer as a realistic training platform and 71% of experienced robotic surgeons ranked it as useful for resident training. Experienced robotic surgeons outperformed novices in many dV-Trainer and da Vinci robot exercises, particularly in the number of errors. On pooled data analysis dV-Trainer total task time and total errors correlated with da Vinci robot total task time and total errors (p = 0.026 and 0.011, respectively). This study confirms the face, content, construct and concurrent validity of the dV-Trainer, which may have a potential role as an assessment tool. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Critical analysis of robotic surgery for laryngeal tumours.

    PubMed

    Esteban, Francisco; Menoyo, Alicia; Abrante, Antonio

    2014-01-01

    In recent years, transoral robotic surgery (TORS) with the Da Vinci robot has been used for the removal of laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. The advantages of TORS are described in this article. However, its disadvantages, mainly high cost amongst others, do not make robotic surgery the current treatment of choice for laryngeal tumours; transoral laser surgery is superior in most cases. Major technical improvements are expected. Smaller, more ergonomic, new-generation robots better adapted to the head and neck will probably be available in the near future.

  3. Current status of robotic surgery in Japan

    PubMed Central

    2015-01-01

    The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed. PMID:25763120

  4. Current status of robotic surgery in Japan.

    PubMed

    Nishimura, Kazuo

    2015-03-01

    The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed.

  5. Robotics in urology: past, present, and future.

    PubMed

    Thiel, David D; Winfield, Howard N

    2008-04-01

    The modern-day urologist is continually armed with new instruments and technology aimed at decreasing the overall invasiveness of urologic procedures. Robotic technology is aimed at improving clinical outcomes by correcting human technical inadequacies such as hand tremors and imprecise suturing. The first reported use of robotics to assist with surgery was in 1985, and the first use of robotics in urology was published in 1989. The currently utilized master-slave system (da Vinci Robotic Platform), Intuitive Surgical, Sunnyvale, CA) has popularized robotic surgery for use in numerous urologic conditions including prostate cancer, bladder cancer, renal cancer, uretero-pelvic junction obstruction, and pelvic prolapse. New developments in robotic technology may revolutionize many other aspects of urology including percutaneous renal access and rounding on patients after surgery. This review provides a brief overview of the history of robotics in urology, a description of the da Vinci surgical system and its current utilization as well as limitations, and a review of evolving robotic technology in the field of urology.

  6. Robotic-assisted pyeloplasty:recent developments in efficacy, outcomes, and new techniques.

    PubMed

    Seideman, Casey A; Bagrodia, Aditya; Gahan, Jeffrey; Cadeddu, Jeffrey A

    2013-02-01

    Within the last decade, the adaptation of robotic urologic surgery has had a profound impact on surgical practice, with robotic upper tract reconstruction for ureteropelvic junction obstruction gaining rapid acceptance. Recent advances in robotic reconstruction demonstrate efficacious outcomes of robotic pyeloplasty, as compared with conventional laparoscopic pyeloplasty, even in the case of secondary surgery. Furthermore, efforts to continue to reduce the morbidity of laparoscopic surgery have led to the development and implementation of laparoendoscopic single-site (LESS) surgery. The recent applications of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has demonstrated the potential to further decrease morbidity, improve surgeon ergonomics, and improve cosmesis.

  7. [Robotic-assisted and laparoscopic hepatic resections for nonparasitic cysts of posterior liver segments].

    PubMed

    Berelavichus, S V; Kriger, A G; Starkov, Iu G; Shishin, K V; Gorin, D S; Poliakov, I S

    2013-01-01

    Results of 36 robotic-assisted and laparoscopic hepatic resections for nonparasitic cysts of posterior liver segments were demonstrated. Technical aspects of the procedure, advantages and drawbacks of each method were discussed. Important intra- and postoperative indexes were compared. The study allows to state, that the use of the da Vinci robotic surgical system has certain technical advantages over the standard laparoscopic technique in case of the posterior location of liver cysts.

  8. [Robotic surgery in gynecology].

    PubMed

    Csorba, Roland

    2012-06-24

    Minimally invasive surgery has revolutionized gynecological interventions over the past 30 years. The introduction of the da Vinci robotic surgery in 2005 has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. It can be utilized mainly in general gynecology and reproductive gynecology. The robot is being increasingly used for procedures such as hysterectomy, myomectomy, adnexal surgery, and tubal anastomosis. In urogynecology, the robot is being utilized for sacrocolopexy as well. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomy and lymphadenectomy in oncologic diseases. Despite the rapid and widespread adaption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. This article presents the development, technical aspects and indications of robotic surgery in gynecology, based on the previously published reviews. Robotic surgery can be highly advantageous with the right amount of training, along with appropriate patient selection. Patients will have less blood loss, less post-operative pain, faster recovery, and fewer complications compared to open surgery and laparoscopy. However, until larger randomized control trials are completed which report long-term outcomes, robotic surgery cannot be stated to have priority over other surgical methods.

  9. A critical comparison of robotic versus conventional laparoscopic splenectomies.

    PubMed

    Bodner, Johannes; Kafka-Ritsch, Reinhold; Lucciarini, Paolo; Fish, John H; Schmid, Thomas

    2005-08-01

    The benefit of robotic systems for general surgery is a matter of debate. We compare our initial series of robotic splenectomies with our first series of conventional laparoscopic ones. A retrospective analysis of the first six robotic versus the first six conventional laparoscopic splenectomies is presented. Patients were matched with regard to age, body-mass index, ASA score, and preoperative platelet levels. All procedures were performed by a single surgeon. Size and weight of the resected specimens were comparable in both groups. Median overall operating time was 154 (range, 115-292) min for the robotic and 127 (range, 95-174) min for the laparoscopic group. No complications occurred. There were no open conversions. The median postoperative hospital stay was 7 (robotic group) and 6 (laparoscopic group) days. Median average costs were 6927 dollars for the robotic procedure versus $4084 for the conventional laparoscopic procedure (p < 0.05). Minimally invasive splenectomies are feasible using either conventional laparoscopic techniques or the da Vinci robotic system. In this analysis, procedures performed with the da Vinci robotic system resulted in prolonged overall operative time and significantly higher procedural costs. The use of a robotic system for laparoscopic splenectomy offers, at this stage, no relevant benefit and thus is not justified.

  10. Current trends in robotic surgery for otolaryngology.

    PubMed

    Byrd, J Kenneth; Duvvuri, Umamaheswar

    2013-09-01

    As minimally invasive surgery has become common in head and neck surgery, the role of robotic surgery has expanded from thyroid surgery and transoral robotic surgery (TORS) of the oropharynx and supraglottic to other areas. Surgeons have advanced the limits of TORS, adapting lasers to the Da Vinci robot for glottic cancer, and combining existing techniques for transoral supraglottic laryngectomy and hypopharyngectomy to perform transoral total laryngectomy. Skull base approaches have been reported with some success in case reports and cadaver models, but the current instrument size and configuration limit the applicability of the current robotic system. Surgeons have reported reconstruction of the head and neck via local and free flaps. Using the previously reported approaches for thyroidectomy via modified facelift incision, neck dissection has also been reported. Future applications of robotic surgery in otolaryngology may be additionally expanded, as several new robotic technologies are under development for endolaryngeal work and neurotology.

  11. The debate over robotics in benign gynecology.

    PubMed

    Rardin, Charles R

    2014-05-01

    The debate over the role of the da Vinci surgical robotic platform in benign gynecology is raging with increasing fervor and, as product liability issues arise, greater financial stakes. Although the best currently available science suggests that, in the hands of experts, robotics offers little in surgical advantage over laparoscopy, at increased expense, the observed decrease in laparotomy for hysterectomy is almost certainly, at least in part, attributable to the availability of the robot. In this author's opinion, the issue is not whether the robot has any role but rather to define the role in an institutional environment that also supports the safe use of vaginal and laparoscopic approaches in an integrated minimally invasive surgery program. Programs engaging robotic surgery should have a clear and self-determined regulatory process and should resist pressures in place that may preferentially support robotics over other forms of minimally invasive surgery. Copyright © 2014 Mosby, Inc. All rights reserved.

  12. Single site robotic-assisted apical lateral suspension (SS R-ALS) for advanced pelvic organ prolapse: first case reported.

    PubMed

    Giannini, Andrea; Russo, Eleonora; Mannella, Paolo; Simoncini, Tommaso

    2016-12-17

    While single-port laparoscopy for gynecological surgery is technically challenging, the Da Vinci Single-Site(®) robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present the first case of single-incision, robotic apical lateral suspension (R-ALS) using this device in pelvic organ prolapse (POP) surgery. A 71-year-old female with advanced symptomatic anterior and apical prolapse (POP-Q stage III/III) was operated with a single-site approach using the Da Vinci Single-Site(®) robotic surgery device. After docking the robot, the complete surgery was performed by robotic approach; only abdominal sub-peritoneal passages of the lateral arms of the mesh were performed extra-corporeally as described in the canonical surgical technique of R-ALS. The procedure was successfully completed in 155 min. No surgical complications occurred during the intervention and the postoperative stay and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of R-ALS using the Da Vinci Single-Site robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are reduced instrument clashes and less surgical scars for the patient. Restoration of triangulation and the lack of monopolar scissors are still limits which are partially overcome by the degrees of freedom of robotic instruments.

  13. Rossum's universal robots: not the machines.

    PubMed

    Moran, Michael E

    2007-12-01

    One assumes in the era of rapidly expanding technology that robot implies mechanical beings. This is not how the word was used initially and represents one of those metamorphoses to another conceptualization. This is an investigation into Capek's original play, Rossum's Universal Robots, for an understanding of his intended meaning. Karel Capek was Czechoslovakian. His play was written in 1920, first performed in 1921, and presented in New York in 1922. It has come to symbolize Western society's feelings about robots. Capek's writing and the original play might clarify the definition of robot for the record, in light of some controversy as to whether the da Vinci Surgical System is a robot or not. THE PLAY: Rossum was a great physiologist who chemically synthesized living protoplasm and was capable of constructing artificial life forms: first, a dog; then, a man. His son was an engineer who quickly was able to manufacture large numbers of humanoids at lower costs " ... producing a robot has been brought down within 15 years from $10,000 to $150." This is the first foreshadowing of Moore's Law. But critically, these are not machines, even though his robots outperform humans. The story turns sinister as the robots eventually revolt and kill their creators. Like many things in our vocabulary, the term robot was initially used for a biologic organism that was created for servitude. Defined by the Robotic Institute of America (1979), a robot is ... "a reprogrammable, multifunctional manipulator designed to move materials, parts, tools, or specialized devices through various programmed motions for the performance of a variety of tasks." This is far from the in tended use envisioned by Capek, but applies to the da Vinci Surgical System. As Alquist in R.U.R. concludes: "... if there are no more human beings left, at least let there be Robots!"

  14. Mentoring console improves collaboration and teaching in surgical robotics.

    PubMed

    Hanly, Eric J; Miller, Brian E; Kumar, Rajesh; Hasser, Christopher J; Coste-Maniere, Eve; Talamini, Mark A; Aurora, Alexander A; Schenkman, Noah S; Marohn, Michael R

    2006-10-01

    One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P < 0.01) and by 34% compared to single-resident operation (P < 0.001). While swap mode was found to be most helpful during parts of surgical procedures that require multiple hands (such as isolation and division of vessels), nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

  15. Reforming Upper Secondary Education in Europe. The Leonardo da Vinci Project Post-16 Strategies. Surveys of Strategies for Post-16 Education To Improve the Parity of Esteem for Initial Vocational Education in Eight European Educational Systems. Theory into Practice 92. Institute for Educational Research Publication Series B.

    ERIC Educational Resources Information Center

    Lasonen, Johanna, Ed.

    This book contains the following papers on the Leonardo da Vinci project: "Looking for Post-16 Education Strategies for Parity of Esteem in Europe" (Lasonen); "Improving Parity of Esteem as a Policy Goal" (Makinen, Volanen); "Alternative Strategies for Parity of Esteem between General/Academic and Vocational Education in…

  16. A second Leonardo da Vinci?

    PubMed

    Nakano, Mitsuko; Endo, Toshitaka; Tanaka, Shigeki

    2003-10-01

    We describe a young woman who suddenly began mirror writing with her right hand and has not reverted to normal writing for more than 6 years, although she writes normally with her left hand. She is ambidextrous, although she had previously used only her right hand for writing and drawing. Since it is much easier for her to use right-handed mirror writing, she uses her left hand only for writing meant to be read by others and her right hand for all other writing. Her hobbies are sculpture and painting, and her chief complaint is migraine accompanied by sensory and perceptive disturbances.

  17. [Planning and simulation of minimally-invasive robotic heart surgery].

    PubMed

    Coste-Manière, Eve; Adhami, Louaï; Severac-Bastide, Renault; Boissonnat, Jean-Daniel; Carpentier, Alain

    2002-04-01

    Due to their numerous advantages, mainly in terms of patient benefit, mini-invasive robotically assisted interventions are gaining in importance in various surgical fields. However, this conversion has its own challenges that stem from both its novelty and complexity. In this paper we propose to accompany the surgeons in their transition, by offering an integrated environment that enables them to make better use of this new technology. The proposed system is patient-dependent, and enables the planning, validation, simulation, teaching and archiving of robotically assisted interventions. The approach is illustrated for a coronary bypass graft using the daVinci tele-operated robot.

  18. [Laparoscopic colorectal surgery--SILS, robots, and NOTES].

    PubMed

    D'Hoore, André; Wolthuis, Albert M; Mizrahi, Hagar; Parker, Mike; Bemelman, Willem A; Wara, Pål

    2011-04-04

    Single incision laparoscopic surgery resection of colon is feasible, but so far evidence of benefit compared to standard laparoscopic technique is lacking. In addition to robot-controlled camera, there is only one robot system on the market capable of performing laparoscopic surgery. The da Vinci robot may contribute to making complex laparoscopic procedures easier to perform, but the system is costly in purchase and maintenance. Natural orifice transluminal endoscopic surgery aiming to reduce abdominal wall trauma is developing and bringing new technology. Combinations of laparoscopic and endoscopic techniques will expand future indications.

  19. Transareolar Robotic-Assisted Access to the Mitral Valve.

    PubMed

    Musumeci, Francesco; Mariscalco, Giovanni; Ranocchi, Federico; Tosi, Daniele; Persichetti, Paolo

    2015-01-01

    During the past years, a rapid development and refinements of robotic heart valve techniques have led to consider robotic mitral valve (MV) surgery safe, effective, and durable. Robotic MV surgery has proven to be a cost-effective and cost-saving strategy in MV operations, being associated with reduced morbidity and mortality rates. We present a novel video-assisted transareolar approach to access the MV using the da Vinci Si HD telemanipulation system (Intuitive Surgical, Inc, Sunnyvale, CA USA). This technique is effective and reproducible, providing maximum patient satisfaction from both the clinical and cosmetic points of view.

  20. Planning, simulation, and augmented reality for robotic cardiac procedures: The STARS system of the ChIR team.

    PubMed

    Coste-Manière, Eve; Adhami, Louaï; Mourgues, Fabien; Carpentier, Alain

    2003-04-01

    This paper presents STARS (Simulation and Transfer Architecture for Robotic Surgery), a versatile system that aims at enhancing minimally invasive robotic surgery through patient-dependent optimized planning, realistic simulation, safe supervision, and augmented reality. The underlying architecture of the proposed approach is presented, then each component is detailed. An experimental validation is conducted on a dog for a coronary bypass intervention using the Da Vinci(TM) surgical system focusing on planing, registration, and augmented reality trials.

  1. [Future aspect of robotic surgery].

    PubMed

    Shimada, Mitsuo; Sugimachi, Keizo

    2002-04-01

    Minimally invasive surgery has become a standard options of surgery. We have introduced a master-slave manipulator "da Vinci" to the clinical situation in July 2000, and developed new operative techniques, which are safer and more tender for patients than before. Up to now, a total of 45 patients underwent a robot-assisted endoscopic surgery using "da Vinci" system. Several procedures including laparoscopic splenectomy and thoracoscopic mediastinal tumor extirpation were first performed in the world. This system provided surgeons with motion scaling, physiological tremor elimination, and high-resolution 3-dimensional vision. Thanks to those sophisticated functions, all surgical procedures, which have been limited due to endoscopic circumstances, were performed much easily and safely than before. Every effort to develop a new type of robotic has been made in collaboration with other fields of scientists. A next-generation robotic surgery is required to equip new functions including tactile sensation system, a real-time navigation system and tele-operation system. Robotic surgery is believed to be one of the most promising and important fields of surgery in the near future.

  2. Predicting the long-term effects of human-robot interaction: a reflection on responsibility in medical robotics.

    PubMed

    Datteri, Edoardo

    2013-03-01

    This article addresses prospective and retrospective responsibility issues connected with medical robotics. It will be suggested that extant conceptual and legal frameworks are sufficient to address and properly settle most retrospective responsibility problems arising in connection with injuries caused by robot behaviours (which will be exemplified here by reference to harms occurred in surgical interventions supported by the Da Vinci robot, reported in the scientific literature and in the press). In addition, it will be pointed out that many prospective responsibility issues connected with medical robotics are nothing but well-known robotics engineering problems in disguise, which are routinely addressed by roboticists as part of their research and development activities: for this reason they do not raise particularly novel ethical issues. In contrast with this, it will be pointed out that novel and challenging prospective responsibility issues may emerge in connection with harmful events caused by normal robot behaviours. This point will be illustrated here in connection with the rehabilitation robot Lokomat.

  3. Robotic-assisted bladder diverticulectomy: tips and tricks.

    PubMed

    Thiel, David D; Young, Paul R; Wehle, Michael J; Broderick, Gregory A; Petrou, Steven P; Igel, Todd C

    2011-05-01

    The da Vinci Surgical System has become extremely popular in the field of urology for procedures requiring complex reconstructive maneuvers, such as radical prostatectomy and pyeloplasty. A natural extension of these procedures is the use of the da Vinci system for complex urinary tract reconstruction deep in the pelvis, such as bladder diverticulectomy. In our report and accompanying Video, we have demonstrated some technical tips and tricks with regard to patient selection, preoperative imaging, patient positioning, port placement, intraoperative diverticulum recognition/excision, and cystotomy repair that the surgeon might find beneficial for successful completion of robotic-assisted bladder diverticulectomy. The tips and tricks we have presented might aid in the successful completion of robotic bladder diverticulectomy. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. System design and animal experiment study of a novel minimally invasive surgical robot.

    PubMed

    Wang, Wei; Li, Jianmin; Wang, Shuxin; Su, He; Jiang, Xueming

    2016-03-01

    Robot-assisted minimally invasive surgery has shown tremendous advances over the traditional technique. However, currently commercialized systems are large and complicated, which vastly raises the system cost and operation room requirements. A MIS robot named 'MicroHand' was developed over the past few years. The basic principle and the key technologies are analyzed in this paper. Comparison between the proposed robot and the da Vinci system is also presented. Finally, animal experiments were carried out to test the performance of MicroHand. Fifteen animal experiments were carried out from July 2013 to December 2013. All animal experiments were finished successfully. The proposed design method is an effective way to resolve the drawbacks of previous generations of the da Vinci surgical system. The animal experiment results confirmed the feasibility of the design. Copyright © 2015 John Wiley & Sons, Ltd.

  5. Robotic assisted minimally invasive surgery

    PubMed Central

    Palep, Jaydeep H

    2009-01-01

    The term “robot” was coined by the Czech playright Karel Capek in 1921 in his play Rossom's Universal Robots. The word “robot” is from the check word robota which means forced labor. The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder) prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK), FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany) have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist®. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naïve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions. PMID:19547687

  6. Future of robotic surgery in urology.

    PubMed

    Rassweiler, Jens J; Autorino, Riccardo; Klein, Jan; Mottrie, Alex; Goezen, Ali Serdar; Stolzenburg, Jens-Uwe; Rha, Koon H; Schurr, Marc; Kaouk, Jihad; Patel, Vipul; Dasgupta, Prokar; Liatsikos, Evangelos

    2017-03-20

    To provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives. A non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors. The relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results. Several console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the

  7. A prototype surgical manipulator for robotic intraocular micro surgery.

    PubMed

    Mulgaonkar, Amit P; Hubschman, Jean-Pierre; Bourges, Jean-Louis; Jordan, Brett L; Cham, Christopher; Wilson, Jason T; Tsao, Tsu-Chin; Culjat, Martin O

    2009-01-01

    A prototype manipulator system was developed for ophthalmologic microsurgery. The system, consisting of two parallel X-Y stages, can mechanically maintain a fixed-point of rotation at the surface of the eye, potentially reducing trauma during surgical procedures. The initial prototype was designed to function in concert with the da Vinci Surgical System for gross positioning. Robotic tests demonstrated the mechanical fitness of the prototype while an in vitro surgical sclerectomy was performed to demonstrate functionality of the approach.

  8. Robotic surgery twice performed in the treatment of hilar cholangiocarcinoma with deep jaundice: delayed right hemihepatectomy following the right-hepatic vascular control.

    PubMed

    Zhu, Zhenyu; Liu, Quanda; Chen, Junzhou; Duan, Weihong; Dong, Maosheng; Mu, Peiyuan; Cheng, Di; Che, Honglei; Zhang, Tao; Xu, Xiaoya; Zhou, Ningxin

    2014-10-01

    To explore and find a new method to treat hilar cholangiocarcinoma with deep jaundice assisted by Da Vinci robot. A hilar cholangiocarcinoma patient of type Bismuch-Corlette IIIa was found with deep jaundice (total bilirubin: 635 µmol/L). On the first admission, we performed Da Vinci robotic surgery including drainage of left hepatic duct, dissection of right hepatic vessels (right portal vein and right hepatic artery), and placement of right-hepatic vascular control device. Three weeks later on the second admission when the jaundice disappeared we occluded right-hepatic vascular discontinuously for 6 days and then sustained later. On the third admission after 3 weeks of right-hepatic vascular control, the right hemihepatectomy was performed by Da Vinci robot for the second time. The future liver remnant after the right-hepatic vascular control increased from 35% to 47%. The volume of left lobe increased by 368 mL. When the total bilirubin and liver function were all normal, right hemihepatectomy was performed by Da Vinci robot 10 weeks after the first operation. The removal of atrophic right hepatic lobe with tumor in bile duct was found with no pathologic cancer remaining in the margin. The patient was followed up at our outpatient clinic every 3 months and no tumor recurrence occurs by now (1 y). Under the Da Vinci robotic surgical system, a programmed treatment can be achieved: first, the hepatic vessels were controlled gradually together with biliary drainage, which results in liver's partial atrophy and compensatory hypertrophy in the other part. Then a radical hepatectomy could be achieved. Such programmed hepatectomy provides a new treatment for patients of hilar cholangiocarcinoma with deep jaundice who have the possibility of radical heptolobectomy.

  9. Transoral robotic-assisted surgery for the approach to anterior cervical spine lesions.

    PubMed

    Molteni, Gabriele; Greco, Marco Giuseppe; Presutti, Livio

    2017-09-01

    The Da Vinci robotic surgical system is increasingly being used by head and neck surgeons in transoral approaches for head and neck cancer. Our experience using the Da Vinci system for transoral robotic-assisted surgery (TORS) is presented. The feasibility of TORS for lesions involving the anterior portion of C1-C2 and the cranio-cervical junction has been evaluated from an anatomical viewpoint in a cadaveric laboratory. Two patients treated using the Da Vinci system to reach C1-C2 benign lesions are presented. The anatomical cadaveric study showed that this approach is safe and feasible. The first two cases which we describe confirmed the advantages of the Da Vinci system in the anterior approach to the cervical spine and allowed the limitations of this procedure to be assessed. TORS may be useful to reach anterior lesions of the cervical spine localized at the level of C1 and C2: first, for removal of small benign and well-delineated lesions; and second, for diagnostic purposes with biopsy of large lesions. Further studies and new instruments are needed to confirm the safety and results of this approach in terms of morbidity.

  10. Sensorization of a surgical robotic instrument for force sensing

    NASA Astrophysics Data System (ADS)

    Shahzada, Kaspar S.; Yurkewich, Aaron; Xu, Ran; Patel, Rajni V.

    2016-03-01

    This paper presents the development and application of an approach for sensorizing a surgical robotic instrument for two degree-of-freedom (DOF) lateral force sensing. The sensorized instrument is compatible with the da Vinci® Surgical System and can be used for skills assessment and force control in specific surgical tasks. The sensing technology utilizes a novel layout of four fiber Bragg grating (FBG) sensors attached to the shaft of a da Vinci® surgical instrument. The two cross-section layout is insensitive to error caused by combined force and torque loads, and the orientation of the sensors minimizes the condition number of the instrument's compliance matrix. To evaluate the instrument's sensing capabilities, its performance was tested using a commercially available force-torque sensor, and showed a resolution of 0.05N at 1 kHz sampling rate. The performance of the sensorized instrument was evaluated by performing three surgical tasks on phantom tissue using the da Vinci® system with the da Vinci Research Kit (dVRK): tissue palpation, knot tightening during suturing and Hem-O-Lok® tightening during knotless suturing. The tasks were designed to demonstrate the robustness of the sensorized force measurement approach. The paper reports the results of further evaluation by a group of expert and novice surgeons performing the three tasks mentioned above.

  11. Toward image guided robotic surgery: system validation.

    PubMed

    Herrell, Stanley D; Kwartowitz, David Morgan; Milhoua, Paul M; Galloway, Robert L

    2009-02-01

    Navigation for current robotic assisted surgical techniques is primarily accomplished through a stereo pair of laparoscopic camera images. These images provide standard optical visualization of the surface but provide no subsurface information. Image guidance methods allow the visualization of subsurface information to determine the current position in relationship to that of tracked tools. A robotic image guided surgical system was designed and implemented based on our previous laboratory studies. A series of experiments using tissue mimicking phantoms with injected target lesions was performed. The surgeon was asked to resect "tumor" tissue with and without the augmentation of image guidance using the da Vinci robotic surgical system. Resections were performed and compared to an ideal resection based on the radius of the tumor measured from preoperative computerized tomography. A quantity called the resection ratio, that is the ratio of resected tissue compared to the ideal resection, was calculated for each of 13 trials and compared. The mean +/- SD resection ratio of procedures augmented with image guidance was smaller than that of procedures without image guidance (3.26 +/- 1.38 vs 9.01 +/- 1.81, p <0.01). Additionally, procedures using image guidance were shorter (average 8 vs 13 minutes). It was demonstrated that there is a benefit from the augmentation of laparoscopic video with updated preoperative images. Incorporating our image guided system into the da Vinci robotic system improved overall tissue resection, as measured by our metric. Adding image guidance to the da Vinci robotic surgery system may result in the potential for improvements such as the decreased removal of benign tissue while maintaining an appropriate surgical margin.

  12. A prospective comparison of robotic and laparoscopic pyeloplasty.

    PubMed

    Link, Richard E; Bhayani, Sam B; Kavoussi, Louis R

    2006-04-01

    To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.

  13. Robotic general surgery: current practice, evidence, and perspective.

    PubMed

    Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

    2015-04-01

    Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

  14. Application of robotics in general surgery: initial experience.

    PubMed

    Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

    2004-10-01

    Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

  15. Preoperative planning system for surgical robotics setup with kinematics and haptics.

    PubMed

    Hayashibe, M; Suzuki, N; Hashizume, M; Kakeji, Y; Konishi, K; Suzuki, S; Hattori, A

    2005-01-01

    Recently, some useful robotic surgical systems have been developed and applied in many surgical situations. Systems such as the da Vinci surgical system of Intuitive Surgical Inc., which facilitates minimally invasive surgery with increased dexterity, are commercially available. Preoperative simulation and planning of surgical robot setups should accompany advanced robotic surgery if their advantages are to be further pursued. Feedback from the planning system will play an essential role in computer-aided robotic surgery in addition to preoperative detailed geometric information from patient CT/MRI images. Surgical robot setup simulation systems for appropriate trocar site placement have been developed especially for abdominal surgery. The motion of the surgical robot can be simulated and rehearsed with kinematic constraints at the trocar site, and the inverse-kinematics of the robot. Results from simulation using clinical patient data verify the effectiveness of the proposed system. Copyright 2005 Robotic Publications Ltd.

  16. Robotic systems in spine surgery.

    PubMed

    Onen, Mehmet Resid; Naderi, Sait

    2014-01-01

    Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

  17. Robotics and medicine: A scientific rainbow in hospital.

    PubMed

    Jeelani, S; Dany, A; Anand, B; Vandana, S; Maheswaran, T; Rajkumar, E

    2015-08-01

    The journey of robotics is a real wonder and astonishingly can be considered as a scientific rainbow showering surprising priceless power in the era of future technologies. The astonishing seven technologies discussed in this paper are da Vinci Robotic surgical system and sperm sorters for infertility, Veebot for blood investigation, Hanako the robotic dental patient for simulating the dental patient and helping a trainee dentist, RP-7 robot who is around-the-clock physician connecting the physician and patient, Robot for Interactive Body Assistance (RIBA) who is a RIBA serving as a nurse, Bushbot serving as a brilliant surgeon, and Virtibot helping in virtual autopsy. Thus, robotics in medicine is a budding field contributing a great lot to human life from before birth to afterlife in seven forms thus gracefully portraying a scientific rainbow in hospital environment.

  18. [Robotics in general surgery: personal experience, critical analysis and prospectives].

    PubMed

    Fracastoro, Gerolamo; Borzellino, Giuseppe; Castelli, Annalisa; Fiorini, Paolo

    2005-01-01

    Today mini invasive surgery has the chance to be enhanced with sophisticated informative systems (Computer Assisted Surgery, CAS) like robotics, tele-mentoring and tele-presence. ZEUS and da Vinci, present in more than 120 Centres in the world, have been used in many fields of surgery and have been tested in some general surgical procedures. Since the end of 2003, we have performed 70 experimental procedures and 24 operations of general surgery with ZEUS robotic system, after having properly trained 3 surgeons and the operating room staff. Apart from the robot set-up, the mean operative time of the robotic operations was similar to the laparoscopic ones; no complications due to robotic technique occurred. The Authors report benefits and disadvantages related to robots' utilization, problems still to be solved and the possibility to make use of them with tele-surgery, training and virtual surgery.

  19. Robotic Single-Site® Sacrocolpopexy: First Report and Technique Using the Single-Site® Wristed Needle Driver

    PubMed Central

    2016-01-01

    The recently introduced da Vinci Single-Site® platform offers cosmetic benefits when compared with standard Multi-Site® robotic surgery. The innovative endowristed technology has increased the use of the da Vinci Single-Site® platform. The newly introduced Single-Site® Wristed Needle Driver has made it feasible to perform various surgeries that require multiple laparoscopic sutures and knot tying. Laparoscopic sacrocolpopexy is also a type of technically difficult surgery requiring multiple sutures, and there have been no reports of it being performed using the da Vinci Single-Site® platform. Thus, to the best of our knowledge, this is the first report of robotic single-site (RSS) sacrocolpopexy, and I found this procedure to be feasible and safe. All RSS procedures were completed successfully. The mean operative time was 122.17±22.54 minutes, and the mean blood loss was 66.67±45.02 mL. No operative or major postoperative complications occurred. Additional studies should be performed to assess the benefits of RSS sacrocolpopexy. I present the first six cases of da Vinci Single-Site® surgery in urogynecology and provide a detailed description of the technique. PMID:27189301

  20. Robotic surgery in gynecology

    PubMed Central

    Sinha, Rooma; Sanjay, Madhumati; Rupa, B.; Kumari, Samita

    2015-01-01

    FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over. PMID:25598600

  1. [Current status of robotic surgery for gastric cancer].

    PubMed

    Suda, Koichi; Ishida, Yoshinori; Uyama, Ichiro

    2014-11-01

    Robotic surgery was launched in Japan in 2000.In particular, the development of the da Vinci S Surgical System was a major breakthrough. It was introduced in Japan for the first time through our hospital in January 2009. Since then, the number of surgical robots used has been dramatically increasing, with up to approximately 160 robots all over the country. To date, we have performed more than 500 robotic surgeries, including 180 gastrectomies, at our hospital. Our data suggest that compared with the conventional laparoscopic approach, the use of the da Vinci Surgical System in minimally invasive gastrectomy for gastric cancer might improve short-term outcomes, particularly in terms of preventing postoperative local complications. Thus, we believe that use of surgical robots become increasingly beneficial for more extensive resections and operations that require more advanced skills, even though a couple of issues remain to be solved, such as long operative time, high cost, and limited experience and evidence. In this article, the current status and future perspectives regarding robotic gastrectomy for gastric cancer are presented based on our experience and a review of the literature.

  2. A case of silicone mesh extrusion into the bladder associated with robotic sacrocolpopexy.

    PubMed

    Mukati, Marium; Shobeiri, S Abbas

    2013-01-01

    Over the past several years, the daVinci robot has been used in gynecologic surgery as a new surgical approach. The literature is being slowly populated with pros and cons of this technology. We report a 60-year-old woman with a history of pelvic organ prolapse who had a robotic sacrocolpopexy. She presented with mesh extrusion into her vagina, which was removed by exploratory laparotomy. Two years later, she presented with mesh erosion into her bladder, which was removed. This case report provides an example of significant mesh complication associated with robotic sacrocolpopexy 4 years after surgery and then again 2 years later.

  3. Virtual reality-assisted robotic surgery simulation.

    PubMed

    Albani, Justin M; Lee, David I

    2007-03-01

    For more than a decade, advancing computer technologies have allowed incorporation of virtual reality (VR) into surgical training. This has become especially important in training for laparoscopic procedures, which often are complex and leave little room for error. With the advent of robotic surgery and the development and prevalence of a commercial surgical system (da Vinci robot; Intuitive Surgical, Sunnyvale, CA), a valid VR-assisted robotic surgery simulator could minimize the steep learning curve associated with many of these complex procedures and thus enable better outcomes. To date, such simulation does not exist; however, several agencies and corporations are involved in making this dream a reality. We review the history and progress of VR simulation in surgical training, its promising applications in robotic-assisted surgery, and the remaining challenges to implementation.

  4. 30 Years of Robotic Surgery.

    PubMed

    Leal Ghezzi, Tiago; Campos Corleta, Oly

    2016-10-01

    The idea of reproducing himself with the use of a mechanical robot structure has been in man's imagination in the last 3000 years. However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first "robot surgeon" used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of "master-slave" robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, EndoWrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci(®) robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

  5. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

  6. Use of Robotics During Laparoscopic Gastric Bypass for Morbid Obesity

    PubMed Central

    Artuso, Dominick; Grossi, Robert

    2005-01-01

    To evaluate the theoretical increased precision offered by utilization of the robotic instrument, we attempted to determine whether incorporation of its use into traditional laparoscopic gastric bypass would duplicate or improve the success of the operation without increasing complications. The Roux-en-Y gastric bypass is the most commonly performed procedure for morbid obesity in the United States. We performed 120 gastric bypass procedures with traditional laparoscopy during a 30-month period. We began introducing the da Vinci Robotic Surgical System into our laparoscopic gastric bypass procedure and evaluated its effectiveness. PMID:16121869

  7. [Robotic surgery in gynecology: is it the future?].

    PubMed

    Coronado Martín, Pluvio Jesús

    2011-01-01

    Gynecologic surgery has been undergone a significant change in the last decade thanks to innovation in health technology. The appearance of the Da Vinci Surgical System has revolutionized the concept of minimally invasive surgery, due to add advantages over conventional laparoscopic surgery, such us three-dimensional vision, wristed forceps and a complete control of the instruments by the surgeon. The evidence published reflects that robotic surgery is preferable to laparotomy and laparoscopic approach, because it is more accurate, versatile, intuitive, and reduces perioperative morbidity. The future of Gynecologic Surgery is linked to the robotic approach.

  8. System for robot-assisted real-time laparoscopic ultrasound elastography

    NASA Astrophysics Data System (ADS)

    Billings, Seth; Deshmukh, Nishikant; Kang, Hyun Jae; Taylor, Russell; Boctor, Emad M.

    2012-02-01

    Surgical robots provide many advantages for surgery, including minimal invasiveness, precise motion, high dexterity, and crisp stereovision. One limitation of current robotic procedures, compared to open surgery, is the loss of haptic information for such purposes as palpation, which can be very important in minimally invasive tumor resection. Numerous studies have reported the use of real-time ultrasound elastography, in conjunction with conventional B-mode ultrasound, to differentiate malignant from benign lesions. Several groups (including our own) have reported integration of ultrasound with the da Vinci robot, and ultrasound elastography is a very promising image guidance method for robotassisted procedures that will further enable the role of robots in interventions where precise knowledge of sub-surface anatomical features is crucial. We present a novel robot-assisted real-time ultrasound elastography system for minimally invasive robot-assisted interventions. Our system combines a da Vinci surgical robot with a non-clinical experimental software interface, a robotically articulated laparoscopic ultrasound probe, and our GPU-based elastography system. Elasticity and B-mode ultrasound images are displayed as picture-in-picture overlays in the da Vinci console. Our system minimizes dependence on human performance factors by incorporating computer-assisted motion control that automatically generates the tissue palpation required for elastography imaging, while leaving high-level control in the hands of the user. In addition to ensuring consistent strain imaging, the elastography assistance mode avoids the cognitive burden of tedious manual palpation. Preliminary tests of the system with an elasticity phantom demonstrate the ability to differentiate simulated lesions of varied stiffness and to clearly delineate lesion boundaries.

  9. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

    PubMed Central

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

    2009-01-01

    Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably

  10. [Haptic tracking control for minimally invasive robotic surgery].

    PubMed

    Xu, Zhaohong; Song, Chengli; Wu, Wenwu

    2012-06-01

    Haptic feedback plays a significant role in minimally invasive robotic surgery (MIRS). A major deficiency of the current MIRS is the lack of haptic perception for the surgeon, including the commercially available robot da Vinci surgical system. In this paper, a dynamics model of a haptic robot is established based on Newton-Euler method. Because it took some period of time in exact dynamics solution, we used a digital PID arithmetic dependent on robot dynamics to ensure real-time bilateral control, and it could improve tracking precision and real-time control efficiency. To prove the proposed method, an experimental system in which two Novint Falcon haptic devices acting as master-slave system has been developed. Simulations and experiments showed proposed methods could give instrument force feedbacks to operator, and bilateral control strategy is an effective method to master-slave MIRS. The proposed methods could be used to tele-robotic system.

  11. Update on anesthetic complications of robotic thoracic surgery.

    PubMed

    Campos, J; Ueda, K

    2014-01-01

    In the last decade, there has been increasing use of the da Vinci® robot surgical system to perform minimally invasive thoracic surgery. The robotic technology can be applied for surgery of the lungs, mediastinum, and esophagus. A number of case reports have been shown steep learning curve, and promising surgical outcome with this new technology. However, anesthesia management of the robotic thoracic surgery can be complex and requires further education. For example, most of the cases require sufficient lung collapse in order to provide adequate surgical field. In addition, a unique operative setting, such as patient positioning and capnothorax can make anesthesia management further challenging. Hence, anesthesiologists should have better awareness of adverse events or complications related to the robotic surgery to accomplish successful anesthesia management. This review will focus on the potential complications of robotic thoracic surgery involving the lungs, mediastinum and esophagus.

  12. Robotic technology in spine surgery: current applications and future developments.

    PubMed

    Stüer, Carsten; Ringel, Florian; Stoffel, Michael; Reinke, Andreas; Behr, Michael; Meyer, Bernhard

    2011-01-01

    Medical robotics incrementally appears compelling in nowadays surgical work. The research regarding an ideal interaction between physician and computer assistance has reached a first summit with the implementation of commercially available robots (Intuitive Surgical's® da Vinci®). Moreover, neurosurgery--and herein spine surgery--seems an ideal candidate for computer assisted surgery. After the adoption of pure navigational support from brain surgery to spine surgery a meanwhile commercially available miniature robot (Mazor Surgical Technologies' The Spine Assist®) assists in drilling thoracic and lumbar pedicle screws. Pilot studies on efficacy, implementation into neurosurgical operating room work flow proved the accuracy of the system and we shortly outline them. Current applications are promising, and future possible developments seem far beyond imagination. But still, medical robotics is in its infancy. Many of its advantages and disadvantages must be delicately sorted out as the patients safety is of highest priority. Medical robots may achieve a physician's supplement but not substitute.

  13. The Robotic-Assisted Laparoscopy, Isthmusectomy, and Pyeloplasty in a Patient With Horseshoe Kidney: A Case Report.

    PubMed

    Tai, Sheng; Wang, Jianzhong; Zhou, Jun; Hao, Zongyao; Shi, Haoqiang; Zhang, Yifei; Liang, Chaozhao

    2016-01-01

    The aim of this case report was to evaluate the results of isthmusectomy and pyeloplasty of horseshoe kidney with the da Vinci robotic-assisted laparoscopy system.This case presented 1 patient with left back pain, associated with lower abdominal pain, and then she underwent the isthmusectomy and dismembered pyeloplasty using robotic-assisted laparoscopy simultaneously. The operation was performed by a transperitoneal approach using 5 ports.We cut the renal isthmus by means of bipolar scissors and then closed the renal parenchyma with 3-0 absorbed stitches. The total operation time was 123 min including simultaneous dismembered pyeloplasty. Blood loss was <50 mL. There were no complications either during or after the procedure. The oral nutrition and mobilization were included on the second day after surgery. The peritoneal drainage was removed on the eighth day. Long-term follow-up after treatment showed good results.The da Vinci robotic-assisted laparoscopy is an alternative to open surgery and laparoscopy, particularly in the correction of congenital defects of the urinary tract. Furthermore, the da Vinci robotic-assisted laparoscopy technique in isthmusectomy and pyeloplasty is safe for patient as shown by our results.

  14. Virtual reality robotic surgery simulation curriculum to teach robotic suturing: a randomized controlled trial.

    PubMed

    Kiely, Daniel J; Gotlieb, Walter H; Lau, Susie; Zeng, Xing; Samouelian, Vanessa; Ramanakumar, Agnihotram V; Zakrzewski, Helena; Brin, Sonya; Fraser, Shannon A; Korsieporn, Pira; Drudi, Laura; Press, Joshua Z

    2015-09-01

    The objective of this randomized, controlled trial was to assess whether voluntary participation in a proctored, proficiency-based, virtual reality robotic suturing curriculum using the da Vinci(®) Skills Simulator™ improves robotic suturing performance. Residents and attending surgeons were randomized to participation or non-participation during a 5 week training curriculum. Robotic suturing skills were evaluated before and after training using an inanimate vaginal cuff model, which participants sutured for 10 min using the da Vinci(®) Surgical System. Performances were videotaped, anonymized, and subsequently graded independently by three robotic surgeons. 27 participants were randomized. 23 of the 27 completed both the pre- and post-test, 13 in the training group and 10 in the control group. Mean training time in the intervention group was 238 ± 136 min (SD) over the 5 weeks. The primary outcome (improvement in GOALS+ score) and the secondary outcomes (improvement in GEARS, total knots, satisfactory knots, and the virtual reality suture sponge 1 task) were significantly greater in the training group than the control group in unadjusted analysis. After adjusting for lower baseline scores in the training group, improvement in the suture sponge 1 task remained significantly greater in the training group and a trend was demonstrated to greater improvement in the training group for the GOALS+ score, GEARS score, total knots, and satisfactory knots.

  15. Robotic microsurgery optimization.

    PubMed

    Brahmbhatt, Jamin V; Gudeloglu, Ahmet; Liverneaux, Philippe; Parekattil, Sijo J

    2014-05-01

    The increased application of the da Vinci robotic platform (Intuitive Surgical Inc.) for microsurgery has led to the development of new adjunctive surgical instrumentation. In microsurgery, the robotic platform can provide high definition 12×-15× digital magnification, broader range of motion, fine instrument handling with decreased tremor, reduced surgeon fatigue, and improved surgical productivity. This paper presents novel adjunctive tools that provide enhanced optical magnification, micro-Doppler sensing of vessels down to a 1-mm size, vein mapping capabilities, hydro-dissection, micro-ablation technology (with minimal thermal spread-CO2 laser technology), and confocal microscopy to provide imaging at a cellular level. Microsurgical outcomes from the use of these tools in the management of patients with infertility and chronic groin and testicular pain are reviewed. All these instruments have been adapted for the robotic console and enhance the robot-assisted microsurgery experience. As the popularity of robot-assisted microsurgery grows, so will its breadth of instrumentation.

  16. Robotic Microsurgery Optimization

    PubMed Central

    Brahmbhatt, Jamin V; Gudeloglu, Ahmet; Liverneaux, Philippe

    2014-01-01

    The increased application of the da Vinci robotic platform (Intuitive Surgical Inc.) for microsurgery has led to the development of new adjunctive surgical instrumentation. In microsurgery, the robotic platform can provide high definition 12×-15× digital magnification, broader range of motion, fine instrument handling with decreased tremor, reduced surgeon fatigue, and improved surgical productivity. This paper presents novel adjunctive tools that provide enhanced optical magnification, micro-Doppler sensing of vessels down to a 1-mm size, vein mapping capabilities, hydro-dissection, micro-ablation technology (with minimal thermal spread-CO2 laser technology), and confocal microscopy to provide imaging at a cellular level. Microsurgical outcomes from the use of these tools in the management of patients with infertility and chronic groin and testicular pain are reviewed. All these instruments have been adapted for the robotic console and enhance the robot-assisted microsurgery experience. As the popularity of robot-assisted microsurgery grows, so will its breadth of instrumentation. PMID:24883272

  17. Surgery with cooperative robots.

    PubMed

    Lehman, Amy C; Berg, Kyle A; Dumpert, Jason; Wood, Nathan A; Visty, Abigail Q; Rentschler, Mark E; Platt, Stephen R; Farritor, Shane M; Oleynikov, Dmitry

    2008-03-01

    Advances in endoscopic techniques for abdominal procedures continue to reduce the invasiveness of surgery. Gaining access to the peritoneal cavity through small incisions prompted the first significant shift in general surgery. The complete elimination of external incisions through natural orifice access is potentially the next step in reducing patient trauma. While minimally invasive techniques offer significant patient advantages, the procedures are surgically challenging. Robotic surgical systems are being developed that address the visualization and manipulation limitations, but many of these systems remain constrained by the entry incisions. Alternatively, miniature in vivo robots are being developed that are completely inserted into the peritoneal cavity for laparoscopic and natural orifice procedures. These robots can provide vision and task assistance without the constraints of the entry incision, and can reduce the number of incisions required for laparoscopic procedures. In this study, a series of minimally invasive animal-model surgeries were performed using multiple miniature in vivo robots in cooperation with existing laparoscopy and endoscopy tools as well as the da Vinci Surgical System. These procedures demonstrate that miniature in vivo robots can address the visualization constraints of minimally invasive surgery by providing video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

  18. Robotic Surgery in Gynecologic Field

    PubMed Central

    Kim, Sang Wun; Jung, Yong Wook

    2008-01-01

    Operative laparoscopy was initially developed in the field of gynecology earlier on and the advent of laparoscopic surgery led to advances in general surgery as well. In the last few years, a number of articles have been published on the performance of surgical procedures using the robot-assisted laparoscopy. The shortcomings of conventional laparoscopy have led to the development of robotic surgical system and future of telerobotic surgery is not far away, enabling a surgeon to operate at a distance from the operating table. The complete loss of tactile sensation is often quoted as a big disadvantage of working with robotic systems. Although the first generation da Vinci robotic surgical system provides improved imaging and instrumentation, the absence of tactile feedback and the high cost of the technology remain as limitations. New generations of the robotic surgical systems have been developed, allowing visualization of preoperative imaging during the operation. Though the introduction of robotics is very recent, the potential for robotics in several specialties is significant. However, the benefit to patients must be carefully evaluated and proven before this technology can become widely accepted in the gynecologic surgery. PMID:19108009

  19. Robotics applied in laparoscopic kidney surgery: the Yonsei University experience of 127 cases.

    PubMed

    Lorenzo, Enrique Ian S; Jeong, Wooju; Oh, Cheol Kyu; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

    2011-01-01

    We report our experience on 127 kidney surgeries with the da Vinci surgical system and show the feasibility of a robotics application in a variety of kidney surgeries by both a laparoscopically-trained and a laparoscopically-naïve surgeon. Clinical data of patients who underwent kidney surgery with the da Vinci surgical system from September 2006 to April 2009 were reviewed. Data acquired from medical records included patient demographics, operative time, estimated blood loss (EBL), incidence of intraoperative complication, duration of hospital stay, blood transfusion rate, oncological outcomes, and follow-up results. One-hundred twenty-seven kidney surgeries have been conducted with the da Vinci surgical system at our institution. Three urologists--1 with formal endourology training, 1 with laparoscopic experience, and 1 laparoscopically naïve--have used it for a variety of procedures involving the kidney. The cases include 65 partial nephrectomies (RPN), 38 radical nephrectomies (RRN), and 24 nephroureterectomies with bladder cuff (RNU). Results on operative time, EBL, incidence of intraoperative injury, duration of hospital stay, and blood transfusion rate are comparable with contemporary studies. Robotics application in kidney surgery is a viable option for various procedures. Our experience shows it can be safely and effectively conducted by both laparoscopically-trained and laparoscopically-naïve surgeons once they are accustomed to the robotics system. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. The development of robotic surgery in the Middle East

    PubMed Central

    Rabah, Danny M.; Al-Abdin, Osman Zin

    2012-01-01

    Objectives We provide an overview of the development of robotic surgery in the Middle East since its first introduction in April 2003 in the Kingdom of Saudi Arabia (KSA). Methods We searched MEDLINE using 20 keywords/phrases and identified 44 reports, of which only 15 were relevant. Five of these articles were duplicated when using two different keywords. Therefore, no more than 10 articles were found that were relevant to the scope of this review. Results After completing the MEDLINE search to identify articles related to robotic surgery in the Middle East, we noted that all of the nine case series (Level of evidence 3a) reported took place in the KSA, with no other reported series from other Middle-Eastern countries. To the best of our knowledge, there are no operating robotic surgery systems (da Vinci, Intuitive Surgical, CA, USA) in the Middle East other than in the KSA, Qatar and Egypt. The number of robotic surgery cases and newly adapted robotic procedures is increasing. Two major institutions in the KSA have expanded to robotic-assisted pyeloplasty in all of their cases since January 2005. Conclusion There are 10 da Vinci robots in the KSA, with over 35 trained surgeons, yet very few index cases. The cancer incidence rate, lack of practitioners’ referrals, and demographic age distribution are all factors that contribute significantly to the few index cases reported. By consolidating the robotic surgery procedures in high-volume speciality centres, hospitals can increase their case loads by promoting the multidisciplinary use of the robotic system. Even though growth is relatively slow, we believe that robotic surgery is gaining momentum, and its benefits and innovation will soon be grasped in other countries in the Middle East. PMID:26557999

  1. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

    PubMed

    Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

    2016-02-01

    Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

  2. The development of robotic surgery in the Middle East.

    PubMed

    Rabah, Danny M; Al-Abdin, Osman Zin

    2012-03-01

    We provide an overview of the development of robotic surgery in the Middle East since its first introduction in April 2003 in the Kingdom of Saudi Arabia (KSA). We searched MEDLINE using 20 keywords/phrases and identified 44 reports, of which only 15 were relevant. Five of these articles were duplicated when using two different keywords. Therefore, no more than 10 articles were found that were relevant to the scope of this review. After completing the MEDLINE search to identify articles related to robotic surgery in the Middle East, we noted that all of the nine case series (Level of evidence 3a) reported took place in the KSA, with no other reported series from other Middle-Eastern countries. To the best of our knowledge, there are no operating robotic surgery systems (da Vinci, Intuitive Surgical, CA, USA) in the Middle East other than in the KSA, Qatar and Egypt. The number of robotic surgery cases and newly adapted robotic procedures is increasing. Two major institutions in the KSA have expanded to robotic-assisted pyeloplasty in all of their cases since January 2005. There are 10 da Vinci robots in the KSA, with over 35 trained surgeons, yet very few index cases. The cancer incidence rate, lack of practitioners' referrals, and demographic age distribution are all factors that contribute significantly to the few index cases reported. By consolidating the robotic surgery procedures in high-volume speciality centres, hospitals can increase their case loads by promoting the multidisciplinary use of the robotic system. Even though growth is relatively slow, we believe that robotic surgery is gaining momentum, and its benefits and innovation will soon be grasped in other countries in the Middle East.

  3. Intraoperative presentation of Bochdalek's hernia in an adult during robotic-assisted partial nephrectomy: An uncommon situation and literature review.

    PubMed

    Cindolo, Luca; Berardinelli, Francesco; Manzi, Arianna; Spagnuolo, Francesca; Fabbri, Elisa; Castellan, Pietro; Petrini, Flavia; Schips, Luigi

    2016-01-14

    Bochdalek's diaphragmatic hernia (BDH) is a congenital defect of the diaphragm that usually present during the neonatal period and rarely remain silent until adulthood. We present a 45-year-old-female case with diagnosis of double left kidney tumor prepared for robot-assisted partial nephrectomy (RPN). During the preoperative procedure she had a reduction of inspiratory volumes and increased pulmonary pressures: the robotic camera revealed the incidental presence of the left diaphragmatic defect. We report a simultaneous nephron sparing surgery (NSS) and left posterolateral BDH correction done by the da Vinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA).

  4. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.

    PubMed

    Rashid, Hani H; Leung, Yuk-Yuen M; Rashid, Megan J; Oleyourryk, Gregory; Valvo, John R; Eichel, Louis

    2006-07-01

    Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy. Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation. Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents' mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents (P <0.005). A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.

  5. Superiority of robotic surgery for cervical cancer in comparison with traditional approaches: A systematic review and meta-analysis.

    PubMed

    Liu, Zhongyu; Li, Xiuli; Tian, Shuang; Zhu, Tongyu; Yao, Yuanqing; Tao, Ye

    2017-04-01

    To review the safety and effectiveness of da Vinci robotic surgery for cervical cancer in comparison with the traditional open surgery and conventional laparoscopic operation. Based on Medline, the Cochrane library, Embase, and the Journal of Robotic Surgery prior to December 30st, 2015, we searched for controlled trials and observational studies. A systematic review with meta-analyses was conducted to compare the clinical efficacy between the da Vinci robotic surgery, open surgery, and laparoscopic surgery for cervical cancer. Data were pooled using the random effects meta-analysis. Compared with the open surgery, the robotic surgery for cervical cancer would be advantageous in terms of the length of hospital stay, incidence of complications, volume of blood loss and blood transfusion. The operative time of robotic surgery was longer than that of the open surgery, but the prediction intervals indicated that they could be shorter in future studies. Meanwhile, compared with conventional laparoscopic surgery, the robotic surgery could offer more benefits in terms of the length of hospital stay, while no difference was found in terms of the incidence of complications and the volume of blood loss. Compared to open surgery, the robotic surgery would be advantageous for cervical cancer patients in terms of the length of hospital stay, the incidence of complications, blood loss and blood transfusion. Compared with conventional laparoscopic surgery, the robotic surgery would result in longer OT, more BL and shorter LOS. The study quality was poor. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Current status of robot-assisted surgery.

    PubMed

    Ng, Ada T L; Tam, P C

    2014-06-01

    The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.

  7. Face, content and concurrent validity of the Mimic® dV-Trainer for robot-assisted endoscopic surgery: a prospective study.

    PubMed

    Egi, H; Hattori, M; Tokunaga, M; Suzuki, T; Kawaguchi, K; Sawada, H; Ohdan, H

    2013-01-01

    The aim of this study was to determine whether any correlation exists between the performance of the Mimic® dV-Trainer (Mimic Technologies, Seattle, Wash., USA) and the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, Calif., USA). Twelve participants were recruited, ranging from residents to consultants. We used four training tasks, consisting of 'Pick and Place', 'Peg Board', 'Thread the Rings' and 'Suture Sponge', from the software program of the Mimic dV-Trainer. The performance of the participants was recorded and measured. Additionally, we prepared the same tasks for the da Vinci Surgical System. All participants completed the tasks using the da Vinci Surgical System and were assessed according to time, the Objective Structured Assessment of Technical Skill checklist and the global rating score for endoscopic suturing assessed by two independent blinded observers. After performing these tasks, the participants completed a questionnaire that evaluated the Mimic dV-Trainer's face and content validity. The final results for each participant for the Mimic dV-Trainer and the da Vinci Surgical System were compared. All participants ranked the Mimic dV-Trainer as a realistic training platform that is useful for residency training. There was a significant relationship between the Mimic dV-Trainer and the da Vinci Surgical System in all four tasks. We verified the reliability of the assessment of the checklist and the global rating scores for endoscopic suturing assessed by the two blinded observers using Cronbach's alpha test (r = 0.803, 0.891). We evaluated the concurrent validity of the Mimic dV-Trainer and the da Vinci Surgical System. Our results suggest the possibility that training using the Mimic dV-Trainer may therefore be able to improve the operator's performance during live robot-assisted surgery. © 2013 S. Karger AG, Basel.

  8. Robotic Surgical Training in an Academic Institution

    PubMed Central

    Chitwood, W. Randolph; Nifong, L. Wiley; Chapman, William H. H.; Felger, Jason E.; Bailey, B. Marcus; Ballint, Tara; Mendleson, Kim G.; Kim, Victor B.; Young, James A.; Albrecht, Robert A.

    2001-01-01

    Objective To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background Data Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Methods Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Results Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Conclusion Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons

  9. Robotic surgical training in an academic institution.

    PubMed

    Chitwood, W R; Nifong, L W; Chapman, W H; Felger, J E; Bailey, B M; Ballint, T; Mendleson, K G; Kim, V B; Young, J A; Albrecht, R A

    2001-10-01

    To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors' two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely.

  10. Surgical treatment of parietal defects with “da Vinci” surgical robot

    PubMed Central

    Vasilescu, D; Paun, S

    2012-01-01

    The robotic surgery has come through the development of telemedicine and minimally invasive surgery concepts, being developed in the military medicine by NASA during the years 1970-1980. The purpose of this paper is to briefly present our experience in the new field of the robotic surgery, by analyzing the results obtained over a lot of 20 patients operated with the “da Vinci” robot within the last 5 years in the Clinical Emergency Hospital Bucharest for various abdominal defects PMID:22802899

  11. [Robots in general surgery: present and future].

    PubMed

    Galvani, Carlos; Horgan, Santiago

    2005-09-01

    Robotic surgery is an emerging technology. We began to use this technique in 2000, after it was approved by the Food and Drug Administration. Our preliminary experience was satisfactory. We report 4 years' experience of using this technique in our institution. Between August 2000 and December 2004, 399 patients underwent robotic surgery using the Da Vinci system. We performed 110 gastric bypass procedures, 30 Lap band, 59 Heller myotomies, 12 Nissen fundoplications, 6 epiphrenic diverticula, 18 total esophagectomies, 3 esophageal leiomyoma resections, 1 pyloroplasty, 2 gastrojejunostomies, 2 transduodenal sphincteroplasties, 10 adrenalectomies and 145 living-related donor nephrectomies. Operating times for fundoplications and Lap band were longer. After the learning curve, the operating times and morbidity of the remaining procedures were considerably reduced. Robot-assisted surgery allows advanced laparoscopic procedures to be performed with enhanced results given that it reduces the learning curve as measured by operating time and morbidity.

  12. Applications of robotics in surgery.

    PubMed

    Panait, L; Doarn, C R; Merrell, R C

    2002-01-01

    The end of the 20th century brought an increased use of computerized technology in medicine and surgery. The development of robotic surgical systems opened new approaches in general and cardiac surgery. Two leading robotic companies, Computer Motion, Inc. and Intuitive Surgical, Inc. have developed the Zeus and Da Vinci respectively, as very effective tools for surgeons to use. Both of them consist of a surgeon console, located far from the operating table, and three robotic arms, which reproduce inside the patient's body the movements performed by the surgeon at the console. The advantages of robotic surgery over laparoscopy and open surgery include: better eye-hand coordination, tremor filtration, steadiness of camera, 3-D vision, motion scale, more degrees of freedom for instruments etc. Of course, there are also some disadvantages, like the lack of tactile feedback, long time of set up, long learning curve, high cost etc. However, the advantages seem to overcome the disadvantages and more and more operations are conducted using robots. The impact of robotics in surgery is therefore very promising and in the future it will probably open even more new ways in the surgical practice and education both in Romania and across the globe.

  13. Early experience with robotic rectopexy.

    PubMed

    Buchs, Nicolas C; Pugin, François; Ris, Frederic; Volonte, Francesco; Morel, Philippe; Roche, Bruno

    2013-12-01

    The introduction of robotics in colorectal surgery has been gaining increasing acceptance. However, experience remains still limited for pelvic floor disorders. We report herein our first cases of fully robotic rectopexy and promontofixation for rectal prolapse. From October 2011 to June 2012, five female patients underwent a robotic rectopexy at our institution. The patients were selected according to their primary pathology and their medical history for this preliminary experience. Four of them presented a rectal prolapse associated or not with a vaginal prolapse and the last patient presented a recurrent rectal prolapse 5 years after a laparoscopic repair. The study was approved by our local ethics committee. The robot da Vinci Si (Intuitive Surgical Inc, Sunnyvale, CA) was used with a 4-port setting in all cases. The mean operative time was 170 minutes (range: 120-270). There was no conversion. The blood loss was minimal. One patient presented a retrorectal hematoma, treated conservatively with success. There was no other complication. The mean hospital stay was 3.6 days (range: 2-7). At 2 months, there was neither recurrence nor readmission. In comparison with the laparoscopic approach, there were no statistically significant differences. Robotic rectopexy and promontofixation are feasible and safe. The outcomes are encouraging, but functional results and long-term outcomes are required to evaluate the exact role of robotics for rectal prolapse. Copyright © 2013 John Wiley & Sons, Ltd.

  14. Robot-Assisted Surgery of the Shoulder Girdle and Brachial Plexus

    PubMed Central

    Facca, Sybille; Hendriks, Sarah; Mantovani, Gustavo; Selber, Jesse C.; Liverneaux, Philippe

    2014-01-01

    New developments in the surgery of the brachial plexus include the use of less invasive surgical approaches and more precise techniques. The theoretical advantages of the use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional vision, high definition, magnification, and superior ergonomics. On a fresh cadaver, a dissection space was created and maintained by insufflation of CO2. The supraclavicular brachial plexus was dissected using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA). A segment of the C5 nerve root was grafted robotically. A series of eight clinical cases of nerve damage around the shoulder girdle were operated on using the da Vinci robot. The ability to perform successful microneural repair was confirmed in both the authors' clinical and experimental studies, but the entire potential of robotically assisted microneural surgery was not realized during these initial cases because an open incision was still required. Robotic-assisted surgery of the shoulder girdle and brachial plexus is still in its early stages. It would be ideal to have even finer and more suitable instruments to apply fibrin glue or electrostimulation in nerve surgery. Nevertheless, the prospects of minimally invasive techniques would allow acute and subacute surgical approach of traumatic brachial plexus palsy safely, without significant and cicatricial morbidity. PMID:24872778

  15. Novel application of simultaneous multi-image display during complex robotic abdominal procedures.

    PubMed

    Woo, Yanghee; Choi, Gi Hong; Min, Byung Soh; Hyung, Woo Jin

    2014-03-15

    The surgical robot offers the potential to integrate multiple views into the surgical console screen, and for the assistant's monitors to provide real-time views of both fields of operation. This function has the potential to increase patient safety and surgical efficiency during an operation. Herein, we present a novel application of the multi-image display system for simultaneous visualization of endoscopic views during various complex robotic gastrointestinal operations. All operations were performed using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) with the assistance of Tilepro, multi-input display software, during employment of the intraoperative scopes. Three robotic operations, left hepatectomy with intraoperative common bile duct exploration, low anterior resection, and radical distal subtotal gastrectomy with intracorporeal gastrojejunostomy, were performed by three different surgeons at a tertiary academic medical center. The three complex robotic abdominal operations were successfully completed without difficulty or intraoperative complications. The use of the Tilepro to simultaneously visualize the images from the colonoscope, gastroscope, and choledochoscope made it possible to perform additional intraoperative endoscopic procedures without extra monitors or interference with the operations. We present a novel use of the multi-input display program on the da Vinci Surgical System to facilitate the performance of intraoperative endoscopies during complex robotic operations. Our study offers another potentially beneficial application of the robotic surgery platform toward integration and simplification of combining additional procedures with complex minimally invasive operations.

  16. Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique.

    PubMed

    Kandil, Emad; Noureldine, Salem I; Saggi, Bob; Buell, Joseph F

    2013-01-01

    Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21-68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10-200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

  17. VINCI: the VLT Interferometer commissioning instrument

    NASA Astrophysics Data System (ADS)

    Kervella, Pierre; Coudé du Foresto, Vincent; Glindemann, Andreas; Hofmann, Reiner

    2000-07-01

    The Very Large Telescope Interferometer (VLTI) is a complex system, made of a large number of separated elements. To prepare an early successful operation, it will require a period of extensive testing and verification to ensure that the many devices involved work properly together, and can produce meaningful data. This paper describes the concept chosen for the VLTI commissioning instrument, LEONARDO da VINCI, and details its functionalities. It is a fiber based two-way beam combiner, associated with an artificial star and an alignment verification unit. The technical commissioning of the VLTI is foreseen as a stepwise process: fringes will first be obtained with the commissioning instrument in an autonomous mode (no other parts of the VLTI involved); then the VLTI telescopes and optical trains will be tested in autocollimation; finally fringes will be observed on the sky.

  18. Robotic surgery in gynecology

    PubMed Central

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the “patient cart,” an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the “patient cart” provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology. PMID:27990092

  19. [Surgical robotics in neurosurgery].

    PubMed

    Haidegger, Tamás; Benyó, Zoltán

    2009-09-06

    Surgical robotics is one of the most dynamically advancing areas of biomedical engineering. In the past few decades, computer-integrated interventional medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for nephrectomy, cholecystectomy, as well as in orthopedics and radiosurgery. Estimates show that 70% of the radical prostatectomies were performed with the da Vinci robot in the United States last year. Robot-aided procedures offer remarkable advantages in neurosurgery both for the patient and the surgeon, making microsurgery and Minimally Invasive Surgery a reality, and even complete teleoperation accessible. This paper introduces surgical robotic systems developed primarily for brain and spine applications, besides, it focuses on the different research strategies applied to provide smarter, better and more advanced tools to surgeons. A new system is discussed in details that we have developed together with the Johns Hopkins University in Baltimore. This cooperatively-controlled system can assist with skull base drilling to improve the safety and quality of neurosurgery while reducing the operating time. The paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research.

  20. Robotic surgery in gynecology.

    PubMed

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  1. Peer Review and Surgical Innovation: Robotic Surgery and Its Hurdles

    PubMed Central

    Vyas, Dinesh; Cronin, Sean

    2016-01-01

    The peer review processes as outlined in the Health Care Quality Improvement Act (HCQIA) is meant ensure quality standard of care through a self-policing mechanism by the medical community. This process grants immunity for people filing a peer review, which is meant to protect whistleblowers. However, it also creates a loophole that can be used maliciously to hinder competition. This is accentuated when surgeons are integrating new technologies, such as robotic surgery, into their practice. With more than 2000 da Vinci robots in use and more than 300 new units being shipped each year, robotic surgery has become a mainstay in the surgical field. The applications for robots continue to expand as surgeons discover their expanding capability. We need a better peer review process. That ensures the peer review is void of competitive bias. Peer reviewers need to be familiar with the procedure and the technology. The current process could stymie innovation in the name of competition. PMID:27517092

  2. Peer Review and Surgical Innovation: Robotic Surgery and Its Hurdles.

    PubMed

    Vyas, Dinesh; Cronin, Sean

    2015-12-01

    The peer review processes as outlined in the Health Care Quality Improvement Act (HCQIA) is meant ensure quality standard of care through a self-policing mechanism by the medical community. This process grants immunity for people filing a peer review, which is meant to protect whistleblowers. However, it also creates a loophole that can be used maliciously to hinder competition. This is accentuated when surgeons are integrating new technologies, such as robotic surgery, into their practice. With more than 2000 da Vinci robots in use and more than 300 new units being shipped each year, robotic surgery has become a mainstay in the surgical field. The applications for robots continue to expand as surgeons discover their expanding capability. We need a better peer review process. That ensures the peer review is void of competitive bias. Peer reviewers need to be familiar with the procedure and the technology. The current process could stymie innovation in the name of competition.

  3. Urologic robotic surgery in Korea: past and present.

    PubMed

    Seo, Ill Young

    2015-08-01

    Since 2005 when the da Vinci surgical system was approved as a medical device by the Korean Ministry of Health and Welfare, 51 systems have been installed in 40 institutions as of May 2015. Although robotic surgery is not covered by the national health insurance service in Korea, it has been used in several urologic fields as a less invasive surgery. Since the first robotic-assisted laparoscopic radical prostatectomy in 2005, partial nephrectomy, radical cystectomy, pyeloplasty, and other urologic surgeries have been performed. The following should be considered to extend the indications for robotic surgery: training systems including accreditation, operative outcomes from follow-up results, and cost-effectiveness. In this review, the history and current status of robotic surgeries in Korea are presented.

  4. Urologic robotic surgery in Korea: Past and present

    PubMed Central

    2015-01-01

    Since 2005 when the da Vinci surgical system was approved as a medical device by the Korean Ministry of Health and Welfare, 51 systems have been installed in 40 institutions as of May 2015. Although robotic surgery is not covered by the national health insurance service in Korea, it has been used in several urologic fields as a less invasive surgery. Since the first robotic-assisted laparoscopic radical prostatectomy in 2005, partial nephrectomy, radical cystectomy, pyeloplasty, and other urologic surgeries have been performed. The following should be considered to extend the indications for robotic surgery: training systems including accreditation, operative outcomes from follow-up results, and cost-effectiveness. In this review, the history and current status of robotic surgeries in Korea are presented. PMID:26279823

  5. Robotic surgery: review of prostate and bladder cancer.

    PubMed

    Sohn, William; Lee, Hak J; Ahlering, Thomas E

    2013-01-01

    Minimally invasive laparoscopic surgery has become to replace many of the open procedures in urology because of the obvious benefits in perioperative morbidity. However, because of the technical challenges and steep learning curve, the adoption of laparoscopy has been limited to only highly skilled laparoscopic surgeons. The introduction of the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, Calif) has offered significant technical advantages over laparoscopic surgery. Because of the wide acceptance of robotic-assisted radical prostatectomy over the past decade, it has paved the way for urologists to tackle other complex operations, such as a radical cystectomy to decrease the morbidity of the operation. The goal of this article was to review the history and discuss the application and current status of the robot in both prostate and bladder cancer management. We present our technique of performing a robotic-assisted radical prostatectomy and the application of the robust prostate experience to robotic cystectomy.

  6. Robotic mitral valve surgery: overview, methodology, results, and perspective

    PubMed Central

    2016-01-01

    Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author’s series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the “heart team” approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. PMID:27942486

  7. Robotic resection of intraductal neoplasm of the pancreas.

    PubMed

    Machado, Marcel A C; Makdissi, Fábio F; Surjan, Rodrigo C; Abdalla, Ricardo Z

    2009-12-01

    Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional open surgery. Computer-assisted surgical devices have recently been approved for general surgical use. The aim of this study was to report the first known case of pancreatic resection with the use of a computer-assisted, or robotic, surgical device in Latin America. A 37-year-old female with a previous history of radical mastectomy for bilateral breast cancer due to a BRCA2 mutation presented with an acute pancreatitis episode. Radiologic investigation disclosed an intraductal pancreatic neoplasm located in the neck of the pancreas with atrophy of the body and tail. The main pancreatic duct was enlarged. The surgical decision was to perform a laparoscopic subtotal pancreatectomy, using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). Five trocars were used. Pancreatic transection was achieved with vascular endoscopic stapler. The surgical specimen was removed without an additional incision. Operative time was 240 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. The subtotal laparoscopic pancreatic resection can safely be performed. The da Vinci robotic system allowed for technical refinements of laparoscopic pancreatic resection. Robotic assistance improved the dissection and control of major blood vessels due to three-dimensional visualization of the operative field and instruments with wrist-type end-effectors.

  8. Robotics in pulmonology and thoracic surgery: what, why and when?

    PubMed

    Gioutsos, Konstantinos; Kocher, Gregor J; Schmid, Ralph A

    2016-12-01

    Robot-assisted surgery emerged and evolved in order to increase the surgical precision and due to the need to overcome the drawbacks of conventional minimally invasive surgery. In thoracic surgery the first reported use of a robotic device was in a series of 12 patients with different lung pathologies with the assistance of the DaVinci Robotic Surgical System in 2002. The DaVinci system has been used for various procedures in the field of thoracic surgery since then. While its advantages for the resection of early stage thymoma have been well documented, its role in the treatment of lung cancer and other pathologies is still under investigation. A systematic literature search was performed on the following medical databases: Medline, EMBASE and Cochrane Library. The search was performed in June 2016 and was limited to material published since the first report of a robotic system for a surgical procedure in 1985. The results for various thoracic surgical procedures were analyzed with focus on the benefits and limitations of the robotic system compared to open and thoracoscopic or video-assisted techniques. Although numerous studies have shown the feasibility and safety of robotic surgery for various procedures, they were not able to show superior postoperative outcomes in terms of morbidity and mortality in exchange for the higher costs of robotic surgery compared to conventional video-assisted thoracic surgery (VATS), except for early-stage thymoma resection. Therefore, randomized control trials comparing robotic particularly with VATS, but also with open procedures are required to further evaluate this crucial topic.

  9. Robotic intercostal nerve harvest: a feasibility study in a pig model.

    PubMed

    Miyamoto, Hideaki; Serradori, Thomas; Mikami, Yoji; Selber, Jesse; Santelmo, Nicola; Facca, Sybille; Liverneaux, Philippe

    2016-01-01

    The aim of this study was to report the feasibility of robotic intercostal nerve harvest in a pig model. A surgical robot, the da Vinci Model S system, was installed after the creation of 3 ports in the pig's left chest. The posterior edges of the fourth, fifth, and sixth intercostal nerves were isolated at the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvesting procedures, requiring an average of 33 minutes, were successfully performed in 3 pigs without major complications. The advantages of robotic microsurgery for intercostal nerve harvest include elimination of physiological tremor, free movement of joint-equipped robotic arms, and amplification of the surgeon's hand motion by as much as 5 times. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvest for brachial plexus reconstruction.

  10. Robotic phrenic nerve harvest: a feasibility study in a pig model.

    PubMed

    Porto de Melo, P; Miyamoto, H; Serradori, T; Ruggiero Mantovani, G; Selber, J; Facca, S; Xu, W-D; Santelmo, N; Liverneaux, P

    2014-10-01

    The aim of this study was to report on the feasibility of robotic phrenic nerve harvest in a pig model. A surgical robot (Da Vinci S™ system, Intuitive Surgical(®), Sunnyvale, CA) was installed with three ports on the pig's left chest. The phrenic nerve was transected distally where it enters the diaphragm. The phrenic nerve harvest was successfully performed in 45 minutes without major complications. The advantages of robotic microsurgery for phrenic nerve harvest are the motion scaling up to 5 times, elimination of physiological tremor, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for harvesting the phrenic nerve for brachial plexus reconstruction.

  11. A pilot study of surgical training using a virtual robotic surgery simulator.

    PubMed

    Tergas, Ana I; Sheth, Sangini B; Green, Isabel C; Giuntoli, Robert L; Winder, Abigail D; Fader, Amanda N

    2013-01-01

    Our objectives were to compare the utility of learning a suturing task on the virtual reality da Vinci Skills Simulator versus the da Vinci Surgical System dry laboratory platform and to assess user satisfaction among novice robotic surgeons. Medical trainees were enrolled prospectively; one group trained on the virtual reality simulator, and the other group trained on the da Vinci dry laboratory platform. Trainees received pretesting and post-testing on the dry laboratory platform. Participants then completed an anonymous online user experience and satisfaction survey. We enrolled 20 participants. Mean pretest completion times did not significantly differ between the 2 groups. Training with either platform was associated with a similar decrease in mean time to completion (simulator platform group, 64.9 seconds [P = .04]; dry laboratory platform group, 63.9 seconds [P < .01]). Most participants (58%) preferred the virtual reality platform. The majority found the training "definitely useful" in improving robotic surgical skills (mean, 4.6) and would attend future training sessions (mean, 4.5). Training on the virtual reality robotic simulator or the dry laboratory robotic surgery platform resulted in significant improvements in time to completion and economy of motion for novice robotic surgeons. Although there was a perception that both simulators improved performance, there was a preference for the virtual reality simulator. Benefits unique to the simulator platform include autonomy of use, computerized performance feedback, and ease of setup. These features may facilitate more efficient and sophisticated simulation training above that of the conventional dry laboratory platform, without loss of efficacy.

  12. Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDA MAUDE database.

    PubMed

    Andonian, Sero; Okeke, Zeph; Okeke, Deidre A; Rastinehad, Ardeshir; Vanderbrink, Brian A; Richstone, Lee; Lee, Benjamin R

    2008-02-01

    Robot-assisted laparoscopic surgery has increased in the areas of cardiac and urologic surgery. We sought to determine the number of reported device malfunctions leading to patient injuries. We performed a review of the MAUDE database of the FDA. Adverse events (AE) were defined as potential and actual product use errors and product quality problems. All incidents involving the ZEUS and da Vinci surgical robots were analyzed. The MAUDE database was last accessed on August 27, 2007. A total of 189 AEs were reported from 2000 to August 27, 2007. Assuming that 50,000 robotic-assisted laparoscopic cases have been performed, this represents 0.38% overall estimated failure rate. Twenty-one malfunctions were reported for the ZEUS robotic system between 2001 and 2003, while 168 malfunctions were reported for the da Vinci robotic system between 2000 and 2007. The rate of open conversions due to device malfunction decreased from 94% in 2003 to 16% in 2007. Of the 189 reported device malfunctions, only 9 (4.8%) were associated with patient injury. The increasing use of robotic-assisted surgery has led to an increase in the number of reported device malfunctions, albeit at a very small estimated rate of 0.38%. With experience, the rate of open conversions due to device malfunction decreased. Only a small percentage of these adverse occurrences were associated with patient injury.

  13. Web-connected surgery: using the internet for teaching and proctoring of live robotic surgeries.

    PubMed

    Lenihan, John; Brower, Melissa

    2012-03-01

    The purpose of this study was to assess the feasibility of using live teleconferencing for teaching of new robotic-assisted surgical techniques. This was a prospective study with review of outcomes (Canadian Task Force classification II-3) in a community hospital. In 2009, our community hospital acquired the da Vinci Connect™ System, a technology which allows for live surgeon-to-surgeon interaction during robotic surgery via a secure internet connection. We utilized this technology from March 2009 through March 2011 to perform 28 live robotic surgeries that were observed by surgeons and hospital staff in 14 different US states as well as in France. We also had 14 episodes where new robotic surgeons in our facilities were mentored by experienced robotic surgeons in other geographic locations live through the da Vinci Connect internet connection. We performed two live surgeries for continuing medical education courses with live interactions between the course attendees and the console surgeon. Finally, one surgeon in our hospital proctored new surgeons remotely in distant sites on challenging cases. Utilizing computers that allow an experienced mentor surgeon to interact with less experienced surgeons on a live case is invaluable and presages the way we will train surgeons in the future. This feasibility study validates the need to pursue this technology for future education and training as well as for real-time collaboration.

  14. Robotics.

    ERIC Educational Resources Information Center

    Waddell, Steve; Doty, Keith L.

    1999-01-01

    "Why Teach Robotics?" (Waddell) suggests that the United States lags behind Europe and Japan in use of robotics in industry and teaching. "Creating a Course in Mobile Robotics" (Doty) outlines course elements of the Intelligent Machines Design Lab. (SK)

  15. Robotics.

    ERIC Educational Resources Information Center

    Waddell, Steve; Doty, Keith L.

    1999-01-01

    "Why Teach Robotics?" (Waddell) suggests that the United States lags behind Europe and Japan in use of robotics in industry and teaching. "Creating a Course in Mobile Robotics" (Doty) outlines course elements of the Intelligent Machines Design Lab. (SK)

  16. The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective

    PubMed Central

    Ghomi, Ali

    2010-01-01

    Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot. PMID:21278882

  17. Robot-assisted urological surgery: Current status and future perspectives

    PubMed Central

    Ghani, Khurshid R.; Trinh, Quoc-Dien; Sammon, Jesse; Jeong, Wooju; Dabaja, Ali; Menon, Mani

    2012-01-01

    Objectives To discuss the current status of robot-assisted urological surgery. Methods We searched PubMed for articles published from 2008 using the search terms ‘advances’, ‘robotic surgery equipment’ and ‘instrumentation’. We also searched PubMed for articles describing the latest developments in reconstructive techniques for lower and upper urinary tract procedures. Finally, we searched PubMed for original articles containing the terms ‘robotic surgery training’ and ‘credentialing’. Results With each release of hardware or ancillary instrumentation, the reconstructive abilities of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) improve. Recent developments in reconstructive capabilities of robotic urological surgery include posterior reconstruction during robot-assisted radical prostatectomy, barbed sutures for urethrovesical anastomosis, sliding-clip renorrhaphy for robot-assisted partial nephrectomy, and repair of pelvic organ prolapse. The safe implementation of robotic surgery is aided by new guidelines in credentialing and proctoring, and the introduction of virtual reality simulators for training. Conclusion Robotic urological surgery is rapidly developing and expanding globally. To achieve the highest levels of safety for patients, surgeons must ensure that the implementation of robotic surgery is an integrative and effective process. PMID:26558000

  18. Robot-assisted urological surgery: Current status and future perspectives.

    PubMed

    Ghani, Khurshid R; Trinh, Quoc-Dien; Sammon, Jesse; Jeong, Wooju; Dabaja, Ali; Menon, Mani

    2012-03-01

    To discuss the current status of robot-assisted urological surgery. We searched PubMed for articles published from 2008 using the search terms 'advances', 'robotic surgery equipment' and 'instrumentation'. We also searched PubMed for articles describing the latest developments in reconstructive techniques for lower and upper urinary tract procedures. Finally, we searched PubMed for original articles containing the terms 'robotic surgery training' and 'credentialing'. With each release of hardware or ancillary instrumentation, the reconstructive abilities of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) improve. Recent developments in reconstructive capabilities of robotic urological surgery include posterior reconstruction during robot-assisted radical prostatectomy, barbed sutures for urethrovesical anastomosis, sliding-clip renorrhaphy for robot-assisted partial nephrectomy, and repair of pelvic organ prolapse. The safe implementation of robotic surgery is aided by new guidelines in credentialing and proctoring, and the introduction of virtual reality simulators for training. Robotic urological surgery is rapidly developing and expanding globally. To achieve the highest levels of safety for patients, surgeons must ensure that the implementation of robotic surgery is an integrative and effective process.

  19. Current status of robotic gastrectomy for gastric cancer.

    PubMed

    Obama, Kazutaka; Sakai, Yoshiharu

    2016-05-01

    Although over 3000 da Vinci Surgical System (DVSS) devices have been installed worldwide, robotic surgery for gastric cancer has not yet become widely spread and is only available in several advanced institutions. This is because, at least in part, the advantages of robotic surgery for gastric cancer remain unclear. The safety and feasibility of robotic gastrectomy have been demonstrated in several retrospective studies. However, no sound evidence has been reported to support the superiority of a robotic approach for gastric cancer treatment. In addition, the long-term clinical outcomes following robotic gastrectomy have yet to be clarified. Nevertheless, a robotic approach can potentially overcome the disadvantages of conventional laparoscopic surgery if the advantageous functions of this technique are optimized, such as the use of wristed instruments, tremor filtering and high-resolution 3-D images. The potential advantages of robotic gastrectomy have been discussed in several retrospective studies, including the ability to achieve sufficient lymphadenectomy in the area of the splenic hilum, reductions in local complication rates and a shorter learning curve for the robotic approach compared to conventional laparoscopic gastrectomy. In this review, we present the current status and discuss issues regarding robotic gastrectomy for gastric cancer.

  20. Robotic virtual reality simulation plus standard robotic orientation versus standard robotic orientation alone: a randomized controlled trial.

    PubMed

    Vaccaro, Christine M; Crisp, Catrina C; Fellner, Angela N; Jackson, Christopher; Kleeman, Steven D; Pavelka, James

    2013-01-01

    The objective of this study was to compare the effect of virtual reality simulation training plus robotic orientation versus robotic orientation alone on performance of surgical tasks using an inanimate model. Surgical resident physicians were enrolled in this assessor-blinded randomized controlled trial. Residents were randomized to receive either (1) robotic virtual reality simulation training plus standard robotic orientation or (2) standard robotic orientation alone. Performance of surgical tasks was assessed at baseline and after the intervention. Nine of 33 modules from the da Vinci Skills Simulator were chosen. Experts in robotic surgery evaluated each resident's videotaped performance of the inanimate model using the Global Rating Scale (GRS) and Objective Structured Assessment of Technical Skills-modified for robotic-assisted surgery (rOSATS). Nine resident physicians were enrolled in the simulation group and 9 in the control group. As a whole, participants improved their total time, time to incision, and suture time from baseline to repeat testing on the inanimate model (P = 0.001, 0.003, <0.001, respectively). Both groups improved their GRS and rOSATS scores significantly (both P < 0.001); however, the GRS overall pass rate was higher in the simulation group compared with the control group (89% vs 44%, P = 0.066). Standard robotic orientation and/or robotic virtual reality simulation improve surgical skills on an inanimate model, although this may be a function of the initial "practice" on the inanimate model and repeat testing of a known task. However, robotic virtual reality simulation training increases GRS pass rates consistent with improved robotic technical skills learned in a virtual reality environment.

  1. Robot-assisted laparoscopic retroperitoneal lymph node dissection for stage IIIb mixed germ cell testicular cancer after chemotherapy.

    PubMed

    Lee, Sang Hyub; Kim, Dong Soo; Chang, Sung-Goo; Jeon, Seung Hyun

    2015-07-01

    Laparoscopic retroperitoneal lymph node dissection, especially when performed with the da Vinci Surgical System (Intuitive Surgical), has shown excellent cosmetic results with similar oncologic outcomes to those of open surgery. In this study, we present a case of robot-assisted retroperitoneal lymph node dissection performed in an 18-year-old man who was diagnosed with a stage IIIb mixed germ cell tumor and who was initially treated with radical orchiectomy, followed by chemotherapy. This case shows that robot-assisted retroperitoneal lymph node dissection is technically feasible, safe, and cosmetically favorable, even when performed on patients with high-stage disease or after chemotherapy.

  2. Robotic-Assisted Laparoscopy in Gynecological Surgery

    PubMed Central

    Saberi, Naghmeh S.; Shahmohamady, Babac; Nezhat, Farr

    2006-01-01

    Background: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. Methods: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. Results: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. Conclusion: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The

  3. Do laparoscopic skills transfer to robotic surgery?

    PubMed

    Panait, Lucian; Shetty, Shohan; Shewokis, Patricia A; Sanchez, Juan A

    2014-03-01

    Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform. Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task. Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P < 0.001). Subgroup analysis of senior residents revealed a lower robotic-PT score when compared with laparoscopic-PT (92 versus 105; P < 0.05). Scores for CC and IS were similar in this subgroup (64 ± 9 versus 69 ± 15 and 95 ± 3 versus 92 ± 10; P > 0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%). For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Robotic malfunction during live robotic urologic surgery: live surprise in a robotic surgery congress.

    PubMed

    Tugcu, Volkan; Mutlu, Bircan; Canda, Abdullah Erdem; Sonmezay, Erkan; Tasci, Ali Ihsan

    2012-12-01

    Robotic-assisted laparoscopic radical prostatectomy (RARP) has increasingly become a preferred treatment of choice. Since it is a device dependant surgery, robotic surgery may be a challenging procedure due to failure. We report how we managed to complete successfully a case of RARP with laparoscopic approach in spite of right robotic arm failure during live surgery. A 56-year-old male patient diagnosed with localized prostate cancer (PCa) (Gleason score 3 + 3 = 6) with a serum prostate specific antigen (PSA) level of 7.6 ng/mL was elected for a live RARP case during the 1st Turkish National Robotic Surgery Congress in 2011. Following 120 minutes from starting the RARP procedure, the right robotic arm failed surprisingly with a "recoverable fault" message appeared on the screen. Pressing "recover fault" button did not work and the right arm operated for few seconds more but the fault repeated again. We replaced the robotic instruments, shut down and restarted the system again that were all useless. Finally, all of the arms were out of order and we were not able to use the robot anymore. Therefore, we laparoscopically completed the procedure successfully without converting to open surgery. Although da Vinci surgical system failure rarely occurs, surgical team should be prepared to convert to open or complete the procedure laparoscopically. Having previous laparoscopic experience seems to be an advantage in order to complete the procedure without converting to open. Patients should be informed about the possibility of robotic failure and about its consequences before the surgery.

  5. [Current status and future of surgical robotic systems].

    PubMed

    Esumi, G; Tomikawa, M; Hashizume, M; Konishi, K; Shimada, M; Sugimachi, K

    2001-09-01

    In this review, we are commenting the current status and the future of surgical robotic systems. AESOP is a voice-controlled laparoscope manipulator that enables the "Solo-surgery". ZEUS is a master-slave manipulator that is characterized by its simplicity and lightness. da Vinci is another master-slave manipulator that has more range of freedom, therefore a surgeon can perform the operation with fewer difficulties. The technological development of high-quality and real-time 3D simulation, minimization of scopes and power saving techniques made these surgical robots realized. Although many pending matters such as lack of safety guideline or lack of accuracy of sensor/monitor have been raised in current surgical robotics, the development of the technologies may promise to resolve such matters in the future.

  6. [Robotic surgery -- the modern surgical treatment of prostate cancer].

    PubMed

    Szabó, Ferenc János; Alexander, de la Taille

    2014-09-01

    Minimally invasive laparoscopic surgery replaces many open surgery procedures in urology due to its advantages concerning post-operative morbidity. However, the technical challenges and need of learning have limited the application of this method to the work of highly qualified surgeons. The introduction of da Vinci surgical system has offered important technical advantages compared to the laparoscopic surgical procedure. Robot-assisted radical prostatectomy became a largely accepted procedure. It has paved the way for urologists to start other, more complex operations, decreasing this way the operative morbidity. The purpose of this article is to overview the history of robotic surgery, its current and future states in the treatment of the cancer. We present our robot-assisted radical prostatectomy and the results.

  7. Patient Positioning and Port Placement for Robot-Assisted Surgery

    PubMed Central

    Chang, Charles; Steinberg, Zoe; Shah, Anup

    2014-01-01

    Abstract The introduction of robotic surgical systems and their integration into minimally invasive procedures have changed the landscape of laparoscopic surgery dramatically. Intuitive Surgical's da Vinci Surgical System was first approved by the Food and Drug Administration for cardiothoracic procedures in the late 1990s. This trend quickly spread through other surgical specialties, with urologists as one of the frontrunners in adoption. Subsequently, pediatric urologists have adopted robot-assisted procedures in selected centers, performing procedures such as pyeloplasty for ureteropelvic junction obstruction, partial and complete nephrectomy, and both intravesical and extravesical ureteral reimplantation. In this article, we will discuss technical considerations related to patient positioning and port placement in pediatric robot-assisted surgery. PMID:24548088

  8. Robotic Surgery in Gynecology: An Updated Systematic Review

    PubMed Central

    Weinberg, Lori; Rao, Sanjay; Escobar, Pedro F.

    2011-01-01

    The introduction of da Vinci Robotic Surgery to the field of Gynecology has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. In general gynecology and reproductive gynecology, the robot is being increasingly used for procedures such as hysterectomies, myomectomies, adnexal surgery, and tubal anastomosis. Among urogynecology the robot is being utilized for sacrocolopexies. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomies and lymphadenectomies in oncologic diseases. Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. Our aim is to update previously published reviews with a focus on only comparative observational studies. We determined that, with the right amount of training and skill, along with appropriate patient selection, robotic surgery can be highly advantageous. Patients will likely have less blood loss, less post-operative pain, faster recoveries, and fewer complications compared to open surgery and potentially even laparoscopy. However, until larger, well-designed observational studies or randomized control trials are completed which report long-term outcomes, we cannot definitively state the superiority of robotic surgery over other surgical methods. PMID:22190948

  9. Robotic-assisted surgery in children: advantages and limitations.

    PubMed

    Al-Bassam, Abdulrahman

    2010-05-01

    The use of surgical robots in minimally invasive surgery was developed to overcome difficulties seen with conventional laparoscopic surgery. I report my experience with pediatric robotic-assisted surgery and highlight its feasibility, safety, advantages, and limitations. Children and infants included in this study underwent robotic-assisted laparoscopic procedures performed by the author, using the original da Vinci surgical system, between July 2005 and July 2008. Their medical records were reviewed with respect to demographic data, robot setup times, techniques and operative procedures, complications, outcomes, and follow-up duration. Forty-three patients (20 female, 23 male), ranging in age from 2.5 months to 16 years, underwent 46 robotic-assisted procedures. Mean setup time was 17.6 min. One primary and two to four working ports were used, allowing insertion of 5- and 8-mm robotic instruments. Five- and 11-mm telescopes were used based on patient size. All procedures were successfully completed except for two. The most common procedure was Nissen fundoplication (N = 26). There were no intraoperative complications or deaths, but three patients developed postoperative complications. Mean follow-up time was 12 months. Robotic-assisted surgery in children is safe, feasible, and applicable to a wide range of procedures. Advantages include improved visibility, dexterity, and ergonomics, although it does have certain limitations. Technological refinements will allow its use in more complex procedures, with probable greater use of robots in pediatric surgery.

  10. Future robotic platforms in urologic surgery: Recent Developments

    PubMed Central

    Herrell, S. Duke; Webster, Robert; Simaan, Nabil

    2014-01-01

    Purpose of review To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice. Recent findings Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted presently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and allow for previously impossible needle access and ablation delivery. Summary Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and TURBT, a purpose-specific robotic system for LESS, and a needle sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator. PMID:24253803

  11. Applications of Evolving Robotic Technology for Head and Neck Surgery.

    PubMed

    Sharma, Arun; Albergotti, W Greer; Duvvuri, Umamaheswar

    2016-03-01

    Assess the use and potential benefits of a new robotic system for transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy in a cadaver dissection. Three previously described robotic procedures (transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy) were performed in a cadaver using the da Vinci Xi Surgical System. Surgical exposure and access, operative time, and number of collisions were examined objectively. The new robotic system was used to perform transoral radical tonsillectomy with dissection and preservation of glossopharyngeal nerve branches, transoral supraglottic laryngectomy, and retroauricular thyroidectomy. There was excellent exposure without any difficulties in access. Robotic operative times (excluding set-up and docking times) for the 3 procedures in the cadaver were 12.7, 14.3, and 21.2 minutes (excluding retroauricular incision and subplatysmal elevation), respectively. No robotic arm collisions were noted during these 3 procedures. The retroauricular thyroidectomy was performed using 4 robotic ports, each with 8 mm instruments. The use of updated and evolving robotic technology improves the ease of previously described robotic head and neck procedures and may allow surgeons to perform increasingly complex surgeries. © The Author(s) 2015.

  12. Future robotic platforms in urologic surgery: recent developments.

    PubMed

    Herrell, S Duke; Webster, Robert; Simaan, Nabil

    2014-01-01

    To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice. Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted currently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and to allow for previously impossible needle access and ablation delivery. Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and transurethral bladder tumor, a purpose-specific robotic system for LESS, and a needle-sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator.

  13. Robotics as a new surgical minimally invasive approach to treatment of endometriosis: a systematic review.

    PubMed

    Carvalho, Luiz; Abrão, Mauricio Simões; Deshpande, Abhishek; Falcone, Tommaso

    2012-06-01

    This systematic review evaluates the role of robotics in the surgical treatment of endometriosis. Electronic database searches were conducted in MEDLINE, Scopus, and ISI Web of Knowledge for relevant studies over the past 10 years. Four published articles were found that used robotic assisted laparoscopy to perform endometriosis surgery. All four studies used the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). Three studies were case reports, and one was a cohort study. Robotics appears to be as effective as conventional laparoscopy in the management of endometriosis. There were no reports of any major complications. Few studies have been published and show us that robotic endometriosis surgery is feasible even in severe endometriosis cases without conversion. There is a lack of long-term outcome papers in the literature. Randomized controlled trials are necessary. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Single-site robotic surgery in gynecologic cancer: a pilot study

    PubMed Central

    Yoo, Ha-Na; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2015-01-01

    Objective To discuss the feasibility of single-site robotic surgery for benign gynecologic tumors and early stage gynecologic cancers. Methods In this single institution, prospective analysis, we analyzed six patients who had undergone single-site robotic surgery between December 2013 and August 2014. Surgery was performed using the da Vinci Si Surgical System. Patient characteristics and surgical outcomes were analyzed. Results Single-site robotic surgery was performed successfully in all six cases. The median patient age was 48 years, and the median body mass index was 25.5 kg/m2 (range, 22 to 33 kg/m2). The median total operative time was 211 minutes, and the median duration of intracorporeal vaginal cuff suturing was 32 minutes (range, 22 to 47 minutes). The median duration of pelvic lymph node dissection was 31 minutes on one side and 27 minutes on the other side. Patients' postoperative courses were uneventful. The median postoperative hospital stay was 4 days. No postoperative complications occurred. Conclusion When used to treat benign gynecologic tumors and early stage gynecologic cancers, the single-site da Vinci robotic surgery is feasible, safe, and produces favorable surgical outcomes. PMID:25609162

  15. Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study.

    PubMed

    Chauvet, Dorian; Missistrano, Antoine; Hivelin, Mikaël; Carpentier, Alexandre; Cornu, Philippe; Hans, Stéphane

    2014-10-01

    Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to reach the pituitary fossa by the oral cavity. Cavum mucosa dissection was performed by the head and neck surgeon at the console and then the sphenoid was drilled by the neurosurgeon at the bedside, with intraoperative fluoroscopy and a "double surgeon" control. Mucosa closure was attempted with robotic arms. We succeeded in performing a sellar opening in all cadavers with a minimally invasive approach, as the hard palate was never drilled. The video endoscope offered a large view inside the sphenoidal sinus, as observed in transnasal endoscopy, but with 3D visualization. The camera arm could be inserted into the sphenoidal sinus, and instrument arms in the pituitary fossa. Operative time to reach the pituitary fossa was approximately 60 min in all procedures: 20 min of initial setup, 10 min of mucosal dissection, and 30 min of sphenoid surgery. New anatomical landmarks were defined. Advantages and pitfalls of such an unpublished technique were discussed. This is the first cadaveric study reported da Vinci robotic transoral approach to the sella turcica with a minimally invasive procedure. This innovative technique may modify the usual pituitary adenoma removal as the sella is approached infero-superiorly.

  16. Robotic-assisted transoral removal of a bilateral floor of mouth ranulas

    PubMed Central

    2011-01-01

    Objective To describe the management of bilateral oral ranulas with the use of the da Vinci Si Surgical System and discuss advantages and disadvantages over traditional transoral resection. Study Design Case Report and Review of Literature. Results A 47 year old woman presented to our service with an obvious right floor of mouth swelling. Clinical evaluation and computerized tomography scan confirmed a large floor of mouth ranula on the right and an incidental asymptomatic early ranula of the left sublingual gland. After obtaining an informed consent, the patient underwent a right transoral robotic-assisted transoral excision of the ranula and sublingual gland with identification and dissection of the submandibular duct and lingual nerve. The patient had an excellent outcome with no evidence of lingual nerve paresis and a return to oral intake on the first postoperative day. Subsequently, the patient underwent an elective transoral robotic-assisted excision of the incidental ranula on the left sublingual gland. Conclusion We describe the first robotic-assisted excision of bilateral oral ranulas in current literature. The use of the da Vinci system provides excellent visualization, magnification, and dexterity for transoral surgical management of ranulas with preservation of the lingual nerve and Wharton's duct with good functional outcomes. However, the use of the robotic system for anterior floor of mouth surgery in terms of improved surgical outcomes as compared to traditional transoral surgery, long-term recurrence rates, and cost effectiveness needs further validation. PMID:21767364

  17. Modeling and optimal design of an optical MEMS tactile sensor for use in robotically assisted surgery

    NASA Astrophysics Data System (ADS)

    Ahmadi, Roozbeh; Kalantari, Masoud; Packirisamy, Muthukumaran; Dargahi, Javad

    2010-06-01

    Currently, Minimally Invasive Surgery (MIS) performs through keyhole incisions using commercially available robotic surgery systems. One of the most famous examples of these robotic surgery systems is the da Vinci surgical system. In the current robotic surgery systems like the da Vinci, surgeons are faced with problems such as lack of tactile feedback during the surgery. Therefore, providing a real-time tactile feedback from interaction between surgical instruments and tissue can help the surgeons to perform MIS more reliably. The present paper proposes an optical tactile sensor to measure the contact force between the bio-tissue and the surgical instrument. A model is proposed for simulating the interaction between a flexible membrane and bio-tissue based on the finite element methods. The tissue is considered as a hyperelastic material with the material properties similar to the heart tissue. The flexible membrane is assumed as a thin layer of silicon which can be microfabricated using the technology of Micro Electro Mechanical Systems (MEMS). The simulation results are used to optimize the geometric design parameters of a proposed MEMS tactile sensor for use in robotic surgical systems to perform MIS.

  18. [Studies of vision by Leonardo da Vinci].

    PubMed

    Berggren, L

    2001-01-01

    Leonardo was an advocate of the intromission theory of vision. Light rays from the object to the eye caused visual perceptions which were transported to the brain ventricles via a hollow optic nerve. Leonardo introduced wax injections to explore the ventricular system. Perceptions were assumed to go to the "senso comune" in the middle (3rd) ventricle, also the seat of the soul. The processing station "imprensiva" in the anterior lateral horns together with memory "memoria" in th posterior (4th) ventricle integrated the visual perceptions to visual experience. - Leonardo's sketches with circular lenses in the center of the eye reveal that his dependence on medieval optics prevailed over anatomical observations. Drawings of the anatomy of the sectioned eye are missing although Leonardo had invented a new embedding technique. In order to dissect the eye without spilling its contents, the eye was first boiled in egg white and then cut. The procedure was now repeated and showed that the ovoid lens after boiling had become spherical. - Leonardo described that light rays were refracted and reflected in the eye but his imperfect anatomy prevented a development of physiological optics. He was, however, the first to compare the eye with a pin-hole camera (camera obscura). Leonardo's drawings of the inverted pictures on the back wall of a camera obscura inspired to its use as an instrument for artistic practice. The camera obscura was for centuries a model for explaining human vision.

  19. Tourism. Leonardo da Vinci Series: Good Practices.

    ERIC Educational Resources Information Center

    Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

    This brochure, part of a series about good practices in vocational training in the European Union, describes 10 projects that have promoted investment in human resources through training in the tourism sector to promote sustainable, or responsible, tourism. The projects and their countries of origin are as follows: (1) BEEFT, training of mobility…

  20. Automated Support for da Vinci Surgical System

    DTIC Science & Technology

    2011-05-01

    flexible and scalable client-server architecture to share data collected from different platforms (Figure 9). The system consists of • an HTTP web ...server with a secure web -based user interface and Simple Object Access Protocol (SOAP) end-point • a Java based application server based on the business...comparing performance data in the form of a dV-Trainer database. The web -server’s interface will provide an alternative for those who do not have

  1. Robotically assisted mitral valve replacement.

    PubMed

    Gao, Changqing; Yang, Ming; Xiao, Cangsong; Wang, Gang; Wu, Yang; Wang, Jiali; Li, Jiachun

    2012-04-01

    In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 ± 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 ± 21.9 minutes (range, 105-168) and 99.3 ± 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  2. Robotics

    SciTech Connect

    Scheide, A.W.

    1983-11-01

    This article reviews some of the technical areas and history associated with robotics, provides information relative to the formation of a Robotics Industry Committee within the Industry Applications Society (IAS), and describes how all activities relating to robotics will be coordinated within the IEEE. Industrial robots are being used for material handling, processes such as coating and arc welding, and some mechanical and electronics assembly. An industrial robot is defined as a programmable, multifunctional manipulator designed to move material, parts, tools, or specialized devices through variable programmed motions for a variety of tasks. The initial focus of the Robotics Industry Committee will be on the application of robotics systems to the various industries that are represented within the IAS.

  3. Establishing a pediatric robotic surgery program in Canada.

    PubMed

    Bütter, Andreana; Merritt, Neil; Dave, Sumit

    2017-06-01

    Despite the introduction of robotic surgery in 2000, few pediatric surgeons outside the United States have embraced this technology. We discuss our experience with establishing the first Canadian pediatric robotic surgery program. After simulator training, live animal surgery and observation of robotically assisted cases at an outside institution, we performed our first pediatric da Vinci(®) surgery in July 2013. A prospective database was established to assess outcomes. Forty one children have undergone robotically assisted surgery for the following 42 procedures: (a) pyeloplasty (17), (b) ureteral reimplantations (12), (c) uretero-uretostomy (1), (d) cholecystectomies (10), (e) interval appendectomy (1) and (f) distal pancreatectomy (1). The average age was 9.7 years (range 1.6-17.9) and 66% of patients were female. Average operative time was 174 min (range 47-301). Length of stay was 3 days (range 0-20). All procedures were completed without conversion to open or laparoscopy. There were no technical failures. Two post re-implantation patients had urine leaks which required conservative treatment. Despite the lack of haptic feedback, we have noted that the markedly enhanced three-dimensional visualization and instrument dexterity offer significant advantages for complex reconstructive pediatric surgery. This platform may also enable trainees to perform more advanced minimally invasive pediatric surgery. We have successfully established the first pediatric robotic surgery program in Canada. Our da Vinci(®) system is shared with our adult colleagues, which enables more frequent use as well as some cost sharing. A dedicated group of operative nurses and surgeons are required to allow adoption of this new technology.

  4. Emerging role of robotics in urology

    PubMed Central

    Kumar, Rajeev; Hemal, Ashok K.

    2005-01-01

    Robotic assistance is one of the latest additions to the field of laparoscopic surgery. The most commonly used robotic device in Urology is the da Vinci® system of which over 200 devices are installed worldwide including 3 in India. This robot consists of three or four arms, one of which is used to hold and manipulate the laparoscopic camera while the others are used to manipulate specialized laparoscopic instruments with endowrist® technology that allows 7 degrees of freedom. The robot is currently used primarily for radical prostatectomies where complex dissection and reconstruction can be performed in less than 2 hours with excellent outcomes. There is a progressive increase in the number of surgeries being performed by this device which allows laparoscopy naïve surgeons to offer the benefits of minimally invasive surgery to their patients. The other surgeries where this device has been used to benefit are pyeloplasty, cystectomy with urinary diversion, nephrectomy and ureteric re-implant. The principal drawbacks of the device are the steep cost of machine and disposables. However, the benefits achieved in terms of improved surgical precision, magnified 3 dimensional vision, scaling of movements, remote surgery and as a teaching tools will help the robot establish a definitive place in the urologic armamentarium. PMID:21206664

  5. [Robotic surgery: first pediatric series in Spain].

    PubMed

    Marhuenda, C; Giné, C; Asensio, M; Guillén, G; Martínez Ibáñez, V

    2011-04-01

    Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to robotic laparoscopy. Retrospective review of all the pediatric laparoscopic surgery assisted by the da Vinci robot (Intuitive Surgical), in our center, between April 2009 and February 2010. 8 patients were operated (7-15 years), with an average weight of 42 Kg (18 to 83 Kg). 11 procedures were performed: bilateral salpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4), splenectomy (2), resection of pancreatic mass (1), fundoplication (1), adrenalectomy (1). All proceedings, except two, were completed with the robot. As complications, there was one intraoperative bleeding that required blood transfusion, and in the postoperative period, there was a surgical wound infection. There were no conversions to open surgery. The average time of preparation before surgery was 130 minutes. The three-dimensional vision and lack of tremor are the main advantages cited by all surgeons. The learning curve of Robotic Surgery is shorter than that of conventional laparoscopy. Trained surgeons can perform complex procedures laparoscopically from the outset. The main difficulty in children is the proper planning of trocar placement, due to the smaller size of the surgical field. The organization of surgery is complex and success depends on close collaboration of all stakeholders.

  6. Robotic-Assisted Upper Face Rejuvenation

    PubMed Central

    Rybakin, Arthur V.; Manturova, Natalia E.; Gladyshev, Dmitriy V.; Kamalov, David M.; Shcherbakov, Kirill G.; Staisupov, Valeriy J.; Kuzin, Danila A.

    2016-01-01

    Summary: Robotic-assisted technology has not been used in aesthetic surgery so far. The authors examined the feasibility and potential advantages of robotic-assisted technology in upper face rejuvenation surgery, as well as utility of the tools available in the market. Forehead lift was performed along with blepharoplasty in 4 patients. Robotic da Vinci Surgical System (Intuitive Surgical, Inc.) was used at the stage of dissection. The stereo endoscope 30 degrees, 12 mm and later 8.5 mm in diameter, and the set of tools, 8 mm and later 5 mm in diameter, were used. Overall results appeared to be essentially the same as after usual endoscope-assisted brow lift. The advantages of the robotic-assisted surgery were as follows: the best possible display, scalability of the picture; lack of tremor, scalability of the movements’ amplitude; high degree of freedom of movements exceeding human capabilities; quick and easy switch between the endoscope and any of the 3 manipulating arms; and enhanced comfort for a surgeon. The drawbacks noted were as follows: cost, steep learning curve, lack of tactile feedback, and absence of instruments specially adjusted for aesthetic surgery. The authors conclude that robots will enter the field of aesthetic plastic surgery in the same way as endoscopy, the proviso being to adjust tools to the specific needs.

  7. Robotic surgery in Italy national survey (2011).

    PubMed

    Santoro, Eugenio; Pansadoro, Vito

    2013-03-01

    Robotic surgery in Italy has become a clinical reality that is gaining increasing acceptance. As of 2011 after the United States, Italy together with Germany is the country with the largest number of active Robotic centers, 46, and da Vinci Robots installed, with at least 116 operators already trained. The number of interventions performed in Italy in 2011 exceeded 6,000 and in 2010 were 4,784, with prevalence for urology, general surgery and gynecology, however these interventions have also begun to be applied in other fields such as cervicofacial, cardiothoracic and pediatric surgery. In Italy Robotic centers are mostly located in Northern Italy, while in the South there are only a few centers, and four regions are lacking altogether. Of the 46 centers which were started in 1999, the vast majority is still operational and almost half handle over 200 cases a year. The quality of the work is also especially high with large diffusion of radical prostatectomy in urology and liver resection and colic in general surgery. The method is very well accepted among operators, over 80 %, and among patients, over 95 %. From the analysis of world literature and a survey carried out in Italy, Robotic surgery, which at the moment could be better defined as telesurgery, represents a significant advantage for operators and a consistent gain for the patient. However, it still has important limits such as high cost and non-structured training of operators.

  8. Cost analysis of pediatric robot-assisted and laparoscopic pyeloplasty.

    PubMed

    Casella, Daniel P; Fox, Janelle A; Schneck, Francis X; Cannon, Glenn M; Ost, Michael C

    2013-03-01

    An increasing percentage of pediatric pyeloplasties are being performed with assistance of the da Vinci® Surgical System. A review of the recent literature shows decreased operative times and length of hospital stays when robotic procedures are performed, although there are few published data comparing the cost of pediatric robotic and pure laparoscopic pyeloplasty. We reviewed a representative sample of pyeloplasties performed at our institution and performed a cost analysis. We retrospectively identified 23 robot-assisted and 23 laparoscopic pyeloplasties performed at our institution between August 2008 and April 2012. Total cost was calculated from direct and indirect costs provided by our billing department. Robotic procedures were shorter than pure laparoscopic procedures (200 vs 265 minutes, p <0.001) but there was no significant difference in the total cost of the 2 procedures ($15,337 vs $16,067, p <0.46). When compared to laparoscopic cases, subgroup analysis demonstrated decreased operative times (140 vs 265 minutes, p <0.00001) and total cost ($11,949 vs $16,067, p <0.0001) in robotic cases where stents were placed in an antegrade fashion. With widespread use the cost of robotic instrumentation may decrease, and experience may further shorten operative times. However, it currently remains to be seen whether robotic technology will become a cost-effective replacement for pure laparoscopy in the management of pediatric ureteropelvic junction obstruction. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer.

    PubMed

    Nakamura, Hiroshige

    2014-01-01

    The safety and efficacy of thoracoscopic and robot-assisted lobectomies for primary lung cancer were reviewed in the literature. Thoracoscopic surgery is less invasive compared to thoracotomy, and it has been reported to be superior with regard to the outcome. In addition, the operability of a surgical robot (da Vinci) is favorable and supplements the disadvantages of conventional endoscopic surgery. Robot-assisted lobectomy has been reported to be comparable to thoracoscopic surgery with regard to the safety and efficacy based on analysis of perioperative results and superior with regard to the operability and length of the learning curve. However, a high cost and a long operative time are of concern. Since robot-assisted surgery has been performed only in early cases, the continuation of a comparative investigation may be necessary.

  10. Use of a mobile tower-based robot--The initial Xi robot experience in surgical oncology.

    PubMed

    Yuh, Bertram; Yu, Xian; Raytis, John; Lew, Michael; Fong, Yuman; Lau, Clayton

    2016-01-01

    The da Vinci Xi platform provides expanded movement of the arms relative to the base, theoretically allowing increased versatility in complex multi-field or multi-quadrant surgery. We describe the initial Xi experience in oncologic surgery at a tertiary cancer center. One hundred thirty unique robot-assisted procedures were performed using the Xi between 2014 and 2015, 112 of which were oncology surgeries. For procedures involving multiple quadrants, the robot was re-targeted. Complications were assessed according to Martin criteria and the Clavien-Dindo classification up to 90 days after operation. Thirteen different operations were performed in five oncology subspecialties (urology, gynecology, thoracic, hepatobiliary, and gastrointestinal surgery). Median operative times ranged from 183 min for nephroureterectomy to 543 min for esophagogastrectomy. Median estimated blood loss did not exceed 200 ml for any of the categorized procedures . No patients were transfused intraoperatively and no positioning injuries occurred. Conversions to open operation occurred in three cases (2.7%), though not related to complications or technical considerations. Overall complication rate was 26% with major complication rate of 4%. Readmissions were necessary in 11 (10%) patients. The da Vinci Xi can be safely assimilated into a surgical oncology program. The Xi offers versatility to various oncologic procedures with satisfactory complication and readmission rates. © 2015 Wiley Periodicals, Inc.

  11. Robotic surgery basic skills training: Evaluation of a pilot multidisciplinary simulation-based curriculum

    PubMed Central

    Foell, Kirsten; Finelli, Antonio; Yasufuku, Kazuhiro; Bernardini, Marcus Q.; Waddell, Thomas K.; Pace, Kenneth T.; Honey, R. John D.’A.; Lee, Jason Y.

    2013-01-01

    Purpose: Simulation-based training improves clinical skills, while minimizing the impact of the educational process on patient care. We present results of a pilot multidisciplinary, simulation-based robotic surgery basic skills training curriculum (BSTC) for robotic novices. Methods: A 4-week, simulation-based, robotic surgery BSTC was offered to the Departments of Surgery and Obstetrics & Gynecology (ObGyn) at the University of Toronto. The course consisted of various instructional strategies: didactic lecture, self-directed online-training modules, introductory hands-on training with the da Vinci robot (dVR) (Intuitive Surgical Inc., Sunnyvale, CA), and dedicated training on the da Vinci Skills Simulator (Intuitive Surgical Inc., Sunnyvale, CA) (dVSS). A third of trainees participated in competency-based dVSS training, all others engaged in traditional time-based training. Pre- and post-course skill testing was conducted on the dVR using 2 standardized skill tasks: ring transfer (RT) and needle passing (NP). Retention of skills was assessed at 5 months post-BSTC. Results: A total of 37 participants completed training. The mean task completion time and number of errors improved significantly post-course on both RT (180.6 vs. 107.4 sec, p < 0.01 and 3.5 vs. 1.3 sec, p < 0.01, respectively) and NP (197.1 vs. 154.1 sec, p < 0.01 and 4.5 vs. 1.8 sec, p = 0.04, respectively) tasks. No significant difference in performance was seen between specialties. Competency-based training was associated with significantly better post-course performance. The dVSS demonstrated excellent face validity. Conclusions: The implementation of a pilot multidisciplinary, simulation-based robotic surgery BSTC revealed significantly improved basic robotic skills among novice trainees, regardless of specialty or level of training. Competency-based training was associated with significantly better acquisition of basic robotic skills. PMID:24381662

  12. Robotic surgery basic skills training: Evaluation of a pilot multidisciplinary simulation-based curriculum.

    PubMed

    Foell, Kirsten; Finelli, Antonio; Yasufuku, Kazuhiro; Bernardini, Marcus Q; Waddell, Thomas K; Pace, Kenneth T; Honey, R John D 'a; Lee, Jason Y

    2013-01-01

    Simulation-based training improves clinical skills, while minimizing the impact of the educational process on patient care. We present results of a pilot multidisciplinary, simulation-based robotic surgery basic skills training curriculum (BSTC) for robotic novices. A 4-week, simulation-based, robotic surgery BSTC was offered to the Departments of Surgery and Obstetrics & Gynecology (ObGyn) at the University of Toronto. The course consisted of various instructional strategies: didactic lecture, self-directed online-training modules, introductory hands-on training with the da Vinci robot (dVR) (Intuitive Surgical Inc., Sunnyvale, CA), and dedicated training on the da Vinci Skills Simulator (Intuitive Surgical Inc., Sunnyvale, CA) (dVSS). A third of trainees participated in competency-based dVSS training, all others engaged in traditional time-based training. Pre- and post-course skill testing was conducted on the dVR using 2 standardized skill tasks: ring transfer (RT) and needle passing (NP). Retention of skills was assessed at 5 months post-BSTC. A total of 37 participants completed training. The mean task completion time and number of errors improved significantly post-course on both RT (180.6 vs. 107.4 sec, p < 0.01 and 3.5 vs. 1.3 sec, p < 0.01, respectively) and NP (197.1 vs. 154.1 sec, p < 0.01 and 4.5 vs. 1.8 sec, p = 0.04, respectively) tasks. No significant difference in performance was seen between specialties. Competency-based training was associated with significantly better post-course performance. The dVSS demonstrated excellent face validity. The implementation of a pilot multidisciplinary, simulation-based robotic surgery BSTC revealed significantly improved basic robotic skills among novice trainees, regardless of specialty or level of training. Competency-based training was associated with significantly better acquisition of basic robotic skills.

  13. Limb replantation with two robots: a feasibility study in a pig model.

    PubMed

    Taleb, Chihab; Nectoux, Eric; Liverneaux, Philippe

    2009-01-01

    The aim of this study is to assess the feasibility of limb replantations and transplantations by telesurgery. The material consisted in a large white pig and two surgical robots (DaVinciS telemanipulators). The procedure consisted in a trans-humeral cross-section of the left thoracic limb, which was secondarily replanted. Results showed good vascular permeability, while the operator's physiological tremor was suppressed. Our results seem to demonstrate that telesurgery could improve limb replantation and transplantation management, especially regarding operating gesture precision. (c) 2009 Wiley-Liss, Inc.

  14. Robotic-assisted laparoscopic surgery: recent advances in urology.

    PubMed

    Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H

    2014-10-01

    The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. ROBOTIC ASSISTED SINGLE SITE FOR BILATERAL INGUINAL HERNIA REPAIR.

    PubMed

    Bosi, Henrique Rasia; Guimarães, José Ricardo; Cavazzola, Leandro Totti

    2016-01-01

    The inguinal hernia is one of the most frequent surgical diseases, being frequent procedure and surgeon´s everyday practice. To present technical details in making hernioplasty using robotic equipment on bilateral inguinal hernia repair with single port and preliminary results with the method. The bilateral inguinal hernia repair was performed by using the Single-Site(c) Da Vinci Surgical Access Platform to the abdominal cavity and the placement of clamps. This technique proved to be effective for inguinal hernia and have more aesthetic result when compared to other techniques. Inguinal hernia repair robot-assisted with single-trocar is feasible and effective. However, still has higher costs needing surgical team special training. A hérnia inguinal é uma das doenças cirúrgicas mais frequentes, tornando-a procedimento frequente e do cotidiano do cirurgião. Apresentar detalhes da técnica da hernioplastia inguinal bilateral robótica por single-site e resultados preliminares com o método. Foi realizada hernioplastia inguinal bilateral assistida por robô, utilizando-se da Vinci Single-Site(c) Surgical Platform para acesso a cavidade abdominal e colocação das pinças. Esta técnica demonstrou-se efetiva para correção da hérnia inguinal, além de apresentar melhor resultado estético quando comparado às outras técnicas. A hernioplastia inguinal assistida por robô com trocarte único é viável e eficaz. Contudo, ainda apresenta custos mais elevados e necessidade de treinamento especial por parte da equipe cirúrgica.

  16. Remote ultrasound palpation for robotic interventions using absolute elastography.

    PubMed

    Schneider, Caitlin; Baghani, Ali; Rohling, Robert; Salcudean, Septimiu

    2012-01-01

    Although robotic surgery has addressed many of the challenges presented by minimally invasive surgery, haptic feedback and the lack of knowledge of tissue stiffness is an unsolved problem. This paper presents a system for finding the absolute elastic properties of tissue using a freehand ultrasound scanning technique, which utilizes the da Vinci Surgical robot and a custom 2D ultrasound transducer for intraoperative use. An external exciter creates shear waves in the tissue, and a local frequency estimation method computes the shear modulus. Results are reported for both phantom and in vivo models. This system can be extended to any 6 degree-of-freedom tracking method and any 2D transducer to provide real-time absolute elastic properties of tissue.

  17. Ectopic lingual goiter treated by transoral robotic surgery.

    PubMed

    Pellini, R; Mercante, G; Ruscito, P; Cristalli, G; Spriano, G

    2013-10-01

    Multinodular goiter in lingual thyroid is quite rare. Surgical removal is indicated in symptomatic patients and when cancer is suspected. An external approach is most often used, but is associated with morbidity and sequelae. In this study, we present for the first time the technique of transoral robotic surgery (TORS) for removal of a massive lingual goiter. Prospective patient data were collected, including demographics, medical history, symptoms, comorbidities and drugs prescribed. The da Vinci Surgical System was used for a transoral approach to the oropharynx. The technique was validated in a 31-year-old woman with signs and symptoms of multinodular goiter presenting since childhood. The procedure required 115 min, with intervals as follows: tracheotomy, 25 min; robot setting time, 20 min; and console time, 70 min. TOR S is feasible in cases of multinodular goiter in a lingual thyroid. The procedure appears to be safe, with quick recovery of swallowing and speech.

  18. Robotic trans-abdominal transplant nephrectomy for a failed renal allograft.

    PubMed

    Mulloy, M R; Tan, M; Wolf, J H; D'Annunzio, S H; Pollinger, H S

    2014-12-01

    Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans-abdominal transplant nephrectomy (TN). A 34-year-old male with Alport's syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra-abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235 min and the estimated blood loss was less than 25 cm(3). There were no peri-operative complications observed and the patient was discharged to home less than 24 h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans-abdominal TN.

  19. [Current status and future perspectives of robotic surgery and laparoscopic surgery for gastric cancer].

    PubMed

    Jiang, Zhi-wei; Li, Jie-shou

    2012-08-01

    Laparoscopic gastrectomy has not become a common procedure for gastric cancer due to the difficulties of performing D2 lymphadenectomy and reconstruction of digestive tract by the conventional laparoscopic instruments. The da Vinci system provides 3D visualization, enhanced magnification, and seven degrees of freedom of the instruments to suture and knot in the narrow surgical space, so it can perform totally robotic gastrectomy with D2 lymphadenectomy and robot-sewing anastomosis for reconstruction. Application of robotic system can expand the indications of minimally invasive surgery in treatment of gastric cancer. Combination fast-track surgery to optimize the perioperative management with the technique of minimally invasive surgery can enhance the recovery of surgical gastric cancer patients.

  20. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach.

    PubMed

    Wang, Shumin; Xu, Shiguang; Liu, Bo

    2014-05-01

    A 53-year-old man was referred to our department with a history of cough, especially at night, for 3 months. He was found to have a huge retrosternal goiter. We applied a novel combined cervical and robot-assisted approach to resect this difficult goiter. Using the da Vinci robot system, the intrathoracic part of the goiter was dissected and mobilized completely from the mediastinum to the inlet of the thorax. The dissected part of the goiter was left in the thorax. A right cervical half-collar incision about 6 cm was then performed. The goiter was finally removed from the neck incision. Histopathologic examination reported a multinodular goiter. By the method shown in the case, resection of huge retrosternal goiters through a combined cervical and robot-assisted approach is feasible and safe. This method provides an alternative option to the more invasive traditional approaches.

  1. Combined totally endoscopic robotic coronary bypass and mitral valve repair via right-sided ports.

    PubMed

    Maciolek, Kimberly A; Krienbring, Dorothy J; Naum, Efstathios S; Arnsdorf, Susan E; Balkhy, Husam H

    2013-01-01

    We present a case of combined coronary artery bypass grafting and mitral valve (MV) repair using a robotic totally endoscopic right-sided approach. A 61-year-old man presented with fatigue due to significant mitral regurgitation and was found to have a tight stenosis in the mid left anterior descending artery. Using the da Vinci robotic system, the patient underwent a left internal mammary artery graft to the left anterior descending artery using the C-Port Flex A distal anastomotic device followed by a MV repair. Both procedures were performed endoscopically via right chest ports and right femorofemoral bypass successfully. The patient was discharged from the hospital 3 days postoperatively and returned to normal activity within 3 weeks after surgery. This case study shows the feasibility of using an endoscopic robotic approach in selected patients undergoing combined MV coronary artery bypass grafting surgery.

  2. [Objective surgery -- advanced robotic devices and simulators used for surgical skill assessment].

    PubMed

    Suhánszki, Norbert; Haidegger, Tamás

    2014-12-01

    Robotic assistance became a leading trend in minimally invasive surgery, which is based on the global success of laparoscopic surgery. Manual laparoscopy requires advanced skills and capabilities, which is acquired through tedious learning procedure, while da Vinci type surgical systems offer intuitive control and advanced ergonomics. Nevertheless, in either case, the key issue is to be able to assess objectively the surgeons' skills and capabilities. Robotic devices offer radically new way to collect data during surgical procedures, opening the space for new ways of skill parameterization. This may be revolutionary in MIS training, given the new and objective surgical curriculum and examination methods. The article reviews currently developed skill assessment techniques for robotic surgery and simulators, thoroughly inspecting their validation procedure and utility. In the coming years, these methods will become the mainstream of Western surgical education.

  3. A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?

    PubMed

    Rowe, Courtney K; Pierce, Michael W; Tecci, Katherine C; Houck, Constance S; Mandell, James; Retik, Alan B; Nguyen, Hiep T

    2012-07-01

    Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery. We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures. Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates. Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.

  4. Critical appraisal of technical problems with robotic urological surgery.

    PubMed

    Nayyar, Rishi; Gupta, Narmada P

    2010-06-01

    To record the technical problems and complications associated with the use of da Vinci S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) and to review previous reports. We analysed our records for all machine- or instrument-related errors during the course of 340 consecutive robot-assisted urological operations at our centre from July 2006 to March 2009, using one robotic machine. The cause of the error (machine or human), troubleshooting methods and consequences of the errors were evaluated. The overall device failure rate was 10.9% (37/340). The most frequent technical problems were related to robotic instruments (23/37). Other failures included colour/hue changes in the console image, intermittent double vision, fused illuminator bulb and problems with the master tool-manipulator device (hand-piece unit), patient cart circuitry, patient-side manipulator arm, closed-circuit camera unit or camera cable. Of 37 problems, 28 (76%) were surmountable during the course of surgery. The overall conversions to standard open/laparoscopic procedure attributable to mechanical failures of the robot were 0.6% (2/340). There were no complications or direct harm to the patient in any case. Most faults could be corrected or bypassed with some addition to operating room time. Despite an association of various types of new technical problems with robotic surgery, it provides a safe mode of minimally invasive surgery with very low conversion rates attributable to it, and no direct patient injury.

  5. Visual measurement of suture strain for robotic surgery.

    PubMed

    Martell, John; Elmer, Thomas; Gopalsami, Nachappa; Park, Young Soo

    2011-01-01

    Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.

  6. 2D–3D radiograph to cone-beam computed tomography (CBCT) registration for C-arm image-guided robotic surgery

    PubMed Central

    Liu, Wen Pei; Otake, Yoshito; Azizian, Mahdi; Wagner, Oliver J.; Sorger, Jonathan M.; Armand, Mehran; Taylor, Russell H.

    2015-01-01

    Purpose C-arm radiographs are commonly used for intraoperative image guidance in surgical interventions. Fluoroscopy is a cost-effective real-time modality, although image quality can vary greatly depending on the target anatomy. Cone-beam computed tomography (CBCT) scans are sometimes available, so 2D–3D registration is needed for intra-procedural guidance. C-arm radiographs were registered to CBCT scans and used for 3D localization of peritumor fiducials during a minimally invasive thoracic intervention with a da Vinci Si robot. Methods Intensity-based 2D–3D registration of intraoperative radiographs to CBCT was performed. The feasible range of X-ray projections achievable by a C-arm positioned around a da Vinci Si surgical robot, configured for robotic wedge resection, was determined using phantom models. Experiments were conducted on synthetic phantoms and animals imaged with an OEC 9600 and a Siemens Artis zeego, representing the spectrum of different C-arm systems currently available for clinical use. Results The image guidance workflow was feasible using either an optically tracked OEC 9600 or a Siemens Artis zeego C-arm, resulting in an angular difference of Δθ : ~ 30°. The two C-arm systems provided TREmean ≤ 2.5 mm and TREmean ≤ 2.0 mm, respectively (i.e., comparable to standard clinical intraoperative navigation systems). Conclusions C-arm 3D localization from dual 2D–3D registered radiographs was feasible and applicable for intraoperative image guidance during da Vinci robotic thoracic interventions using the proposed workflow. Tissue deformation and in vivo experiments are required before clinical evaluation of this system. PMID:25503592

  7. 2D-3D radiograph to cone-beam computed tomography (CBCT) registration for C-arm image-guided robotic surgery.

    PubMed

    Liu, Wen Pei; Otake, Yoshito; Azizian, Mahdi; Wagner, Oliver J; Sorger, Jonathan M; Armand, Mehran; Taylor, Russell H

    2015-08-01

    C-arm radiographs are commonly used for intraoperative image guidance in surgical interventions. Fluoroscopy is a cost-effective real-time modality, although image quality can vary greatly depending on the target anatomy. Cone-beam computed tomography (CBCT) scans are sometimes available, so 2D-3D registration is needed for intra-procedural guidance. C-arm radiographs were registered to CBCT scans and used for 3D localization of peritumor fiducials during a minimally invasive thoracic intervention with a da Vinci Si robot. Intensity-based 2D-3D registration of intraoperative radiographs to CBCT was performed. The feasible range of X-ray projections achievable by a C-arm positioned around a da Vinci Si surgical robot, configured for robotic wedge resection, was determined using phantom models. Experiments were conducted on synthetic phantoms and animals imaged with an OEC 9600 and a Siemens Artis zeego, representing the spectrum of different C-arm systems currently available for clinical use. The image guidance workflow was feasible using either an optically tracked OEC 9600 or a Siemens Artis zeego C-arm, resulting in an angular difference of Δθ:∼ 30°. The two C-arm systems provided TRE mean ≤ 2.5 mm and TRE mean ≤ 2.0 mm, respectively (i.e., comparable to standard clinical intraoperative navigation systems). C-arm 3D localization from dual 2D-3D registered radiographs was feasible and applicable for intraoperative image guidance during da Vinci robotic thoracic interventions using the proposed workflow. Tissue deformation and in vivo experiments are required before clinical evaluation of this system.

  8. Electrosurgical injuries during robot assisted surgery: insights from the FDA MAUDE database

    NASA Astrophysics Data System (ADS)

    Fuller, Andrew; Vilos, George A.; Pautler, Stephen E.

    2012-02-01

    Introduction: The da Vinci surgical system requires the use of electrosurgical instruments. The re-use of such instruments creates the potential for stray electrical currents from capacitive coupling and/or insulation failure with subsequent injury. The morbidity of such injuries may negate many of the benefits of minimally invasive surgery. We sought to evaluate the rate and nature of electrosurgical injury (ESI) associated with this device. Methods: The Manufacturer and User Facility Device Experience (MAUDE) database is administered by the US Food and Drug Administration (FDA) and reports adverse events related to medical devices in the United States. We analyzed all incidents in the context of robotic surgery between January 2001 and June 2011 to identify those related to the use of electrosurgery. Results: In the past decade, a total of 605 reports have been submitted to the FDA with regard to adverse events related to the da Vinci robotic surgical platform. Of these, 24 (3.9%) were related to potential or actual ESI. Nine out of the 24 cases (37.5%) resulted in additional surgical intervention for repair. There were 6 bowel injuries of which only one was recognized and managed intra-operatively. The remainder required laparotomy between 5 and 8 days after the initial robotic procedure. Additionally, there were 3 skin burns. The remaining cases required conservative management or resulted in no harm. Conclusion: ESI in the context of robotic surgery is uncommon but remains under-recognized and under-reported. Surgeons performing robot assisted surgery should be aware that ESI can occur with robotic instruments and vigilance for intra- and post-operative complications is paramount.

  9. Multiportal robotic access to the anterior cranial fossa: a surgical and engineering feasibility study.

    PubMed

    Bly, Randall A; Su, David; Lendvay, Thomas S; Friedman, Diana; Hannaford, Blake; Ferreira, Manuel; Moe, Kris S

    2013-12-01

    Integration of robotic surgical technology into skull base surgery is limited due to minimum angle requirements between robotic tools (narrow funnel effect), steep angle of approach, and instrumentation size. The objectives of this study were to systematically analyze surgical approach portals using a computer model, determine optimal approaches, and assess feasibility of the derived approaches on robotic surgical systems. Computer analysis on 10 computed tomography scans was performed to determine approach trajectories, angles between robotic tools, and distances to specified skull base target locations for transorbital and transnasal surgical approach portals. Dry laboratory and cadaver laboratory. The optimal combinations were tested on the da Vinci and Raven robotic systems. Multiportal analyses showed the angles between 2 robotic tools were 14.7, 28.3, and 52.0 degrees in the cases of 2 transnasal portals, combined transnasal and medial orbit portals, and bilateral superior orbit portals, respectively, approaching a prechiasmatic target. The addition of medial and superior transorbital portals improved the skull base trajectory angles 21 and 27 degrees, respectively. Two robotic tools required an angle of at least 20 degrees between them to function effectively at skull base targets. Technical feasibility of robotic transorbital and transnasal approaches to access sella and parasellar target locations was demonstrated. This technique addresses the 2 major drawbacks of (1) the narrow funnel effect generated from portals in close proximity and (2) the steep angle of approach to the skull base, as observed in previous studies analyzing transoral, transcervical, transmaxillary, and transhyoid portals.

  10. Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach.

    PubMed

    De Virgilio, A; Park, Y M; Kim, W S; Lee, S Y; Seol, J H; Kim, S-H

    2012-11-01

    The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2 min (range 62-185 min) and that for setting the robotic system was 8.2 min (range 5-15 min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.

  11. An all-joint-control master device for single-port laparoscopic surgery robots.

    PubMed

    Shim, Seongbo; Kang, Taehun; Ji, Daekeun; Choi, Hyunseok; Joung, Sanghyun; Hong, Jaesung

    2016-08-01

    Robots for single-port laparoscopic surgery (SPLS) typically have all of their joints located inside abdomen during surgery, whereas with the da Vinci system, only the tip part of the robot arm is inserted and manipulated. A typical master device that controls only the tip with six degrees of freedom (DOFs) is not suitable for use with SPLS robots because of safety concerns. We designed an ergonomic six-DOF master device that can control all of the joints of an SPLS robot. We matched each joint of the master, the slave, and the human arm to decouple all-joint motions of the slave robot. Counterbalance masses were used to reduce operator fatigue. Mapping factors were determined based on kinematic analysis and were used to achieve all-joint control with minimal error at the tip of the slave robot. The proposed master device has two noteworthy features: efficient joint matching to the human arm to decouple each joint motion of the slave robot and accurate mapping factors, which can minimize the trajectory error of the tips between the master and the slave. We confirmed that the operator can manipulate the slave robot intuitively with the master device and that both tips have similar trajectories with minimal error.

  12. Novel training methods for robotic surgery

    PubMed Central

    Sun, Andrew J.; Aron, Monish; Hung, Andrew J.

    2014-01-01

    Objectives: The objectives of this review are to summarize the current training modalities and assessment tools used in urological robotic surgery and to propose principles to guide the formation of a comprehensive robotics curriculum. Materials and Methods: The PUBMED database was systematically searched for relevant articles and their citations utilized to broaden our search. These articles were reviewed and summarized with a focus on novel developments. Results: A multitude of training modalities including didactic, dry lab, wet lab, and virtual reality have been developed. The use of these modalities can be divided into basic skills-based exercises and more advanced procedure-based exercises. Clinical training has largely followed traditional methods of surgical teaching with the exception of the unique development of tele-mentoring for the da Vinci interface. Tools to assess both real-life and simulator performance have been developed, including adaptions from Fundamentals of Laparoscopic Surgery and Objective Structured Assessment of Technical Skill, and novel tools such as Global Evaluative Assessment of Robotic Skills. Conclusions: The use of these different entities to create a standardized curriculum for robotic surgery remains elusive. Selection of training modalities and assessment tools should be based upon performance data-based validity and practical feasibility. Comparative assessment of different modalities (cross-modality validity) can help strengthen the development of common skill sets. Constant data collection must occur to guide continuing curriculum improvement. PMID:25097322

  13. Robotic cardiac surgery: an anaesthetic challenge.

    PubMed

    Wang, Gang; Gao, Changqing

    2014-08-01

    Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach.

    PubMed

    Narula, Vimal K; Mikami, Dean J; Melvin, W Scott

    2010-03-01

    Minimally invasive surgery is beneficial for complex operations; robotics may improve performance in these procedures; however, robotic pancreaticoduodenectomy (PD) has been plagued by long operative times. We describe a small series (n = 5) of patients who underwent a hybrid PD for treatment of obstructive jaundice and pancreatic mass. After diagnostic laparoscopy, the gallbladder was retracted cephalad and the porta hepatis was dissected. The lesser sac was opened to expose the superior mesenteric vein below the pancreas. Once the vein was cleared, the bile duct, stomach, pancreas, and jejunum were transected. After the uncinate process was cleared, the specimen was removed. The da Vinci S Surgical Robotic System was docked to perform a mucosa-to-mucosa pancreaticojejunostomy and an end-to-side choledochojejunostomy. A stapled gastrojejunostomy and drain placement completed the operation. Five patients underwent hybrid PD between May 2006 and June 2007. All patients had a history of pancreatitis and presented with obstructive jaundice and a pancreatic mass. The operations were completed with 5 ports. The mean operative time was 7 hours. The mean hospital stay was 9.6 days. At 6 months after the operation, all patients were disease-free. Complex procedures such as PD can be accomplished with minimally invasive surgical techniques using robotic instrumentation.

  15. Diminished suture strength after robotic needle driver manipulation.

    PubMed

    Ricchiuti, Daniel; Cerone, Jeffrey; Shie, Scott; Jetley, Ajay; Noe, Donald; Kovacik, Mark

    2010-09-01

    Robot-assisted minimally invasive surgery has become a routine surgical option for the treatment of prostate cancer. Despite its technical advancements, the da Vinci(®) Surgical System still lacks haptic feedback to the surgeon, resulting in a maximally applied compressive force by the robotic needle driver during every grasping maneuver. Without this perceptional sense of touch and grip control, repetitive robotic needle driver manipulation may unknowingly lead to irreparable damage to fine sutures used during delicate anastomotic repairs. For robotic prostatectomy, any such loss of integrity can potentially lead to premature breakdown of the urethrovesical anastomosis and urine extravasation, especially important for a less-than-perfectly fashioned anastomotic repair. Although it has already been established that overhandling of sutures using handheld laparoscopic instruments can lead to reduced suture strength, it has not been established to what extent this may occur after robotic surgical procedures. We present analytical data and analyses concerning the failure strength of fine sutures commonly used for urethrovesical anastomotic repair during robotic prostatectomy, after repetitive robotic needle driver manipulation. When compared with noncompromised monofilament suture controls, the average maximal failure force after repetitive robotic manipulation was significantly reduced by 35% (p < 0.0001). Similarly, the average maximal failure force of braided sutures was significantly reduced after repetitive robotic manipulation by 3% (p = 0.009). This work demonstrates that significant reductions in monofilament and braided suture strength integrity can occur after customary repetitive manipulation by robotic needle drivers in an ex vivo model, with further research warranted in the in vivo setting.

  16. Robotic cardiac surgery at Epworth hospital.

    PubMed

    Skillington, Peter D; Moshinsky, Randall; Goldblatt, John C; Almedia, Aubrey A

    2004-01-01

    Epworth Hospital is the first in the southern hemisphere to acquire the da Vinci Robot to facilitate minimally invasive cardiac surgery. Applications for this new technology include mitral valve repair, atrial septal defect closure, single coronary artery bypass graft to coronary arteries on the front of the heart, ablative surgery for atrial fibrillation and insertion of epicardial pacemaker electrodes. A team of surgeons from the Epworth Hospital have trained at East Carolina University (ECU) Greenville, North Carolina, USA; including surgeons, anesthetists, perfusionist and nurses. Following this, during a week in March, a proctoring surgeon from the USA, Dr. Wiley Nifong, assisted the Epworth team with their initial seven operations, which all proceeded without incident. The initial operative times were longer than the standard surgery, although with additional experience, now totalling 24 patients in all, these times have shortened considerably. The experience to date is summarized as an Addendum to this manuscript.

  17. Robotic surgical skills: acquisition, maintenance, and degradation.

    PubMed

    Jenison, Eric L; Gil, Karen M; Lendvay, Thomas S; Guy, Michael S

    2012-01-01

    The degradation in robotic skills that occurs during periods of robotic surgical inactivity in newly trained surgeons was measured. The role of animate training in robotic skill was also assessed. Robotically naive resident and attending surgeons underwent training with the da Vinci robot on needle passage (DN), rocking ring transfer peg board (RPB), and running suture pod tasks (SP). Errors were established to convert actual time to adjusted time. Participants were deemed "proficient" once their adjusted times were within 80% of those set by experienced surgeons through repeated trials. Participants did not use the robot except for repeating the tasks once at 4, 8, and 12 weeks (tests). Participants then underwent animate training and completed a final test within 7 days. Twenty-five attending and 29 resident surgeons enrolled; 3 withdrew. There were significant increases in time to complete each of the tasks, and in errors, by 4 weeks (Adjusted times: DN: 122.9 +/- 2.2 to 204.2 +/- 11.7, t = 6.9, P < .001; RPB: 262.4 +/- 2.5 to 364.7 +/- 8.0, t = 12.4, P < .001; SP: 91.4 +/- 1.4 to 169.9 +/- 6.8, t = 11.3, P < .001). Times decreased following animate training, but not to levels observed after proficiency training for the RPB and SP modules. Robotic surgical skills degrade significantly within 4 weeks of inactivity in newly trained surgeons. Animate training may provide different skills than those acquired in the dry lab.

  18. Robotic Surgical Skills: Acquisition, Maintenance, and Degradation

    PubMed Central

    Gil, Karen M.; Lendvay, Thomas S.; Guy, Michael S.

    2012-01-01

    Background and Objectives: The degradation in robotic skills that occurs during periods of robotic surgical inactivity in newly trained surgeons was measured. The role of animate training in robotic skill was also assessed. Methods: Robotically naïve resident and attending surgeons underwent training with the da Vinci® robot on needle passage (DN), rocking ring transfer peg board (RPB), and running suture pod tasks (SP). Errors were established to convert actual time to adjusted time. Participants were deemed “proficient” once their adjusted times were within 80% of those set by experienced surgeons through repeated trials. Participants did not use the robot except for repeating the tasks once at 4, 8, and 12 weeks (tests). Participants then underwent animate training and completed a final test within 7 days. Results: Twenty-five attending and 29 resident surgeons enrolled; 3 withdrew. There were significant increases in time to complete each of the tasks, and in errors, by 4 weeks (Adjusted times: DN: 122.9 ± 2.2 to 204.2 ± 11.7, t=6.9, P<.001; RPB: 262.4 ± 2.5 to 364.7 ± 8.0, t=12.4, P<.001; SP: 91.4 ± 1.4 to 169.9 ± 6.8, t=11.3, P<.001). Times decreased following animate training, but not to levels observed after proficiency training for the RPB and SP modules. Conclusions: Robotic surgical skills degrade significantly within 4 weeks of inactivity in newly trained surgeons. Animate training may provide different skills than those acquired in the dry lab. PMID:23477169

  19. [Robot-assisted laparoscopic prostatectomy: surgical technique].

    PubMed

    Rocco, B; Coelho, R F; Albo, G; Patel, V R

    2010-09-01

    Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl).

  20. Single-port plus an additional port robotic complete mesocolic excision and intracorporeal anastomosis using a robotic stapler for right-sided colon cancer

    PubMed Central

    Bae, Sung Uk; Jeong, Woon Kyung

    2016-01-01

    The concept of complete mesocolic excision and central vascular ligation for colonic cancer has been recently introduced. The paper describes a technique of right-sided complete mesocolic excision and intracorporeal anastomosis by using a single-port robotic approach with an additional conventional robotic port. We performed a single-port plus an additional port robotic surgery using the Da Vinci Single-Site platform via the Pfannenstiel incision and the wristed robotic instruments via an additional robotic port in the left lower quadrant. The total operative and docking times were 280 and 25 minutes, respectively. The total number of lymph nodes harvested was 36 and the proximal and distal resection margins were 31 and 50 cm, respectively. Single-port plus an additional port robotic surgery for right-sided complete mesocolic excision and intracorporeal anastomosis appears to be feasible and safe. This system can overcome certain limitations of the previous robotic systems and conventional single-port laparoscopic surgery. PMID:27757400

  1. Concurrent upper and lower urinary tract robotic surgery: strategies for success.

    PubMed

    Eun, Daniel; Bhandari, Akshay; Boris, Ronald; Rogers, Craig; Bhandari, Mahendra; Menon, Mani

    2007-11-01

    To assess the feasibility of combined upper and lower urinary tract robot-assisted laparoscopic surgery (RALS) during one operative session. We describe strategies for port placement and the use of the new da Vinci S surgical system (Intuitive Surgical, Sunnyvale, CA, USA), equipped with a fourth arm, for concurrent surgeries in a porcine model and in humans within one operative session. We studied various schemes of port placement, patient positioning and robotic arm manoeuvring while doing concurrent ipsilateral upper and lower urinary tract surgery on six pigs. The operative times and estimated blood loss were recorded prospectively. Qualitative data such as robotic arm ergonomics, advantages and disadvantages of various port placement strategies were noted. During the various surgical exercises, particular attention was given to the extent and the limits of instrument arm reach and mobility of the various port-placement schemes. These concepts for port placement and patient positioning were then further evaluated in a cadaver followed by demonstration of feasibility by performing a robot-assisted laparoscopic surgery (RAL) right nephroureterectomy in a patient. We describe a four-port 'baseball diamond' strategy to allow instrument access to the entire ipsilateral urinary tract in one operating session without repositioning the patient and re-docking the robot. Furthermore, if additional instrument length is required to reach the deep pelvis, we describe a novel 'pivoting triangle' manoeuvre that incorporates the fourth arm and allows dual-port cannulation and lens telescoping. Single session, concurrent multiple quadrant RALS is facilitated by using the da Vinci S surgical system with a 'baseball diamond' port-placement strategy.

  2. Robotic-assisted laparoscopic Nissen fundoplication with gastrostomy preservation in neurologically impaired children.

    PubMed

    Margaron, Franklin C; Oiticica, Claudio; Lanning, David A

    2010-06-01

    Robotic fundoplication has equivalent safety profiles, hospital stay, and time to alimentation, compared to laparoscopic fundoplication, but is not indicated for routine repair due to higher cost, decreased availability, and longer procedure time. Robotic surgery does offer key advantages over standard laparoscopy by employing internally articulating arms, a stable camera platform, and three dimensional imaging. Children presenting for initial or redo fundoplication after feeding gastrostomy are a subset of patients that may benefit from the robotic approach. Minimal dissection of the phrenoesophageal ligament, in combination with four anchoring sutures from the esophagus to the crura, has been shown to lead to less wrap herniation in children. This technique is particularly difficult in standard laparoscopy without dislodgement of the gastrostomy, particularly if there are abundant adhesions or a replaced left hepatic artery to preserve. In this article, we present 15 children with neurologic impairment and previous gastrostomy who underwent Nissen fundoplication, using the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA). All patients underwent a floppy Nissen fundoplication after crural closure and placement of four anchoring stitches to the crura. Six patients (40%) had redo Nissens and 5 (33.3%) had replaced left hepatic or accessory arteries that were preserved. Seven patients underwent repair of a hiatal hernia and 2 had biologic mesh placed. There were no conversions to open or intraoperative complications. One child had a revision of the gastrostomy site, because the prior percutaneous endoscopic gastrostomy had been placed through the transverse mesocolon. There were only a few minor postoperative complications. All children were doing well at latest follow-up (average, 32 months). The da Vinci surgical robot can be used to safely perform fundoplications in patients with gastrostomy tubes. The articulating instruments allow for the

  3. Transoral robotic surgery in head and neck cancer.

    PubMed

    Hans, S; Delas, B; Gorphe, P; Ménard, M; Brasnu, D

    2012-02-01

    Robots have invaded industry and, more recently, the field of medicine. Following the development of various prototypes, Intuitive Surgical® has developed the Da Vinci surgical robot. This robot, designed for abdominal surgery, has been widely used in urology since 2000. The many advantages of this transoral robotic surgery (TORS) are described in this article. Its disadvantages are essentially its high cost and the absence of tactile feedback. The first feasibility studies in head and neck cancer, conducted in animals, dummies and cadavers, were performed in 2005, followed by the first publications in patients in 2006. The first series including more than 20 patients treated by TORS demonstrated the feasibility for the following sites: oropharynx, supraglottic larynx and hypopharynx. However, these studies did not validate the oncological results of the TORS technique. TORS decreases the number of tracheotomies, and allows more rapid swallowing rehabilitation and a shorter length of hospital stay. Technical improvements are expected. Smaller, more ergonomic, new generation robots, therefore more adapted to the head and neck, will probably be available in the future. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  4. Robotic Anterior and Midline Skull Base Surgery: Preclinical Investigations

    SciTech Connect

    O'Malley, Bert W. Weinstein, Gregory S.

    2007-10-01

    Purpose: To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation. Methods and Materials: Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed. Results: Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base. Conclusion: Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development.

  5. [Totally robotic mitral valve surgery in 60 cases].

    PubMed

    Yang, Ming; Gao, Chang-qing; Wang, Gang; Wang, Jia-li; Xiao, Cang-song; Wu, Yang

    2011-10-01

    To evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system. We conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results. None of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group. In selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

  6. Robotic surgery and cancer: the present state, problems and future vision.

    PubMed

    Hashizume, Makoto; Tsugawa, Kouji

    2004-05-01

    In the 1990s, laparoscopic surgery entirely changed the traditional style of surgical operations. Laparoscopic cholecystectomy has spread rapidly and is now established as the standard treatment. However, besides cholecystectomy, endoscopic procedures are still not applied so widely to a variety of surgical operations. This is because laparoscopic techniques, such as suturing or ligation, make it difficult for surgeons to perform other kinds of operations and thus greatly increase their mental and physical stress. It is necessary to introduce various advanced technologies such as: surgical robots, three dimensional (3D) images, computer graphics (CG), computer simulation technology and others. Surgical robots, including the AESOP, da Vinci and ZEUS systems, provide surgeons with technologically advanced vision and hand skills. As a result, such systems are expected to revolutionize the field of surgery. However, there have so far been few studies which discuss the indications of robotic surgery for tumors/cancer. Therefore, herein we review various studies published in English to focus on the application of robotic surgery to tumors/cancer. We point out that there are several problems to be solved for robot surgery: i) price of surgical robots, ii) training systems for surgeon, iii) coverage by medical insurance, iv) downsizing and v) navigation system. In conclusion, we believe that, in the near future as robotic technology continues to develop, almost all kinds of endoscopic surgery will be performed by this technology. It will replace traditional surgery not only in the treatment of benign diseases but also in malignant illnesses.

  7. Current Status of Robot-Assisted Laparoscopic Surgery in Pediatric Urology

    PubMed Central

    Song, Sang Hoon

    2014-01-01

    Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated. PMID:25132942

  8. Robot assisted radical prostatectomy: how I do it. Part I: Patient preparation and positioning.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-10-01

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM)-Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

  9. Virtual reality robotic surgical simulation: an analysis of gynecology trainees.

    PubMed

    Sheth, Sangini S; Fader, Amanda N; Tergas, Ana I; Kushnir, Christina L; Green, Isabel C

    2014-01-01

    To analyze the learning curves of gynecology trainees on several virtual reality da Vinci Skills Simulator exercises. Prospective cohort pilot study. Academic hospital-based gynecology training program. Novice robotic surgeons from a gynecology training program. Novice robotic surgeons from an academic gynecology training program completed 10 repetitions of 4 exercises on the da Vinci Skills Simulator: matchboard, ring and rail, suture sponge, and energy switching. Performance metrics measured included time to completion, economy of instrument movement, excessive force, collisions, master workspace range, missed targets, misapplied energy, critical errors, and overall score. Statistical analyses were conducted to define the learning curve for trainees and the optimal number of repetitions for each exercise. A total of 34 participants were enrolled, of which 9 were medical students, 22 were residents, and 3 were fellows. There was a significant improvement in performance between the 1st and 10th repetitions across multiple metrics for all exercises. Senior trainees performed the suture exercise significantly faster than the junior trainees during the first and last repetitions (p = 0.004 and p = 0.003, respectively). However, the performance gap between seniors and juniors narrowed significantly by the 10th repetition. The mean number of repetitions required to achieve performance plateau ranged from 6.4 to 9.3. Virtual reality robotic simulation improves ability through repetition at all levels of training. Further, a performance plateau may exist during a single training session. Larger studies are needed to further define the most high-yield simulator exercises, the ideal number of repetitions, and recommended intervals between training sessions to improve operative performance. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Robotic single-site pelvic lymphadenectomy.

    PubMed

    Tateo, Saverio; Nozza, Arrigo; Del Pezzo, Chiara; Mereu, Liliana

    2014-09-01

    To examine the feasibility of performing pelvic lymphadenectomy with robotic single site approach. Recent papers described the feasibility of robotic-single site hysterectomy [1-3] for benign and malign pathologies but only with the development of new single site 5mm instruments as the bipolar forceps, robotic single site platform can be safely utilized also for lymphadenectomy. A 65 year-old, multiparous patient with a body mass index of 22.5 and diagnosed with well differentiated adenocarcinoma of the endometrium underwent a robotic single-site peritoneal washing, total hysterectomy, bilateral adnexectomy and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2,5 cm umbilical incision, with a multi-channel system and two single site robotic 5mm instruments. A 3-dimensional, HD 8.5mm endoscope and a 5mm accessory instrument were also utilized. Type I lymphonodes dissection for external iliac and obturator regions was performed [4]. Total operative time was 210 min; incision, trocar placement and docking time occurring in 12 min. Total console time was 183 min, estimated blood loss was 50 ml, no intra-operative or post-operative complications occurred. Hospital discharge occurred on post operative day 2 and total number of lymphnodes removed was 33. Difficulties in term of instrument's clashing and awkward motions have been encountered. Robotic single-site pelvic lymphadenectomy using bipolar forceps and monopolar hook is feasible. New developments are needed to improve surgical ergonomics and additional studies should be performed to explore possible benefits of this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Cost effectiveness of robotic mitral valve surgery

    PubMed Central

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  12. Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.

    PubMed

    Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

    2011-06-01

    This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

  13. External force estimation and implementation in robotically assisted minimally invasive surgery.

    PubMed

    Sang, Hongqiang; Yun, Jintian; Monfaredi, Reza; Wilson, Emmanuel; Fooladi, Hadi; Cleary, Kevin

    2017-06-01

    Robotically assisted minimally invasive surgery can offer many benefits over open surgery and laparoscopic minimally invasive surgery. However, currently, there is no force sensing and force feedback. This research was implemented using the da Vinci research kit. An external force estimation and implementation method was proposed based on dynamics and motor currents. The dynamics of the Patient Side Manipulator was modeled. The dynamic model was linearly parameterized. The estimation principle of external force was derived. The dynamic parameters were experimentally identified using a least squares method. Several experiments including dynamic parameter identification, joint torque estimation, and external force estimation were performed. The results showed that the proposed method could implement force estimation without using a force sensor. The force estimation method was proposed and implemented and experimental results showed the method worked and was feasible. This method could be used for force sensing in minimally invasive surgical robotics in the future. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Modifiable factors to decrease the cost of robotic-assisted procedures.

    PubMed

    Nayeemuddin, Mohammed; Daley, Susan C; Ellsworth, Pamela

    2013-10-01

    In 2000, the US Food and Drug Administration approved the da Vinci Surgical System® for use in the United States. Since that time, the number of surgical robotic systems throughout the United States has continued to grow. The costs for using the system include the initial purchase ($1 million to $2.3 million) plus annual maintenance fees ($100,000 to $150,000) and the cost of limited-use or disposable instruments. Increasing the number of procedures that are performed using the robotic system can decrease the per-procedure costs. Two modifiable factors that contribute to increasing the annual caseload are increasing the number of surgeons capable of using the system and having a properly educated perioperative nursing team. An educated surgical team decreases turnover time, facilitates proper flow of each surgical procedure, and is able to actively and passively solve intraoperative problems. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. Kinematic analysis of motor performance in robot-assisted surgery: a preliminary study.

    PubMed

    Nisky, Ilana; Patil, Sangram; Hsieh, Michael H; Okamura, Allison M

    2013-01-01

    The inherent dynamics of the master manipulator of a teleoperated robot-assisted surgery (RAS) system can affect the movements of a human operator, in comparison with free-space movements. To measure the effects of these dynamics on operators with differing levels of surgical expertise, a da Vinci Si system was instrumented with a custom surgeon grip fixture and magnetic pose trackers. We compared users' performance of canonical motor control movements during teleoperation with the manipulator and freehand cursor control, and found significant differences in several aspects of motion, including target acquisition error, movement speed, and acceleration. In addition, there was preliminary evidence for differences between experts and novices. These findings could impact robot design, control, and training methods for RAS.

  16. Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery

    PubMed Central

    Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

    2013-01-01

    This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information. PMID:24398557

  17. A case report of intraoperative endoscopic ultrasound during robotic assisted Heller myotomy for severe esophageal achalasia.

    PubMed

    Abdel Khalek, Mohamed; Abbas, Abbas; Joshi, Virendra; Hariri, Nizar; Kandil, Emad

    2011-01-01

    Esophageal achalasia is the best described primary esophageal motility disorder. Endoscopic ultrasound (EUS) is considered a useful adjunct for grading and establishing the prognosis of these patients. Recent experience using Da Vinci robotic assisted myotomy has demonstrated that this is a safe and effective approach of treatment. The benefit of magnification and three dimensional imaging helps prevent esophageal perforation and identify residual circular muscle fibers. This paper reports the relative efficacy and safety of intraoperative ultrasound during robotic assisted myotomy in a patient with severe achalasia. Intraoperative esophageal endoscopic ultrasound is a safe technique that may improve the success rate of surgery by confirming the adequacy of myotomy, thereby decreasing the likelihood of recurrent symptoms.

  18. Global robotic experience and the type of surgical system impact the types of robotic malfunctions and their clinical consequences: an FDA MAUDE review.

    PubMed

    Lucas, Steven M; Pattison, Erik A; Sundaram, Chandru P

    2012-04-01

    To assess annual rates of robotic system malfunctions and compare the da Vinci S(®) system (dVS) and da Vinci(®) surgical system (dV). To assess the types of malfunctions and associated outcomes for robotic cases and determine the extent to which experience and technological improvements impact these. This study is a retrospective review of the US Food and Drug Administration (FDA) MAUDE (Manufacturer and User Facility Device Experience) database, a publicly available, voluntary reporting system (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm). The database was searched using the two phrases 'da Vinci' and 'Intuitive Surgical' from 2003 to 2009. Malfunctions of the instruments, console, patient-side cart, camera and cannula were recorded. Data on intraoperative injuries, case delays and conversions were also collected. In all, 1914 reports were reviewed (991 dVS and 878 dV, 45 unclassified) with peak years for reports of 2008 for dVS (571) and 2007 for dV (211), P < 0.001. With respect to time, the proportion of console and patient-side cart malfunctions declined from 2007 onward compared with the proportions prior to 2007 (5.1% vs 9.4% and 6.6% vs 10.9%). Patient injury did not change with year of surgery (0.5-5.4% of malfunctions, P= 0.358), open conversions declined (21.3% of malfunctions before 2007 vs 9.9% from 2007 onward, P < 0.001) and patient deaths increased (0.0013% of cases before 2007 vs 0.0061% of cases from 2007 onward, P < 0.001). With regard to robotic system, console and patient-side cart malfunctions were more frequent with the dV than the dVS: 82/878 vs 39/991 and 100/878 vs 48/991, P < 0.001. Open conversion was more frequent with dV than dVS (19.3% vs 7.7% of reported malfunctions, P < 0.001), while patient injury was less with dV than dVS (3.5% vs 5.9%, P= 0.021). The dVS decreased console and patient-side cart errors relative to total malfunctions, which were also influenced by surgical year. Open conversions were

  19. Robotic-assisted laparoscopic reconstruction of the upper urinary tract: tips and tricks.

    PubMed

    Thiel, David D; Leroy, Timothy J; Winfield, Howard N; Igel, Todd C

    2010-08-01

    To examine whether simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder. The da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) has been widely accepted by urologists for complex reconstructive maneuvers such as radical prostatectomy and pyeloplasty. The manuscript and accompanying video outline tips and tricks for patient selection, patient evaluation, port placement, dissection techniques, robotic docking, ureteral repair, and stent management for complex urinary tract reconstruction of the upper urinary tract from the level of the renal calyx to the bladder. Modifications such as port placement, robotic docking techniques, and ureter reconstruction have simplified the technique of complex robotic-assisted laparoscopic reconstruction of the urinary tract. Numerous scenarios can be encountered during robotic-assisted laparoscopic repair of the upper urinary tract. Simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder. Copyright 2010 Elsevier Inc. All rights reserved.

  20. Robot-assisted laparoscopic surgery in gynecology: scientific dream or reality?

    PubMed

    Nezhat, Camran; Lavie, Ofer; Lemyre, Madeleine; Unal, Ebru; Nezhat, Ceana H; Nezhat, Farr

    2009-06-01

    To analyze the feasibility, safety, advantages, and disadvantages of using robotic technology for gynecologic surgeries in a large group of patients. Retrospective study (Canadian Task Force classification II-3). Tertiary endoscopic referral centers. Eighty-seven patients requiring laparoscopic treatments for benign gynecologic conditions. Charts reviewed from robotic-assisted gynecologic operative laparoscopies. Length of surgery, time for robot assembly and disassembly, rate of conversion to laparotomies, and complications. Between January 2006 and August 2007, 137 robotically assisted gynecologic procedures were performed in 87 patients. The da Vinci Surgical System was used. The average length of the surgeries was 205 minutes (60-420 minutes). Assembly of the robot lasted 16 minutes (10-27 minutes) when disassembly took 2.5 minutes (2-6 minutes). There were no conversions to laparotomy. There were three complications. Robotic-assisted technology, in its present state, is enabling more surgeons to perform endoscopic surgery. Its advantages are 3D Vision and a faster learning curve for suturing and operating while sitting. It's an exciting enabling technology with a great future.

  1. The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques.

    PubMed

    Park, Seungwan; Kim, Nam Kyu

    2015-07-01

    The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment.

  2. Objective Measures for Longitudinal Assessment of Robotic Surgery Training

    PubMed Central

    Kumar, Rajesh; Jog, Amod; Vagvolgyi, Balazs; Nguyen, Hiep; Hager, Gregory; Chen, Chi Chiung Grace; Yuh, David

    2011-01-01

    Objectives Current robotic training approaches lack criteria for automatically assessing and tracking (over time) technical skills separately from clinical proficiency. We describe the development and validation of a novel automated and objective framework for assessment of training. Methods We are able to record all system variables (stereo instrument video, hand and instrument motion, buttons and pedal events) from the da Vinci surgical systems using a portable archival system integrated with the robotic surgical system. Data can be collected unsupervised, and the archival system does not change system operation in any way. Our open-ended multi-center protocol is collecting surgical skill benchmarking data from 24 trainees to surgical proficiency, subject only to their continued availability. Two independent experts performed structured (OSATS) assessments on longitudinal data from 8 novice and 4 expert surgeons to generate ground truth for training and to validate our computerized statistical analysis methods in identifying ranges of operational and clinical skill measures. Results Objective differences in operational and technical skill between known experts and other subjects were quantified. Longitudinal learning curves and statistical analysis for trainee performance measures are reported. Graphical representations of skills developed for feedback to the trainees are also included. Conclusions We describe an open-ended longitudinal study and automated motion recognition system capable of objectively differentiating between clinical and technical operational skills in robotic surgery. Our results demonstrate a convergence of trainee skill parameters towards those derived from expert robotic surgeons over the course of our training protocol. PMID:22172215

  3. MAUDE: analysis of robotic-assisted gynecologic surgery.

    PubMed

    Manoucheri, Elmira; Fuchs-Weizman, Noga; Cohen, Sarah L; Wang, Karen C; Einarsson, Jon

    2014-01-01

    To evaluate the adverse events encountered during robotic gynecologic surgery, as reported to the FDA MAUDE database from January 2006 to December 2012. Database search (Canadian Task Force classification III). A search of the FDA MAUDE database was performed by brand name "da Vinci" and manufacturer "Intuitive Surgical." Reports reflecting gynecologic procedures either by description or procedure name were included. A record of reports was kept to ensure that no duplicates were added. The date and type of event (operator-related error, technical system failure, or surgical injuries attributed to use of the robot) and the clinical outcome were recorded. Twenty-six percent of reported events (n = 73) resulted in injury, and 8.5% (n = 24) resulted in death. Of note, although adnexal procedures were performed in <3% of the cohort, they accounted for 20% of the fatalities. Twenty-one percent of injuries were attributed to operator-related error, and 14% to technical system failure; 65% were not directly related to use of the robot. Fifteen deaths were reported during planned hysterectomy. Four of those were due to injury to a major blood vessel (iliac artery in 3, and aorta in 1), although a detailed description of how the injury occurred was absent from the event description. It is important to continue to evaluate the occurrence of injuries during robot-assisted surgery in an effort to identify unique challenges associated with this advanced technology. Published by Elsevier Inc.

  4. Transoral robotic surgery for the pediatric head and neck surgeries.

    PubMed

    Erkul, Evren; Duvvuri, Umamaheswar; Mehta, Deepak; Aydil, Utku

    2017-03-01

    Pediatric robotic surgery is a relatively new technology that has been shown to be safe and feasible for a number of pediatric procedures. Our literature analysis was performed using Pubmed database between January 2005 and December 2015, using key words: "robotic," "robotic surgery," "TORS," "pediatric," "children," "head and neck," and "da Vinci". We selected only publications in English. Eight published reports met the selection criteria. We totally found 41 patients, and the age range was between 2 months and 19 years. The cases are 16 only lingual tonsillectomy, nine base of tongue and lingual tonsillectomy, two malignant disease in the oropharynx (high-grade undifferentiated sarcoma and biphasic synovial sarcoma), one tongue base thyroglossal duct cyst, 11 laryngeal cleft cyst, one posterior glottic stenosis, and one congenital true vocal cord paralysis surgeries. One intraoperative complication was reported. No patient needed postoperative tracheotomy. Hospital duration time had a range of 1-16 days. TORS is new for pediatric patients in head and neck areas, and there were few reports. It is becoming increasingly used in head and neck surgeries and those reports above are encouraging for pediatric robotic airway surgeries in otolaryngology in the future.

  5. Totally robotic single-position 'flip' arm technique for splenic flexure mobilizations and low anterior resections.

    PubMed

    Obias, Vincent; Sanchez, Caroline; Nam, Arthur; Montenegro, Grace; Makhoul, Rami

    2011-06-01

    Using the da Vinci robot in low anterior resection (LAR) has not been widely adopted due to limited range of motion of the robotic arms and the need to move the robot during operations. Our technique uses all three arms for both the splenic flexure and the pelvis, but with only one docking position. The robot is placed to the left of the patient. The camera port is 3 cm to the right of the umbilicus. Arm 1 is placed in the RLQ. Arm 2 is placed midepigastric. Arm 3 is placed in the LLQ. Arm 3 starts off on the left side of the robot, on the same side as Arm 1 aimed cephalad. During mobilization of colon and splenic flexure, Arms 2 and 3 help retract the colon while Arm 1 dissects. Our pelvic dissection begins with Arm 3 "flipped" to the right side of the robot and redocked to the same left sided port aimed caudally. The robot does not need to be repositioned and the patient does not need to be moved. The pelvic dissection can now be done in the standard fashion. Our early experience includes four patients: two LARs and two left hemicolectomies. Mean operative time = 347 minutes, docking time = 20 minutes, and robotic surgical time = 195 minutes. Two complications occurred: post-operative ileus and high ostomy output. Mean LOS = 5. The robotic "flip" arm technique allows the surgeon to fully utilize all the robotic arms in LAR, which is unique versus other techniques. Copyright © 2011 John Wiley & Sons, Ltd.

  6. Four-arm robotic lobectomy for the treatment of early-stage lung cancer.

    PubMed

    Veronesi, Giulia; Galetta, Domenico; Maisonneuve, Patrick; Melfi, Franca; Schmid, Ralph Alexander; Borri, Alessandro; Vannucci, Fernando; Spaggiari, Lorenzo

    2010-07-01

    We investigated the feasibility and safety of four-arm robotic lung lobectomy in patients with lung cancer and described the robotic lobectomy technique with mediastinal lymph node dissection. Over 21 months, 54 patients underwent robotic lobectomy for early-stage lung cancer at our institute. We used a da Vinci Robotic System (Intuitive Surgical, Inc, Mountain View, Calif) with three ports plus one utility incision to isolate hilum elements and perform vascular and bronchial resection using standard endoscopic staplers. Standard mediastinal lymph node dissection was performed subsequently. Surgical outcomes were compared with those in 54 patients who underwent open surgery over the same period and were matched to the robotic group using propensity scores for a series of preoperative variables. Conversion to open surgery was necessary in 7 (13%) cases. Postoperative complications (11/54, 20%, in each group) and median number of lymph nodes removed (17.5 robotic vs 17 open) were similar in the 2 groups. Median robotic operating time decreased by 43 minutes (P = .02) from first tertile (18 patients) to the second-plus-third tertile (36 patients). Median postoperative hospitalization was significantly shorter after robotic (excluding first tertile) than after open operations (4.5 days vs 6 days; P = .002). Robotic lobectomy with lymph node dissection is practicable, safe, and associated with shorter postoperative hospitalization than open surgery. From the number of lymph nodes removed it also appears oncologically acceptable for early lung cancer. Benefits in terms of postoperative pain, respiratory function, and quality of life still require evaluation. We expect that technologic developments will further simplify the robotic procedure. 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial.

    PubMed

    Kudsi, Omar Yusef; Castellanos, Andres; Kaza, Srinivas; McCarty, Justin; Dickens, Eugene; Martin, David; Tiesenga, Frederick M; Konstantinidis, Konstantinos; Hirides, Petros; Mehendale, Shilpa; Gonzalez, Anthony

    2017-08-01

    Single-incision laparoscopic cholecystectomy evolved from the traditional multiport laparoscopic technique. Prior trials have demonstrated improved cosmesis with the single-incision technique. Robotic single-site surgery minimizes the technical difficulties associated with laparoscopic single-incision approach. This is the first prospective, randomized, controlled study comparing robotic single-site cholecystectomy (RSSC) and multiport laparoscopic cholecystectomy (MPLC) in terms of cosmesis and patient satisfaction. Patients with symptomatic benign gallbladder disease were randomized to RSSC or MPLC. Data included perioperative variables such as operative time, conversion and complications and cosmesis satisfaction, body image perception, quality of life using validated questionnaires, at postoperative visits of 2, 6 weeks and 3 months. One hundred thirty-six patients were randomized to RSSC (N = 83) and MPLC (N = 53) at 8 institutions. Both cohorts were dominated by higher enrollment of females (RSSC = 78%, MPLC = 92%). The RSSC and MPLC cohorts were otherwise statistically matched. Operative time was longer for RSSC (61 min vs. 44 min, P < 0.0001). There were no differences in complication rates. RSSC demonstrated a significant superiority in cosmesis satisfaction and body image perception (P value < 0.05 at every follow-up). There was no statistically significant difference in patient-reported quality of life. Multivariate analysis of female patients demonstrated significantly higher preference for RSSC over MPLC in cosmesis satisfaction and body image perception with no difference seen in overall quality of life. Results from this trial show that RSSC is associated with improved cosmesis satisfaction and body image perception without a difference in observed complication rate. The uncompromised safety and the improved cosmesis satisfaction and body image perception provided by RSSC for female patients support consideration of the robotic single

  8. Toward Intraoperative Image-Guided Transoral Robotic Surgery

    PubMed Central

    Liu, Wen P.; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M.; Siewerdsen, Jeffrey H.; Richmon, Jeremy; Taylor, Russell H.

    2014-01-01

    This paper presents the development and evaluation of video augmentation on the stereoscopic da Vinci S system with intraoperative image guidance for base of tongue tumor resection in transoral robotic surgery (TORS). Proposed workflow for image-guided TORS begins by identifying and segmenting critical oropharyngeal structures (e.g., the tumor and adjacent arteries and nerves) from preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging. These preoperative planned data can be deformably registered to the intraoperative endoscopic view using mobile C-arm cone-beam computed tomography (CBCT) [1, 2]. Augmentation of TORS endoscopic video defining surgical targets and critical structures has the potential to improve navigation, spatial orientation, and confidence in tumor resection. Experiments in animal specimens achieved statistically significant improvement in target localization error when comparing the proposed image guidance system to simulated current practice. PMID:25525474

  9. Robot-assisted surgery in children: current status.

    PubMed

    Sinha, C K; Haddad, M

    2008-01-01

    The horizon of robotic paediatric surgery has grown in leaps and bounds with advances in technology. The aim of this study was to analyse the extent of robotic involvement in paediatric surgical practice. A systematic database search was performed. Data about children who had undergone robot-assisted procedures were reviewed retrospectively from all published reports up to October 2007. Success rates were defined in term of completion of the procedures, their complications, and the time taken. These results were further studied in comparison with the procedures performed by open and laparoscopic methods. A total of 31 studies were identified describing 566 patients. Of these, four studies were case control, comparing with either laparoscopic or open procedures, one study was a prospective trial, and the rest of the studies were either case reports or series. The most common robotic system used was the da Vinci (23 studies) followed by the Zeus (four studies). The mean age of the children was 8.3 years. The commonest operation was pyeloplasty (141 cases), followed by fundoplication (122 cases) and patent ductus arteriosus ligation (50 cases). The mean operation time for robot-assisted pyeloplasty was 221 min (open pyeloplasty 214 min). The mean operation times for fundoplication were robotic, 170 min, laparoscopic, 158 min, and open, 121 min. The mean operation times for patent ductus arteriosus ligation were 166 min (robotic) and 83 min (open). Overall conversion rate for all paediatric robotic procedures was 4.7% and complications ranged from 0 to 15%. For robotic fundoplications the conversion and complication rates were 0.8 and 3.3%, respectively. For robotic pyeloplasties the conversion and complication rates were 2.1 and 3.5%, respectively. Many other major operations were performed successfully. All studies recommended robotic procedure as safe and feasible. Currently, the most common robotic operations in practice are pyeloplasties and

  10. Robotics

    NASA Technical Reports Server (NTRS)

    Ambrose, Robert O.

    2007-01-01

    Lunar robotic functions include: 1. Transport of crew and payloads on the surface of the moon; 2. Offloading payloads from a lunar lander; 3. Handling the deployment of surface systems; with 4. Human commanding of these functions from inside a lunar vehicle, habitat, or extravehicular (space walk), with Earth-based supervision. The systems that will perform these functions may not look like robots from science fiction. In fact, robotic functions may be automated trucks, cranes and winches. Use of this equipment prior to the crew s arrival or in the potentially long periods without crews on the surface, will require that these systems be computer controlled machines. The public release of NASA's Exploration plans at the 2nd Space Exploration Conference (Houston, December 2006) included a lunar outpost with as many as four unique mobility chassis designs. The sequence of lander offloading tasks involved as many as ten payloads, each with a unique set of geometry, mass and interface requirements. This plan was refined during a second phase study concluded in August 2007. Among the many improvements to the exploration plan were a reduction in the number of unique mobility chassis designs and a reduction in unique payload specifications. As the lunar surface system payloads have matured, so have the mobility and offloading functional requirements. While the architecture work continues, the community can expect to see functional requirements in the areas of surface mobility, surface handling, and human-systems interaction as follows: Surface Mobility 1. Transport crew on the lunar surface, accelerating construction tasks, expanding the crew s sphere of influence for scientific exploration, and providing a rapid return to an ascent module in an emergency. The crew transport can be with an un-pressurized rover, a small pressurized rover, or a larger mobile habitat. 2. Transport Extra-Vehicular Activity (EVA) equipment and construction payloads. 3. Transport habitats and

  11. Robotics

    NASA Technical Reports Server (NTRS)

    Ambrose, Robert O.

    2007-01-01

    Lunar robotic functions include: 1. Transport of crew and payloads on the surface of the moon; 2. Offloading payloads from a lunar lander; 3. Handling the deployment of surface systems; with 4. Human commanding of these functions from inside a lunar vehicle, habitat, or extravehicular (space walk), with Earth-based supervision. The systems that will perform these functions may not look like robots from science fiction. In fact, robotic functions may be automated trucks, cranes and winches. Use of this equipment prior to the crew s arrival or in the potentially long periods without crews on the surface, will require that these systems be computer controlled machines. The public release of NASA's Exploration plans at the 2nd Space Exploration Conference (Houston, December 2006) included a lunar outpost with as many as four unique mobility chassis designs. The sequence of lander offloading tasks involved as many as ten payloads, each with a unique set of geometry, mass and interface requirements. This plan was refined during a second phase study concluded in August 2007. Among the many improvements to the exploration plan were a reduction in the number of unique mobility chassis designs and a reduction in unique payload specifications. As the lunar surface system payloads have matured, so have the mobility and offloading functional requirements. While the architecture work continues, the community can expect to see functional requirements in the areas of surface mobility, surface handling, and human-systems interaction as follows: Surface Mobility 1. Transport crew on the lunar surface, accelerating construction tasks, expanding the crew s sphere of influence for scientific exploration, and providing a rapid return to an ascent module in an emergency. The crew transport can be with an un-pressurized rover, a small pressurized rover, or a larger mobile habitat. 2. Transport Extra-Vehicular Activity (EVA) equipment and construction payloads. 3. Transport habitats and

  12. First 101 Robotic General Surgery Cases in a Community Hospital

    PubMed Central

    Robertson, Jarrod C.; Alrajhi, Sharifah

    2016-01-01

    Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

  13. Comparative assessment of three standardized robotic surgery training methods.

    PubMed

    Hung, Andrew J; Jayaratna, Isuru S; Teruya, Kara; Desai, Mihir M; Gill, Inderbir S; Goh, Alvin C

    2013-10-01

    To evaluate three standardized robotic surgery training methods, inanimate, virtual reality and in vivo, for their construct validity. To explore the concept of cross-method validity, where the relative performance of each method is compared. Robotic surgical skills were prospectively assessed in 49 participating surgeons who were classified as follows: 'novice/trainee': urology residents, previous experience <30 cases (n = 38) and 'experts': faculty surgeons, previous experience ≥30 cases (n = 11). Three standardized, validated training methods were used: (i) structured inanimate tasks; (ii) virtual reality exercises on the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA); and (iii) a standardized robotic surgical task in a live porcine model with performance graded by the Global Evaluative Assessment of Robotic Skills (GEARS) tool. A Kruskal-Wallis test was used to evaluate performance differences between novices and experts (construct validity). Spearman's correlation coefficient (ρ) was used to measure the association of performance across inanimate, simulation and in vivo methods (cross-method validity). Novice and expert surgeons had previously performed a median (range) of 0 (0-20) and 300 (30-2000) robotic cases, respectively (P < 0.001). Construct validity: experts consistently outperformed residents with all three methods (P < 0.001). Cross-method validity: overall performance of inanimate tasks significantly correlated with virtual reality robotic performance (ρ = -0.7, P < 0.001) and in vivo robotic performance based on GEARS (ρ = -0.8, P < 0.0001). Virtual reality performance and in vivo tissue performance were also found to be strongly correlated (ρ = 0.6, P < 0.001). We propose the novel concept of cross-method validity, which may provide a method of evaluating the relative value of various forms of skills education and assessment. We externally confirmed the construct validity of each featured training tool. © 2013 BJU

  14. Robotic lung segmentectomy for malignant and benign lesions

    PubMed Central

    Toker, Alper; Ayalp, Kemal; Uyumaz, Elena; Kaba, Erkan; Demirhan, Özkan

    2014-01-01

    Objective Surgical use of robots has evolved over the last 10 years. However, the academic experience with robotic lung segmentectomy remains limited. We aimed to analyze our lung segmentectomy experience with robot-assisted thoracoscopic surgery. Methods Prospectively recorded clinical data of 21 patients who underwent robotic lung anatomic segmentectomy with robot-assisted thoracoscopic surgery were retrospectively reviewed. All cases were done using the da Vinci System. A three incision portal technique with a 3 cm utility incision in the posterior 10th to 11th intercostal space was performed. Individual dissection, ligation and division of the hilar structures were performed. Systematic mediastinal lymph node dissection or sampling was performed in 15 patients either with primary or secondary metastatic cancers. Results Fifteen patients (75%) were operated on for malignant lung diseases. Conversion to open surgery was not necessary. Postoperative complications occurred in four patients. Mean console robotic operating time was 84±26 (range, 40-150) minutes. Mean duration of chest tube drainage and mean postoperative hospital stay were 3±2.1 (range, 1-10) and 4±1.4 (range, 2-7) days respectively. The mean number of mediastinal stations and number of dissected lymph nodes were 4.2 and 14.3 (range, 2-21) from mediastinal and 8.1 (range, 2-19) nodes from hilar and interlobar stations respectively. Conclusions Robot-assisted thoracoscopic segmentectomy for malignant and benign lesions appears to be practical, safe, and associated with few complications and short postoperative hospitalization. Lymph node removal also appears oncologically acceptable for early lung cancer patients. Benefits in terms of postoperative pain, respiratory function, and quality of life needs a comparative, prospective series particularly with video-assisted thoracoscopic surgery. PMID:25093090

  15. First 101 Robotic General Surgery Cases in a Community Hospital.

    PubMed

    Oviedo, Rodolfo J; Robertson, Jarrod C; Alrajhi, Sharifah

    2016-01-01

    The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.

  16. Robotics

    NASA Technical Reports Server (NTRS)

    Rothschild, Lynn J.

    2012-01-01

    Earth's upper atmosphere is an extreme environment: dry, cold, and irradiated. It is unknown whether our aerobiosphere is limited to the transport of life, or there exist organisms that grow and reproduce while airborne (aerophiles); the microenvironments of suspended particles may harbor life at otherwise uninhabited altitudes[2]. The existence of aerophiles would significantly expand the range of planets considered candidates for life by, for example, including the cooler clouds of a hot Venus-like planet. The X project is an effort to engineer a robotic exploration and biosampling payload for a comprehensive survey of Earth's aerobiology. While many one-shot samples have been retrieved from above 15 km, their results are primarily qualitative; variations in method confound comparisons, leaving such major gaps in our knowledge of aerobiology as quantification of populations at different strata and relative species counts[1]. These challenges and X's preliminary solutions are explicated below. X's primary balloon payload is undergoing a series of calibrations before beginning flights in Spring 2012. A suborbital launch is currently planned for Summer 2012. A series of ground samples taken in Winter 2011 is being used to establish baseline counts and identify likely background contaminants.

  17. The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon's Experience While Introducing the Robotic Technology in a Bariatric Surgery Department

    PubMed Central

    Vilallonga, Ramon; Fort, José Manuel; Gonzalez, Oscar; Caubet, Enric; Boleko, Angeles; Neff, Karl John; Armengol, Manel

    2012-01-01

    Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases. PMID:23029610

  18. Objective Assessment in Residency Based Training for Transoral Robotic Surgery

    PubMed Central

    Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

    2015-01-01

    Objective To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity and leading up to procedure specific training. In particular, we investigate applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci Robotic system. Study Design Prospective blinded data collection and objective evaluation (OSATS) of three distinct phases using the da Vinci Robotic surgical system. Setting Academic University Medical Engineering/Computer Science laboratory Methods Between September 2010 and July 2011, 8 Otolaryngology Head and Neck Surgery residents and 4 staff “experts” from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set-up of the patient side system, and 3) a complete ex-vivo surgical extirpation of an oropharyngeal “tumor” located in the base of tongue. Trainees performed multiple (4) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data was obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces (API) of the da Vinci system, as well as separate video cameras as appropriate. All data was assessed using automated skill measures of task efficiency, and correlated with structured assessment (OSATS, and similar Likert scale) from three experts to assess expert and trainee differences, and compute automated and expert assessed learning curves. Results Our data shows that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set-up and console manipulation. Experts (e.g. average OSATS 25, Stdev. 3.1, module 1 – suturing) and trainees (average

  19. Effects of robotic manipulators on movements of novices and surgeons.

    PubMed

    Nisky, Ilana; Okamura, Allison M; Hsieh, Michael H

    2014-07-01

    Robot-assisted surgery is widely adopted for many procedures but has not realized its full potential to date. Based on human motor control theories, the authors hypothesized that the dynamics of the master manipulators impose challenges on the motor system of the user and may impair performance and slow down learning. Although studies have shown that robotic outcomes are correlated with the case experience of the surgeon, the relative contribution of cognitive versus motor skill is unknown. This study quantified the effects of da Vinci Si master manipulator dynamics on movements of novice users and experienced surgeons and suggests possible implications for training and robot design. In the reported study, six experienced robotic surgeons and ten novice nonmedical users performed movements under two conditions: teleoperation of a da Vinci Si Surgical system and freehand. A linear mixed model was applied to nine kinematic metrics (including endpoint error, movement time, peak speed, initial jerk, and deviation from a straight line) to assess the effects of teleoperation and expertise. To assess learning effects, t tests between the first and last movements of each type were used. All the users moved slower during teleoperation than during freehand movements (F(1,9343) = 345; p < 0.001). The experienced surgeons had smaller errors than the novices (F(1,14) = 36.8; p < 0.001). The straightness of movements depended on their direction (F(7,9343) = 117; p < 0.001). Learning effects were observed in all conditions. Novice users first learned the task and then the dynamics of the manipulator. The findings showed differences between the novices and the experienced surgeons for extremely simple point-to-point movements. The study demonstrated that manipulator dynamics affect user movements, suggesting that these dynamics could be improved in future robot designs. The authors showed the partial adaptation of novice users to the dynamics. Future studies are needed to evaluate

  20. Upper quadrant port placement for robot-assisted renal surgery: implementation of the Floating Arm and the XL Protype.

    PubMed

    Totonchi, Samer; Elgin, Robert; Monahan, Michael; Johnston, William K

    2014-08-01

    Abstract Background and Purpose: Placement of the fourth arm (4th arm) in the lower quadrant (LQ) is commonly described for robot-assisted renal surgical procedures but has anatomic restrictions and limited ergonomics. An alternative, upper quadrant (UQ) location is desirable, but patient habitus and spacing may restrict robotic attachment. We investigate current trends in 4th arm port placement and propose an alternative method at attaching the robot-the "Floating Arm" (FLA). Robotic surgeons from the Endourological Society were surveyed. A 20-cm extra-long (XL Protype) da Vinci instrument was developed for the FLA technique. A dry lab allowed quantitative comparison of spacing and ranges of motion for standard da Vinci ports (dVP), bariatric dVP, telescoping dVP, and FLA. There were 108 respondents who participated. Half of the respondents avoid using the 4th arm (30% lack of need and 20% because of interference). The majority (90%) typically positions the 4th arm in the LQ, but many reported limitations in this location. Few (5%) place 4th arm in the UQ, while most (73%) have never heard of UQ placement. Existing techniques may increase shoulder height clearance but inversely shorten the working length of the instrument intracorporeally. Alternatively, the XL Protype significantly increased the shoulder length and maintained available working distances intracorporeally. Adjacent arm interference angle was essentially identical (27 degrees) for all ports except a greater range of movement for the XL Protype (35 degrees). Few surgeons are using an UQ positioning or use techniques to improve attachment of the 4th arm. The greatest freedom may be obtained by implementing the FLA, but this necessitates production of a longer instrument.

  1. Randomized controlled trial of virtual reality and hybrid simulation for robotic surgical training.

    PubMed

    Feifer, Andrew; Al-Ammari, Adel; Kovac, Evan; Delisle, Josee; Carrier, Serge; Anidjar, Maurice

    2011-11-01

    To evaluate if two commonly used laparoscopic simulators could be adapted and used successfully for the robotics platform in a laparoscopic and robotic naïve medical student population. We identified two widely validated laparoscopic simulation programs, LapSim(®) (Surgical Science Sweden AB), and ProMIS(®) (Haptica, Ireland)for inclusion in the study. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(®) task set was used for ProMIS, and adapted for the DaVinci(®) console (Intuitive Surgical, Inc., Sunnyvale, CA, USA) robotic platform. We then randomized 20 naïve medical students to receive training on either LapSim or ProMIS, both or neither, and evaluated them before and after training. When the groups were compared at baseline, there were no statistical differences in mean scores amongst the groups in univariate analysis (α= 0.05). When comparing mean scores within groups before and after training sessions, statistically significant performance enhancement in all four robotic tasks were identified in the groups receiving dual training. We have shown that the use of ProMIS hybrid and LapSim virtual reality (VR) simulators in conjunction with each other can considerable improve robotic console performance in novice medical students compared with hybrid and VR simulation alone. © 2011 BJU INTERNATIONAL. NO CLAIM TO ORIGINAL US GOVERNMENT WORKS.

  2. Real-time video fusion using a distributed architecture in robotic surgery

    NASA Astrophysics Data System (ADS)

    Kwartowitz, David M.; Rettmann, Maryam E.; Holmes, David R., III; Robb, Richard A.

    2009-02-01

    The use of medical robotics has been increasing in recent years. This increase in popularity can be attributed to the improvement in dexterity robots provide over traditional laparoscopy, as well as the increasing number of applications of robotic surgery. The daVinci from Intuitive Surgical, one of the more commonly used robotic surgery systems, relies on stereo laparoscopic video for guidance, which restricts visualization to only surface anatomy. Oftentimes the localization of subsurface anatomic structures is critical to the success of surgical intervention. The implementation of image guidance in medical robotics adds the ability to see into the surface; however, current implementations are restrictive in terms of flexibility or scalability, especially in the ability to process real-time video data. We present a system architecture which allows for use of multiple computers through a centralized database; which can fuse additional information to the real-time video stream. This architecture is independent of hardware or software and is extensible to a large number of clinical applications.

  3. Lingual Thyroid Excision with Transoral Robotic Surgery

    PubMed Central

    Ersoy Callıoglu, Elif; Bozdemir, Kazım; Ulusoy, Bulent; Oguzhan, Tolga; Korkmaz, M. Hakan

    2015-01-01

    Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented. PMID:26064746

  4. Improved depth perception with three-dimensional auxiliary display and computer generated three-dimensional panoramic overviews in robot-assisted laparoscopy

    PubMed Central

    Wieringa, Fokko P.; Bouma, Henri; Eendebak, Pieter T.; van Basten, Jean-Paul A.; Beerlage, Harrie P.; Smits, Geert A. H. J.; Bos, Jelte E.

    2014-01-01

    Abstract. In comparison to open surgery, endoscopic surgery offers impaired depth perception and narrower field-of-view. To improve depth perception, the Da Vinci robot offers three-dimensional (3-D) video on the console for the surgeon but not for assistants, although both must collaborate. We improved the shared perception of the whole surgical team by connecting live 3-D monitors to all three available Da Vinci generations, probed user experience after two years by questionnaire, and compared time measurements of a predefined complex interaction task performed with a 3-D monitor versus two-dimensional. Additionally, we investigated whether the complex mental task of reconstructing a 3-D overview from an endoscopic video can be performed by a computer and shared among users. During the study, 925 robot-assisted laparoscopic procedures were performed in three hospitals, including prostatectomies, cystectomies, and nephrectomies. Thirty-one users participated in our questionnaire. Eighty-four percent preferred 3-D monitors and 100% reported spatial-perception improvement. All participating urologists indicated quicker performance of tasks requiring delicate collaboration (e.g., clip placement) when assistants used 3-D monitors. Eighteen users participated in a timing experiment during a delicate cooperation task in vitro. Teamwork was significantly (40%) faster with the 3-D monitor. Computer-generated 3-D reconstructions from recordings offered very wide interactive panoramas with educational value, although the present embodiment is vulnerable to movement artifacts. PMID:26158026

  5. Improved depth perception with three-dimensional auxiliary display and computer generated three-dimensional panoramic overviews in robot-assisted laparoscopy.

    PubMed

    Wieringa, Fokko P; Bouma, Henri; Eendebak, Pieter T; van Basten, Jean-Paul A; Beerlage, Harrie P; Smits, Geert A H J; Bos, Jelte E

    2014-04-01

    In comparison to open surgery, endoscopic surgery offers impaired depth perception and narrower field-of-view. To improve depth perception, the Da Vinci robot offers three-dimensional (3-D) video on the console for the surgeon but not for assistants, although both must collaborate. We improved the shared perception of the whole surgical team by connecting live 3-D monitors to all three available Da Vinci generations, probed user experience after two years by questionnaire, and compared time measurements of a predefined complex interaction task performed with a 3-D monitor versus two-dimensional. Additionally, we investigated whether the complex mental task of reconstructing a 3-D overview from an endoscopic video can be performed by a computer and shared among users. During the study, 925 robot-assisted laparoscopic procedures were performed in three hospitals, including prostatectomies, cystectomies, and nephrectomies. Thirty-one users participated in our questionnaire. Eighty-four percent preferred 3-D monitors and 100% reported spatial-perception improvement. All participating urologists indicated quicker performance of tasks requiring delicate collaboration (e.g., clip placement) when assistants used 3-D monitors. Eighteen users participated in a timing experiment during a delicate cooperation task in vitro. Teamwork was significantly (40%) faster with the 3-D monitor. Computer-generated 3-D reconstructions from recordings offered very wide interactive panoramas with educational value, although the present embodiment is vulnerable to movement artifacts.

  6. The Minimally Invasive Manipulator: an ergonomic and economic non-robotic alternative for endoscopy?

    PubMed

    Bosma, Jesse; Aarts, Sanne; Jaspers, Joris

    2015-02-01

    Since the da Vinci robotic system was introduced, it has been reported to have ergonomic advantages over conventional laparoscopy (COV). High investments associated with this system challenged us to design a more economical, mechanical alternative for improvement of laparoscopic ergonomics: the Minimally Invasive Manipulator (MIM). An earlier reported MIM prototype was investigated. Its shortcomings were input for the establishment of design criteria for a new prototype. A new prototype was developed, aiming at improved intuitiveness and ergonomics. The handle and instrument tip were redesigned and the parallelogram mechanism was converted from linear moving parts to mainly rotating parts. The new prototype was tested by a panel of experts and novices during an indicative ergonomic experiment. A major advantage of the MIM seems to be the possibility to perform laparoscopic surgery in a sitting position, in line with the working axis, instead of standing at the side of the patient. At an estimated cost level of 10% of the da Vinci system, the MIM can be an economical alternative for the enhancement of laparoscopy ergonomics. However, further development for clinical feasibility is necessary.

  7. Cutaneous Feedback of Fingertip Deformation and Vibration for Palpation in Robotic Surgery.

    PubMed

    Pacchierotti, Claudio; Prattichizzo, Domenico; Kuchenbecker, Katherine J

    2016-02-01

    Despite its expected clinical benefits, current teleoperated surgical robots do not provide the surgeon with haptic feedback largely because grounded forces can destabilize the system's closed-loop controller. This paper presents an alternative approach that enables the surgeon to feel fingertip contact deformations and vibrations while guaranteeing the teleoperator's stability. We implemented our cutaneous feedback solution on an Intuitive Surgical da Vinci Standard robot by mounting a SynTouch BioTac tactile sensor to the distal end of a surgical instrument and a custom cutaneous display to the corresponding master controller. As the user probes the remote environment, the contact deformations, dc pressure, and ac pressure (vibrations) sensed by the BioTac are directly mapped to input commands for the cutaneous device's motors using a model-free algorithm based on look-up tables. The cutaneous display continually moves, tilts, and vibrates a flat plate at the operator's fingertip to optimally reproduce the tactile sensations experienced by the BioTac. We tested the proposed approach by having eighteen subjects use the augmented da Vinci robot to palpate a heart model with no haptic feedback, only deformation feedback, and deformation plus vibration feedback. Fingertip deformation feedback significantly improved palpation performance by reducing the task completion time, the pressure exerted on the heart model, and the subject's absolute error in detecting the orientation of the embedded plastic stick. Vibration feedback significantly improved palpation performance only for the seven subjects who dragged the BioTac across the model, rather than pressing straight into it.

  8. First ALPPS procedure using a total robotic approach.

    PubMed

    Vicente, E; Quijano, Y; Ielpo, B; Fabra, I

    2016-12-01

    ALPPS procedure is gaining interest. Indications and technical aspects of this technique are still under debate [1]. Only 4 totally laparoscopic ALPPS procedures have been described in the literature and none by robotic approach [2-4]. This video demonstrates the technical aspects of totally robotic ALPPS. A 58 year old man with sigmoid adenocarcinoma with multiple right liver metastases extended to segment IV and I underwent Xelox and 5 Fluoro-uracil neoadjuvancy. Preoperative CT volumetric scan showed a FLR/TLV (Future Liver Remnant/Total Liver Volume) of 28%. ALPPS totally robotic procedure was planned using the DaVinci Si. Tumor resection from the FLR (including segment I) is followed by parenchymal transection between the FLR and the diseased part of the liver with concomitant right portal vein ligation. Small branches to segment IV from left portal vein have been resected along the round ligament, at this step. The right biliary tract was resected as it was partially debilitated after its dissection as partially encircled by a metastasis at segment IV. Second stage was performed totally robotic on 13th postoperative days with a FLR/TLV of 40%. No strong adherences are found, making this stage much easer than open approach. During this step, right hepatic artery and right supra hepatic vein are resected. Finally, the specimen was retrieved inside a plastic bag through a Pfannenstiel incision. Postoperative pathology showed margins free from disease. ALPPS procedure performed by robotic approach could be a safe and feasible technique in experienced centers with advanced robotic skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Transoral robotic surgery: simulation-based standardized training.

    PubMed

    Zhang, Ning; Sumer, Baran D

    2013-11-01

    Simulation-based standardized training is important for the clinical training of physicians practicing robotic surgery. To train robotic surgery-naïve student volunteers using the da Vinci Skills Simulator (dVSS) for transoral robotic surgery (TORS). Prospective inception cohort in 2012. Academic referral center. Sixteen medical student volunteers lacking experience in robotic surgery. Participants trained with the dVSS in 12 exercises until competent, defined as an overall score of at least 91%. After a 1-, 3-, 5-, or 7-week postinitial training hiatus (n = 4 per group), participants reachieved competence on follow-up. Total training time (TTT) to achieve competency, total follow-up time (TFT) to reachieve competency, and performance metrics. All participants became competent. The TTT distribution was normal based on the Anderson-Darling normality test (P > .50), but our sample was divided into a short training time (STT) group (n = 10 [63%]) and long training time (LTT) group (n = 6 [37%]). The mean (SD) TTT was 2.4 (0.6) hours for the STT group and 4.7 (0.5) hours for the LTT group. All participants reachieved competence with a mean TFT that was significantly shorter than TTT. There was no significant difference between STT and LTT in mean TFT at 1 and 3 weeks (P = .79), but the LTT group had a longer TFT at 5 and 7 weeks (P = .04) but with no difference in final follow-up scores (P = .12). Physicians in training can acquire robotic surgery competency. Participants who acquire skills faster regain robotic skills faster after a training hiatus, but, on retraining, all participants can regain equivalent competence. This information provides a benchmark for a simulator training program.

  10. Robotic applications in abdominal surgery: their limitations and future developments.

    PubMed

    Taylor, G W; Jayne, D G

    2007-03-01

    In the past 20 years, the technical aspects of abdominal surgery have changed dramatically. Operations are now routinely performed by laparoscopic techniques utilizing small abdominal incisions, with less patient discomfort, earlier recovery, improved cosmesis, and in many cases reduced economic burden on the healthcare provider. These benefits have largely been seen in the application of laparoscopic techniques to relatively straightforward procedures. It is not clear whether the same benefits carry through to more complex abdominal operations, which are more technically demanding and for which current laparoscopic instrumentation is less well adapted. The aim of surgical robotics is to address these problems and allow the advantages of minimal access surgery to be seen in a greater range of operations. A literature search was performed to ascertain the current state of the art in surgical robotics for the abdomen, and the technologies emerging within this field. The reference lists of the sourced articles were also searched for further relevant papers. Currently available robotic devices for abdominal surgery are limited to large, costly 'slave-master' or telemanipulator systems, such as the da Vinci (Intuitive Surgical, Sunny Vale, CA). In addition to their size and expense, these systems share the same limitation, by virtue of the fulcrum effect on instrument manipulation inherent in the use of ports by which external instruments gain access to the abdominal cavity. In order to overcome these limitations several smaller telemanipulator systems are being developed, and progress towards freely mobile intracorporeal devices is being made. While current robotic systems have considerable advantages over conventional laparoscopic techniques, they are not without limitations. Miniaturisation of robotic components and systems is feasible and necessary to allow minimally invasive techniques to reach full potential. The ultimate extrapolation of this progress is the

  11. Vaginal Cuff Dehiscence in Robotic-Assisted Total Hysterectomy

    PubMed Central

    Kashani, Shabnam; Gallo, Taryn; Sargent, Anita; ElSahwi, Karim; Silasi, Dan-Arin

    2012-01-01

    Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Methods: This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy. Results: There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk. Conclusion: In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic-assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature. PMID:23484559

  12. Robotic cardiac surgery in Brazil.

    PubMed

    Poffo, Robinson; Toschi, Alisson P; Pope, Renato B; Montanhesi, Paola K; Santos, Ricardo S; Teruya, Alexandre; Hatanaka, Dina M; Rusca, Gabriel F; Fischer, Claudio H; Vieira, Marcelo C; Makdisse, Marcia R

    2017-01-01

    Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci(®) robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

  13. Robotic cardiac surgery in Brazil

    PubMed Central

    Toschi, Alisson P.; Pope, Renato B.; Montanhesi, Paola K.; Santos, Ricardo S.; Teruya, Alexandre; Hatanaka, Dina M.; Rusca, Gabriel F.; Fischer, Claudio H.; Vieira, Marcelo C.; Makdisse, Marcia R.

    2017-01-01

    Background Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. Methods From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. Results The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. Conclusions Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology. PMID:28203537

  14. Robot assisted Aortic and Non-aortic Vascular Operations.

    PubMed

    Štádler, P; Dvořáček, L; Vitásek, P; Matouš, P

    2016-07-01

    The aim of this study was to evaluate the clinical experience with 310 robot assisted vascular procedures. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon. From November 2005 to May 2014, 310 robot assisted vascular operations were performed. Two hundred and twenty four patients were prospectively evaluated for occlusive disease, 61 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, four for a splenic artery aneurysm, one for a internal mammary artery aneurysm, and after the unsuccessful endovascular treatment five for hybrid procedures, two patients for median arcuate ligament release and nine for endoleak II treatment post EVAR. Among these patients, 224 underwent robotic occlusive disease treatment (Group I), 65 robotic aorto-iliac aneurysm surgery (Group II) and 21 other robotic procedures (Group III). A total of 298 cases (96.1%) were successfully completed robotically. In 10 patients (3.2%) conversion was necessary. The 30 day mortality was 0.3%, and two (0.6%) late prosthetic infections were seen. Targeted Group I and Group II patients were compared. Robotic ilio-femoral bypass, aorto-femoral bypass, or aorto-iliac thrombo-endarterectomy with prosthetic patch (Group I) required an operative time of 194 (range, 127-315) minutes and robotic aorto-iliac aneurysm surgery (Group II), 253 (range, 185-360) minutes. The mean aortic cross clamping time was 37 minutes in Group I and 93 minutes in Group II. The mean blood loss was more significant in Group II (1,210 mL) than in Group I (320 mL). From a practical point of view, the greatest advantage of the robot assisted procedure has been the speed and relative simplicity of construction of the vascular anastomosis. This experience with robot assisted laparoscopic surgery has demonstrated the feasibility of this technique in different areas of vascular surgery. Copyright

  15. Current status and future directions of robotic single-site surgery: a systematic review.

    PubMed

    Autorino, Riccardo; Kaouk, Jihad H; Stolzenburg, Jens-Uwe; Gill, Inderbir S; Mottrie, Alex; Tewari, Ash; Cadeddu, Jeffrey A

    2013-02-01

    Despite the increasing interest in laparoendoscopic single-site surgery (LESS) worldwide, the actual role of this novel approach in the field of minimally invasive urologic surgery remains to be determined. It has been postulated that robotic technology could be applied to LESS to overcome the current constraints. To summarize and critically analyze the available evidence on the current status and future of robotic applications in single-site surgery. A systematic literature review was performed in April 2011 using PubMed and the Thomson-Reuters Web of Science. In the free-text protocol, the following terms were applied: robotic single site surgery, robotic single port surgery, robotic single incision surgery, and robotic laparoendoscopic single site surgery. Review articles, editorials, commentaries, and letters to the editor were included only if deemed to contain relevant information. In addition, cited references from the selected articles and from review articles retrieved in the search were assessed for significant manuscripts not previously included. The authors selected 55 articles according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. The volume of available clinical outcomes of robotic LESS (R-LESS) has considerably grown since the pioneering description of the first successful clinical series of single-port robotic procedures. So far, a cumulative number of roughly 150 robotic urologic LESS cases have been reported by different institutions across the globe with a variety of techniques and port configurations. The feasibility of robot-assisted single-incision colorectal procedures, as well as of many gynecologic procedures, has also been demonstrated. A novel set of single-site instruments specifically dedicated to LESS is now commercially available for use with the da Vinci Si surgical system, and both experimental and clinical use have been reported. However, the current robotic systems

  16. Robotics in Gynecology: Why is this Technology Worth Pursuing?

    PubMed Central

    Ayala-Yáñez, Rodrigo; Olaya-Guzmán, Emilio José; Haghenbeck-Altamirano, Javier

    2013-01-01

    Robotic laparoscopy in gynecology, which started in 2005 when the Da Vinci Surgical System (Intuitive Surgical Inc) was approved by the US Food and Drug Administration for use in gynecologic procedures, represents today a modern, safe, and precise approach to pathology in this field. Since then, a great deal of experience has accumulated, and it has been shown that there is almost no gynecological surgery that cannot be approached with this technology, namely hysterectomy, myomectomy, sacrocolpopexia, and surgery for the treatment of endometriosis. Albeit no advantages have been observed over conventional laparoscopy and some open surgical procedures, robotics do seem to be advantageous in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required, as in the case of oncologic surgery. There is no doubt that implementation of better logistics in finance, training, design, and application will exert a positive effect upon robotics expansion in gynecological medicine. Contrary to expectations, we estimate that a special impact is to be seen in emerging countries where novel technologies have resulted in benefits in the organization of health care systems. PMID:24453521

  17. Technology advances in hospital practices: robotics in treatment of patients.

    PubMed

    Rosiek, Anna; Leksowski, Krzysztof

    2015-06-01

    Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world. © The Author(s) 2014.

  18. Virtual reality suturing task as an objective test for robotic experience assessment.

    PubMed

    Liss, Michael A; Kane, Christopher J; Chen, Tony; Baumgartner, Joel; Derweesh, Ithaar H

    2015-07-03

    We performed a pilot study using a single virtual-simulation suturing module as an objective measurement to determine functional use of the robotic system. This study will assist in designing a study for an objective, adjunctive test for use by a surgical proctor. After IRB approval, subjects were recruited at a robotic renal surgery course to perform two attempts of the "Tubes" module without warm-up using the Da Vinci® Surgical Skills Simulator™. The overall MScore (%) from the simulator was compared among various skill levels to provide construct validity. Correlation with MScore and number of robotic cases was performed and pre-determined skill groups were tested. Nine metrics that make up the overall score were also tested via paired t test and subsequent logistic regression to determine which skills differed among experienced and novice robotic surgeons. We enrolled 38 subjects with experience ranging from 0- < 200 robotic cases. Median time to complete both tasks was less than 10 min. The MScore on the first attempt was correlated to the number of previous robotic cases (R(2) = 0.465; p = 0.003). MScore was different between novice and more experienced robotic surgeons on the first (44.7 vs. 63.9; p = 0.005) and second attempt (56.0 vs. 69.9; p = 0.037). A single virtual simulator exercise can provide objective information in determining proficient use of the robotic surgical system.

  19. Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery.

    PubMed

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Harper, Mick; Parvaiz, Amjad

    2016-11-27

    To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: "rectal cancer" or "colorectal cancer" and robot* or "da Vinci" and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

  20. Evaluation of three laparoscopic modalities: robotics versus three-dimensional vision laparoscopy versus standard laparoscopy.

    PubMed

    LaGrange, Chad A; Clark, Curtis J; Gerber, Eric W; Strup, Stephen E

    2008-03-01

    Standard laparoscopy has undergone many recent advances with the advent of three-dimensional visual systems and robotic surgical systems. In evaluating the usefulness of these new systems, it is difficult to objectively measure their advantages in the operating room. Therefore, we designed a trial using three different laparoscopic modalities to evaluate the strengths and weaknesses of each modality. Twenty-seven subjects were entered into the study. Three different laparoscopic modalities were tested. These included standard laparoscopy with two-dimensional cameras, the 3Di Endosite visual system, and the daVinci Robotic Surgical System. A standard laparoscopic trainer was utilized and testing consisted of three different tasks: peg transfer, ring manipulation, and cannulation. Of the 27 subjects, 16 (60%) reported some degree of laparoscopic experience. The number of pegs transferred with standard laparoscopy and the Endosite 3Di system was significantly greater than with the robot. The number of errors committed during the peg transfer test and the amount of time required was significantly lower with the Endosite 3Di system compared to the robot. Subjects completed the ring manipulation task significantly faster with the robot, but the number of errors committed was no different among the three modalities. Subjects were able to complete the cannulation task with their dominant hand significantly faster with the robot compared to the Endosite 3Di system or standard laparoscopy, and committed fewer errors using the robot compared to standard laparoscopy. This study showed improved performance using three-dimensional optics on some tasks, but not a significant improvement in overall results. Three-dimensional vision does appear beneficial during performance of some complex tasks. The wrist-like action of the robot improved performance on some tasks, while the lack of tactile feedback likely was a source of errors on other tasks.

  1. The robotic third arm as a competent analog of an assisting surgeon in radical gastrectomy: impact on short-term clinical outcomes.

    PubMed

    Shim, Jung Ho; Kim, Jun Gi; Jeon, Hae Myung; Park, Cho Hyun; Song, Kyo Young

    2013-05-01

    Robotic surgery was invented to overcome difficulties associated with conventional laparoscopic surgery. However, ways in which to improve the efficacy of such surgery have not yet been discussed. This report focuses on the role of a robotic third arm in maximizing the efficacy of lymph node dissection in robot-assisted gastrectomy. Thirty-five robotic gastrectomies were performed between April 2009 and December 2010. We evaluated our surgical procedures by reviewing video recordings of robotic operations and analyzed the steps involved in lymph node dissections frame by frame. Then, we analyzed the short-term clinical outcomes to look at the impact of standardized use of the third arm on clinical outcomes. The initial 15 cases (Group A) were compared with 20 later cases (Group B) in terms of postoperative inflammation and pancreatitis. The clinicopathologic characteristics, including operation type, hospital stay, morbidity, and pathological features, were not different between the two groups. However, postoperative serum amylase levels as well as drain amylase levels were significantly lower in Group B than in Group A (P<.05). The incidence of postoperative pancreatic fistula was also lower in Group B (P<.05). Gastrectomy with extragastric lymph node dissection using the da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA) can be performed safely and effectively with the appropriate and sophisticated use of a robotic third arm.

  2. Laparoscopic robotic-assisted gastrointestinal surgery: the Geneva experience.

    PubMed

    Soravia, Claudio; Schwieger, Ian; Witzig, Jacques-Alain; Wassmer, Frank-Alain; Vedrenne, Thierry; Sutter, Pierre; Dufour, Jean-Philippe; Racloz, Yves

    2008-01-01

    The continuing development of robotic surgery supports its use in laparoscopic gastrointestinal surgery. Our study retrospectively reviewed the surgical outcome and patient's satisfaction of gastrointestinal laparoscopic robotic procedures. From January 2003 to September 2007, 94 patients (27 women, 67 men) with a mean age of 53 years (range 19-84 years) underwent laparoscopic surgery with a da Vinci robotic system. There were 40 colorectal cases (43%), 31 anti-reflux surgery cases (33%) and 14 obesity surgery cases (15%); the remaining cases consisted of gastric and gallbladder surgery, intra-abdominal tumour excisions, and hepatic cyst resections. The majority of the cases (88, 94%) were performed for benign disease. The mean operative time was 153 min (range 60-330 min). One patient needed a blood transfusion. The mean body mass index was 25 (range 16-47). No death occurred. Five cases (5.3%) were converted to conventional laparoscopic surgery (n = 3) or to laparotomy (n = 2). Morbidity consisted of one Nissen redo surgery to loosen a tight anti-reflux valve 6 days after robotic surgery, a robotic left ureter repair and pelvic haemorrhage following proctectomy requiring re-operation to control haemostasis and to remove pelvic haematoma. Mean follow-up time was 11 months (range 15 days to 34 months). One case of incisional trocar hernia needed re-operation. Overall patient's satisfaction was high: few scars were cheloïd, while functional surgical outcome was rated high by most of the patients. Our preliminary experience was encouraging, with minimal morbidity and very high acceptance by patients.

  3. Multi-imager compatible actuation principles in surgical robotics

    PubMed Central

    Stoianovici, D

    2011-01-01

    Today’s most successful surgical robots are perhaps surgeon-driven systems, such as the daVinci (Intuitive Surgical Inc., USA, www.intuitivesurgical.com). These have already enabled surgery that was unattainable with classic instrumentation; however, at their present level of development, they have limited utility. The drawback of these systems is that they are independent self-contained units, and as such, they do not directly take advantage of patient data. The potential of these new surgical tools lies much further ahead. Integration with medical imaging and information are needed for these devices to achieve their true potential. Surgical robots and especially their subclass of image-guided systems require special design, construction and control compared to industrial types, due to the special requirements of the medical and imaging environments. Imager compatibility raises significant engineering challenges for the development of robotic manipulators with respect to imager access, safety, ergonomics, and above all the non-interference with the functionality of the imager. These apply to all known medical imaging types, but are especially challenging for achieving compatibility with the class of MRI systems. Even though a large majority of robotic components may be redesigned to be constructed of MRI compatible materials, for other components such as the motors used in actuation, prescribing MRI compatible materials alone is not sufficient. The electromagnetic motors most commonly used in robotic actuation, for example, are incompatible by principle. As such, alternate actuation principles using “intervention friendly” energy should be adopted and/or devised for these special surgical and radiological interventions. This paper defines the new concept of Multi-imager Compatibility of surgical manipulators and describes its requirements. Subsequently, the paper gives several recommendations and proposes new actuation principles for this concept. Several

  4. Multi-imager compatible actuation principles in surgical robotics.

    PubMed

    Stoianovici, D

    2005-01-01

    Today's most successful surgical robots are perhaps surgeon-driven systems, such as the daVinci (Intuitive Surgical Inc., USA, www.intuitivesurgical.com). These have already enabled surgery that was unattainable with classic instrumentation; however, at their present level of development, they have limited utility. The drawback of these systems is that they are independent self-contained units, and as such, they do not directly take advantage of patient data. The potential of these new surgical tools lies much further ahead. Integration with medical imaging and information are needed for these devices to achieve their true potential. Surgical robots and especially their subclass of image-guided systems require special design, construction and control compared to industrial types, due to the special requirements of the medical and imaging environments. Imager compatibility raises significant engineering challenges for the development of robotic manipulators with respect to imager access, safety, ergonomics, and above all the non-interference with the functionality of the imager. These apply to all known medical imaging types, but are especially challenging for achieving compatibility with the class of MRI systems. Even though a large majority of robotic components may be redesigned to be constructed of MRI compatible materials, for other components such as the motors used in actuation, prescribing MRI compatible materials alone is not sufficient. The electromagnetic motors most commonly used in robotic actuation, for example, are incompatible by principle. As such, alternate actuation principles using "intervention friendly" energy should be adopted and/or devised for these special surgical and radiological interventions. This paper defines the new concept of Multi-Imager Compatibility of surgical manipulators and describes its requirements. Subsequently, the paper gives several recommendations and proposes new actuation principles for this concept. Several

  5. Lessons learned over a decade of pediatric robotic ureteral reimplantation

    PubMed Central

    Baek, Minki

    2017-01-01

    The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer. PMID:28097262

  6. Suture damage during robot-assisted vascular surgery: is it an issue?

    PubMed

    Diks, Jeroen; Nio, Denise; Linsen, Matteus A; Rauwerda, Jan A; Wisselink, Willem

    2007-12-01

    Manipulation of sutures during endoscopic surgery could lead to damage of suture structure, supposedly resulting in loss of strength. Lack of tactile feedback in robotic surgical systems might increase this problem. The objective of this study is to evaluate suture strength after robotic manipulation and to determine which suture material is least susceptible to damage from robotic manipulation. The da Vinci surgical system was used to manipulate sutures. Three different suture materials (Prolene, ePTFE, Ethibond) of 3 different sizes (3-0, 4-0, and 5-0) were tested. A total of 270 sutures were pulled on a Servohydraulic Universal Testing Machine. The frequency of breaks at a manipulation-point and the maximum applied force (N) before the suture broke were used for statistic analysis. No loss in strength was shown in the ePTFE sutures after manipulation, whereas both Prolene and Ethibond sutures showed a significant loss of strength. ePTFE sutures are least susceptible to robotic manipulations and are, therefore, to be considered as a material of first choice.

  7. Augmented reality and cone beam CT guidance for transoral robotic surgery.

    PubMed

    Liu, Wen P; Richmon, Jeremy D; Sorger, Jonathan M; Azizian, Mahdi; Taylor, Russell H

    2015-09-01

    In transoral robotic surgery preoperative image data do not reflect large deformations of the operative workspace from perioperative setup. To address this challenge, in this study we explore image guidance with cone beam computed tomographic angiography to guide the dissection of critical vascular landmarks and resection of base-of-tongue neoplasms with adequate margins for transoral robotic surgery. We identify critical vascular landmarks from perioperative c-arm imaging to augment the stereoscopic view of a da Vinci si robot in addition to incorporating visual feedback from relative tool positions. Experiments resecting base-of-tongue mock tumors were conducted on a series of ex vivo and in vivo animal models comparing the proposed workflow for video augmentation to standard non-augmented practice and alternative, fluoroscopy-based image guidance. Accurate identification of registered augmented critical anatomy during controlled arterial dissection and en bloc mock tumor resection was possible with the augmented reality system. The proposed image-guided robotic system also achieved improved resection ratios of mock tumor margins (1.00) when compared to control scenarios (0.0) and alternative methods of image guidance (0.58). The experimental results show the feasibility of the proposed workflow and advantages of cone beam computed tomography image guidance through video augmentation of the primary stereo endoscopy as compared to control and alternative navigation methods.

  8. Augmented reality and cone beam CT guidance for transoral robotic surgery

    PubMed Central

    Richmon, Jeremy D.; Sorger, Jonathan M.; Azizian, Mahdi; Taylor, Russell H.

    2015-01-01

    In transoral robotic surgery preoperative image data do not reflect large deformations of the operative workspace from perioperative setup. To address this challenge, in this study we explore image guidance with cone beam computed tomographic angiography to guide the dissection of critical vascular landmarks and resection of base-of-tongue neoplasms with adequate margins for transoral robotic surgery. We identify critical vascular landmarks from perioperative c-arm imaging to augment the stereoscopic view of a da Vinci si robot in addition to incorporating visual feedback from relative tool positions. Experiments resecting base-of-tongue mock tumors were conducted on a series of ex vivo and in vivo animal models comparing the proposed workflow for video augmentation to standard non-augmented practice and alternative, fluoroscopy-based image guidance. Accurate identification of registered augmented critical anatomy during controlled arterial dissection and en bloc mock tumor resection was possible with the augmented reality system. The proposed image-guided robotic system also achieved improved resection ratios of mock tumor margins (1.00) when compared to control scenarios (0.0) and alternative methods of image guidance (0.58). The experimental results show the feasibility of the proposed workflow and advantages of cone beam computed tomography image guidance through video augmentation of the primary stereo endoscopy as compared to control and alternative navigation methods. PMID:26531203

  9. Tele-surgery simulation with a patient organ model for robotic surgery training.

    PubMed

    Suzuki, S; Suzuki, N; Hattori, A; Hayashibe, M; Konishi, K; Kakeji, Y; Hashizume, M

    2005-12-01

    Robotic systems are increasingly being incorporated into general laparoscopic and thoracoscopic surgery to perform procedures such as cholecystectomy and prostatectomy. Robotic assisted surgery allows the surgeon to conduct minimally invasive surgery with increased accuracy and with potential benefits for patients. However, current robotic systems have their limitations. These include the narrow operative field of view, which can make instrument manipulation difficult. Current robotic applications are also tailored to specific surgical procedures. For these reasons, there is an increasing demand on surgeons to master the skills of instrument manipulation and their surgical application within a controlled environment. This study describes the development of a surgical simulator for training and mastering procedures performed with the da Vinci surgical system. The development of a tele-surgery simulator and the construction of a training center are also described, which will enable surgeons to simulate surgery from or in remote places, to collaborate over long distances, and for off-site expert assistance. Copyright 2005 John Wiley & Sons, Ltd.

  10. Thoracic robotics at the Heart Hospital Baylor Plano: the first 20 cases.

    PubMed

    Jett, G Kimble

    2012-10-01

    A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay.

  11. Thoracic robotics at the Heart Hospital Baylor Plano: the first 20 cases

    PubMed Central

    2012-01-01

    A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay. PMID:23077378

  12. Technology Insight: surgical robots--expensive toys or the future of urologic surgery?

    PubMed

    Wiklund, N Peter

    2004-12-01

    There is an increasing demand for minimally invasive surgery, despite any controversy over whether patients benefit from minimally invasive procedures rather than undergoing open surgery. In the field of urology, the performance of more complicated procedures is still a challenge even for experienced laparoscopic surgeons. Recently, robots have been introduced to enhance operative performance, increase applicability and precision of laparoscopy, and improve the learning curve for complicated minimally invasive procedures. With the introduction of master-slave systems where the surgeon is seated remotely from the robot and uses controls to maneuver the mechanical arms placed inside the patient, a new development in robot-assisted surgery has commenced. Several authors have suggested that surgical robots similar to the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA), which have three-dimensional (3D) vision and wristed instruments thus giving a greater degree of freedom than rigid laparoscopic instruments, will facilitate the outcome of these more challenging laparoscopic procedures. Whether these features will translate into better functional and oncological results remains to be evaluated. Data published so far clearly suggest that the patient will benefit from less postoperative pain, decreased bleeding and a shorter hospital stay compared with open surgery, and that the surgeon benefits from a faster learning curve than for conventional laparoscopy. For the benefit of our patients and for the development of urology it is vital that we understand both the limitations of telerobotics and when it is appropriate to incorporate these new techniques in day-to-day urologic surgery.

  13. Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy.

    PubMed

    Akdemir, Ali; Zeybek, Burak; Ozgurel, Banu; Oztekin, Mehmet Kemal; Sendag, Fatih

    2015-01-01

    To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Retrospective study (Canadian Task Force classification II-1). University hospital. Twenty-four patients with benign indications for hysterectomy. Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  14. Robotic anatomic lung resections: the initial experience and description of learning in 102 cases.

    PubMed

    Toker, Alper; Özyurtkan, Mehmet Oğuzhan; Kaba, Erkan; Ayalp, Kemal; Demirhan, Özkan; Uyumaz, Elena

    2016-02-01

    The aim of this study was to analyze our initial pulmonary resection experience with robotic surgery (Da Vinci, Intuitive Surgical, Inc., Mountain View, California, USA) and define the learning curve based on the duration of operations. A retrospective review was conducted on patients undergoing robotic pulmonary resections from October 2011 to December 2014. The operating time, including the docking and console times, postoperative hospitalization, and peri- and postoperative complications were studied. Hundred patients underwent 102 robotic anatomic pulmonary resections due to various pathologies. Fifty-three percent of the patients underwent lobectomy procedure, whereas 45% underwent segmentectomy. The mean operating time was 104 ± 34 min. The learning curve was calculated to be 14 patients (R(2) = 0.57). The complication rate in our series was 24% (n = 24) and higher in elderly patients (p = 0.03) and in patients with longer operating times (p = 0.03). Prolonged air leaks were observed in 10, and arrhythmia developed in nine patients. Two patients died, due to a concurrent lymphoblastic leukemia diagnosed at the postoperative period and exacerbation of interstitial fibrosis, respectively. Robotic pulmonary resections prove to be safe and effective even at the initial learning experience. The duration of operations is considered to be acceptable. The learning curve could be established after 14 cases.

  15. The role of three-dimensional visualization in robotics-assisted cardiac surgery

    NASA Astrophysics Data System (ADS)

    Currie, Maria; Trejos, Ana Luisa; Rayman, Reiza; Chu, Michael W. A.; Patel, Rajni; Peters, Terry; Kiaii, Bob

    2012-02-01

    Objectives: The purpose of this study was to determine the effect of three-dimensional (3D) versus two-dimensional (2D) visualization on the amount of force applied to mitral valve tissue during robotics-assisted mitral valve annuloplasty, and the time to perform the procedure in an ex vivo animal model. In addition, we examined whether these effects are consistent between novices and experts in robotics-assisted cardiac surgery. Methods: A cardiac surgery test-bed was constructed to measure forces applied by the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) during mitral valve annuloplasty. Both experts and novices completed roboticsassisted mitral valve annuloplasty with 2D and 3D visualization. Results: The mean time for both experts and novices to suture the mitral valve annulus and to tie sutures using 3D visualization was significantly less than that required to suture the mitral valve annulus and to tie sutures using 2D vision (p∠0.01). However, there was no significant difference in the maximum force applied by novices to the mitral valve during suturing (p = 0.3) and suture tying (p = 0.6) using either 2D or 3D visualization. Conclusion: This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery. Keywords: Robotics-assisted surgery, visualization, cardiac surgery

  16. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    PubMed

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  17. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias.

    PubMed

    Chen, Y Julia; Huynh, Desmond; Nguyen, Scott; Chin, Edward; Divino, Celia; Zhang, Linda

    2017-03-01

    The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p < 0.0001). The average defect size was significantly larger for the robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p < 0.0001), although there was no significant difference in the average size of mesh used (13 vs. 13 cm). There was no difference in patients requiring postoperative admission or length of stay between the two groups. The mean duration of follow-up was 47 days. There was no difference in complication rate during this time, and no recurrences were reported. There are no significant differences in terms of safety and early efficacy when comparing small-sized ventral hernias repaired using the robot-assisted technique versus the standard laparoscopic repair.

  18. Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

    PubMed

    Karaman, Murat; Gün, Taylan; Temelkuran, Burak; Aynacı, Engin; Kaya, Cem; Tekin, Ahmet Mahmut

    2017-05-01

    To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

  19. Robotic surgery in complicated gynecologic diseases: experience of Tri-Service General Hospital in Taiwan.

    PubMed

    Tan, Shun-Jen; Lin, Chi-Kung; Fu, Pei-Te; Liu, Yung-Liang; Sun, Cheng-Chian; Chang, Cheng-Chang; Yu, Mu-Hsien; Lai, Hung-Cheng

    2012-03-01

    Minimally invasive surgery has been the trend in various specialties and continues to evolve as new technology develops. The development of robotic surgery in gynecology remains in its infancy. The present study reports the first descriptive series of robotic surgery in complicated gynecologic diseases in Taiwan. From March 2009 to February 2011, the records of patients undergoing robotic surgery using the da Vinci Surgical System were reviewed for patient demographics, indications, operative time, hospital stay, conversion to laparotomy, and complications. Sixty cases were reviewed in the present study. Forty-nine patients had benign gynecologic diseases, and 11 patients had malignancies. These robot-assisted laparoscopic procedures include nine hysterectomy, 15 subtotal hysterectomy, 13 myomectomy, eight staging operation, two radical hysterectomy, five ovarian cystectomy, one bilateral salpingo-oophorectomy and myomectomy, two resections of deep pelvic endometriosis, one pelvic adhesiolysis, three sacrocolpopexy and one tuboplasty. Thirty-three patients had prior pelvic surgery, and one had a history of pelvic radiotherapy. Adhesiolysis was necessary in 38 patients to complete the whole operation. Robotic myomectomy was easily accomplished in patients with huge uterus or multiple myomas. The suturing of myometrium or cervical stump after ligation of the uterine arteries minimized the blood loss. In addition, it was much easier to dissect severe pelvic adhesions. The dissection of para-aortic lymph nodes can be easily accomplished. All these surgeries were performed smoothly without ureteral, bladder or bowel injury. The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases. Copyright © 2012. Published by

  20. [First national survey on use of robotics for visceral surgery in Germany].

    PubMed

    Kissler, H J; Bauschke, A; Settmacher, U

    2016-08-01

    The operation robot is the most advanced technology available in minimally invasive surgery for facilitating complex surgical procedures and is increasingly used in visceral surgery; however, to date no data are available concerning its use in visceral surgery in Germany. The aim of the survey was to document the development and current state of the art of robotics for visceral surgery in Germany. All 41 surgical departments with access to the da Vinci robot were invited to participate in the survey. Data were acquired with a specially designed Excel spreadsheet, documenting all procedures and also the dignity in gastrointestinal operations for each year since inception of the robot program up to 2015. Of the 41 surgical departments with an active robotic program only 23 participated in the analysis. The overall volume rose steadily from 4 procedures in 2010 to 50 in 2012, 106 in 2013, 441 in 2014 and reached 819 in 2015. In this period 2 centers had > 200 operations, 1 center had 150, 3 centers had ≥ 100, 3 departments had ≥ 50 and 14 departments had < 50 operations. The type of robotic procedures used encompassed the full scope of laparoscopic surgery. Colorectal surgery was predominant with 50 % of all procedures and was performed in 87 % of the departments. Thymus resections amounted to 10 % of all surgical procedures and gastric surgery to 9 %. Approximately 5 % of all cases involved the esophagus, gall bladder and pancreas. Hepatic surgery amounted to only 2.4 % and all other operations even less and were performed in only a few departments. Despite a doubling of procedures in recent years, robotics is still in the initial phase for visceral surgery in Germany.

  1. Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system.

    PubMed

    Basto, Marnique; Sathianathen, Niranjan; Te Marvelde, Luc; Ryan, Shane; Goad, Jeremy; Lawrentschuk, Nathan; Costello, Anthony J; Moon, Daniel A; Heriot, Alexander G; Butler, Jim; Murphy, Declan G

    2016-06-01

    To compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. We retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One- and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). We identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robot-assisted surgical approach in the

  2. The virtual reality simulator dV-Trainer(®) is a valid assessment tool for robotic surgical skills.

    PubMed

    Perrenot, Cyril; Perez, Manuela; Tran, Nguyen; Jehl, Jean-Philippe; Felblinger, Jacques; Bresler, Laurent; Hubert, Jacques

    2012-09-01

    Exponential development of minimally invasive techniques, such as robotic-assisted devices, raises the question of how to assess robotic surgery skills. Early development of virtual simulators has provided efficient tools for laparoscopic skills certification based on objective scoring, high availability, and lower cost. However, similar evaluation is lacking for robotic training. The purpose of this study was to assess several criteria, such as reliability, face, content, construct, and concurrent validity of a new virtual robotic surgery simulator. This prospective study was conducted from December 2009 to April 2010 using three simulators dV-Trainers(®) (MIMIC Technologies(®)) and one Da Vinci S(®) (Intuitive Surgical(®)). Seventy-five subjects, divided into five groups according to their initial surgical training, were evaluated based on five representative exercises of robotic specific skills: 3D perception, clutching, visual force feedback, EndoWrist(®) manipulation, and camera control. Analysis was extracted from (1) questionnaires (realism and interest), (2) automatically generated data from simulators, and (3) subjective scoring by two experts of depersonalized videos of similar exercises with robot. Face and content validity were generally considered high (77 %). Five levels of ability were clearly identified by the simulator (ANOVA; p = 0.0024). There was a strong correlation between automatic data from dV-Trainer and subjective evaluation with robot (r = 0.822). Reliability of scoring was high (r = 0.851). The most relevant criteria were time and economy of motion. The most relevant exercises were Pick and Place and Ring and Rail. The dV-Trainer(®) simulator proves to be a valid tool to assess basic skills of robotic surgery.

  3. Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System.

    PubMed

    Maurice, Matthew J; Ramirez, Daniel; Kaouk, Jihad H

    2017-04-01

    Robotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non-purpose-built robotic platforms have hindered the application of this approach. To assess the feasibility of retroperitoneal renal surgery using a new purpose-built robotic single-port surgical system. This was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery. We used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n=1) and bilateral partial nephrectomy (n=4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port. The primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times. All cases were completed without the need for conversion. There were no intraoperative complications. The operative time was 100min for radical nephrectomy, and the mean operative time was 91.8±18.5min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group. Single-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology. In an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small

  4. Humanlike Articulate Robotic Headform to Replace Human Volunteers in Respirator Fit Testing

    DTIC Science & Technology

    2012-12-01

    the Surgeon General, Walter Reed Army Medical Center. 1997. 6. McCurdy, E. (Ed.). The notebooks of Leonardo da Vinci (Vol. 2). London, England...B.C. by the Chinese and during the Peloponnesian War.[5] As a corollary to an arsenical smoke weapon he proposed for naval warfare, Leonardo da... Vinci suggested that a wet, finely woven cloth could protect sailors from the particles [6] and, later in the 16th century, Agricola described a

  5. Scientific Aspects of Leonardo da Vinci's Drawings: An Interdisciplinary Model.

    ERIC Educational Resources Information Center

    Struthers, Sally A.

    While interdisciplinary courses can help demonstrate the relevance of learning to students and reinforce education from different fields, they can be difficult to implement and are often not cost effective. An interdisciplinary art history course at Ohio's Sinclair Community College incorporates science into the art history curriculum, making use…

  6. Distance Learning. Leonardo da Vinci Series: Good Practices.

    ERIC Educational Resources Information Center

    Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

    This brochure, part of a series about good practices in vocational training in the European Union, describes 12 projects that use distance learning to promote lifelong learning in adults. The projects and their countries of origin are as follows: (1) 3D Project, training in the use of IT tools for 3D simulation and animation and practical…

  7. Leonardo Da Vinci, the genius and the monsters. Casual encounters?

    PubMed

    Ciseri, Lorenzo Montemagno

    2014-01-01

    This article analyses Leonardo's interest in monsters and deformed reality, one of the lesser known aspects of his vast and multifaceted output. With the possible exception of his studies of physiognomy, relevant drawings, sketches and short stories represent a marginal aspect of his work, but they are nevertheless significant for historians of teratology. The purpose of this study is to provide a broad overview of the relationship between Leonardo and both the literature on mythological monsters and the reports on monstrous births that he either read about or witnessed personally. While aspects of his appreciation and attention to beauty and the pursuit of perfection and good proportions are the elements most emphasised in Leonardo's work, other no less interesting aspects related to deformity have been considered of marginal importance. My analysis will demonstrate that Leonardo approached the realm of monstrosity as if he considered abnormality a mirror of normality, deformity a mirror of harmony, and disease a mirror of health, as if to emphasise that, ultimately, it is the monster that gives the world the gift of normality. Two special cases of monstrosity are analysed: the famous monster of Ravenna, whose image was found among his papers, and a very rare case of parasitic conjoined twins (thoracopagus parasiticus) portrayed for the first time alive, probably in Florence, by Leonardo himself.

  8. Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm.

    PubMed

    Lin, Judith C; Kaul, Sanjeev A; Bhandari, Akshay; Peterson, Edward L; Peabody, James O; Menon, Mani

    2012-01-01

    Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a total robotic-assisted aortic dissection and vascular reconstruction vs robotic-assisted aortic procedures for aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). From February 2006 to August 2010, 21 patients were selected for robotic-assisted aortic procedures: aortobifemoral bypass in 12, AAA repair in 6, iliac aneurysm repair in 1, and ligation of type II endoleak after endovascular aneurysm repair in 2. Inclusion criteria included AAA >5 cm, iliac aneurysm >3 cm, and AIOD TransAtlantic InterSociety Classification (TASC) C or D lesions. The da Vinci S Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif) was used for the abdominal aortic dissection in all cases and for the aortic anastomosis in three cases. The 21 patients (6 women, 15 men) were an average age of 65.7 years (range, 44-86 years), had a body mass index (BMI) of 27.23 kg/m(2), and 90.4% were American Society of Anesthesiologists (ASA) class 3 or 4. Robotic dissection of the abdominal aorta was successful in 20 patients (95.2%). One patient required full conversion to open AAA repair due to trocar injury. Of the remaining 20 patients, the average robotic dissection time of the infrarenal aorta was 113.1 minutes, and the average aortic clamp time was 86 minutes. The procedure in 15 patients was performed with a minilaparotomy using an average abdominal incision of 13 cm to implant the Dacron or polytetrafluoroethylene graft. Five patients underwent a total robotic-assisted procedure with robotic aortic reconstruction or ligation of a type II endoleak. The 30-day survival rate was 100%. Median length of stay was 7.5 days. All grafts were patent at a median follow-up of 32.0 months. For aortic procedures completed total robotically without

  9. Detection and Localization of Robotic Tools in Robot-Assisted Surgery Videos Using Deep Neural Networks for Region Proposal and Detection.

    PubMed

    Sarikaya, Duygu; Corso, Jason J; Guru, Khurshid A

    2017-07-01

    Video understanding of robot-assisted surgery (RAS) videos is an active research area. Modeling the gestures and skill level of surgeons presents an interesting problem. The insights drawn may be applied in effective skill acquisition, objective skill assessment, real-time feedback, and human-robot collaborative surgeries. We propose a solution to the tool detection and localization open problem in RAS video understanding, using a strictly computer vision approach and the recent advances of deep learning. We propose an architecture using multimodal convolutional neural networks for fast detection and localization of tools in RAS videos. To the best of our knowledge, this approach will be the first to incorporate deep neural networks for tool detection and localization in RAS videos. Our architecture applies a region proposal network (RPN) and a multimodal two stream convolutional network for object detection to jointly predict objectness and localization on a fusion of image and temporal motion cues. Our results with an average precision of 91% and a mean computation time of 0.1 s per test frame detection indicate that our study is superior to conventionally used methods for medical imaging while also emphasizing the benefits of using RPN for precision and efficiency. We also introduce a new data set, ATLAS Dione, for RAS video understanding. Our data set provides video data of ten surgeons from Roswell Park Cancer Institute, Buffalo, NY, USA, performing six different surgical tasks on the daVinci Surgical System (dVSS) with annotations of robotic tools per frame.

  10. Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules.

    PubMed

    Mouraviev, Vladimir; Klein, Martina; Schommer, Eric; Thiel, David D; Samavedi, Srinivas; Kumar, Anup; Leveillee, Raymond J; Thomas, Raju; Pow-Sang, Julio M; Su, Li-Ming; Mui, Engy; Smith, Roger; Patel, Vipul

    2016-03-01

    In pursuit of improving the quality of residents' education, the Southeastern Section of the American Urological Association (SES AUA) hosts an annual robotic training course for its residents. The workshop involves performing a robotic live porcine nephrectomy as well as virtual reality robotic training modules. The aim of this study was to evaluate workload levels of urology residents when performing a live porcine nephrectomy and the virtual reality robotic surgery training modules employed during this workshop. Twenty-one residents from 14 SES AUA programs participated in 2015. On the first-day residents were taught with didactic lectures by faculty. On the second day, trainees were divided into two groups. Half were asked to perform training modules of the Mimic da Vinci-Trainer (MdVT, Mimic Technologies, Inc., Seattle, WA, USA) for 4 h, while the other half performed nephrectomy procedures on a live porcine model using the da Vinci Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA). After the first 4 h the groups changed places for another 4-h session. All trainees were asked to complete the NASA-TLX 1-page questionnaire following both the MdVT simulation and live animal model sessions. A significant interface and TLX interaction was observed. The interface by TLX interaction was further analyzed to determine whether the scores of each of the six TLX scales varied across the two interfaces. The means of the TLX scores observed at the two interfaces were similar. The only significant difference was observed for frustration, which was significantly higher at the simulation than the animal model, t (20) = 4.12, p = 0.001. This could be due to trainees' familiarity with live anatomical structures over skill set simulations which remain a real challenge to novice surgeons. Another reason might be that the simulator provides performance metrics for specific performance traits as well as composite scores for entire exercises. Novice trainees experienced

  11. Paediatric robotic surgery in clinical practice: a cost analysis.

    PubMed

    Anderberg, M; Kockum, C C; Arnbjornsson, E

    2009-10-01

    Since 2006 we have used robotic assistance when performing minimally invasive laparoscopic fundoplications in children. We compared the costs of robotic surgery with the costs for open and laparoscopic surgery to test our hypothesis that the increased costs of the new technology are acceptable. Costs were calculated using the regional hospital prices for our first 14 fundoplications in children, performed with the aid of the da Vinci Surgical System from Intuitive Surgical. We compared these costs with those of our ten latest fundoplications performed using open and laparoscopic surgery, respectively. There were no differences in the demographic data, work-up or indications for surgery between the three groups of children. The mean cost of robotic surgical fundoplications (EUR 9 584) was 7% higher than the mean cost of laparoscopic surgery (EUR 8 982) and 9% lower than the mean costs for open surgical procedures (EUR 10 521). These differences can be explained by the increased cost of robotic instruments (EUR 2 081 per operation). The duration of the operation and the duration of in-hospital stay are comparable to those of laparoscopic surgical interventions. The time required for the operative intervention was considerably longer than for the open surgical procedure; the duration of the in-hospital stay was only half of that of the open surgical procedure. The patients seemed to benefit from the use of robotic instruments with less morphine (as a marker of less postoperative pain) and a shorter hospital stay. The introduction of robotic assistance into surgical practice involves increased in-hospital costs, mainly because of the cost of the new instruments. This increase in cost can be offset by the shorter hospital stay compared to open surgery. After laparoscopic surgery the hospital stay is about the same as after operations performed with robotic assistance. Cheaper instruments and shorter operating time will make robotic surgery cost efficient in the future

  12. Impact of trainee involvement with robotic-assisted radical prostatectomy.

    PubMed

    Thomas, Anil A; Derboghossians, Armen; Chang, Allen; Karia, Rajiv; Finley, David S; Slezak, Jeff; Jacobsen, Steven J; Chien, Gary W

    2013-09-01

    Robotic-assisted surgery has been rapidly adopted within urology practice. As a result, academic centers are challenged with the burden of how to effectively train residents and fellows to perform robotic-assisted surgery without compromising outcomes. We evaluated the perioperative outcomes of trainee involvement with robotic-assisted radical prostatectomy (RARP) within our healthcare organization. We retrospectively reviewed RARP cases performed at our institution between September 2008 and December 2010 using a single da Vinci robotic platform. Trainees consisted of urology residents and fellows who operated with staff surgeons on select operating days, whereas two staff surgeon teams performed RARP on alternate days. We compared clinicopathologic variables including operating time, estimated blood loss, surgical margin rates, and complication rates between the trainee and staff-only surgeon groups. Overall, 1,019 RARP surgeries were performed within the study period and trainees participated in 162 cases (16 %). Clinical characteristics were similar between men undergoing surgery with a trainee and those without. Positive surgical margin rates were lower for patients with pT2 disease for cases with trainee involvement (11 vs. 19 %, p = 0.02), although overall margin rates and margin rates for patients with pT3 disease were similar between the groups (p = 0.34). Surgical cases involving trainees were longer (241 vs. 200 min, p < 0.001) and resulted in higher estimated blood loss (190 vs. 120 mL, p < 0.001) than the two staff surgeon cases. However, transfusion rates as well as intraoperative and postoperative complication rates did not differ significantly between groups. In conclusion, surgical margin rates were lower in teaching cases for patients with pT2 disease. Importantly, trainee involvement in RARP is safe, with similar perioperative outcomes to staff-only surgical cases. This information may be useful for training and surgical planning.

  13. Robotic thoracic surgery: The state of the art

    PubMed Central

    Kumar, Arvind; Asaf, Belal Bin

    2015-01-01

    Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures. PMID:25598601

  14. Robotic hybrid technique in rectal surgery for deep pelvic endometriosis.

    PubMed

    Cassini, Diletta; Cerullo, Guido; Miccini, Michelangelo; Manoochehri, Farshad; Ercoli, Alfredo; Baldazzi, Gianandrea

    2014-02-01

    Deep pelvic endometriosis is a complex disorder that affects 6% to 12% of all women in childbearing age. The incidence of bowel endometriosis ranges between 5.3% and 12%, with rectum and sigma being the most frequently involved tracts, accounting for about 80% of cases. It has been reported that segmental colorectal resection is the best surgical option in terms of recurrence rate and improvement of symptoms. The aim of this study is to analyze indications, feasibility, limits, and short-term results of robotic (Da Vinci Surgical System)-assisted laparoscopic rectal sigmoidectomy for the treatment of deep pelvic endometriosis. Between January 2006 and December 2010, 19 women with bowel endometriosis underwent colorectal resection through the robotic-assisted laparoscopic approach. Intraoperative and postoperative data were collected. All procedures were performed in a single center and short-term complications were evaluated. Nineteen robotic-assisted laparoscopic colorectal resections for infiltrating endometriosis were achieved. Additional procedures were performed in 7 patients (37%). No laparotomic conversion was performed. No intraoperative complications were observed. The mean operative time was 370 minutes (range = 250-720 minutes), and the estimated blood loss was 250 mL (range = 50-350 mL). The overall complication rate was 10% (2 rectovaginal fistulae). Deep pelvic endometriosis is a benign condition but may have substantial impact on quality of life due to severe pelvic symptoms. We believe that robotic-assisted laparoscopic colorectal resection is a feasible and relatively safe procedure in the context of close collaboration between gynecologists and surgeons for treatment of deep pelvic endometriosis with intestinal involvement, with low rates of complications and significant improvement of intestinal symptoms.

  15. Augmented environments for the targeting of hepatic lesions during image-guided robotic liver surgery.

    PubMed

    Buchs, Nicolas C; Volonte, Francesco; Pugin, François; Toso, Christian; Fusaglia, Matteo; Gavaghan, Kate; Majno, Pietro E; Peterhans, Matthias; Weber, Stefan; Morel, Philippe

    2013-10-01

    Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery. Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins. Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications. The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Evaluating Tactile Feedback in Robotic Surgery for Potential Clinical Application using an Animal Model

    PubMed Central

    Genovese, Bradley; Nowroozi, Bryan N.; Hart, Steven D.; Bisley, James W.; Grundfest, Warren S.; Dutson, Erik P.

    2016-01-01

    Introduction The aims of this study were to evaluate 1) grasping forces with the application of a tactile feedback system in vivo 2) the incidence of tissue damage incurred during robotic tissue manipulation. Robotic-assisted minimally invasive surgery has been shown to be beneficial in a variety of surgical specialties, particularly radical prostatectomy. This innovative surgical tool offers advantages over traditional laparoscopic techniques, such as improved wrist-like maneuverability, stereoscopic video displays, and scaling of surgical gestures to increase precision. A widely cited disadvantage associated with robotic systems is the absence of tactile feedback. Methods and Procedure Nineteen subjects were categorized into two groups: 5 experts (six or more robotic cases) and 14 novices (five cases or less). The subjects used the da Vinci with integrated tactile feedback to run porcine bowel in the following conditions: (T1: deactivated tactile feedback; T2: activated tactile feedback; and T3: deactivated tactile feedback). The grasping force, incidence of tissue damage, and the correlation of grasping force and tissue damage were analyzed. Tissue damage was evaluated both grossly and histologically by a pathologist blinded to the sample. Results Tactile feedback resulted in significantly decreased grasping forces for both experts and novices (P < 0.001 in both conditions). The overall incidence of tissue damage was significantly decreased in all subjects (P < 0.001). A statistically significant correlation was found between grasping forces and incidence of tissue damage (P = 0.008). The decreased forces and tissue damage were retained through the third trial when the system was deactivated (P > 0.05 in all subjects). Conclusions The in vivo application of integrated tactile feedback in the robotic system demonstrates significantly reduced grasping forces, resulting in significantly less tissue damage. This tactile feedback system may improve surgical outcomes

  17. Robotically Assisted Minimally Invasive Off-Pump Coronary Artery Bypass Surgery in a Patient With Permanent Tracheostomy.

    PubMed

    Ramponi, Fabio; Flynn, Campbell D; Wilson, Michael K

    2017-11-01

    Patients with a permanent tracheostomy requiring coronary surgery represent a unique challenge, being at increased risk of sternal wound complications, mediastinitis and stoma necrosis. Several techniques have been described including manubrium sparing sternotomy, thoracoscopic internal mammary harvest and hybrid revascularisation. We report a case of robotic assisted (daVinci(®)Xi™ Surgical System) total arterial off-pump revascularisation in a patient with previous laryngectomy and permanent tracheostomy. The main advantage of this approach was to minimise the risk of postoperative sternal complication and mediastinatis, whilst still providing the prognostic benefit of total arterial grafting and the neurological advantage of the aorta no-touch technique. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

  18. Robot-assisted internal mammary lymph chain excision for breast cancer: A case report.

    PubMed

    Du, Junze; Mo, Hongbiao; Fan, Linjun; Jiang, Jun

    2017-09-01

    Understanding the status of internal mammary lymph nodes of breast cancer is critical in the accurate staging of breast cancer and the development of accurate therapeutic regimen for selected patients. Current techniques for dissection of internal mammary lymph node biopsy involve endoscopic or Traditional thoracic surgery, An important drawback of the current techniques is the great trauma caused by them. Da Vinci robotic surgery system (Intuitive Surgical Inc. Sunnyvale, CA) was used to perform the internal mammary lymph chain excision for a breast cancer patient with left internal mammary lymph node metastasis. Positron emission tomography-computed tomography examination and Ultrasonography examination. In this paper, we introduce a Robot-assisted technique for dissection of internal mammary lymph node biopsy with only 3 small trocar ports. This technique reduces the incision size and considerably reduce the trauma. The operation lasted a duration of 1.5 hours. The operation was carried out smoothly with removal of 9 internal mammary lymph nodes in total. The amount of intra operative bleeding was less than 10 ml. The patient's postoperative recovery was fast. 11-month postoperative follow-up showed that the patient recovered well after surgery, no local recurrence or distant metastasis was found, and no obvious discomfort was reported. Robot-assisted excision of internal mammary lymph chain in breast cancer is a safe, effective and simple operation with minimal invasion.

  19. History and current status of robotic totally endoscopic coronary artery bypass.

    PubMed

    Lee, Jeffrey D; Srivastava, Mukta; Bonatti, Johannes

    2012-01-01

    Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart. It is a procedure that can be a useful alternative to the classic open procedure performed through sternotomy. After extensive modeling in cadavers, the first clinical case was performed in June 1998 placing a left internal thoracic artery graft (LITA) to the left anterior descending artery completely robotically on the arrested heart. During the early and late 2000s, international groups have adopted this evolving technology, which has included iterations such as beating-heart TECAB, use of bilateral ITA grafting and radial artery grafting, as well as 3- and 4-vessel TECAB. TECAB is combined with percutaneous coronary intervention in hybrid procedures. Despite increasing complexity of endoscopic coronary bypass surgery, conversion rates to open bypass surgery have dropped significantly and operative times have decreased. Published major morbidities and mortality rates in arrested-and beating-heart TECAB have been cumulatively in the 0-2% range and are considered well within the expected range for these highly complex surgical procedures. Long-term survival and freedom from major adverse events also meet the standards of open bypass surgery.

  20. General surgery training and robotics: Are residents improving their skills?

    PubMed

    Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa

    2016-02-01

    While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p < 0.001). The median overall scores did not differ: 188 (84-201) for MS, 183 (91-234) for JR, 197 (153-218) for MLR, and 205 (169-229) for SR (p = 0.14). The median SutureSponge score was highest for SR (61, range 39-81) compared to MS (43, range 26-61), JR (43, range 11-72), and MLR (55, range 36-68) (p = 0.039). However, there were no significant differences in MatchBoard (p = 0.27) or EnergyDissection (p = 0.99) scores between groups. There was a positive correlation between SutureSponge score and number of laparoscopic cases logged (p = 0.005, r(2) = 0.21), but this correlation did not exist for the MatchBoard or EnergyDissection tasks. Lastly, there was no correlation between total lifetime hours of video gaming and overall score (p = 0.89, R(2) = 0.0006). Robotic skillsets acquired during general surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.

  1. Transoral robotic surgery for sellar tumors: first clinical study.

    PubMed

    Chauvet, Dorian; Hans, Stéphane; Missistrano, Antoine; Rebours, Celeste; Bakkouri, Wissame El; Lot, Guillaume

    2016-12-23

    OBJECTIVE The aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal approaches. METHODS The authors performed a prospective study of TORS in patients with symptomatic sellar tumors. Specific anatomical features were required for inclusion in the study and were determined on the basis of preoperative open-mouth CT scans of the brain. The main outcome measure was sellar accessibility using the robot. Resection quality, mean operative time, postoperative changes in patients' vision, side effects, and complications were additionally reported. RESULTS Between February and May 2016, 4 patients (all female, mean age 49.5 years) underwent TORS for resection of sellar tumors as participants in this study. All patients presented with symptomatic visual deficits confirmed as bitemporal hemianopsia. All tumors had a suprasellar portion and a cystic part. In all 4 cases, the operation was performed via TORS, without the need for a second surgery. Sella turcica accessibility was satisfactory in all cases. In 3 cases, tumor resection was complete. The mean operative time was 2 hours 43 minutes. Three patients had a significant visual improvement at Day 1. No rhinological side effects or complications in patients occurred. No pathological examination was performed regarding the fluid component of the tumors. There was 1 postoperative delayed CSF leak and 1 case of transient diabetes insipidus. Side effects specific to TORS included minor sore throat, transient hypernasal speech, and 1 case of delayed otitis media. The mean length of hospital stay and mean follow up were 8.25 days and 82 days, respectively. CONCLUSIONS To our knowledge, this is the first report of the surgical treatment of sellar tumors by

  2. Setting up robotic surgery in gynaecology: the experience of the Strasbourg teaching hospital.

    PubMed

    Sananès, N; Garbin, O; Hummel, M; Youssef, C; Vizitiu, R; Lemaho, D; Rottenberg, D; Diemunsch, P; Wattiez, A

    2011-06-01

    Teleoperated surgical robots could provide a genuine breakthrough in laparoscopy and it is for this reason that the development of robot-assisted laparoscopy is one of the priorities of the Strasbourg University Hospitals' strategic plan. The hospitals purchased a da Vinci S(®) robot in June 2006 and Strasbourg has, in IRCAD, one of the few robotic surgery training centres in the world. Our experience has, however, revealed the difficulties involved in setting up robotic surgery, the first of which are organizational issues. This prospective work was carried out between December 2007 and September 2008, primarily to examine the possibility of setting up robotic surgery on a regular basis for gynaecological surgical procedures at the Strasbourg University Hospitals. We maintained a "logbook" in which we prospectively noted all the resources implemented in setting up the robotic surgery service. The project was divided into two phases: the preparatory phase up until the first hysterectomy and then the second phase with the organization of subsequent hysterectomies. The first surgical procedure took 5 months to organize, and followed 25 interviews, 10 meetings, 53 telephone conversations and 48 e-mails with a total of 40 correspondents. The project was presented to seven separate groups, including the hospital medical commission, the gynaecology unit committee and the surgical staff. Fifteen members of the medical and paramedical team attended a two-day training course. Preparing the gynaecology department for robotic surgery required freeing up 8.5 days of "physician time" and 12.5 days of "nurse time". In the following five months, we performed five hysterectomies. Preparation for each procedure involved on average 5 interviews, 19 telephone conversations and 11 e-mails. The biggest obstacle was obtaining an operating slot, as on average it required 18 days, four telephone calls and four e-mails to be assigned a slot in the operating theatre schedule, which is

  3. Robot-assisted Laparoscopic Augmentation Ileocystoplasty and Mitrofanoff Appendicovesicostomy in Children: Updated Interim Results.

    PubMed

    Murthy, Prithvi; Cohn, Joshua A; Selig, Ryan B; Gundeti, Mohan S

    2015-12-01

    Robot-assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) may protect the upper urinary tract and reestablish continence in patients with refractory neurogenic bladder. Robotic assistance can provide the benefits of minimally invasive surgery without the steep learning curve of pure laparoscopy. To highlight the interim outcomes of RALIMA with salient tips and technical modifications through comparison with patients undergoing open augmentation ileocystoplasty (OAI). A retrospective chart review of 17 patients undergoing robot-assisted laparoscopic augmentation ileocystoplasty (RALI) and 13 patients undergoing OAI by a single surgeon at an academic center from 2008 to 2012 (OAI) or 2014 (RALI). RALI and all concomitant procedures were performed completely intracorporeally using the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Outcomes of interest included change in bladder capacity, operative time, pain medication use, hospitalization time, and perioperative complication rates. Of 17 patients selected, 15 successfully underwent RALI. Overall, 11, 6, and 4 patients had a concomitant Mitrofanoff appendicovesicostomy, antegrade colonic enema channel, and bladder neck closure, respectively. The median operative time was significantly longer in RALI (623 vs 287 min; p<0.01). Median length of stay (LOS) was shorter in RALI (6 vs 8 d; p=0.01). The postoperative percentage increase in bladder capacity, narcotic use, and complication rates did not differ between RALI and OAI. Limitations include the retrospective study design and the small cohort of patients. RALI appears to offer functional outcomes similar to OAI. Although it is a significantly longer procedure, it may decrease LOS and avoid epidural use. Further refinements may reduce operative time. In this report, we examined outcomes after robotic bladder augmentation surgery in children. We found that the robotic approach may eliminate epidural

  4. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation.

    PubMed

    Patil, Nilesh N; Mottrie, Alexandre; Sundaram, Bala; Patel, Vipul R

    2008-07-01

    To report the collective experience of three multinational institutions with the use of robotics to evaluate and treat complex distal ureteral obstruction. A total of 12 patients from The Ohio State University, Columbus, Ohio; Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium; and Hospital Sultanah Aminah, Kuala Lumpur, Malaysia underwent robotic-assisted laparoscopic ureteral reimplantation between August 2004 and July 2006. The indications for ureteral reimplantation included ureteral stricture (n = 10) and ureterovaginal fistula (n = 2). Nine patients had pathology on the left side and 4 patients had right-sided disease. Surgery was performed by three experienced laparoscopic robotic surgeons with the daVinci Surgical System. The mean patient age (range) was 41.3 years (19 to 67 years). The mean operative time was 208 minutes (80 to 360 minutes). The mean robot time was 173 minutes (75 to 300 minutes). The mean estimated blood loss was 48 mL (45 to 100 minutes). The mean length of hospitalization was 4.3 days (2 to 8 days). All the procedures were completed successfully robotically without open conversion. There were no intraoperative or postoperative complications. Postoperative intravenous urography and Mercapto Acetyl TriGlycine 3 showed normal findings in 10 patients and a mild residual hydronephrosis in 2 patients. After a mean follow-up of 15.5 months, all patients were asymptomatic of their initial disease state. This multi-institutional, multinational experience illustrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat lower tract ureteral obstruction.

  5. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America.

    PubMed

    Lira, Renan Bezerra; Chulam, Thiago Celestino; Kowalski, Luiz Paulo

    2017-06-01

    In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected

  6. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America

    PubMed Central

    Chulam, Thiago Celestino; Kowalski, Luiz Paulo

    2017-01-01

    In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures,