Development of autonomous eating mechanism for biomimetic robots

NASA Astrophysics Data System (ADS)

Jeong, Kil-Woong; Cho, Ik-Jin; Lee, Yun-Jung

2005-12-01

Most of the recently developed robots are human friendly robots which imitate animals or humans such as entertainment robot, bio-mimetic robot and humanoid robot. Interest for these robots are being increased because the social trend is focused on health, welfare, and graying. Autonomous eating functionality is most unique and inherent behavior of pets and animals. Most of entertainment robots and pet robots make use of internal-type battery. Entertainment robots and pet robots with internal-type battery are not able to operate during charging the battery. Therefore, if a robot has an autonomous function for eating battery as its feeds, the robot is not only able to operate during recharging energy but also become more human friendly like pets. Here, a new autonomous eating mechanism was introduced for a biomimetic robot, called ELIRO-II(Eating LIzard RObot version 2). The ELIRO-II is able to find a food (a small battery), eat and evacuate by itself. This work describe sub-parts of the developed mechanism such as head-part, mouth-part, and stomach-part. In addition, control system of autonomous eating mechanism is described.

Developing a successful robotics program.

PubMed

Luthringer, Tyler; Aleksic, Ilija; Caire, Arthur; Albala, David M

2012-01-01

Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to evaluate the important considerations in developing a new robotics program at a given healthcare institution. Patients' interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. Given proper surgeon experience and an efficient system, robotic-assisted procedures have been cost comparable to open surgical alternatives. Surgeon training and experience is closely linked to the efficiency of a new robotics program. Formally trained robotic surgeons have better patient outcomes and shorter operative times. Training in robotics has shown no negative impact on patient outcomes or mentor learning curves. Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volume. A mature, experienced surgeon is integral to the success of a new robotics program.

Effect of Gravity on Robot-Assisted Motor Training After Chronic Stroke: A Randomized Trial

PubMed Central

Conroy, Susan S.; Whitall, Jill; Dipietro, Laura; Jones-Lush, Lauren M.; Zhan, Min; Finley, Margaret A.; Wittenberg, George F.; Krebs, Hermano I.; Bever, Christopher T.

2015-01-01

Objectives To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes. Design Randomized controlled trial, single-blinded, with 12-week follow-up. Setting Research setting in a large medical center. Participants Adults (N=62) with chronic, stroke-related arm weakness stratified by impairment severity using baseline UE motor assessments. Interventions Sixty minutes, 3 times a week for 6 weeks of robot-assisted planar reaching (gravity compensated), combined planar with vertical robot-assisted reaching, or intensive conventional arm exercise program. Main Outcome Measure UE Fugl-Meyer Assessment (FMA) mean change from baseline to final training. Results All groups showed modest gains in the FMA from baseline to final with no significant between group differences. Most change occurred in the planar robot group (mean change ± SD, 2.94± 0.77; 95% confidence interval [CI], 1.40 – 4.47). Participants with greater motor impairment (n=41) demonstrated a larger difference in response (mean change ± SD, 2.29±0.72; 95% CI, 0.85–3.72) for planar robot-assisted exercise compared with the intensive conventional arm exercise program (mean change ± SD, 0.43±0.72; 95% CI, −1.00 to 1.86). Conclusions Chronic UE deficits because of stroke are responsive to intensive motor task training. However, training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone. PMID:21849168

Robotic Surgical Education: a Collaborative Approach to Training Postgraduate Urologists and Endourology Fellows

PubMed Central

Mirheydar, Hossein; Jones, Marklyn; Koeneman, Kenneth S.

2009-01-01

Objective: Currently, robotic training for inexperienced, practicing surgeons is primarily done vis-à-vis industry and/or society-sponsored day or weekend courses, with limited proctorship opportunities. The objective of this study was to assess the impact of an extended-proctorship program at up to 32 months of follow-up. Methods: An extended-proctorship program for robotic-assisted laparoscopic radical prostatectomy was established at our institution. The curriculum consisted of 3 phases: (1) completing an Intuitive Surgical 2-day robotic training course with company representatives; (2) serving as assistant to a trained proctor on 5 to 6 cases; and (3) performing proctored cases up to 1 year until confidence was achieved. Participants were surveyed and asked to evaluate on a 5-point Likert scale their operative experience in robotics and satisfaction regarding their training Results: Nine of 9 participants are currently performing robotic-assisted laparoscopic radical prostatectomy (RALP) independently. Graduates of our program have performed 477 RALP cases. The mean number of cases performed within phase 3 was 20.1 (range, 5 to 40) prior to independent practice. The program received a rating of 4.2/5 for effectiveness in teaching robotic surgery skills. Conclusion: Our robotic program, with extended proctoring, has led to an outstanding take-rate for disseminating robotic skills in a metropolitan community. PMID:19793464

Robotic surgical education: a collaborative approach to training postgraduate urologists and endourology fellows.

PubMed

Mirheydar, Hossein; Jones, Marklyn; Koeneman, Kenneth S; Sweet, Robert M

2009-01-01

Currently, robotic training for inexperienced, practicing surgeons is primarily done vis-à-vis industry and/or society-sponsored day or weekend courses, with limited proctorship opportunities. The objective of this study was to assess the impact of an extended-proctorship program at up to 32 months of follow-up. An extended-proctorship program for robotic-assisted laparoscopic radical prostatectomy was established at our institution. The curriculum consisted of 3 phases: (1) completing an Intuitive Surgical 2-day robotic training course with company representatives; (2) serving as assistant to a trained proctor on 5 to 6 cases; and (3) performing proctored cases up to 1 year until confidence was achieved. Participants were surveyed and asked to evaluate on a 5-point Likert scale their operative experience in robotics and satisfaction regarding their training. Nine of 9 participants are currently performing robotic-assisted laparoscopic radical prostatectomy (RALP) independently. Graduates of our program have performed 477 RALP cases. The mean number of cases performed within phase 3 was 20.1 (range, 5 to 40) prior to independent practice. The program received a rating of 4.2/5 for effectiveness in teaching robotic surgery skills. Our robotic program, with extended proctoring, has led to an outstanding take-rate for disseminating robotic skills in a metropolitan community.

Essential elements to the establishment and design of a successful robotic surgery programme.

PubMed

Patel, Vipul R

2006-03-01

The application of robotic assisted technology has created a new era in surgery, by addressing some of the limitations of conventional open and laparoscopic surgery. To optimize success the incorporation of robotics into a surgical program must be performed with a structured approach. We discuss the key factors for building a successful robotic surgery program. Prior to implementing a robotics program certain essential elements must be examined. One must assess the overall goals of the program, the initial applications of the technology and the time line for success. In addition a financial analysis of the potential impact of the technology must also be performed. Essential personnel should also be identified in order to form a cohesive robotic surgery team. These preparatory sets help coordinate the establishment of the program and help to prevent unrealistic expectations; while generating the best environment for success. Once the purchase of the robotic system has been approved a robotic surgery team is created with certain essential components. This staff includes: the surgeons, nursing staff, physician assistants, resident/fellows, program coordinator, marketing and a financial analysis team. This team will work together to achieve the common goals for the program. Robotic assisted surgery has grown tremendously over the last half decade in certain surgical fields such as urology. The success of programs has been variable and often related to the infrastructure of the program. The key factors appear to be creation of a sound financial plan, early identification of applicable specialties and a motivated surgical team. Copyright 2006 John Wiley & Sons, Ltd.

Integrating robotic partial nephrectomy to an existing robotic surgery program.

PubMed

Yuh, Bertram; Muldrew, Shantel; Menchaca, Anita; Yip, Wesley; Lau, Clayton; Wilson, Timothy; Josephson, David

2012-04-01

As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN. Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models. Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions. The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.

Survey on Robot-Assisted Surgical Techniques Utilization in US Pediatric Surgery Fellowships.

PubMed

Maizlin, Ilan I; Shroyer, Michelle C; Yu, David C; Martin, Colin A; Chen, Mike K; Russell, Robert T

2017-02-01

Robotic technology has transformed both practice and education in many adult surgical specialties; no standardized training guidelines in pediatric surgery currently exist. The purpose of our study was to assess the prevalence of robotic procedures and extent of robotic surgery education in US pediatric surgery fellowships. A deidentified survey measured utilization of the robot, perception on the utility of the robot, and its incorporation in training among the program directors of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellowships in the United States. Forty-one of the 47 fellowship programs (87%) responded to the survey. While 67% of respondents indicated the presence of a robot in their facility, only 26% reported its utilizing in their surgical practice. Among programs not utilizing the robot, most common reasons provided were lack of clear supportive evidence, increased intraoperative time, and incompatibility of instrument size to pediatric patients. While 58% of program directors believe that there is a future role for robotic surgery in children, only 18% indicated that robotic training should play a part in pediatric surgery education. Consequently, while over 66% of survey respondents received training in robot-assisted surgical technique, only 29% of fellows receive robot-assisted training during their fellowship. A majority of fellowships have access to a robot, but few utilize the technology in their current practice or as part of training. Further investigation is required into both the technology's potential benefits in the pediatric population and its role in pediatric surgery training.

A Self-Organizing Interaction and Synchronization Method between a Wearable Device and Mobile Robot.

PubMed

Kim, Min Su; Lee, Jae Geun; Kang, Soon Ju

2016-06-08

In the near future, we can expect to see robots naturally following or going ahead of humans, similar to pet behavior. We call this type of robots "Pet-Bot". To implement this function in a robot, in this paper we introduce a self-organizing interaction and synchronization method between wearable devices and Pet-Bots. First, the Pet-Bot opportunistically identifies its owner without any human intervention, which means that the robot self-identifies the owner's approach on its own. Second, Pet-Bot's activity is synchronized with the owner's behavior. Lastly, the robot frequently encounters uncertain situations (e.g., when the robot goes ahead of the owner but meets a situation where it cannot make a decision, or the owner wants to stop the Pet-Bot synchronization mode to relax). In this case, we have adopted a gesture recognition function that uses a 3-D accelerometer in the wearable device. In order to achieve the interaction and synchronization in real-time, we use two wireless communication protocols: 125 kHz low-frequency (LF) and 2.4 GHz Bluetooth low energy (BLE). We conducted experiments using a prototype Pet-Bot and wearable devices to verify their motion recognition of and synchronization with humans in real-time. The results showed a guaranteed level of accuracy of at least 94%. A trajectory test was also performed to demonstrate the robot's control performance when following or leading a human in real-time.

Motion and Emotional Behavior Design for Pet Robot Dog

NASA Astrophysics Data System (ADS)

Cheng, Chi-Tai; Yang, Yu-Ting; Miao, Shih-Heng; Wong, Ching-Chang

A pet robot dog with two ears, one mouth, one facial expression plane, and one vision system is designed and implemented so that it can do some emotional behaviors. Three processors (Inter® Pentium® M 1.0 GHz, an 8-bit processer 8051, and embedded soft-core processer NIOS) are used to control the robot. One camera, one power detector, four touch sensors, and one temperature detector are used to obtain the information of the environment. The designed robot with 20 DOF (degrees of freedom) is able to accomplish the walking motion. A behavior system is built on the implemented pet robot so that it is able to choose a suitable behavior for different environmental situation. From the practical test, we can see that the implemented pet robot dog can do some emotional interaction with the human.

Animal-assisted therapy and loneliness in nursing homes: use of robotic versus living dogs.

PubMed

Banks, Marian R; Willoughby, Lisa M; Banks, William A

2008-03-01

Loneliness is a common problem in long-term care facilities (LTCF) and previous work has shown that animal-assisted therapy (AAT) can to some degree reverse loneliness. Here, we compared the ability of a living dog (Dog) and a robotic dog (AIBO) to treat loneliness in elderly patients living in LTCF. In comparison with a control group not receiving AAT, both the Dog and AIBO groups had statistically significant improvements in their levels of loneliness. As measured by a modified Lexington Attachment to Pets Scale (MLAPS), residents showed high levels of attachment to both the dog and AIBO. Subscale analysis showed that the AIBO group scored lower than the living dog on "animal rights/animal welfare" but not on "general attachment" or "people substituting." However, MLAPS measures did not correlate with changes in loneliness, showing that attachment was not the mechanism by which AAT decreases loneliness. We conclude that interactive robotic dogs can reduce loneliness in residents of LTCF and that residents become attached to these robots. However, level of attachment does not explain the decrease in loneliness associated with AAT conducted with either a living or robotic dog.

A Self-Organizing Interaction and Synchronization Method between a Wearable Device and Mobile Robot

PubMed Central

Kim, Min Su; Lee, Jae Geun; Kang, Soon Ju

2016-01-01

In the near future, we can expect to see robots naturally following or going ahead of humans, similar to pet behavior. We call this type of robots “Pet-Bot”. To implement this function in a robot, in this paper we introduce a self-organizing interaction and synchronization method between wearable devices and Pet-Bots. First, the Pet-Bot opportunistically identifies its owner without any human intervention, which means that the robot self-identifies the owner’s approach on its own. Second, Pet-Bot’s activity is synchronized with the owner’s behavior. Lastly, the robot frequently encounters uncertain situations (e.g., when the robot goes ahead of the owner but meets a situation where it cannot make a decision, or the owner wants to stop the Pet-Bot synchronization mode to relax). In this case, we have adopted a gesture recognition function that uses a 3-D accelerometer in the wearable device. In order to achieve the interaction and synchronization in real-time, we use two wireless communication protocols: 125 kHz low-frequency (LF) and 2.4 GHz Bluetooth low energy (BLE). We conducted experiments using a prototype Pet-Bot and wearable devices to verify their motion recognition of and synchronization with humans in real-time. The results showed a guaranteed level of accuracy of at least 94%. A trajectory test was also performed to demonstrate the robot’s control performance when following or leading a human in real-time. PMID:27338384

Socially assistive robotics for post-stroke rehabilitation

PubMed Central

Matarić, Maja J; Eriksson, Jon; Feil-Seifer, David J; Winstein, Carolee J

2007-01-01

Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot and discuss its potential for effectiveness. Results We describe a pilot study involving an autonomous assistive mobile robot that aids stroke patient rehabilitation by providing monitoring, encouragement, and reminders. The robot navigates autonomously, monitors the patient's arm activity, and helps the patient remember to follow a rehabilitation program. We also show preliminary results from a follow-up study that focused on the role of robot physical embodiment in a rehabilitation context. Conclusion We outline and discuss future experimental designs and factors toward the development of effective socially assistive post-stroke rehabilitation robots. PMID:17309795

Retention of robot-assisted surgical skills in urological surgeons acquired using Mimic dV-Trainer.

PubMed

Teishima, Jun; Hattori, Minoru; Inoue, Shogo; Ikeda, Kenichiro; Hieda, Keisuke; Ohara, Shinya; Egi, Hiroyuki; Ohdan, Hideki; Matsubara, Akio

2014-07-01

We assess the retention of robot-assisted surgical skills among urologic surgeons. The robot-assisted surgery skills of 20 urologic surgeons were assessed using a Mimic dV-Trainer program (Mimic Technologies, Inc., Seattle, WA) consisting of 6 tasks. These 20 surgeons had no previous experience either using the Mimic dV-Trainer or acting as the main surgeon in robot-assisted surgery. The surgeons completed the program 4 times in a row; after 1 year, they completed it again for a fifth time. Performance scores were recorded using the Mimic dV-Trainer's built-in algorithm. For all 6 tasks, there were significant improvements to the scores in the fourth trials compared with those in the first trials. The scores in the fifth trials did not significantly decline compared with those in the fourth trials. There was no significant difference between the fifth trial scores of surgeons with laparoscopic surgery skills/experience and those without. Our results indicate that fundamental robot-assisted surgical skills can be retained in the long-term after they are acquired.

A novel semi-robotized device for high-precision 18F-FDG-guided breast cancer biopsy.

PubMed

Hellingman, D; Teixeira, S C; Donswijk, M L; Rijkhorst, E J; Moliner, L; Alamo, J; Loo, C E; Valdés Olmos, R A; Stokkel, M P M

To assess the 3D geometric sampling accuracy of a new PET-guided system for breast cancer biopsy (BCB) from areas within the tumour with high 18 F-FDG uptake. In the context of the European Union project MammoCare, a prototype semi-robotic stereotactic prototype BCB-device was incorporated into a dedicated high resolution PET-detector for breast imaging. The system consists of 2 stacked rings, each containing 12 plane detectors, forming a dodecagon with a 186mm aperture for 3D reconstruction (1mm 3 voxel). A vacuum-assisted biopsy needle attached to a robot-controlled arm was used. To test the accuracy of needle placement, the needle tip was labelled with 18 F-FDG and positioned at 78 target coordinates distributed over a 35mm×24mm×28mm volume within the PET-detector field-of-view. At each position images were acquired from which the needle positioning accuracy was calculated. Additionally, phantom-based biopsy proofs, as well as MammoCare images of 5 breast cancer patients, were evaluated for the 3D automated locating of 18 F-FDG uptake areas within the tumour. Needle positioning tests revealed an average accuracy of 0.5mm (range 0-1mm), 0.6mm (range 0-2mm), and 0.4mm (range 0-2mm) for the x/y/z-axes, respectively. Furthermore, the MammoCare system was able to visualize and locate small (<10mm) regions with high 18 F-FDG uptake within the tumour suitable for PET-guided biopsy after being located by the 3D automated application. Accuracy testing demonstrated high-precision of this semi-automatic 3D PET-guided system for breast cancer core needle biopsy. Its clinical feasibility evaluation in breast cancer patients scheduled for neo-adjuvant chemotherapy will follow. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Robot-Assisted Mckeown Esophagectomy is Feasible After Neoadjuvant Chemoradiation. Our Initial Experience.

PubMed

Goel, Ashish; Shah, Swati H; Selvakumar, Veda Padma Priya; Garg, Shubha; Kumar, Kapil

2018-02-01

Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical oncologists have now shifted to video-assisted and robot-assisted thoracoscopic esophagectomy; there is still limited experience for the use of minimal-assisted approaches in patients undergoing surgery after neoadjuvant chemoradiation. Most surgeons have concerns of feasibility, safety, and oncological outcomes as well as issues related to difficult learning curve in adopting robotic esophagectomy in patients after chemoradiation. We present our initial experience of Robot-Assisted Mckeown Esophagectomy in 27 patients after neoadjuvant chemoradiation, from May 2013 to October 2014. All patients underwent neoadjuvant chemoradiation to a dose of 50.4 Gy/25Fr with concurrent weekly cisplatin, followed by reassessment with clinical examination and repeat FDG PET/CT 6 weeks after completion of chemoradiation. Patients with progressive disease underwent palliative chemotherapy while patients with either partial or significant response to chemoradiation underwent Robot-Assisted Mckeown Esophagectomy with esophageal replacement by gastric conduit and esophagogastric anastomosis in the left neck. Out of 27 patients, 92.5 % patients had stage cT3/T4 tumours and node-positive disease in 48.1 % on imaging. Most patients were middle thoracic esophageal cancers (23/27), with squamous histology in all except for one. All patients received neoadjuvant chemoradiation and subsequently underwent Robot Assisted Mckeown Esophagectomy. The average time for robot docking, thoracic mobilization and total surgical procedure was 13.2, 108.4 and 342.7 min, respectively. The procedure was well tolerated by all patients with only one case of peri-operative mortality. Average ICU stay was 6.35 days (range 3-9 days). R0 resection rate of 96.3 % and average lymph node yield of 18 could be achieved. Pathological node negativity rate (pN0) and complete response (pCR) were 66.6 and 44.4 %, respectively. In the initial cases, four patients had to be converted to open due technical reasons or intraoperative complications. The present study, with shorter operative times, similar ICU stay, overall low morbidity, and mortality and optimal oncological outcomes suggest that robot-assisted thoracic mobilization of esophagus in patients with prior chemoradiation is feasible and safe with acceptable oncological outcomes. It has a shorter learning curve and hence allows for a transthoracic minimally invasive transthoracic esophagectomy to more and more patients, otherwise unfit for conventional approach.

Improving Quality of Life and Depression After Stroke Through Telerehabilitation

PubMed Central

Linder, Susan M.; Rosenfeldt, Anson B.; Bay, R. Curtis; Sahu, Komal; Wolf, Steven L.

2015-01-01

OBJECTIVE. The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke. METHOD. A multisite randomized controlled clinical trial was completed with 99 people <6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy + home exercise program, and participated in an 8-wk home intervention. RESULTS. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups. CONCLUSION. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke. PMID:26122686

Improving Quality of Life and Depression After Stroke Through Telerehabilitation.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Bay, R Curtis; Sahu, Komal; Wolf, Steven L; Alberts, Jay L

2015-01-01

The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke. A multisite randomized controlled clinical trial was completed with 99 people<6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy+home exercise program, and participated in an 8-wk home intervention. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke. Copyright © 2015 by the American Occupational Therapy Association, Inc.

Tips on establishing a robotics program in an academic setting.

PubMed

Steers, William D

2006-02-17

Over the past 5 years, robotic-assisted laparoscopic surgery has gone from being a novelty to an accepted approach for intra-abdominal and pelvic surgery. Driving this trend has been the large number of robotic-assisted laparoscopic prostatectomies performed throughout the U.S. Nearly a quarter of the prostatectomies done for prostate cancer in the U.S. in 2006 will use robotic assistance, yet reports fail to confirm cost effectiveness. The most important predictor of a successful program is a champion at the institution. Studies have demonstrated safety and immediate benefits with regard to reduced surgical morbidity such as pain, loss of work, quality of life, and blood loss for a variety of surgeries patients. Specific to prostatectomy for cancer, long-term data on biochemical (PSA) failures and cancer cures, as well as validated secondary outcomes for continence and potency, are still unavailable. Benefits accrue for the surgeon as well with improved ergonomics and potential extension of a surgical career. Yet, enthusiasm for robotics must be tempered by this lack of data and economic limitations. However, if a thoughtful and thorough process in initiating a robotic program is undertaken, the risks to the institution can be minimized. With proper training, the risk to the patient is reduced and with due diligence with regard to market and operative resources, the risk to the surgeon can be eliminated. This report reviews the steps to assess, plan, initiate, and maintain a robotics program at an academic institution with the hope that other programs can benefit from lessons acquired by early adopters of this expensive technology.

Tips on Establishing a Robotics Program in an Academic Setting

PubMed Central

Steers, William D.

2006-01-01

Over the past 5 years, robotic-assisted laparoscopic surgery has gone from being a novelty to an accepted approach for intra-abdominal and pelvic surgery. Driving this trend has been the large number of robotic-assisted laparoscopic prostatectomies performed throughout the U.S. Nearly a quarter of the prostatectomies done for prostate cancer in the U.S. in 2006 will use robotic assistance, yet reports fail to confirm cost effectiveness. The most important predictor of a successful program is a champion at the institution. Studies have demonstrated safety and immediate benefits with regard to reduced surgical morbidity such as pain, loss of work, quality of life, and blood loss for a variety of surgeries patients. Specific to prostatectomy for cancer, long-term data on biochemical (PSA) failures and cancer cures, as well as validated secondary outcomes for continence and potency, are still unavailable. Benefits accrue for the surgeon as well with improved ergonomics and potential extension of a surgical career. Yet, enthusiasm for robotics must be tempered by this lack of data and economic limitations. However, if a thoughtful and thorough process in initiating a robotic program is undertaken, the risks to the institution can be minimized. With proper training, the risk to the patient is reduced and with due diligence with regard to market and operative resources, the risk to the surgeon can be eliminated. This report reviews the steps to assess, plan, initiate, and maintain a robotics program at an academic institution with the hope that other programs can benefit from lessons acquired by early adopters of this expensive technology. PMID:17619728

An Intelligent Agent-Controlled and Robot-Based Disassembly Assistant

NASA Astrophysics Data System (ADS)

Jungbluth, Jan; Gerke, Wolfgang; Plapper, Peter

2017-09-01

One key for successful and fluent human-robot-collaboration in disassembly processes is equipping the robot system with higher autonomy and intelligence. In this paper, we present an informed software agent that controls the robot behavior to form an intelligent robot assistant for disassembly purposes. While the disassembly process first depends on the product structure, we inform the agent using a generic approach through product models. The product model is then transformed to a directed graph and used to build, share and define a coarse disassembly plan. To refine the workflow, we formulate “the problem of loosening a connection and the distribution of the work” as a search problem. The created detailed plan consists of a sequence of actions that are used to call, parametrize and execute robot programs for the fulfillment of the assistance. The aim of this research is to equip robot systems with knowledge and skills to allow them to be autonomous in the performance of their assistance to finally improve the ergonomics of disassembly workstations.

Robotic learning from demonstration of therapist's time-varying assistance to a patient in trajectory-following tasks.

PubMed

Najafi, Mohammad; Adams, Kim; Tavakoli, Mahdi

2017-07-01

The number of people with physical disabilities and impaired motion control is increasing. Consequently, there is a growing demand for intelligent assistive robotic systems to cooperate with people with disability and help them carry out different tasks. To this end, our group has pioneered the use of robot learning from demonstration (RLfD) techniques, which eliminate the need for task-specific robot programming, in robotic rehabilitation and assistive technologies settings. First, in the demonstration phase, the therapist (or in general, a helper) provides an intervention (typically assistance) and cooperatively performs a task with a patient several times. The demonstrated motion is modelled by a statistical RLfD algorithm, which will later be used in the robot controllers to reproduce a similar intervention robotically. In this paper, by proposing a Tangential-Normal Varying-Impedance Controller (TNVIC), the robotic manipulator not only follows the therapist's demonstrated motion, but also mimics his/her interaction impedance during the therapeutic/assistive intervention. The feasibility and efficacy of the proposed framework are evaluated by conducting an experiment involving a healthy adult with cerebral palsy symptoms being induced using transcutaneous electrical nerve stimulation.

A Human-Robot Co-Manipulation Approach Based on Human Sensorimotor Information.

PubMed

Peternel, Luka; Tsagarakis, Nikos; Ajoudani, Arash

2017-07-01

This paper aims to improve the interaction and coordination between the human and the robot in cooperative execution of complex, powerful, and dynamic tasks. We propose a novel approach that integrates online information about the human motor function and manipulability properties into the hybrid controller of the assistive robot. Through this human-in-the-loop framework, the robot can adapt to the human motor behavior and provide the appropriate assistive response in different phases of the cooperative task. We experimentally evaluate the proposed approach in two human-robot co-manipulation tasks that require specific complementary behavior from the two agents. Results suggest that the proposed technique, which relies on a minimum degree of task-level pre-programming, can achieve an enhanced physical human-robot interaction performance and deliver appropriate level of assistance to the human operator.

Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults.

PubMed

Minnillo, Brian J; Cruz, Jose A S; Sayao, Rogerio H; Passerotti, Carlo C; Houck, Constance S; Meier, Petra M; Borer, Joseph G; Diamond, David A; Retik, Alan B; Nguyen, Hiep T

2011-04-01

Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time. We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed. Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period. This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Use of Robotic Pets in Providing Stimulation for Nursing Home Residents with Dementia.

PubMed

Naganuma, M; Ohkubo, E; Kato, N

2015-01-01

Trial experiments utilized robotic pets to facilitate self-reliance in nursing home residents. A remote-control robot modeled clear and meaningful behaviors to elderly residents. Special attention was paid to its effects on mental and social domains. Employing the robot as a gaze target and center of attention created a cue to initiate a communication channel between residents who normally show no interest in each other. The Sony AIBO robot in this study uses commercially available wireless equipment, and all its components are easily accessible to any medical or welfare institution interested in additional practice of these activities.

Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series

PubMed Central

2018-01-01

Objective To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. Methods A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Results Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Conclusion Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients. PMID:29765872

Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series.

PubMed

Kim, Sang Beom; Lee, Kyeong Woo; Lee, Jong Hwa; Lee, Sook Joung; Park, Jin Gee; Park, Joo Won

2018-04-01

To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients.

The affordability of minimally invasive procedures in major lung resection: a prospective study.

PubMed

Gondé, Henri; Laurent, Marc; Gillibert, André; Sarsam, Omar-Matthieu; Varin, Rémi; Grimandi, Gaël; Peillon, Christophe; Baste, Jean-Marc

2017-09-01

Minimally invasive procedures are used for the surgical treatment of lung cancer. Two techniques are proposed: video-assisted thoracic surgery or robotic-assisted thoracic surgery. Our goal was to study the economic impact of our long-standing program for minimally invasive procedures for major lung resection. We conducted a single-centre, 1-year prospective cost study. Patients who underwent lobectomy or segmentectomy were included. Patient characteristics and perioperative outcomes were collected. Medical supply expenses based on the microcosting method and capital depreciation were estimated. Total cost was evaluated using a national French database. One hundred twelve patients were included, 57 with and 55 without robotic assistance. More segmentectomies were performed with robotic assistance. The median length of stay was 5 days for robotic-assisted and 6 days for video-assisted procedures (P = 0.13). The duration of median chest drains (4 days, P = 0.36) and of operating room time (255 min, P = 0.55) was not significantly different between the groups. The overall conversion rate to thoracotomy was 9%, significantly higher in the video-assisted group than in the robotic group (16% vs 2%, P = 0.008). No difference was observed in postoperative complications. The cost of most robotic-assisted procedures ranged from €10 000 to €12 000 (median €10 972) and that of most video-assisted procedures ranged from €8 000 to €10 000 (median €9 637) (P = 0.007); median medical supply expenses were €3 236 and €2 818, respectively (P = 0.004). The overall mean cost of minimally invasive techniques (€11 759) was significantly lower than the mean French cost of lung resection surgical procedures (€13 424) (P = 0.001). The cost at our centre of performing minimally invasive surgical procedures appeared lower than the cost nationwide. Robotic-assisted thoracic surgery demonstrated acceptable additional costs for a long-standing program. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Implementing a robotics curriculum at an academic general surgery training program: our initial experience.

PubMed

Winder, Joshua S; Juza, Ryan M; Sasaki, Jennifer; Rogers, Ann M; Pauli, Eric M; Haluck, Randy S; Estes, Stephanie J; Lyn-Sue, Jerome R

2016-09-01

The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console. 20 surgical residents were included. Residents were provided the curriculum and notified the department upon completion. Bedside assistance and operative console training were completed in the operating room through a mix of biliary, foregut, and colorectal cases. During the fiscal years of 2014 and 2015, there were 164 and 263 robot-assisted surgeries performed within the General Surgery Department, respectively. All 20 residents completed the online and bedside instruction portions of the curriculum. Of the 20 residents trained, 13/20 (65 %) sat at the Surgeon console during at least one case. Utilizing this curriculum, we have trained and incorporated residents into robot-assisted cases in an efficient manner. A successful curriculum must be based on didactic learning, reading, bedside training, simulation, and training in the operating room. Each program must examine their caseload and resident class to ensure proper exposure to this platform.

Integrated Planning for Telepresence With Time Delays

NASA Technical Reports Server (NTRS)

Johnston, Mark; Rabe, Kenneth

2009-01-01

A conceptual "intelligent assistant" and an artificial-intelligence computer program that implements the intelligent assistant have been developed to improve control exerted by a human supervisor over a robot that is so distant that communication between the human and the robot involves significant signal-propagation delays. The goal of the effort is not only to help the human supervisor monitor and control the state of the robot, but also to improve the efficiency of the robot by allowing the supervisor to "work ahead". The intelligent assistant is an integrated combination of an artificial-intelligence planner and a monitor of states of both the human supervisor and the remote robot. The novelty of the system lies in the way it uses the planner to reason about the states at both ends of the time delay. The purpose served by the assistant is to provide advice to the human supervisor about current and future activities, derived from a sequence of high-level goals to be achieved.

Robot-assisted laparoscopic staging surgery for endometrial cancer--a preliminary report.

PubMed

Lee, Chyi-Long; Han, Chien-Min; Su, Hsuan; Wu, Kai-Yun; Wang, Chin-Jung; Yen, Chih-Feng

2010-12-01

The robotic surgical system is reported to overcome some technical difficulties in traditional laparoscopic hysterectomy. This study aimed to evaluate the feasibility and surgical outcomes of a robotic surgery program for endometrial cancer. Patients with endometrial cancer with the intention to receive treatment using robot-assisted laparoscopic staging surgery were recruited in a university hospital from July 2007 to August 2008. All of these surgeries were performed with the da Vinci system. Six patients (mean age, 47.5 ±1.4 years; mean body mass index, 26.2 ±3.5 kg/m(2)) were enrolled and completed robot-assisted laparoscopic staging surgery. The robot docking time was 45.0 ±13.6 minutes and the robot-assisted operation time was 200.3 ±30.0 minutes. The mean estimated blood loss was 180.0 ±147.6 mL. The mean number of lymph nodes retrieved was 23.2 ±7.4. No laparoconversion and no intraoperative or postoperative complications occurred. All patients were alive and free of disease up to the date of this report, at a median follow-up of 6.5 months (range, 5-17 months). Robot-assisted laparoscopic staging surgery is a feasible treatment and helps overcome the technical limitations in conventional laparoscopy for endometrial cancer. Copyright © 2010 Taiwan Association of Obstetric & Gynecology. Published by Elsevier B.V. All rights reserved.

[Implementation of a robotic video-assisted thoracic surgical program].

PubMed

Baste, J-M; Riviera, C; Nouhaud, F-X; Rinieri, P; Melki, J; Peillon, C

2016-03-01

Recent publications from North America have shown the benefits of robot-assisted thoracic surgery. We report here the process of setting up such a program in a French university centre and early results in a unit with an average treatment volume. Retrospective review of a single institution database. The program was launched after a 6-month preparation period. From January 2012 to January 2013, totally endoscopic, full robot-assisted procedures were performed on 30 patients (17 males). Median age was 54 [Q1-Q3, 48-63] years and ASA score 2 [1,2]. Operative procedures included thymectomy (9 ; 30%), lobectomy with nodes resection (11 ; 38%), segmentectomy (4 ; 14%), lymphadenectomy (3 ; 10%), Bronchogenic cyst (2, 5%) and posterior mediastinal mass resection (1 ; 3%). No conversion was required. Median blood loss was 50mL [10-100]. Median operating time was 135 min (105-165) including 30 min [20-40] for docking, 90min for robot-assisted operating [70-120] and 15 min [10-15] for lesion extraction. CO2 insufflation was used in 28 cases (93%). Hospital stay was 4 days [4-6] with 6 minor complications (20%) (Grade 1 according to the Clavien-Dindo classification). After a median 4 months follow-up [2-7], all patients were alive and demonstrated a good quality of life. This series suggests that full robotic thoracic procedures are safe and effective treatment for various pathologies, with low morbidity and without a significant learning curve, even in a lower volume centre. This technology should accompany the development of minimally invasive thoracic surgery. The importance of robotic training should be emphasized to optimize procedures and costs. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Concept and design philosophy of a person-accompanying robot

NASA Astrophysics Data System (ADS)

Mizoguchi, Hiroshi; Shigehara, Takaomi; Goto, Yoshiyasu; Hidai, Ken-ichi; Mishima, Taketoshi

1999-01-01

This paper proposes a person accompanying robot as a novel human collaborative robot. The person accompanying robot is such legged mobile robot that is possible to follow the person utilizing its vision. towards future aging society, human collaboration and human support are required as novel applications of robots. Such human collaborative robots share the same space with humans. But conventional robots are isolated from humans and lack the capability to observe humans. Study on human observing function of robot is crucial to realize novel robot such as service and pet robot. To collaborate and support humans properly human collaborative robot must have capability to observe and recognize humans. Study on human observing function of robot is crucial to realize novel robot such as service and pet robot. The authors are currently implementing a prototype of the proposed accompanying robot.As a base for the human observing function of the prototype robot, we have realized face tracking utilizing skin color extraction and correlation based tracking. We also develop a method for the robot to pick up human voice clearly and remotely by utilizing microphone arrays. Results of these preliminary study suggest feasibility of the proposed robot.

Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.

PubMed

Nilsson, Andreas E; Carlsson, Stefan; Laven, Brett A; Wiklund, N Peter

2006-01-01

The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy. The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002. Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed. Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.

Experiments with an EVA Assistant Robot

NASA Technical Reports Server (NTRS)

Burridge, Robert R.; Graham, Jeffrey; Shillcutt, Kim; Hirsh, Robert; Kortenkamp, David

2003-01-01

Human missions to the Moon or Mars will likely be accompanied by many useful robots that will assist in all aspects of the mission, from construction to maintenance to surface exploration. Such robots might scout terrain, carry tools, take pictures, curate samples, or provide status information during a traverse. At NASA/JSC, the EVA Robotic Assistant (ERA) project has developed a robot testbed for exploring the issues of astronaut-robot interaction. Together with JSC's Advanced Spacesuit Lab, the ERA team has been developing robot capabilities and testing them with space-suited test subjects at planetary surface analog sites. In this paper, we describe the current state of the ERA testbed and two weeks of remote field tests in Arizona in September 2002. A number of teams with a broad range of interests participated in these experiments to explore different aspects of what must be done to develop a program for robotic assistance to surface EVA. Technologies explored in the field experiments included a fuel cell, new mobility platform and manipulator, novel software and communications infrastructure for multi-agent modeling and planning, a mobile science lab, an "InfoPak" for monitoring the spacesuit, and delayed satellite communication to a remote operations team. In this paper, we will describe this latest round of field tests in detail.

Comparison of two techniques of robot-aided upper limb exercise training after stroke.

PubMed

Stein, Joel; Krebs, Hermano Igo; Frontera, Walter R; Fasoli, Susan E; Hughes, Richard; Hogan, Neville

2004-09-01

This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke. A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol. Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry. Subjects capable of participating in resistance training were randomized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training. Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy. Those subjects capable of participating in resistance training at 3 wks were then randomized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training. One subject withdrew due to unrelated medical issues, and data for the remaining 46 subjects were analyzed. Subjects in all groups showed improvement in measures of motor control (mean increase in Fugl-Meyer of 3.3; 95% confidence interval, 2.2-4.4) and maximal force (mean increase in maximal force of 3.5 N, P = 0.027) over the course of robot-aided exercise training. No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups. Subjects' ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control. The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training, though interpretation of these results is limited by sample size. Individuals with better motor control at baseline experienced greater increases in motor control with robotic training.

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

Robots, Jobs, and Education. State-of-the-Art Paper.

ERIC Educational Resources Information Center

Benton, Oliver; Branch, Charles W.

The purpose of this paper is to assist those in education, government, and industry who are responsible for managing vocational and technical training in their decisions about what programs should be initiated to accommodate the growing use of robots. Section 1 describes robot characteristics (type of drive, method of teaching, lifting capacity,…

Affective and Engagement Issues in the Conception and Assessment of a Robot-Assisted Psychomotor Therapy for Persons with Dementia

PubMed Central

Rouaix, Natacha; Retru-Chavastel, Laure; Rigaud, Anne-Sophie; Monnet, Clotilde; Lenoir, Hermine; Pino, Maribel

2017-01-01

The interest in robot-assisted therapies (RAT) for dementia care has grown steadily in recent years. However, RAT using humanoid robots is still a novel practice for which the adhesion mechanisms, indications and benefits remain unclear. Also, little is known about how the robot's behavioral and affective style might promote engagement of persons with dementia (PwD) in RAT. The present study sought to investigate the use of a humanoid robot in a psychomotor therapy for PwD. We examined the robot's potential to engage participants in the intervention and its effect on their emotional state. A brief psychomotor therapy program involving the robot as the therapist's assistant was created. For this purpose, a corpus of social and physical behaviors for the robot and a “control software” for customizing the program and operating the robot were also designed. Particular attention was given to components of the RAT that could promote participant's engagement (robot's interaction style, personalization of contents). In the pilot assessment of the intervention nine PwD (7 women and 2 men, M age = 86 y/o) hospitalized in a geriatrics unit participated in four individual therapy sessions: one classic therapy (CT) session (patient- therapist) and three RAT sessions (patient-therapist-robot). Outcome criteria for the evaluation of the intervention included: participant's engagement, emotional state and well-being; satisfaction of the intervention, appreciation of the robot, and empathy-related behaviors in human-robot interaction (HRI). Results showed a high constructive engagement in both CT and RAT sessions. More positive emotional responses in participants were observed in RAT compared to CT. RAT sessions were better appreciated than CT sessions. The use of a social robot as a mediating tool appeared to promote the involvement of PwD in the therapeutic intervention increasing their immediate wellbeing and satisfaction. PMID:28713296

Affective and Engagement Issues in the Conception and Assessment of a Robot-Assisted Psychomotor Therapy for Persons with Dementia.

PubMed

Rouaix, Natacha; Retru-Chavastel, Laure; Rigaud, Anne-Sophie; Monnet, Clotilde; Lenoir, Hermine; Pino, Maribel

2017-01-01

The interest in robot-assisted therapies (RAT) for dementia care has grown steadily in recent years. However, RAT using humanoid robots is still a novel practice for which the adhesion mechanisms, indications and benefits remain unclear. Also, little is known about how the robot's behavioral and affective style might promote engagement of persons with dementia (PwD) in RAT. The present study sought to investigate the use of a humanoid robot in a psychomotor therapy for PwD. We examined the robot's potential to engage participants in the intervention and its effect on their emotional state. A brief psychomotor therapy program involving the robot as the therapist's assistant was created. For this purpose, a corpus of social and physical behaviors for the robot and a "control software" for customizing the program and operating the robot were also designed. Particular attention was given to components of the RAT that could promote participant's engagement (robot's interaction style, personalization of contents). In the pilot assessment of the intervention nine PwD (7 women and 2 men, M age = 86 y/o) hospitalized in a geriatrics unit participated in four individual therapy sessions: one classic therapy (CT) session (patient- therapist) and three RAT sessions (patient-therapist-robot). Outcome criteria for the evaluation of the intervention included: participant's engagement, emotional state and well-being; satisfaction of the intervention, appreciation of the robot, and empathy-related behaviors in human-robot interaction (HRI). Results showed a high constructive engagement in both CT and RAT sessions. More positive emotional responses in participants were observed in RAT compared to CT. RAT sessions were better appreciated than CT sessions. The use of a social robot as a mediating tool appeared to promote the involvement of PwD in the therapeutic intervention increasing their immediate wellbeing and satisfaction.

Instructional Design Using an In-House Built Teaching Assistant Robot to Enhance Elementary School English-as-a-Foreign-Language Learning

ERIC Educational Resources Information Center

Wu, Wen-Chi Vivian; Wang, Rong-Jyue; Chen, Nian-Shing

2015-01-01

This paper presents a design for a cutting-edge English program in which elementary school learners of English as a foreign language in Taiwan had lively interactions with a teaching assistant robot. Three dimensions involved in the design included (1) a pleasant and interactive classroom environment as the learning context, (2) a teaching…

Considerations for designing robotic upper limb rehabilitation devices

NASA Astrophysics Data System (ADS)

Nadas, I.; Vaida, C.; Gherman, B.; Pisla, D.; Carbone, G.

2017-12-01

The present study highlights the advantages of robotic systems for post-stroke rehabilitation of the upper limb. The latest demographic studies illustrate a continuous increase of the average life span, which leads to a continuous increase of stroke incidents and patients requiring rehabilitation. Some studies estimate that by 2030 the number of physical therapists will be insufficient for the patients requiring physical rehabilitation, imposing a shift in the current methodologies. A viable option is the implementation of robotic systems that assist the patient in performing rehabilitation exercises, the physical therapist role being to establish the therapeutic program for each patient and monitor their individual progress. Using a set of clinical measurements for the upper limb motions, the analysis of rehabilitation robotic systems provides a comparative study between the motions required by clinicians and the ones that robotic systems perform for different therapeutic exercises. A critical analysis of existing robots is performed using several classifications: mechanical design, assistance type, actuation and power transmission, control systems and human robot interaction (HRI) strategies. This classification will determine a set of pre-requirements for the definition of new concepts and efficient solutions for robotic assisted rehabilitation therapy.

[Force-based local navigation in robot-assisted implantation bed anlage in the lateral skull base. An experimental study].

PubMed

Plinkert, P K; Federspil, P A; Plinkert, B; Henrich, D

2002-03-01

Excellent precision, miss of retiring, reproducibility are main characteristics of robots in the operating theatre. Because of these facts their use for surgery in the lateral scull base is of great interest. In recent experiments we determined process parameters for robot assisted reaming of a cochlea implant bed and for a mastoidectomy. These results suggested that optimizing parameters for thrilling with the robot is needed. Therefore we implemented a suitable reaming curve from the geometrical data of the implant and a force controlled process control for robot assisted reaming at the lateral scull base. Experiments were performed with an industrial robot on animal and human scull base specimen. Because of online force detection and feedback of sensory data the reaming with the robot was controlled. With increasing force values above a defined limit feed rates were automatically regulated. Furthermore we were able to detect contact of the thrill to dura mater by analyzing the force values. With the new computer program the desired implant bed was exactly prepared. Our examinations showed a successful reaming of an implant bed in the lateral scull base with a robot. Because of a force controlled reaming process locale navigation is possible and enables careful thrilling with a robot.

Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation. Appendix B: ROBSIM programmer's guide

NASA Technical Reports Server (NTRS)

Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelly, J. H.; Depkovich, T. M.; Wolfe, W. J.; Nguyen, T.

1986-01-01

The purpose of the Robotic Simulation (ROBSIM) program is to provide a broad range of computer capabilities to assist in the design, verification, simulation, and study of robotic systems. ROBSIM is programmed in FORTRAM 77 and implemented on a VAX 11/750 computer using the VMS operating system. The programmer's guide describes the ROBSIM implementation and program logic flow, and the functions and structures of the different subroutines. With the manual and the in-code documentation, an experienced programmer can incorporate additional routines and modify existing ones to add desired capabilities.

Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation, appendix B

NASA Technical Reports Server (NTRS)

Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelly, J. H.; Depkovich, T. M.

1984-01-01

The purpose of the Robotics Simulation (ROBSIM) program is to provide a broad range of computer capabilities to assist in the design, verification, simulation, and study of robotic systems. ROBSIM is programmed in FORTRAN 77 and implemented on a VAX 11/750 computer using the VMS operating system. This programmer's guide describes the ROBSIM implementation and program logic flow, and the functions and structures of the different subroutines. With this manual and the in-code documentation, and experienced programmer can incorporate additional routines and modify existing ones to add desired capabilities.

Consistency of performance of robot-assisted surgical tasks in virtual reality.

PubMed

Suh, I H; Siu, K-C; Mukherjee, M; Monk, E; Oleynikov, D; Stergiou, N

2009-01-01

The purpose of this study was to investigate consistency of performance of robot-assisted surgical tasks in a virtual reality environment. Eight subjects performed two surgical tasks, bimanual carrying and needle passing, with both the da Vinci surgical robot and a virtual reality equivalent environment. Nonlinear analysis was utilized to evaluate consistency of performance by calculating the regularity and the amount of divergence in the movement trajectories of the surgical instrument tips. Our results revealed that movement patterns for both training tasks were statistically similar between the two environments. Consistency of performance as measured by nonlinear analysis could be an appropriate methodology to evaluate the complexity of the training tasks between actual and virtual environments and assist in developing better surgical training programs.

Sprint: The first flight demonstration of the external work system robots

NASA Technical Reports Server (NTRS)

Price, Charles R.; Grimm, Keith

1995-01-01

The External Works Systems (EWS) 'X Program' is a new NASA initiative that will, in the next ten years, develop a new generation of space robots for active and participative support of zero g external operations. The robotic development will center on three areas: the assistant robot, the associate robot, and the surrogate robot that will support external vehicular activities (EVA) prior to and after, during, and instead of space-suited human external activities respectively. The EWS robotics program will be a combination of technology developments and flight demonstrations for operational proof of concept. The first EWS flight will be a flying camera called 'Sprint' that will seek to demonstrate operationally flexible, remote viewing capability for EVA operations, inspections, and contingencies for the space shuttle and space station. This paper describes the need for Sprint and its characteristics.

Developing a robotic pancreas program: the Dutch experience

PubMed Central

Nota, Carolijn L.; Zwart, Maurice J.; Fong, Yuman; Hagendoorn, Jeroen; Hogg, Melissa E.; Koerkamp, Bas Groot; Besselink, Marc G.

2017-01-01

Robot-assisted surgery has been developed to overcome limitations of conventional laparoscopy aiming to further optimize minimally invasive surgery. Despite the fact that robotics already have been widely adopted in urology, gynecology, and several gastro-intestinal procedures, like colorectal surgery, pancreatic surgery lags behind. Due to the complex nature of the procedure, surgeons probably have been hesitant to apply minimally invasive techniques in pancreatic surgery. Nevertheless, the past few years pancreatic surgery has been catching up. An increasing number of procedures are being performed laparoscopically and robotically, despite it being a highly complex procedure with high morbidity and mortality rates. Since the complex nature and extensiveness of the procedure, the start of a robotic pancreatic program should be properly prepared and should comply with several conditions within high-volume centers. Robotic training plays a significant role in the preparation. In this review we discuss the different aspects of preparation when working towards the start of a robotic pancreas program against the background of our nationwide experience in the Netherlands. PMID:29078666

Developing a robotic pancreas program: the Dutch experience.

PubMed

Nota, Carolijn L; Zwart, Maurice J; Fong, Yuman; Hagendoorn, Jeroen; Hogg, Melissa E; Koerkamp, Bas Groot; Besselink, Marc G; Molenaar, I Quintus

2017-01-01

Robot-assisted surgery has been developed to overcome limitations of conventional laparoscopy aiming to further optimize minimally invasive surgery. Despite the fact that robotics already have been widely adopted in urology, gynecology, and several gastro-intestinal procedures, like colorectal surgery, pancreatic surgery lags behind. Due to the complex nature of the procedure, surgeons probably have been hesitant to apply minimally invasive techniques in pancreatic surgery. Nevertheless, the past few years pancreatic surgery has been catching up. An increasing number of procedures are being performed laparoscopically and robotically, despite it being a highly complex procedure with high morbidity and mortality rates. Since the complex nature and extensiveness of the procedure, the start of a robotic pancreatic program should be properly prepared and should comply with several conditions within high-volume centers. Robotic training plays a significant role in the preparation. In this review we discuss the different aspects of preparation when working towards the start of a robotic pancreas program against the background of our nationwide experience in the Netherlands.

Practical Recommendations for Robot-Assisted Treadmill Therapy (Lokomat) in Children with Cerebral Palsy: Indications, Goal Setting, and Clinical Implementation within the WHO-ICF Framework.

PubMed

Aurich-Schuler, Tabea; Warken, Birgit; Graser, Judith V; Ulrich, Thilo; Borggraefe, Ingo; Heinen, Florian; Meyer-Heim, Andreas; van Hedel, Hubertus J A; Schroeder, A Sebastian

2015-08-01

Active participation and the highest level of independence during daily living are primary goals in neurorehabilitation. Therefore, standing and walking are key factors in many rehabilitation programs. Despite inconclusive evidence considering the best application and efficacy of robotic tools in the field of pediatric neurorehabilitation, robotic technologies have been implemented to complement conventional therapies in recent years. A group of experienced therapists and physicians joined in an "expert panel." They compared their clinical application protocols, discussed recurring open questions, and developed experience-based recommendations for robot-assisted treadmill therapy (exemplified by the Lokomat, Hocoma, Volketswil, Switzerland) with a focus on children with cerebral palsy. Specific indications and therapeutic goals were defined considering the severity of motor impairments and the International Classification of Functioning, Disability and Health framework (ICF). After five meetings, consensus was found and recommendations for the implementation of robot-assisted treadmill therapy including postsurgery rehabilitation were proposed. This article aims to provide a comprehensive overview on therapeutical applications in a fast developing field of medicine, where scientific evidence is still scarce. These recommendations can help physicians and therapists to plan the child's individual therapy protocol of robot-assisted treadmill therapy. Georg Thieme Verlag KG Stuttgart · New York.

Manifold traversing as a model for learning control of autonomous robots

NASA Technical Reports Server (NTRS)

Szakaly, Zoltan F.; Schenker, Paul S.

1992-01-01

This paper describes a recipe for the construction of control systems that support complex machines such as multi-limbed/multi-fingered robots. The robot has to execute a task under varying environmental conditions and it has to react reasonably when previously unknown conditions are encountered. Its behavior should be learned and/or trained as opposed to being programmed. The paper describes one possible method for organizing the data that the robot has learned by various means. This framework can accept useful operator input even if it does not fully specify what to do, and can combine knowledge from autonomous, operator assisted and programmed experiences.

Socially assistive robotics for stroke and mild TBI rehabilitation.

PubMed

Matarić, Maja; Tapus, Adriana; Winstein, Carolee; Eriksson, Jon

2009-01-01

This paper describes an interdisciplinary research project aimed at developing and evaluating effective and user-friendly non-contact robot-assisted therapy, aimed at in-home use. The approach stems from the emerging field of social cognitive neuroscience that seeks to understand phenomena in terms of interactions between the social, cognitive, and neural levels of analysis. This technology-assisted therapy is designed to be safe and affordable, and relies on novel human-robot interaction methods for accelerated recovery of upper-extremity function after lesion-induced hemiparesis. The work is based on the combined expertise in the science and technology of non-contact socially assistive robotics and the clinical science of neurorehabilitation and motor learning, brought together to study how to best enhance recovery after stroke and mild traumatic brain injury. Our approach is original and promising in that it combines several ingredients that individually have been shown to be important for learning and long-term efficacy in motor neurorehabilitation: (1) intensity of task specific training and (2) engagement and self-management of goal-directed actions. These principles motivate and guide the strategies used to develop novel user activity sensing and provide the rationale for development of socially assistive robotics therapy for monitoring and coaching users toward personalized and optimal rehabilitation programs.

Making Robot Planes Useful for Scientific Investigation of Earth

NASA Technical Reports Server (NTRS)

Jennison, Chris

2006-01-01

This viewgraph slides presentation reviews the program to use unmanned aerial vehicles to gather information to study the Earth, the changes to the climate, and to protect the Earth. Several robot planes are shown, and cooperative programs with other agencies of the U.S. Government are highlighted. Including one with the United States Forest Service, that is planned to assist in locating fires

Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial.

PubMed

Picelli, Alessandro; Melotti, Camilla; Origano, Francesca; Waldner, Andreas; Gimigliano, Raffaele; Smania, Nicola

2012-09-01

Treadmill training (with or without robotic assistance) has been reported to improve balance skills in patients with Parkinson's disease (PD). However, its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD (Hoehn & Yahr stage ≤3). Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1, as a harness supports them with their feet placed on motor-driven footplates. The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3-4. Thirty-four patients with PD at Hoehn & Yahr stage 3-4 were randomly assigned into two groups. All patients received twelve, 40-min treatment sessions, three days/week, for four consecutive weeks. The Robotic Training group (n = 17) underwent robot-assisted gait training, while the Physical Therapy group (n = 17) underwent a training program not specifically aimed at improving postural stability. Patients were evaluated before, immediately after and 1-month post-treatment. Primary outcomes were: Berg Balance scale; Nutt's rating. A significant improvement was found after treatment on the Berg Balance Scale and the Nutt's rating in favor of the Robotic Training group (Berg: 43.44 ± 2.73; Nutt: 1.38 ± 0.50) compared to the Physical Therapy group (Berg: 37.27 ± 5.68; Nutt: 2.07 ± 0.59). All improvements were maintained at the 1-month follow-up evaluation. Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3-4. Copyright © 2012 Elsevier Ltd. All rights reserved.

Mobile Autonomous Humanoid Assistant

NASA Technical Reports Server (NTRS)

Diftler, M. A.; Ambrose, R. O.; Tyree, K. S.; Goza, S. M.; Huber, E. L.

2004-01-01

A mobile autonomous humanoid robot is assisting human co-workers at the Johnson Space Center with tool handling tasks. This robot combines the upper body of the National Aeronautics and Space Administration (NASA)/Defense Advanced Research Projects Agency (DARPA) Robonaut system with a Segway(TradeMark) Robotic Mobility Platform yielding a dexterous, maneuverable humanoid perfect for aiding human co-workers in a range of environments. This system uses stereo vision to locate human team mates and tools and a navigation system that uses laser range and vision data to follow humans while avoiding obstacles. Tactile sensors provide information to grasping algorithms for efficient tool exchanges. The autonomous architecture utilizes these pre-programmed skills to form human assistant behaviors. The initial behavior demonstrates a robust capability to assist a human by acquiring a tool from a remotely located individual and then following the human in a cluttered environment with the tool for future use.

How to set up a robotic-assisted laparoscopic surgery center and training of staff.

PubMed

Lenihan, John P

2017-11-01

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic System tm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery. Copyright © 2017. Published by Elsevier Ltd.

Anthropomorphic Robot Hand And Teaching Glove

NASA Technical Reports Server (NTRS)

Engler, Charles D., Jr.

1991-01-01

Robotic forearm-and-hand assembly manipulates objects by performing wrist and hand motions with nearly human grasping ability and dexterity. Imitates hand motions of human operator who controls robot in real time by programming via exoskeletal "teaching glove". Telemanipulator systems based on this robotic-hand concept useful where humanlike dexterity required. Underwater, high-radiation, vacuum, hot, cold, toxic, or inhospitable environments potential application sites. Particularly suited to assisting astronauts on space station in safely executing unexpected tasks requiring greater dexterity than standard gripper.

Robotic surgery

MedlinePlus

Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

Minimally Invasive Mitral Valve Surgery III

PubMed Central

Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

2016-01-01

Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

First Experiences with the New Senhance® Telerobotic System in Visceral Surgery.

PubMed

Stephan, Dietmar; Sälzer, Heike; Willeke, Frank

2018-02-01

Until recently, robotic-assisted surgery has exclusively been connected to the name DaVinci®. In 2016, a second robotic system, the Senhance®, became available. To introduce the new robotic system into clinical routine, detailed team training and an integration program were useful. Within the first 6 months, 116 cases were performed with this system. The integration program intended to start with simple and well-standardized clinical cases. We chose inguinal hernia repair using the TAPP (transabdominal preperitoneal) technique as the starting procedure. Subsequently, we added upper gastrointestinal surgery and cholecystectomies, and colorectal procedures have since also been included. Initial experience with the Senhance system as the first installation in Germany shows that it is suitable for surgery in general and for visceral surgery in particular. The application is safe due to the unproblematically quick changeover to normal laparoscopy and easy to integrate due to the very short system integration times (docking times). Since it is a laparoscopic-based system, following an integration program will enable experienced laparoscopic surgeons to very quickly manage more complex procedures. Due to lower costs, introducing robotic surgery starting with simple and standardized procedures is more feasible. After the establishment of this second robotic system, future studies will have to specifically look at differences in surgical results and basic conditions of different robotic-assisted systems. This paper documents the decision-making process of a hospital towards the integration of a robotic system and the selection criteria used while also demonstrating the planning and execution process during the introduction of the system into clinical routine.

Retention of fundamental surgical skills learned in robot-assisted surgery.

PubMed

Suh, Irene H; Mukherjee, Mukul; Shah, Bhavin C; Oleynikov, Dmitry; Siu, Ka-Chun

2012-12-01

Evaluation of the learning curve for robotic surgery has shown reduced errors and decreased task completion and training times compared with regular laparoscopic surgery. However, most training evaluations of robotic surgery have only addressed short-term retention after the completion of training. Our goal was to investigate the amount of surgical skills retained after 3 months of training with the da Vinci™ Surgical System. Seven medical students without any surgical experience were recruited. Participants were trained with a 4-day training program of robotic surgical skills and underwent a series of retention tests at 1 day, 1 week, 1 month, and 3 months post-training. Data analysis included time to task completion, speed, distance traveled, and movement curvature by the instrument tip. Performance of the participants was graded using the modified Objective Structured Assessment of Technical Skills (OSATS) for robotic surgery. Participants filled out a survey after each training session by answering a set of questions. Time to task completion and the movement curvature was decreased from pre- to post-training and the performance was retained at all the corresponding retention periods: 1 day, 1 week, 1 month, and 3 months. The modified OSATS showed improvement from pre-test to post-test and this improvement was maintained during all the retention periods. Participants increased in self-confidence and mastery in performing robotic surgical tasks after training. Our novel comprehensive training program improved robot-assisted surgical performance and learning. All trainees retained their fundamental surgical skills for 3 months after receiving the training program.

Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery.

PubMed

Elsayed, Yahya; Lekakou, Constantina; Ranzani, Tommaso; Cianchetti, Matteo; Morino, Mario; Arezzo, Alberto; Menciassi, Arianna; Geng, Tao; Saaj, Chakravarthini M

2015-01-01

This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Bay, Curtis R; Wolf, Steven L; Alberts, Jay L

2013-01-01

Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Application of an industrial robot to nuclear pharmacy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Viola, J.

1994-12-31

Increased patient throughput and lengthened P.E.T. scan protocols have increased the radiation dose received by P.E.T. technologists. Automated methods of tracer infusion and blood sampling have been introduced to reduce direct contact with the radioisotopes, but significant radiation exposure still exists during the receipt and dispensing of the patient dose. To address this situation the authors have developed an automated robotic system which performs these tasks, thus limiting the physical contact between operator and radioisotope.

Post-therapy lesions in patients with non-Hodgkin's lymphoma characterized by 18F-FDG PET/CT-guided biopsy using automated robotic biopsy arm.

PubMed

Radhakrishnan, Renjith K; Mittal, Bhagwant R; Basher, Rajender K; Prakash, Gaurav; Malhotra, Pankaj; Kalra, Naveen; Das, Ashim

2018-01-01

The aim of this study was to analyse the positive predictive value (PPV) of post-therapy fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT performed for response or recurrence evaluation in patients with non-Hodgkin's lymphoma (NHL) and to appraise the diagnostic utility of F-FDG PET/CT-guided biopsy in this setting. A total of 17 patients with NHL showing F-FDG avid lesions in F-FDG PET/CT performed for response or recurrence assessment underwent F-FDG PET/CT-guided biopsy using automated robotic biopsy arm needle navigation technique. The objectives were analysed in reference to histopathology. In all, 15 of the 17 (88.5%) procedures yielded adequate representative tissue samples. Nine out of 15 lesions were positive for residual disease and the remaining revealed benign findings on histopathology. One patient with inconclusive biopsy underwent surgical resection and histopathology confirmed the presence of residual disease. PPV of theF-FDG PET/CT was observed to be 62.5% (10/16). F-FDG PET/CT for response evaluation in NHL possesses a low PPV and hence warrants histopathological correlation when F-FDG PET/CT findings influence management decision. Diagnostic yield of F-FDG PET/CT-guided biopsy is high and has the potential to reduce sampling errors.

A High School Level Course On Robot Design And Construction

NASA Astrophysics Data System (ADS)

Sadler, Paul M.; Crandall, Jack L.

1984-02-01

The Robotics Design and Construction Class at Sehome High School was developed to offer gifted and/or highly motivated students an in-depth introduction to a modern engineering topic. The course includes instruction in basic electronics, digital and radio electronics, construction skills, robotics literacy, construction of the HERO 1 Heathkit Robot, computer/ robot programming, and voice synthesis. A key element which leads to the success of the course is the involvement of various community assets including manpower and financial assistance. The instructors included a physics/electronics teacher, a computer science teacher, two retired engineers, and an electronics technician.

Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.

PubMed

Linder, Susan M; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B; Clark, Cindy; Wolf, Steven L; Alberts, Jay L

2013-09-01

After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment. The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.

Therapeutic robocat for nursing home residents with dementia: preliminary inquiry.

PubMed

Libin, Alexander; Cohen-Mansfield, Jiska

2004-01-01

Traditional pet therapy enhances individual well-being. However, there are situations where a substitute artificial companion (i.e., robotic pet) may serve as a better alternative because of insufficient available resources to care for a real pet, allergic responses to pets, or other difficulties. This pilot study, which compared the benefits of a robotic cat and a plush toy cat as interventions for elderly persons with dementia, was conducted at a special care unit of a large, not-for-profit nursing home. Various aspects of a person's engagement and affect were assessed through direct observations. Though not identical, similar trends were seen for the two cats. Interacting with the cats was linked with decreased agitation and increased pleasure and interest. The study is intended to pave the way for future research on robotherapy with nursing home residents.

Clinical outcomes in endometrial cancer care when the standard of care shifts from open surgery to robotics.

PubMed

Mok, Zhun Wei; Yong, Eu Leong; Low, Jeffrey Jen Hui; Ng, Joseph Soon Yau

2012-06-01

In Singapore, the standard of care for endometrial cancer staging remains laparotomy. Since the introduction of gynecologic robotic surgery, there have been more data comparing robotic surgery to laparoscopy in the management of endometrial cancer. This study reviewed clinical outcomes in endometrial cancer in a program that moved from laparotomy to robotic surgery. A retrospective review was performed on 124 consecutive endometrial cancer patients. Preoperative data and postoperative outcomes of 34 patients undergoing robotic surgical staging were compared with 90 patients who underwent open endometrial cancer staging during the same period and in the year before the introduction of robotics. There were no significant differences in the mean age, body mass index, rates of diabetes, hypertension, previous surgery, parity, medical conditions, size of specimens, histologic type, or stage of cancer between the robotic and the open surgery groups. The first 20 robotic-assisted cases had a mean (SD) operative time of 196 (60) minutes, and the next 14 cases had a mean time of 124 (64) minutes comparable to that for open surgery. The mean number of lymph nodes retrieved during robot-assisted staging was smaller than open laparotomy in the first 20 cases but not significantly different for the subsequent 14 cases. Robot-assisted surgery was associated with lower intraoperative blood loss (110 [24] vs 250 [83] mL, P < 0.05), a lower rate of postoperative complications (8.8% vs 26.8%, P = 0.032), a lower wound complication rate (0% vs 9.9%, P = 0.044), a decreased requirement for postoperative parenteral analgesia (5.9% vs 51.1, P < 0.001), and shorter length of hospitalization (2.0 [1.1] vs 6.0 [4.5] days, P < 0.001) compared to patients in the open laparotomy group. Our series shows that outcomes traditionally associated with laparoscopic endometrial cancer staging are achievable by laparoscopy-naive gynecologic cancer surgeons moving from laparotomy to robot-assisted endometrial cancer staging after a relatively small number of cases.

School Microware Reviews. Evaluations of Educational Software for Apple, PET, TRS-80, with Index to Evaluations in Other Publications.

ERIC Educational Resources Information Center

School Microware Reviews, 1981

1981-01-01

This document describes the operation and quality of pre-college instructional software sold for use on microcomputers. It also assists in locating other sources of similar information about instructional software. This edition is limited to programs for the Apple II, Commodore PET, and Radio Shack TRS-80 Model I. Fifty reviews of software…

Current Status of Robot-Assisted Radical Cystectomy: What is the Real Benefit?

PubMed

Takenaka, Atsushi

2015-09-01

In recent years, robot-assisted radical cystectomy has received attention worldwide as a useful procedure that helps to overcome the limitations of open radical cystectomy. We compared the surgical technique, perioperative and oncological outcomes, and learning curve of robot-assisted radical cystectomy with those of open radical cystectomy. The indications for robot-assisted radical cystectomy are identical to those of open radical cystectomy. Relative contraindications are due to patient positioning in the Trendelenburg position for long periods. Urinary diversion is performed either extracorporeally with a small skin incision or intracorporeally with a totally robotic-assisted maneuver. Accordingly, robot-assisted radical cystectomy can be performed safely with an acceptable operative time, little blood loss, and low transfusion rates. The lymph node yield and positive surgical margin rate were not significantly different between robot-assisted radical cystectomy and open radical cystectomy. The survival rates after robot-assisted radical cystectomy are estimated to be similar to that after open radical cystectomy. However, the recurrence pattern is different between robot-assisted radical cystectomy and open radical cystectomy, i.e., extrapelvic lymph node recurrence and peritoneal carcinomatosis were more frequently found in patients who underwent robot-assisted radical cystectomy than in those who underwent open radical cystectomy. Further validation is necessary to prove the feasibility of oncological control. A steep learning curve is one of the benefits of the new technique. The experience of only 50 robot-assisted radical prostatectomies is a minimum requirement for performing feasible robot-assisted radical cystectomy, and surgeons who have performed only 30 surgeries can reach an acceptable level of quality for robot-assisted radical cystectomy.

[Initiating a Robotic Program for Abdominal Surgery - Experiences from a Centre in Germany].

PubMed

Brunner, Maximilian; Matzel, Klaus; Aladashvili, Archil; Krautz, Christian; Grützmann, Robert; Croner, Roland

2018-05-18

Robotic systems are becoming increasingly important in abdominal surgery. We describe the implementation of a robotic program at a German centre for abdominal surgery, with focus on feasibility, safety, patient selection, learning curves, financial aspects and the lessons learned. This retrospective analysis covered data on patient demographics, intra- and postoperative parameters, oncological results and costs of all robotic-assisted abdominal operations performed at our institution between August 2012 to December 2016. It was also evaluated how possible factors for preoperative patient selection might influence intra- or postoperative outcome and learning parameters. 81 operations were performed - mostly colorectal resections (n = 35), ventral mesh rectopexy (n = 23) and liver resections (n = 18). The conversion rate was 7%. All oncological patients underwent R0 resection. Mean postoperative hospitalisation was 8.8 days; mean morbidity was 24%, with major complications (Clavien-Dindo > II) in 7%; mortality was 0%. BMI above 33.5 kg/m 2 was associated with significantly higher morbidity (p = 0.024) and rate of major complications (p = 0.046), as well as a significantly longer hospitalisation (p = 0.009). Patients older than 65 years had significantly higher morbidity (p = 0.025). With increasing numbers of operations, time of surgery decreased (p = 0.001). The average cost of a robot-assisted operation, including hospital stay, was 15,221 €. The costs of robotic sigmoid resections or liver resections were higher (compared to the open approach: 106.8 and 62.8% higher, respectively, compared to the laparoscopic approach 93.5 and 66.5% higher, respectively). Robotic surgery is a safe approach. A crucial factor in the successful and safe performance of robotic assisted operations is proper patient selection, especially during the implementation period. The inevitable learning curve and the higher costs compared to open and laparocopic surgery must be respected and specialisation of the whole team is necessary. Georg Thieme Verlag KG Stuttgart · New York.

Training in urological robotic surgery. Future perspectives.

PubMed

El Sherbiny, Ahmed; Eissa, Ahmed; Ghaith, Ahmed; Morini, Elena; Marzotta, Lucilla; Sighinolfi, Maria Chiara; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo

2018-01-01

As robotics are becoming more integrated into the medical field, robotic training is becoming more crucial in order to overcome the lack of experienced robotic surgeons. However, there are several obstacles facing the development of robotic training programs like the high cost of training and the increased operative time during the initial period of the learning curve, which, in turn increase the operative cost. Robotic-assisted laparoscopic prostatectomy is the most commonly performed robotic surgery. Moreover, robotic surgery is becoming more popular among urologic oncologists and pediatric urologists. The need for a standardized and validated robotic training curriculum was growing along with the increased number of urologic centers and institutes adopting the robotic technology. Robotic training includes proctorship, mentorship or fellowship, telementoring, simulators and video training. In this chapter, we are going to discuss the different training methods, how to evaluate robotic skills, the available robotic training curriculum, and the future perspectives.

Evaluation of a pet-assisted living intervention for improving functional status in assisted living residents with mild to moderate cognitive impairment: a pilot study.

PubMed

Friedmann, Erika; Galik, Elizabeth; Thomas, Sue A; Hall, P Sue; Chung, Seon Yoon; McCune, Sandra

2015-05-01

In older adults with cognitive impairment (CI), decreased functional status and increased behavioral symptoms require relocation from assisted living (AL) to nursing homes. Studies support positive effects of pets on health/function. Evaluate the effectiveness of the Pet AL (PAL) intervention to support physical, behavioral, and emotional function in AL residents with CI. Cognitively impaired AL residents randomized to 60-90 minute sessions [PAL (n = 22) or reminiscing (n = 18)] twice/week for 12 weeks. PAL interventionist encourages residents to perform skills with the visiting dog; reminiscing interventionist encourages residents to reminisce. Monthly assessment of physical (energy expenditure, activities of daily living), emotional (depression, apathy), and behavioral (agitation) function. In linear mixed models, physical activity depressive symptoms improved more with PAL. Evidence supports that the PAL program helps preserve/enhance function of AL residents with CI. Additional study is required to evaluate the duration and predictors of effectiveness of the PAL intervention. © The Author(s) 2014.

Animal-Assisted Interventions in Dutch Nursing Homes: A Survey.

PubMed

Schuurmans, Lonneke; Enders-Slegers, Marie-Jose; Verheggen, Theo; Schols, Jos

2016-07-01

Animal-assisted interventions (AAI) have become more and more popular in nursing homes in the past decade. Various initiatives for using animals in nursing homes have been developed over the years (eg, animal visiting programs, residential companion animals, petting zoos) and, on the whole, the number of nursing homes that refuse animals on their premises has declined. In this survey, we aimed to determine how many Dutch nursing homes offer AAIs, what type of interventions are used, and with what aim. We also focus on the use of underlying health, hygiene, and (animal) safety protocols. Using an online Dutch nursing home database, we invited all listed (457) nursing home organizations in the Netherlands (encompassing a total of 804 nursing home locations) to participate in our digital survey, powered by SurveyMonkey. The survey consisted of a total of 45 questions, divided into general questions about the use of animals in interventions; the targeted client population(s); and specific questions about goals, guidelines, and protocols. The results were analyzed with SPSS Statistics. In the end, 244 surveys, representing 165 organizations, were returned: 125 nursing homes used AAI in one way or another, 40 did not. Nursing homes that did not offer AAI cited allergy and hygiene concerns as the most important reasons. Most nursing homes offering AAI used visiting animals, mostly dogs (108) or rabbits (76). A smaller number of nursing homes had resident animals, either living on the ward or in a meadow outside. Almost all programs involved animal-assisted activities with a recreational purpose; none of the participating nursing homes provided animal assisted therapy with therapeutic goals. Psychogeriatric patients were most frequently invited to participate. A total of 88 nursing homes used alternatives when animals were not an option or not available. The most popular alternative was the use of stuffed animals (83) followed by FurReal Friends robotic toys (14). The sophisticated robot seal Paro was used in 7 nursing homes. A large percentage (80%) of nursing homes that worked with animals did not have AAI-specific health protocols or animal welfare and safety protocols underlying the animal activities or specific selection criteria for the selection of suitable animals. Most of the participating Dutch nursing homes offer AAI in recreational programs (animal-assisted activities) for psychogeriatric clients (using visiting animals, especially dogs). Most nursing homes do not have specific AAI protocols for animal welfare, hygiene, and safety during animal activities, nor do they employ specific selection criteria for participating animals and their handlers. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Training with a balance exercise assist robot is more effective than conventional training for frail older adults.

PubMed

Ozaki, Kenichi; Kondo, Izumi; Hirano, Satoshi; Kagaya, Hitoshi; Saitoh, Eiichi; Osawa, Aiko; Fujinori, Yoichi

2017-11-01

To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. The present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65-85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001-0.030) compared with conventional exercise. In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982-1990. © 2017 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation. Appendix A: ROBSIM user's guide

NASA Technical Reports Server (NTRS)

Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelley, J. H.; Depkovich, T. M.; Wolfe, W. J.; Nguyen, T.

1986-01-01

The purpose of the Robotics Simulation Program is to provide a broad range of computer capabilities to assist in the design, verification, simulation, and study of robotics systems. ROBSIM is program in FORTRAN 77 for use on a VAX 11/750 computer under the VMS operating system. This user's guide describes the capabilities of the ROBSIM programs, including the system definition function, the analysis tools function and the postprocessor function. The options a user may encounter with each of these executables are explained in detail and the different program prompts appearing to the user are included. Some useful suggestions concerning the appropriate answers to be given by the user are provided. An example user interactive run in enclosed for each of the main program services, and some of the capabilities are illustrated.

LEGO Mindstorms NXT for elderly and visually impaired people in need: A platform.

PubMed

Al-Halhouli, Ala'aldeen; Qitouqa, Hala; Malkosh, Nancy; Shubbak, Alaa; Al-Gharabli, Samer; Hamad, Eyad

2016-07-27

This paper presents the employment of LEGO Mindstorms NXT robotics as core component of low cost multidisciplinary platform for assisting elderly and visually impaired people. LEGO Mindstorms system offers a plug-and-play programmable robotics toolkit, incorporating construction guides, microcontrollers and sensors, all connected via a comprehensive programming language. It facilitates, without special training and at low cost, the use of such device for interpersonal communication and for handling multiple tasks required for elderly and visually impaired people in-need. The research project provides a model for larger-scale implementation, tackling the issues of creating additional functions in order to assist people in-need. The new functions were built and programmed using MATLAB through a user friendly Graphical User Interface (GUI). Power consumption problem, besides the integration of WiFi connection has been resolved, incorporating GPS application on smart phones enhanced the guiding and tracking functions. We believe that developing and expanding the system to encompass a range of applications beyond the initial design schematics to ease conducting a limited number of pre-described protocols. However, the beneficiaries for the proposed research would be limited to elderly people who require assistance within their household as assistive-robot to facilitate a low-cost solution for a highly demanding health circumstance.

Motor learning characterizes habilitation of children with hemiplegic cerebral palsy.

PubMed

Krebs, Hermano I; Fasoli, Susan E; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2012-09-01

This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization.

OLDER ADULTS’ PREFERENCES FOR AND ACCEPTANCE OF ROBOT ASSISTANCE FOR EVERYDAY LIVING TASKS

PubMed Central

Smarr, Cory-Ann; Prakash, Akanksha; Beer, Jenay M.; Mitzner, Tracy L.; Kemp, Charles C.; Rogers, Wendy A.

2014-01-01

Many older adults value their independence and prefer to age in place. Robots can be designed to assist older people with performing everyday living tasks and maintaining their independence at home. Yet, there is a scarcity of knowledge regarding older adults’ attitudes toward robots and their preferences for robot assistance. Twenty-one older adults (M = 80.25 years old, SD = 7.19) completed questionnaires and participated in structured group interviews investigating their openness to and preferences for assistance from a mobile manipulator robot. Although the older adults were generally open to robot assistance for performing home-based tasks, they were selective in their views. Older adults preferred robot assistance over human assistance for many instrumental (e.g., housekeeping, laundry, medication reminders) and enhanced activities of daily living (e.g., new learning, hobbies). However, older adults were less open to robot assistance for some activities of daily living (e.g., shaving, hair care). Results from this study provide insight into older adults’ attitudes toward robot assistance with home-based everyday living tasks. PMID:25284971

Domestic Robots for Older Adults: Attitudes, Preferences, and Potential

PubMed Central

Mitzner, Tracy L.; Beer, Jenay M.; Prakash, Akanksha; Chen, Tiffany L.; Kemp, Charles C.; Rogers, Wendy A.

2014-01-01

The population of older adults in America is expected to reach an unprecedented level in the near future. Some of them have difficulties with performing daily tasks and caregivers may not be able to match pace with the increasing need for assistance. Robots, especially mobile manipulators, have the potential for assisting older adults with daily tasks enabling them to live independently in their homes. However, little is known about their views of robot assistance in the home. Twenty-one independently living older Americans (65–93 years old) were asked about their preferences for and attitudes toward robot assistance via a structured group interview and questionnaires. In the group interview, they generated a diverse set of 121 tasks they would want a robot to assist them with in their homes. These data, along with their questionnaire responses, suggest that the older adults were generally open to robot assistance but were discriminating in their acceptance of assistance for different tasks. They preferred robot assistance over human assistance for tasks related to chores, manipulating objects, and information management. In contrast, they preferred human assistance to robot assistance for tasks related to personal care and leisure activities. Our study provides insights into older adults' attitudes and preferences for robot assistance with everyday living tasks in the home which may inform the design of robots that will be more likely accepted by older adults. PMID:25152779

Domestic Robots for Older Adults: Attitudes, Preferences, and Potential.

PubMed

Smarr, Cory-Ann; Mitzner, Tracy L; Beer, Jenay M; Prakash, Akanksha; Chen, Tiffany L; Kemp, Charles C; Rogers, Wendy A

2014-04-01

The population of older adults in America is expected to reach an unprecedented level in the near future. Some of them have difficulties with performing daily tasks and caregivers may not be able to match pace with the increasing need for assistance. Robots, especially mobile manipulators, have the potential for assisting older adults with daily tasks enabling them to live independently in their homes. However, little is known about their views of robot assistance in the home. Twenty-one independently living older Americans (65-93 years old) were asked about their preferences for and attitudes toward robot assistance via a structured group interview and questionnaires. In the group interview, they generated a diverse set of 121 tasks they would want a robot to assist them with in their homes. These data, along with their questionnaire responses, suggest that the older adults were generally open to robot assistance but were discriminating in their acceptance of assistance for different tasks. They preferred robot assistance over human assistance for tasks related to chores, manipulating objects, and information management. In contrast, they preferred human assistance to robot assistance for tasks related to personal care and leisure activities. Our study provides insights into older adults' attitudes and preferences for robot assistance with everyday living tasks in the home which may inform the design of robots that will be more likely accepted by older adults.

Robotic assistants in personal care: A scoping review.

PubMed

Bilyea, A; Seth, N; Nesathurai, S; Abdullah, H A

2017-11-01

The aim of this study is to present an overview of the technological advances in the field of robotics developed for assistance with activities of daily living (ADL), and to present areas where further research is required. Four databases were searched for articles presenting either a novel design of one of these personal care robotic system or trial results relating to these systems. Articles presenting nine different robotic personal care systems were examined, six of which had been developed after 2005. These six also all have publications relating to their trials. In the majority of trials, patient independence was improved with operation of the robotic device for a specific subset of ADL. A map of the current state of the field of personal care robotics is presented in this study. Areas requiring further research include improving feedback and awareness, as well as refining control methods and pre-programmed behaviors. Developing an affordable, easy to use system would help fill the current gap in the commercial market. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Promoting Interactions Between Humans and Robots Using Robotic Emotional Behavior.

PubMed

Ficocelli, Maurizio; Terao, Junichi; Nejat, Goldie

2016-12-01

The objective of a socially assistive robot is to create a close and effective interaction with a human user for the purpose of giving assistance. In particular, the social interaction, guidance, and support that a socially assistive robot can provide a person can be very beneficial to patient-centered care. However, there are a number of research issues that need to be addressed in order to design such robots. This paper focuses on developing effective emotion-based assistive behavior for a socially assistive robot intended for natural human-robot interaction (HRI) scenarios with explicit social and assistive task functionalities. In particular, in this paper, a unique emotional behavior module is presented and implemented in a learning-based control architecture for assistive HRI. The module is utilized to determine the appropriate emotions of the robot to display, as motivated by the well-being of the person, during assistive task-driven interactions in order to elicit suitable actions from users to accomplish a given person-centered assistive task. A novel online updating technique is used in order to allow the emotional model to adapt to new people and scenarios. Experiments presented show the effectiveness of utilizing robotic emotional assistive behavior during HRI scenarios.

The role of assistive robotics in the lives of persons with disability.

PubMed

Brose, Steven W; Weber, Douglas J; Salatin, Ben A; Grindle, Garret G; Wang, Hongwu; Vazquez, Juan J; Cooper, Rory A

2010-06-01

Robotic assistive devices are used increasingly to improve the independence and quality of life of persons with disabilities. Devices as varied as robotic feeders, smart-powered wheelchairs, independent mobile robots, and socially assistive robots are becoming more clinically relevant. There is a growing importance for the rehabilitation professional to be aware of available systems and ongoing research efforts. The aim of this article is to describe the advances in assistive robotics that are relevant to professionals serving persons with disabilities. This review breaks down relevant advances into categories of Assistive Robotic Systems, User Interfaces and Control Systems, Sensory and Feedback Systems, and User Perspectives. An understanding of the direction that assistive robotics is taking is important for the clinician and researcher alike; this review is intended to address this need.

Robotic-Assisted Versus Laparoscopic Colectomy: Cost and Clinical Outcomes

PubMed Central

Davis, Bradley R.; Yoo, Andrew C.; Moore, Matt

2014-01-01

Background and Objectives: Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Methods: Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Results: Of 25 758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17 445 vs $15 448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Conclusion: Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies. PMID:24960484

Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes.

PubMed

Davis, Bradley R; Yoo, Andrew C; Moore, Matt; Gunnarsson, Candace

2014-01-01

Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.

Health Care Robotics: A Progress Report

NASA Technical Reports Server (NTRS)

Fiorini, Paolo; Ali, Khaled; Seraji, Homayoun

1997-01-01

This paper describes the approach followed in the design of a service robot for health care applications. Under the auspices of the NASA Technology Transfer program, a partnership was established between JPL and RWI, a manufacturer of mobile robots, to design and evaluate a mobile robot for health care assistance to the elderly and the handicapped. The main emphasis of the first phase of the project is on the development on a multi-modal operator interface and its evaluation by health care professionals and users. This paper describes the architecture of the system, the evaluation method used, and some preliminary results of the user evaluation.

Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China.

PubMed

Jun, Yi; Hao, Li; Demin, Li; Guohua, Dong; Hua, Jing; Yi, Shen

2014-09-01

Da Vinci robot-assisted thymectomy has been used in the past several years in China, however, practical experience in performing this approach in China remains limited. Thus, the study aimed to evaluate the experience of da Vinci robot-assisted thymectomy in China. From June 2010 to December 2012, 55 patients with diseases of the thymus underwent thymectomy using the da Vinci surgical HD robotic system. The clinical data of the da Vinci robot-assisted thymectomies were compared with the data of video-assisted thoracoscopic thymectomies in the same period. All da Vinci robot operations were successful. This is a retrospective analysis which demonstrated that compared with video-assisted thoracoscopic thymectomy in the same period, the clinical outcomes of da Vinci robot-assisted thymectomy were not significantly different. The da Vinci robot-assisted thymectomy is a safe, minimally invasive, and convenient operation, and shows promise for general thoracic surgery in China. Copyright © 2014 John Wiley & Sons, Ltd.

Intracorporeal Double-J stent placement during robot-assisted urinary tract reconstruction: technical considerations.

PubMed

Mufarrij, Patrick W; Rajamahanty, Srinivas; Krane, L Spencer; Hemal, Ashok K

2012-09-01

An integral component of many urologic reconstructive surgical procedures is the positioning of a Double-J stent to span the anastomosis. Some surgeons prefer to place a retrograde stent during cystoscopy, either during or after the reconstruction. In this communication, we describe our straightforward and effective approach of performing this critical step intracorporeally using robotic assistance in a variety of upper tract urologic reconstructive procedures. We examined our Institutional Review Board-approved database of robotic surgeries to identify reconstructive operations that included the intracorporeal placement of a Double-J stent since 2008. Our step-by-step method for stent placement during various robotic urologic reconstructions is detailed, including procedures involving the proximal, mid, and distal ureter. With the aid of a bedside assistant-surgeon, we delineate how the console surgeon is able to perform this step of the procedure completely intracorporeally, without the need for repositioning or cystoscopy. Since the inception of our robotic surgical program in 2008, we have used these robotic stent placement techniques in 150 patients. The average time of robotic intracorporeal stent placement across the anastomosis was 3.5 minutes. Three patients did experience proximal stent migration, as documented on postoperative radiographs, but all were treated with conservative measures, because their anastomosis was not affected and severe symptoms did not develop. No patient needed stent replacement, and each stent was subsequently removed ureteroscopically without sequelae. Our robotic intracorporeal Double-J stent placement approach is simple and effective, avoids the need for cystoscopy and fluoroscopy, and can be used in any type of upper urinary tract urologic reconstruction.

Performance Evaluation Methods for Assistive Robotic Technology

NASA Astrophysics Data System (ADS)

Tsui, Katherine M.; Feil-Seifer, David J.; Matarić, Maja J.; Yanco, Holly A.

Robots have been developed for several assistive technology domains, including intervention for Autism Spectrum Disorders, eldercare, and post-stroke rehabilitation. Assistive robots have also been used to promote independent living through the use of devices such as intelligent wheelchairs, assistive robotic arms, and external limb prostheses. Work in the broad field of assistive robotic technology can be divided into two major research phases: technology development, in which new devices, software, and interfaces are created; and clinical, in which assistive technology is applied to a given end-user population. Moving from technology development towards clinical applications is a significant challenge. Developing performance metrics for assistive robots poses a related set of challenges. In this paper, we survey several areas of assistive robotic technology in order to derive and demonstrate domain-specific means for evaluating the performance of such systems. We also present two case studies of applied performance measures and a discussion regarding the ubiquity of functional performance measures across the sampled domains. Finally, we present guidelines for incorporating human performance metrics into end-user evaluations of assistive robotic technologies.

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke.

PubMed

Pila, Ophélie; Duret, Christophe; Laborne, François-Xavier; Gracies, Jean-Michel; Bayle, Nicolas; Hutin, Emilie

2017-10-13

When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). EudraCT 2016-005121-36 . Date of Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24 (retrospective data).

Human-Robot Interaction: Does Robotic Guidance Force Affect Gait-Related Brain Dynamics during Robot-Assisted Treadmill Walking?

PubMed

Knaepen, Kristel; Mierau, Andreas; Swinnen, Eva; Fernandez Tellez, Helio; Michielsen, Marc; Kerckhofs, Eric; Lefeber, Dirk; Meeusen, Romain

2015-01-01

In order to determine optimal training parameters for robot-assisted treadmill walking, it is essential to understand how a robotic device interacts with its wearer, and thus, how parameter settings of the device affect locomotor control. The aim of this study was to assess the effect of different levels of guidance force during robot-assisted treadmill walking on cortical activity. Eighteen healthy subjects walked at 2 km.h-1 on a treadmill with and without assistance of the Lokomat robotic gait orthosis. Event-related spectral perturbations and changes in power spectral density were investigated during unassisted treadmill walking as well as during robot-assisted treadmill walking at 30%, 60% and 100% guidance force (with 0% body weight support). Clustering of independent components revealed three clusters of activity in the sensorimotor cortex during treadmill walking and robot-assisted treadmill walking in healthy subjects. These clusters demonstrated gait-related spectral modulations in the mu, beta and low gamma bands over the sensorimotor cortex related to specific phases of the gait cycle. Moreover, mu and beta rhythms were suppressed in the right primary sensory cortex during treadmill walking compared to robot-assisted treadmill walking with 100% guidance force, indicating significantly larger involvement of the sensorimotor area during treadmill walking compared to robot-assisted treadmill walking. Only marginal differences in the spectral power of the mu, beta and low gamma bands could be identified between robot-assisted treadmill walking with different levels of guidance force. From these results it can be concluded that a high level of guidance force (i.e., 100% guidance force) and thus a less active participation during locomotion should be avoided during robot-assisted treadmill walking. This will optimize the involvement of the sensorimotor cortex which is known to be crucial for motor learning.

Resident training in a new robotic thoracic surgery program.

PubMed

White, Yasmine N; Dedhia, Priya; Bergeron, Edward J; Lin, Jules; Chang, Andrew A; Reddy, Rishindra M

2016-03-01

The volume of robot-assisted operations has drastically increased over the past decade. New programs have focused on training surgeons, whereas resident training has lagged behind. The objective of this study was to evaluate our institutional experience with resident participation in thoracic robotic surgery cases since the initiation of our program. The first 100 robotic thoracic surgery cases at our institution were retrospectively reviewed and categorized into three sequential cohorts. Procedure type, patient and operative characteristics, level of resident participation (primary surgeon [PS] or assistant), and postoperative variables were evaluated. Of the first 100 cases, 38% were lung resections, 23% were esophageal operations, and 20% were sympathectomies. The distribution of cases changed over time with the proportion of pulmonary resections significantly increasing. Patient age (P < 0.05), body mass index (P = not significant [NS]), and comorbidities (P = NS) increased over time. Resident participation as PS increased from 33%-59% between the early and late cohorts (P < 0.05). A subset analysis of the 20 lobectomies (7 attending PS, 13 residents) showed similar patient characteristics (P = NS): age (67 versus 69), body mass index (29.5 versus 26.1), and American Society of Anesthesiologists category (2.8 versus 2.8). Operative and postoperative characteristics were also similar (P = NS) regardless of PS: operative time (260 versus 249 min), estimated blood loss (187 versus 203 mL), and length of stay (4.8 versus 4.7 d). Residents can participate as the PS in a variety of thoracic operations during the implementation of a robotics program. Operative time, estimated blood loss, and length of stay were similar regardless of level of resident participation. Copyright © 2016 Elsevier Inc. All rights reserved.

Motor Learning Characterizes Habilitation of Children With Hemiplegic Cerebral Palsy

PubMed Central

Krebs, Hermano I.; Fasoli, Susan E.; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2015-01-01

Background This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Methods Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. Results After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Conclusions Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization. PMID:22331211

Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke.

PubMed

Hu, Xiao-Ling; Tong, Raymond Kai-yu; Ho, Newmen S K; Xue, Jing-jing; Rong, Wei; Li, Leonard S W

2015-09-01

Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke. To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training. This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training. The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05). The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress. © The Author(s) 2014.

Assistant Personal Robot (APR): Conception and Application of a Tele-Operated Assisted Living Robot.

PubMed

Clotet, Eduard; Martínez, Dani; Moreno, Javier; Tresanchez, Marcel; Palacín, Jordi

2016-04-28

This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short) and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast high-mobility motion system adapted for tele-operation in plain indoor areas, which incorporates a high-priority collision avoidance procedure. This paper presents the mechanical architecture, electrical fundaments and software implementation required in order to develop the main functionalities of an assistive robot. The APR uses a tablet in order to implement the basic peer-to-peer videoconference and tele-operation control combined with a tactile graphic user interface. The paper also presents the development of some applications proposed in the framework of an assisted living robot.

SSVEP-based Experimental Procedure for Brain-Robot Interaction with Humanoid Robots.

PubMed

Zhao, Jing; Li, Wei; Mao, Xiaoqian; Li, Mengfan

2015-11-24

Brain-Robot Interaction (BRI), which provides an innovative communication pathway between human and a robotic device via brain signals, is prospective in helping the disabled in their daily lives. The overall goal of our method is to establish an SSVEP-based experimental procedure by integrating multiple software programs, such as OpenViBE, Choregraph, and Central software as well as user developed programs written in C++ and MATLAB, to enable the study of brain-robot interaction with humanoid robots. This is achieved by first placing EEG electrodes on a human subject to measure the brain responses through an EEG data acquisition system. A user interface is used to elicit SSVEP responses and to display video feedback in the closed-loop control experiments. The second step is to record the EEG signals of first-time subjects, to analyze their SSVEP features offline, and to train the classifier for each subject. Next, the Online Signal Processor and the Robot Controller are configured for the online control of a humanoid robot. As the final step, the subject completes three specific closed-loop control experiments within different environments to evaluate the brain-robot interaction performance. The advantage of this approach is its reliability and flexibility because it is developed by integrating multiple software programs. The results show that using this approach, the subject is capable of interacting with the humanoid robot via brain signals. This allows the mind-controlled humanoid robot to perform typical tasks that are popular in robotic research and are helpful in assisting the disabled.

SSVEP-based Experimental Procedure for Brain-Robot Interaction with Humanoid Robots

PubMed Central

Zhao, Jing; Li, Wei; Mao, Xiaoqian; Li, Mengfan

2015-01-01

Brain-Robot Interaction (BRI), which provides an innovative communication pathway between human and a robotic device via brain signals, is prospective in helping the disabled in their daily lives. The overall goal of our method is to establish an SSVEP-based experimental procedure by integrating multiple software programs, such as OpenViBE, Choregraph, and Central software as well as user developed programs written in C++ and MATLAB, to enable the study of brain-robot interaction with humanoid robots. This is achieved by first placing EEG electrodes on a human subject to measure the brain responses through an EEG data acquisition system. A user interface is used to elicit SSVEP responses and to display video feedback in the closed-loop control experiments. The second step is to record the EEG signals of first-time subjects, to analyze their SSVEP features offline, and to train the classifier for each subject. Next, the Online Signal Processor and the Robot Controller are configured for the online control of a humanoid robot. As the final step, the subject completes three specific closed-loop control experiments within different environments to evaluate the brain-robot interaction performance. The advantage of this approach is its reliability and flexibility because it is developed by integrating multiple software programs. The results show that using this approach, the subject is capable of interacting with the humanoid robot via brain signals. This allows the mind-controlled humanoid robot to perform typical tasks that are popular in robotic research and are helpful in assisting the disabled. PMID:26650051

Development of robotic program: an Asian experience.

PubMed

Sahabudin, R M; Arni, T; Ashani, N; Arumuga, K; Rajenthran, S; Murali, S; Patel, V; Hemal, A; Menon, M

2006-06-01

Robotic surgery was started in the Department of Urology, Hospital Kuala Lumpur, in April 2004. We present our experience in developing the program and report the results of our first 50 cases of robotic radical prostatectomy. A three-arm da Vinci robotic system was installed in our hospital in March 2004. Prior to installation, the surgeons underwent training at various centers in the United States and Paris. The operating theatre was renovated to house the system. Subsequently, the initial few cases were done with the help of proctors. Data were prospectively collected on all patients who underwent robot-assisted radical prostatectomy for localized carcinoma of the prostate. Fifty patients underwent robot assisted radical prostatectomy from March 2004 to June 2005. Their ages ranged from 52 to 75 years, (average age 60.2 years). PSA levels ranged from 2.5 to 35 ng/ml (mean 10.6 ng/ml). Prostate volume ranged from 18 to 130 cc (average 32.4 cc). Average operating time for the first 20 cases was 4 h and for the next 30 cases was 2.5 h. Patients were discharged 1-3 days post-operatively. Catheters were removed on the fifth day following a cystogram. The positive margin rate as defined by the presence of cancer cells at the inked margin was 30%. Twenty-one patients had T1c disease and one had T1b on clinical staging. Of these, two were apical margin positive. Twenty-six patients had T2 disease and eight of them were apical margin positive. Two patients had T3 disease, one of whom was apical margin positive. Five patients (10%) had PSA recurrence. Five patients had a poorly differentiated carcinoma and the rest had Gleason 6 or 7. Eighty percent of the patients were continent on follow-up at 3 months. Of those who were potent before the surgery, 50% were potent at 3-6 months. The robotic surgery program was successfully implemented at our center on the lines of a structured program, developed at Vattikuti Urology Institute (VUI). We succeeded in creating a team and safely implemented the robotic program in our system. Adequate funding and extensive training followed by a short term proctoring are essential for this implementation.

Development and Validation of a Quality Assurance Score for Robot-assisted Radical Cystectomy: A 10-year Analysis.

PubMed

Hussein, Ahmed A; Dibaj, Shiva; Hinata, Nobuyuki; Field, Erinn; O'leary, Kathleen; Kuvshinoff, Boris; Mohler, James L; Wilding, Gregory; Guru, Khurshid A

2016-11-01

To develop quality assessment tool to evaluate surgical performance for robot-assisted radical cystectomy program. A prospectively maintained quality assurance database of 425 consecutive robot-assisted radical cystectomies performed by a single surgeon between 2005 and 2015 was retrospectively reviewed. Potentially modifiable factors, related to the management and perioperative care of patients, were used to evaluate patient care. Criteria included the following: preoperative (administration of neoadjuvant chemotherapy); operative (operative time <6.5 hours and estimated blood loss <500 cc); pathologic (negative soft tissue surgical margins and lymph node yield ≥20); and postoperative (no high-grade complications, readmission, or noncancer-related mortality within 30 days).The Quality Cystectomy Score (QCS) was developed (1 star: achieving ≤2 criteria or mortality within 30 days; 2 stars: 3 or 4 criteria met; 3 stars: 5 or 6 criteria met; and 4 stars: 7 or all criteria met). Univariate and multivariate Cox proportional hazard regression models were fitted to test for the association between QCS and survival outcomes. Most patients (85%) achieved at least 3 stars, and more patients achieved 4 stars with time. High QCS was associated with better recurrence-free, cancer-specific, and overall survival (P values <.05). None of the patients with 1-star were alive at 1 year. Patients with 4 stars achieved the best survival rates (recurrence-free survival [62%], cancer-specific survival [70%], and overall survival [53%] at 5 years) (log rank P < .0001). Continuous assessment for quality improvement facilitated implementation and maintenance of robot-assisted program for bladder cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Application of External Axis in Robot-Assisted Thermal Spraying

NASA Astrophysics Data System (ADS)

Deng, Sihao; Fang, Dandan; Cai, Zhenhua; Liao, Hanlin; Montavon, Ghislain

2012-12-01

Currently, industrial robots are widely used in the process of thermal spraying because of their high efficiency, security, and repeatability. Although robots are found suitable for use in industrial productions, they have some natural disadvantages because of their six-axis mechanical linkages. When a robot performs a series of stages of production, it could be hard to move from one to another because a few axes reach their limit value. For this reason, an external axis should be added to the robot system to extend the reachable space of the robots. This article concerns the application of external axis on ABB robots in thermal spraying and the different methods of off-line programming with external axis in the virtual environment. The developed software toolkit was applied to coat real workpiece with a complex geometry in atmospheric plasma spraying).

Working and Learning with Knowledge in the Lobes of a Humanoid's Mind

NASA Technical Reports Server (NTRS)

Ambrose, Robert; Savely, Robert; Bluethmann, William; Kortenkamp, David

2003-01-01

Humanoid class robots must have sufficient dexterity to assist people and work in an environment designed for human comfort and productivity. This dexterity, in particular the ability to use tools, requires a cognitive understanding of self and the world that exceeds contemporary robotics. Our hypothesis is that the sense-think-act paradigm that has proven so successful for autonomous robots is missing one or more key elements that will be needed for humanoids to meet their full potential as autonomous human assistants. This key ingredient is knowledge. The presented work includes experiments conducted on the Robonaut system, a NASA and the Defense Advanced research Projects Agency (DARPA) joint project, and includes collaborative efforts with a DARPA Mobile Autonomous Robot Software technical program team of researchers at NASA, MIT, USC, NRL, UMass and Vanderbilt. The paper reports on results in the areas of human-robot interaction (human tracking, gesture recognition, natural language, supervised control), perception (stereo vision, object identification, object pose estimation), autonomous grasping (tactile sensing, grasp reflex, grasp stability) and learning (human instruction, task level sequences, and sensorimotor association).

A robotic home telehealth platform system for treatment adherence, social assistance and companionship - an overview.

PubMed

Oddsson, Lars I E; Radomski, Mary V; White, Matthew; Nilsson, Daniel

2009-01-01

Well-known difficulties of making patients adhere to assigned treatments have made engineers and clinicians look towards technology for possible solutions. Recent studies have found that cell phone-based text messaging can help drive positive changes in patients' disease management and preventive health behavior. Furthermore, work in the area of assistive robotics indicates benefits for patients although robotic solutions tend to become expensive. However, continued improvement in sensor, computer and wireless technologies combined with decreases in cost is paving the way for development of affordable robotic systems that can help improve patient care and potentially add value to the healthcare system. This paper provides a high-level design overview of SKOTEE, the Sister Kenny hOme ThErapy systEm, an inexpensive robotic platform system designed to provide adherence support for home exercise programs, taking medication, appointment reminders and clinician communication. SKOTEE will also offer companionship as well as entertainment and social networking opportunities to the patient in their home. A video of the system is presented at the conference.

Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

PubMed

Dandolu, Vani; Pathak, Prathamesh

2018-06-01

To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health resource utilization and costs than other minimally invasive approaches. Given the high costs associated with robot-assisted hysterectomy, it is important to understand the specific indications for this approach and to identify the patients who may benefit.

Robot-assisted general surgery.

PubMed

Hazey, Jeffrey W; Melvin, W Scott

2004-06-01

With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

Human-Robot Interaction: Does Robotic Guidance Force Affect Gait-Related Brain Dynamics during Robot-Assisted Treadmill Walking?

PubMed Central

Knaepen, Kristel; Mierau, Andreas; Swinnen, Eva; Fernandez Tellez, Helio; Michielsen, Marc; Kerckhofs, Eric; Lefeber, Dirk; Meeusen, Romain

2015-01-01

In order to determine optimal training parameters for robot-assisted treadmill walking, it is essential to understand how a robotic device interacts with its wearer, and thus, how parameter settings of the device affect locomotor control. The aim of this study was to assess the effect of different levels of guidance force during robot-assisted treadmill walking on cortical activity. Eighteen healthy subjects walked at 2 km.h-1 on a treadmill with and without assistance of the Lokomat robotic gait orthosis. Event-related spectral perturbations and changes in power spectral density were investigated during unassisted treadmill walking as well as during robot-assisted treadmill walking at 30%, 60% and 100% guidance force (with 0% body weight support). Clustering of independent components revealed three clusters of activity in the sensorimotor cortex during treadmill walking and robot-assisted treadmill walking in healthy subjects. These clusters demonstrated gait-related spectral modulations in the mu, beta and low gamma bands over the sensorimotor cortex related to specific phases of the gait cycle. Moreover, mu and beta rhythms were suppressed in the right primary sensory cortex during treadmill walking compared to robot-assisted treadmill walking with 100% guidance force, indicating significantly larger involvement of the sensorimotor area during treadmill walking compared to robot-assisted treadmill walking. Only marginal differences in the spectral power of the mu, beta and low gamma bands could be identified between robot-assisted treadmill walking with different levels of guidance force. From these results it can be concluded that a high level of guidance force (i.e., 100% guidance force) and thus a less active participation during locomotion should be avoided during robot-assisted treadmill walking. This will optimize the involvement of the sensorimotor cortex which is known to be crucial for motor learning. PMID:26485148

Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages?

PubMed

Lee, Benjamin E; Korst, Robert J; Kletsman, Elaine; Rutledge, John R

2014-02-01

To determine if there are advantages to transitioning to robotics by a surgeon who is already proficient in performing video-assisted thoracic surgical (VATS) lobectomy. A single surgeon proficient in VATS lobectomy initiated a robotic lobectomy program, and a retrospective review was conducted of his patients undergoing minimally invasive lobectomy (robotics or VATS) for lung cancer between 2011 and 2012. Data collected included patient/tumor characteristics, morbidity, mortality, operative times, and length of hospital stay. Over a 24-month period, a total of 69 patients underwent minimally invasive lobectomy (35 robotic, 34 VATS). Patients in each group were similar in age and clinical stage. Robotic upper lobectomy operative times were longer than VATS (172 vs 134 minutes; P = .001), with no significant difference in lower lobectomies noted (140 vs 123 minutes; P = .1). Median length of stay was 3 days in both groups, and the median number of lymph nodes harvested was 18 (robotic) versus 16 (VATS; P = .42). Morbidity and mortality for robotic versus VATS were 11% versus 18% (P = .46) and 0% versus 3% (P = .49), respectively. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes. The learning curve for robotic upper lobectomies seems to be more significant than that for lower lobectomies. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Perioperative outcomes of video- and robot-assisted segmentectomies.

PubMed

Rinieri, Philippe; Peillon, Christophe; Salaün, Mathieu; Mahieu, Julien; Bubenheim, Michael; Baste, Jean-Marc

2016-02-01

Video-assisted thoracic surgery appears to be technically difficult for segmentectomy. Conversely, robotic surgery could facilitate the performance of segmentectomy. The aim of this study was to compare the early results of video- and robot-assisted segmentectomies. Data were collected prospectively on videothoracoscopy from 2010 and on robotic procedures from 2013. Fifty-one patients who were candidates for minimally invasive segmentectomy were included in the study. Perioperative outcomes of video-assisted and robotic segmentectomies were compared. The minimally invasive segmentectomies included 32 video- and 16 robot-assisted procedures; 3 segmentectomies (2 video-assisted and 1 robot-assisted) were converted to lobectomies. Four conversions to thoracotomy were necessary for anatomical reason or arterial injury, with no uncontrolled bleeding in the robotic arm. There were 7 benign or infectious lesions, 9 pre-invasive lesions, 25 lung cancers, and 10 metastatic diseases. Patient characteristics, type of segment, conversion to thoracotomy, conversion to lobectomy, operative time, postoperative complications, chest tube duration, postoperative stay, and histology were similar in the video and robot groups. Estimated blood loss was significantly higher in the video group (100 vs. 50 mL, p = 0.028). The morbidity rate of minimally invasive segmentectomy was low. The short-term results of video-assisted and robot-assisted segmentectomies were similar, and more data are required to show any advantages between the two techniques. Long-term oncologic outcomes are necessary to evaluate these new surgical practices. © The Author(s) 2016.

STS-61 crew utilizing Virtual Reality in training for HST repair mission

NASA Image and Video Library

1993-06-11

Astronaut Jeffrey A. Hoffman, one of four crewmembers for STS-61 that will conduct scheduled spacewalks during the flight, wears a special helmet and gloves designed to assist in proper positioning near the telescope while on the end of the robot arm. Crewmembers are utilizing a new virtual reality training aid which assists in refining positioning patterns for Space Shuttle Endeavour's Remote Manipulator System (RMS) (36890); Astronaut Claude Nicollier looks at a computer display of the Shuttle's robot arm movements as Thomas D. Akers and Kathryn C. Thornton, mission specialists look on. Nicollier will be responsible for maneuvering the astronauts while they stand in a foot restraint on the end of the RMS arm (36891,36894); Hoffman wears a special helmet and gloves designed to assist in proper positioning near the telescope while on the end of the robot arm (35892); Nicollier looks at a computer display of the Shuttle's robot arm movements as Akers looks on (36893); While (l-r) Astronauts Kenneth Bowersox, Kathryn Thornton, Richard O. Covey and Thomas D. Akers watch, Nicollier moves the Robot arm to desired locations in the Shuttle's payload bay using the Virtual Reality program (36895); Bowersox takes his turn maneuvering the RMS while mission specialist Hoffman, wearing the Virtual Reality helmet, follows his own progress on the end of the robot arm. Crewmembers participating during the training session are (l-r) Astronauts Akers, Hoffman, Bowersox, Nicollier, Covey, and Thornton. In the background, David Homan, an engineer in the JSC Engineering Directorate's Automation and Robotics Division, looks on (36896).

Robot assistant versus human or another robot assistant in patients undergoing laparoscopic cholecystectomy.

PubMed

Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Fusai, Giuseppe; Davidson, Brian R

2012-09-12

The role of a robotic assistant in laparoscopic cholecystectomy is controversial. While some trials have shown distinct advantages of a robotic assistant over a human assistant others have not, and it is unclear which robotic assistant is best. The aims of this review are to assess the benefits and harms of a robot assistant versus human assistant or versus another robot assistant in laparoscopic cholecystectomy, and to assess whether the robot can substitute the human assistant. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (until February 2012) for identifying the randomised clinical trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing robot assistants versus human assistants in laparoscopic cholecystectomy were considered for the review. Randomised clinical trials comparing different types of robot assistants were also considered for the review. Two authors independently identified the trials for inclusion and independently extracted the data. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) using the fixed-effect and the random-effects models based on intention-to-treat analysis, when possible, using Review Manager 5. We included six trials with 560 patients. One trial involving 129 patients did not state the number of patients randomised to the two groups. In the remaining five trials 431 patients were randomised, 212 to the robot assistant group and 219 to the human assistant group. All the trials were at high risk of bias. Mortality and morbidity were reported in only one trial with 40 patients. There was no mortality or morbidity in either group. Mortality and morbidity were not reported in the remaining trials. Quality of life or the proportion of patients who were discharged as day-patient laparoscopic cholecystectomy patients were not reported in any trial. There was no significant difference in the proportion of patients who required conversion to open cholecystectomy (2 trials; 4/63 (weighted proportion 6.4%) in the robot assistant group versus 5/70 (7.1%) in the human assistant group; RR 0.90; 95% CI 0.25 to 3.20). There was no significant difference in the operating time between the two groups (4 trials; 324 patients; MD 5.00 minutes; 95% CI -0.55 to 10.54). In one trial, about one sixth of the laparoscopic cholecystectomies in which a robot assistant was used required temporary use of a human assistant. In another trial, there was no requirement for human assistants. One trial did not report this information. It appears that there was little or no requirement for human assistants in the other three trials. There were no randomised trials comparing one type of robot versus another type of robot. Robot assisted laparoscopic cholecystectomy does not seem to offer any significant advantages over human assisted laparoscopic cholecystectomy. However, all trials had a high risk of systematic errors or bias (that is, risk of overestimation of benefit and underestimation of harm). All trials were small, with few or no outcomes. Hence, the risk of random errors (that is, play of chance) is high. Further randomised trials with low risk of bias or random errors are needed.

Robot-assisted Ivor-Lewis esophagectomy with intrathoracic robot-sewn anastomosis.

PubMed

Jin, Runsen; Xiang, Jie; Han, Dingpei; Zhang, Yajie; Li, Hecheng

2017-11-01

This video clip demonstrated a performance of robot-assisted Ivor-Lewis esophagectomy with intrathoracic robot-sewn anastomosis. The patient had an esophageal mass located approximately 33 cm away from incisor, and robot-assisted Ivor-Lewis esophagectomy was applied for him. Importantly, a double-layer esophago-gastric anastomosis was made by robotic hand-sewn suture. Our early experience demonstrated that the robot-sewn intrathoracic anastomosis is feasible and safe with a lower complication rate and the absence of anastomotic leakage.

Robot-assisted radical cystectomy – first Polish clinical outcomes

PubMed Central

Juszczak, Kajetan; Poblocki, Pawel; Mikolajczak, Witold; Drewa, Tomasz

2017-01-01

Introduction Urothelial cell carcinoma is the most common neoplasm of the genito-urinary tract, which, in advanced stages, is treated with radical cystectomy with pelvic lymphadenectomy. It can be performed by an open or minimally invasive approach (laparoscopic and robot-assisted radical cystectomy). Large meta-analyses showed a significantly lower complication rate in the RARC (robot-assisted radical cystectomy) group compared to ORC (open radical cystectomy) in thirty and ninety days after surgery, with similar oncological and functional outcomes. The clinical outcomes of the first forty Polish RARC are explored in this article. Material and methods The Polish Radical Robotic Cystectomy Program (PRRC) was started in 2016 at the Nicolaus Copernicus Hospital in Toruń. Forty consecutive patients, with indications for cystectomy were included into the study. During radical robot-assisted cystectomy, obturator, external, internal, common iliac and presacral lymph nodes were dissected. Oncological outcomes, early complication rate, and the clinical variables were analyzed. Results The mean age in the study group was sixty-seven years, with the majority of patients being overweight and assessed as American Society of Anesthesiology Scale (ASA) – ASA III and ASA IV (2/3 of patients). RARC was performed, with the median time of surgery being 324 minutes (170 minutes being the shortest). Mean blood loss was 365 ml (lowest – 50 ml), and only 2 patients required intraoperative blood transfusion. Twenty patients had ileal conduit, and nineteen had other methods of urinary diversion. Only twenty-nine out of forty patients had minor complications (Clavien I and II), 11 had Clavien III and IV. Clavien V was not present. Only 3 patients required reoperation. Conclusions RARC is a reproducible oncological procedure, which can be safely performed in centers with robotic expertise, with acceptable operative time, complications, and functional and oncologic outcomes. PMID:29732201

The New Approach to Self-Achievement (N.A.S.A.) Project 2004

NASA Technical Reports Server (NTRS)

Thomas, Candace J.

2004-01-01

The New Approach to Self-Achievement Program is designed to target rising seventh, eighth, and ninth grade students who require assistance in refining their mathematical skills, science awareness and knowledge, and test taking strategies. During the six week duration of the program, students are challenged in these areas through the application of robotic and aeronautic projects which encourage the students to practically apply their mathematical and science awareness accordingly. The first three weeks of my tenure were designated to assisting Mrs. Tammy Allen in the preparation of the 2004 NASA Project. As her assistant, I was held accountable for organizing, filing, preparing, analyzing, and completing the applications for the NASA Project. Additionally, I constructed the apposite databases which contained imperative information which aided in the selection of our participants. During the latter portion of those three weeks, Mrs. Allen, various staff members, and I, interviewed the numerous first-time applicants of the NASA Project. Furthermore, I was assigned to contact the accepted applicants of the program and provide all necessary information for the initiation of the child into the NASA Project. During the six week duration of the program, I will be working as a Project Leader at the Lorain Middle School site located in Lorain, Oh, with Mr. Fondriest Fountain. Mr. Fountain and I Will work with the eighth and ninth grade students in constructing robots, in which the students are told are made for NASA research which is being conducted on the surface of planet Mars. The robots, which are built from LEGOS and programmed through RoboLab computer software, are prepared to complete assigned Missions such as running obstacle courses; plowing and retrieving LEGOS; and scanning surfaces for intense regions of light.

Experimental analysis of robot-assisted needle insertion into porcine liver.

PubMed

Wang, Wendong; Shi, Yikai; Goldenberg, Andrew A; Yuan, Xiaoqing; Zhang, Peng; He, Lijing; Zou, Yingjie

2015-01-01

How to improve placement accuracy of needle insertion into liver tissue is of paramount interest to physicians. A robot-assisted system was developed to experimentally demonstrate its advantages in needle insertion surgeries. Experiments of needle insertion into porcine liver tissue were performed with conic tip needle (diameter 8 mm) and bevel tip needle (diameter 1.5 mm) in this study. Manual operation was designed to compare the performance of the presented robot-assisted system. The real-time force curves show outstanding advantages of robot-assisted operation in improving the controllability and stability of needle insertion process by comparing manual operation. The statistics of maximum force and average force further demonstrates robot-assisted operation causes less oscillation. The difference of liver deformation created by manual operation and robot-assisted operation is very low, 1 mm for average deformation and 2 mm for maximum deformation. To conclude, the presented robot-assisted system can improve placement accuracy of needle by stably control insertion process.

Industrial Robots For Measurement And Inspection Purposes

NASA Astrophysics Data System (ADS)

Ahlers, R.-J.

1989-02-01

The use of industrial robots for measuring and testing is becoming increasingly significant as a component of flexible production. In the early stages of their development robots were used mainly for monotonous and repetitive tasks such as handling and spot welding. Thanks to improvements in the precision with which they work and also in control and regulation technologies, it is possible today to employ robots as flexible, sensor-assisted and even "intellligent" tools for measuring and testing. As a result, however, much higher accuracy is demanded of the robots used for such purposes. In addition, robot measurement and acceptance test requirements have become more exacting. The present paper is based on recommendations that have been developed by cooperative work of the Association of German-Engineers (VDI/GMA). The appropriate working group is entitled "Industrial Robots -Measurement and Inspection". The author is the chairman of this working group. Apart from the technical equipment involved, the use of industrial robots for measuring purposes also calls for the devi-sing and programming of appropriate measuring strategies. In this context the planning and implementation of measuring projects have to be discussed along with software reliability and on-line/off-line programming strategies. Four different utilizations of robots for measuring and testing are presented and illustrated by examples.

Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012.

PubMed

Bowen, Diana K; Faasse, Mark A; Liu, Dennis B; Gong, Edward M; Lindgren, Bruce W; Johnson, Emilie K

2016-07-01

We characterize the use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States from 2000 to 2012. We used the Kids' Inpatient Database to identify patients who underwent ureteral reimplantation for primary vesicoureteral reflux. Before 2009 laparoscopic ureteral reimplantion and robot-assisted laparoscopic ureteral reimplantation were referred to together as minimally invasive ureteral reimplantation. A detailed analysis of open vs robot-assisted laparoscopic ureteral reimplantation was performed for 2009 and 2012. A total of 14,581 ureteral reimplantations were performed. The number of ureteral reimplantations yearly decreased by 14.3%. However, the proportion of minimally invasive ureteral reimplantations increased from 0.3% to 6.3%. A total of 125 robot-assisted laparoscopic ureteral reimplantations were performed in 2012 (81.2% of minimally invasive ureteral reimplantations), representing 5.1% of all ureteral reimplantations, compared to 3.8% in 2009. In 2009 and 2012 mean ± SD patient age was 5.7 ± 3.6 years for robot-assisted laparoscopic ureteral reimplantation and 4.3 ± 3.3 years for open reimplantation (p <0.0001). Mean ± SD length of hospitalization was 1.6 ± 1.3 days for robot-assisted laparoscopic ureteral reimplantation and 2.4 ± 2.6 for open reimplantation (p <0.0001). Median charges were $22,703 for open and $32,409 for robot-assisted laparoscopic ureteral reimplantation (p <0.0001). These relationships maintained significance on multivariate analyses. On multivariate analysis robot-assisted laparoscopic ureteral reimplantation use was associated with public insurance status (p = 0.04) and geographic region outside of the southern United States (p = 0.02). Only 50 of 456 hospitals used both approaches (open and robotic), and only 6 hospitals reported 5 or more robot-assisted laparoscopic ureteral reimplantations during 2012. Treatment of primary vesicoureteral reflux with ureteral reimplantation is decreasing. Robot-assisted laparoscopic ureteral reimplantation is becoming more prevalent but remains relatively uncommon. Length of stay is shorter for the robotic approach but the costs are higher. Nationally robot-assisted laparoscopic ureteral reimplantation appears to still be in the early phase of adoption and is clustered at a small number of hospitals. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Computer-assisted hip and knee arthroplasty. Navigation and active robotic systems: an evidence-based analysis.

PubMed

2004-01-01

The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. NAVIGATION-ASSISTED ARTHROPLASTY: Five studies were identified that examined navigation-assisted arthroplasty.A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1)A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2)A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3)Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that "the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques."(4;5) ROBOTIC-ASSISTED ARTHROPLASTY: Four studies were identified that examined robotic-assisted arthroplasty.A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6)Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6)Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6)Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6)An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7)An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8)An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9).

Computer-Assisted Hip and Knee Arthroplasty. Navigation and Active Robotic Systems

PubMed Central

2004-01-01

Executive Summary Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. The Technology Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. Review Strategy The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. Summary of Findings Navigation-Assisted Arthroplasty Five studies were identified that examined navigation-assisted arthroplasty. A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1) A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2) A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3) Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that “the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques.”(4;5) Robotic-Assisted Arthroplasty Four studies were identified that examined robotic-assisted arthroplasty. A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6) Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6) Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6) Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6) An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7) An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8) An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9) PMID:23074452

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.

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.

Human-robot interaction tests on a novel robot for gait assistance.

PubMed

Tagliamonte, Nevio Luigi; Sergi, Fabrizio; Carpino, Giorgio; Accoto, Dino; Guglielmelli, Eugenio

2013-06-01

This paper presents tests on a treadmill-based non-anthropomorphic wearable robot assisting hip and knee flexion/extension movements using compliant actuation. Validation experiments were performed on the actuators and on the robot, with specific focus on the evaluation of intrinsic backdrivability and of assistance capability. Tests on a young healthy subject were conducted. In the case of robot completely unpowered, maximum backdriving torques were found to be in the order of 10 Nm due to the robot design features (reduced swinging masses; low intrinsic mechanical impedance and high-efficiency reduction gears for the actuators). Assistance tests demonstrated that the robot can deliver torques attracting the subject towards a predicted kinematic status.

Constellation Program Press Conference

NASA Image and Video Library

2006-06-04

Dean Acosta, NASA Deputy Assistant Administrator and Press Secretary, moderates a press conference with NASA Administrator Michael Griffin Scott Horowitz, NASA Associate Administrator for Exploration Systems and Jeff Hanley, Constellation Program Manager, outlining specific center responsibilities associated with the Constellation Program for robotic and human Moon and Mars exploration, Monday, June 5, 2006, at NASA Headquarters in Washington. Photo Credit (NASA/Bill Ingalls)

On the Effectiveness of Robot-Assisted Language Learning

ERIC Educational Resources Information Center

Lee, Sungjin; Noh, Hyungjong; Lee, Jonghoon; Lee, Kyusong; Lee, Gary Geunbae; Sagong, Seongdae; Kim, Munsang

2011-01-01

This study introduces the educational assistant robots that we developed for foreign language learning and explores the effectiveness of robot-assisted language learning (RALL) which is in its early stages. To achieve this purpose, a course was designed in which students have meaningful interactions with intelligent robots in an immersive…

Assistance dogs provide a useful behavioral model to enrich communicative skills of assistance robots.

PubMed

Gácsi, Márta; Szakadát, Sára; Miklósi, Adám

2013-01-01

These studies are part of a project aiming to reveal relevant aspects of human-dog interactions, which could serve as a model to design successful human-robot interactions. Presently there are no successfully commercialized assistance robots, however, assistance dogs work efficiently as partners for persons with disabilities. In Study 1, we analyzed the cooperation of 32 assistance dog-owner dyads performing a carrying task. We revealed typical behavior sequences and also differences depending on the dyads' experiences and on whether the owner was a wheelchair user. In Study 2, we investigated dogs' responses to unforeseen difficulties during a retrieving task in two contexts. Dogs displayed specific communicative and displacement behaviors, and a strong commitment to execute the insoluble task. Questionnaire data from Study 3 confirmed that these behaviors could successfully attenuate owners' disappointment. Although owners anticipated the technical competence of future assistance robots to be moderate/high, they could not imagine robots as emotional companions, which negatively affected their acceptance ratings of future robotic assistants. We propose that assistance dogs' cooperative behaviors and problem solving strategies should inspire the development of the relevant functions and social behaviors of assistance robots with limited manual and verbal skills.

Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study

PubMed Central

Geroin, Christian; Bortolami, Marta; Saltuari, Leopold; Manganotti, Paolo

2018-01-01

Background Bilateral arm training (BAT) has shown promise in expediting progress toward upper limb recovery in chronic stroke patients, but its neural correlates are poorly understood. Objective To evaluate changes in upper limb function and EEG power after a robot-assisted BAT in chronic stroke patients. Methods In a within-subject design, seven right-handed chronic stroke patients with upper limb paresis received 21 sessions (3 days/week) of the robot-assisted BAT. The outcomes were changes in score on the upper limb section of the Fugl-Meyer assessment (FM), Motricity Index (MI), and Modified Ashworth Scale (MAS) evaluated at the baseline (T0), posttraining (T1), and 1-month follow-up (T2). Event-related desynchronization/synchronization were calculated in the upper alpha and the beta frequency ranges. Results Significant improvement in all outcomes was measured over the course of the study. Changes in FM were significant at T2, and in MAS at T1 and T2. After training, desynchronization on the ipsilesional sensorimotor areas increased during passive and active movement, as compared with T0. Conclusions A repetitive robotic-assisted BAT program may improve upper limb motor function and reduce spasticity in the chronically impaired paretic arm. Effects on spasticity were associated with EEG changes over the ipsilesional sensorimotor network. PMID:29780410

Association between robot-assisted surgery and resection quality in patients with colorectal cancer.

PubMed

Fransgaard, Tina; Pinar, Ismail; Thygesen, Lau Caspar; Gögenur, Ismail

2018-06-01

Resection quality after robot-assisted surgery for colorectal cancer have not previously been investigated in a nationwide study. The aim of the study was to examine the resection quality in robot-assisted versus laparoscopic surgery for colorectal cancer. Furthermore, 30-day mortality, postoperative complications, and conversion to open surgery were investigated. Patients undergoing either laparoscopic or robot-assisted surgery for colorectal cancer between 1 January 2010 and 31 December 2015 were included. The primary outcome was whether R0 resection was achieved. Secondary outcomes were 30-day mortality, postoperative complications, and conversions to laparotomy. A total of 8615 and 3934 patients had a diagnosis of colon cancer and rectal cancer respectively. Of the patients with colon cancer, 511 patients underwent robot-assisted surgery and of the patients with rectal cancer, 706 patients underwent robot-assisted surgery. In the multivariate analysis, patients with colon cancer had an odds ratio (OR) = 0.63 (95%CI 0.45-0.88) for receiving R0 resection in the robot-assisted group compared to laparoscopy. For patients with rectal cancer, the OR was 1.20 (95%CI 0.89-1.61). No difference in 30-day mortality or postoperative complications were observed. The OR of conversion to laparotomy was lower in the robot-assisted group compared to the laparoscopic group in both patients with colon - and rectal cancer. The study showed significant lower odds of receiving R0 resection in patients with colon cancer undergoing robot-assisted surgery. In patients with rectal cancer the robot-assisted surgery non-significantly increased the odds of receiving R0 resection. Copyright © 2018 Elsevier Ltd. All rights reserved.

Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis.

PubMed

Yeung, Ling-Fung; Ockenfeld, Corinna; Pang, Man-Kit; Wai, Hon-Wah; Soo, Oi-Yan; Li, Sheung-Wai; Tong, Kai-Yu

2018-06-19

Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer's gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance. This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training. After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion - 2.36° and knee flexion - 8.48°) during swing. Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design. ClinicalTrials.gov NCT02471248 . Registered 15 June 2015 retrospectively registered.

[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.

Effect of Regional Hospital Competition and Hospital Financial Status on the Use of Robotic-Assisted Surgery.

PubMed

Wright, Jason D; Tergas, Ana I; Hou, June Y; Burke, William M; Chen, Ling; Hu, Jim C; Neugut, Alfred I; Ananth, Cande V; Hershman, Dawn L

2016-07-01

Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. To examine the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. A cohort study of 221 637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The association between hospital competition, hospital financial status, and performance of robotic-assisted surgery was examined. The association between hospital competition was measured with the Herfindahl-Hirschman Index (HHI), hospital financial status was estimated as operating margin, and performance of robotic-assisted surgery was examined using multivariate mixed-effects regression models. We identified 221 637 patients who underwent one of the procedures of interest. The cohort included 30 345 patients who underwent radical prostatectomy; 20 802, total nephrectomy; 8060, partial nephrectomy; 134 985, hysterectomy; and 27 445, oophorectomy. Robotic-assisted operations were performed for 20 500 (67.6%) radical prostatectomies, 1405 (6.8%) total nephrectomies, 2759 (34.2%) partial nephrectomies, 14 047 (10.4%) hysterectomies, and 1782 (6.5%) oophorectomies. Use of robotic-assisted surgery increased for each procedure from January 2010 through December 2011. For all 5 operations, increased market competition (as measured by the HHI) was associated with increased use of robotic-assisted surgery. For prostatectomy, the risk ratios (95% CIs) for undergoing a robotic-assisted procedure were 2.20 (1.50-3.24) at hospitals in moderately competitive markets and 2.64 (1.84-3.78) for highly competitive markets compared with noncompetitive markets. For hysterectomy, patients at hospitals in moderately (3.75 [2.26-6.25]) and highly (5.30; [3.27-8.57]) competitive markets were more likely to undergo a robotic-assisted surgery. Increased hospital profitability was associated with use of robotic-assisted surgery only for partial nephrectomy in facilities with medium-high (1.67 [1.13-2.48]) and high (1.50 [0.98-2.29]) operating margins. With analysis limited to patients treated at a hospital that had performed robotic-assisted surgery, there was no longer an association between competition and use of robotic-assisted surgery. Patients undergoing surgery in a hospital in a competitive regional market were more likely to undergo a robotic-assisted procedure. These data imply that regional competition may influence a hospital's decision to acquire a surgical robot.

Robotic Assistance by Impedance Compensation for Hand Movements While Manual Welding.

PubMed

Erden, Mustafa Suphi; Billard, Aude

2016-11-01

In this paper, we present a robotic assistance scheme which allows for impedance compensation with stiffness, damping, and mass parameters for hand manipulation tasks and we apply it to manual welding. The impedance compensation does not assume a preprogrammed hand trajectory. Rather, the intention of the human for the hand movement is estimated in real time using a smooth Kalman filter. The movement is restricted by compensatory virtual impedance in the directions perpendicular to the estimated direction of movement. With airbrush painting experiments, we test three sets of values for the impedance parameters as inspired from impedance measurements with manual welding. We apply the best of the tested sets for assistance in manual welding and perform welding experiments with professional and novice welders. We contrast three conditions: 1) welding with the robot's assistance; 2) with the robot when the robot is passive; and 3) welding without the robot. We demonstrate the effectiveness of the assistance through quantitative measures of both task performance and perceived user's satisfaction. The performance of both the novice and professional welders improves significantly with robotic assistance compared to welding with a passive robot. The assessment of user satisfaction shows that all novice and most professional welders appreciate the robotic assistance as it suppresses the tremors in the directions perpendicular to the movement for welding.

Predicting Functional Recovery in Chronic Stroke Rehabilitation Using Event-Related Desynchronization-Synchronization during Robot-Assisted Movement

PubMed Central

Gramigna, Cristina; Franceschetti, Silvana

2016-01-01

Although rehabilitation robotics seems to be a promising therapy in the rehabilitation of the upper limb in stroke patients, consensus is still lacking on its additive effects. Therefore, there is a need for determining the possible success of robotic interventions on selected patients, which in turn determine the necessity for new investigating instruments supporting the treatment decision-making process and customization. The objective of the work presented in this preliminary study was to verify that fully robot assistance would not affect the physiological oscillatory cortical activity related to a functional movement in healthy subjects. Further, the clinical results following the robotic treatment of a chronic stroke patient, who positively reacted to the robotic intervention, were analyzed and discussed. First results show that there is no difference in EEG activation pattern between assisted and no-assisted movement in healthy subjects. Even more importantly, the patient's pretreatment EEG activation pattern in no-assisted movement was completely altered, while it recovered to a quasi-physiological one in robot-assisted movement. The functional improvement following treatment was large. Using pretreatment EEG recording during robot-assisted movement might be a valid approach to assess the potential ability of the patient for recovering. PMID:27057546

Human likeness: cognitive and affective factors affecting adoption of robot-assisted learning systems

NASA Astrophysics Data System (ADS)

Yoo, Hosun; Kwon, Ohbyung; Lee, Namyeon

2016-07-01

With advances in robot technology, interest in robotic e-learning systems has increased. In some laboratories, experiments are being conducted with humanoid robots as artificial tutors because of their likeness to humans, the rich possibilities of using this type of media, and the multimodal interaction capabilities of these robots. The robot-assisted learning system, a special type of e-learning system, aims to increase the learner's concentration, pleasure, and learning performance dramatically. However, very few empirical studies have examined the effect on learning performance of incorporating humanoid robot technology into e-learning systems or people's willingness to accept or adopt robot-assisted learning systems. In particular, human likeness, the essential characteristic of humanoid robots as compared with conventional e-learning systems, has not been discussed in a theoretical context. Hence, the purpose of this study is to propose a theoretical model to explain the process of adoption of robot-assisted learning systems. In the proposed model, human likeness is conceptualized as a combination of media richness, multimodal interaction capabilities, and para-social relationships; these factors are considered as possible determinants of the degree to which human cognition and affection are related to the adoption of robot-assisted learning systems.

Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

PubMed

Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

2014-11-01

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

Robotic-assisted repair of iatrogenic ureteral ligation following robotic-assisted hysterectomy.

PubMed

Kalisvaart, Jonathan F; Finley, David S; Ornstein, David K

2008-01-01

Ureteral injuries, while rare, do occur during gynecologic procedures. The expansion of laparoscopic and robotic pelvic surgical procedures increases the risk of ureteral injury from these procedures and suggests a role for minimally invasive approaches to the delayed repair of ureteral injuries. We present, to our knowledge, the first case of delayed robotic-assisted ureteral deligation and ureterolysis following iatrogenic ureteral injury occurring during a robotic abdominal hysterectomy. We present a case report and review of the literature. A 57-year-old female underwent a seemingly uncomplicated robotic-assisted laparoscopic total abdominal hysterectomy and bilateral oophorectomy for symptomatic fibroids. On postoperative day 8, she presented with persistent right flank pain. Imaging studies revealed high-grade ureteral obstruction consistent with suture ligation of the right ureter. She underwent successful robotic-assisted ureteral deligation and ureterolysis. Her postoperative course was unremarkable, and she was discharged home on postoperative day 1 from the deligation. Robotic-assisted management of complications from urologic or gynecologic surgery is technically feasible. This can potentially preserve the advantages to the patient that are being seen from the initial less-invasive surgery.

A Dynamic Non Energy Storing Guidance Constraint with Motion Redirection for Robot Assisted Surgery

DTIC Science & Technology

2016-12-01

Abstract— Haptically enabled hands-on or tele-operated surgical robotic systems provide a unique opportunity to integrate pre- and intra... robot -assisted surgical systems aim at improving and extending human capabilities, by exploiting the advantages of robotic systems while keeping the...move during the operation. Robot -assisted beating heart surgery is an example of procedures that can benefit from dynamic constraints. Their

Robotic-Assisted Knee Arthroplasty: An Overview.

PubMed

van der List, Jelle P; Chawla, Harshvardhan; Pearle, Andrew D

2016-01-01

Unicompartmental knee arthroplasty and total knee arthroplasty are reliable treatment options for osteoarthritis. In order to improve survivorship rates, variables that are intraoperatively controlled by the orthopedic surgeon are being evaluated. These variables include lower leg alignment, soft tissue balance, joint line maintenance, and tibial and femoral component alignment, size, and fixation methods. Since tighter control of these factors is associated with improved outcomes of knee arthroplasty, several computer-assisted surgery systems have been developed. These systems differ in the number and type of variables they control. Robotic-assisted systems control these aforementioned variables and, in addition, aim to improve the surgical precision of the procedure. Robotic-assisted systems are active, semi-active, or passive, depending on how independently the systems perform maneuvers. Reviewing the robotic-assisted knee arthroplasty systems, it becomes clear that these systems can accurately and reliably control the aforementioned variables. Moreover, these systems are more accurate and reliable in controlling these variables when compared to the current gold standard of conventional manual surgery. At present, few studies have assessed the survivorship and functional outcomes of robotic-assisted surgery, and no sufficiently powered studies were identified that compared survivorship or functional outcomes between robotic-assisted and conventional knee arthroplasty. Although preliminary outcomes of robotic-assisted surgery look promising, more studies are necessary to assess if the increased accuracy and reliability in controlling the surgical variables leads to better outcomes of robotic-assisted knee arthroplasty.

Assessment of personal care and medical robots from older adults' perspective.

PubMed

Goher, K M; Mansouri, N; Fadlallah, S O

2017-01-01

Demographic reports indicate that population of older adults is growing significantly over the world and in particular in developed nations. Consequently, there are a noticeable number of demands for certain services such as health-care systems and assistive medical robots and devices. In today's world, different types of robots play substantial roles specifically in medical sector to facilitate human life, especially older adults. Assistive medical robots and devices are created in various designs to fulfill specific needs of older adults. Though medical robots are utilized widely by senior citizens, it is dramatic to find out into what extent assistive robots satisfy their needs and expectations. This paper reviews various assessments of assistive medical robots from older adults' perspectives with the purpose of identifying senior citizen's needs, expectations, and preferences. On the other hand, these kinds of assessments inform robot designers, developers, and programmers to come up with robots fulfilling elderly's needs while improving their life quality.

Virtual university applied to telesurgery: from teleeducation to telemanipulation.

PubMed

Marescaux, J; Soler, L; Mutter, D; Leroy, J; Vix, M; Koehl, C; Clément, J M

2000-01-01

PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

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 will be more frequently carried out as a safe, effective and minimally-invasive nephron-sparing surgery procedure. © 2015 The Japanese Urological Association.

Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer.

PubMed

Zhang, Qing; Zang, Shiming; Zhang, Chengwei; Fu, Yao; Lv, Xiaoyu; Zhang, Qinglei; Deng, Yongming; Zhang, Chuan; Luo, Rui; Zhao, Xiaozhi; Wang, Wei; Wang, Feng; Guo, Hongqian

2017-11-07

To evaluate the diagnostic value of 68 Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). We retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D'Amico and without concomitant cancer. Preoperative 68 Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients. Among 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68 Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12-51.75) and 7.22 (range 5.4-11.2), respectively (P < 0.001). 68 Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68 Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68 Ga-PSMA-11 PET-CT and mpMRI in this study. Both 68 Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68 Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.

“Five on a dice” port placement for robot-assisted thoracoscopic right upper lobectomy using robotic stapler

PubMed Central

Chan, Edward Y.

2017-01-01

Early versions of the da Vinci robot system (S and Si) have been used to perform pulmonary lung resection with severe limitations. The lack of a vascular robot stapler required the presence of a trained bedside assistant whose role was to place, manipulate and fire the stapler around major vascular structures. Thus, the techniques developed for the Si robot required a skilled bedside assistant to perform stapling of the hilar structure and manipulation of the lung. With the advent of the da Vinci Xi system with a vascular robot stapler, we postulated that we could develop a new port placement and technique to provide total control for the surgeon during the pulmonary lung resection. We found that the “five on a dice” port placement and technique allows for minimal assistance during the lobectomy with full control by the surgeon. This technique uses the full capability of the Xi robot to make the robot-assisted lobectomy a safe and ergonomic operation. PMID:29312746

"Five on a dice" port placement for robot-assisted thoracoscopic right upper lobectomy using robotic stapler.

PubMed

Kim, Min P; Chan, Edward Y

2017-12-01

Early versions of the da Vinci robot system (S and Si) have been used to perform pulmonary lung resection with severe limitations. The lack of a vascular robot stapler required the presence of a trained bedside assistant whose role was to place, manipulate and fire the stapler around major vascular structures. Thus, the techniques developed for the Si robot required a skilled bedside assistant to perform stapling of the hilar structure and manipulation of the lung. With the advent of the da Vinci Xi system with a vascular robot stapler, we postulated that we could develop a new port placement and technique to provide total control for the surgeon during the pulmonary lung resection. We found that the "five on a dice" port placement and technique allows for minimal assistance during the lobectomy with full control by the surgeon. This technique uses the full capability of the Xi robot to make the robot-assisted lobectomy a safe and ergonomic operation.

Robot-assisted versus other types of radical prostatectomy: Population-based safety and cost comparison in Japan, 2012–2013

PubMed Central

Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Fukuhara, Hiroshi; Kume, Haruki; Changhong, Yu; Kattan, Michael W; Fushimi, Kiyohide; Homma, Yukio

2014-01-01

In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012–March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, −5.1%, −1.8% [not significant], −10.8%) and shorter postoperative length of stay (–9.1%, +0.9% [not significant], –18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P < 0.05). Introduction of robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost. PMID:25183452

Traverse Planning Experiments for Future Planetary Surface Exploration

NASA Technical Reports Server (NTRS)

Hoffman, Stephen J.; Voels, Stephen A.; Mueller, Robert P.; Lee, Pascal C.

2012-01-01

The purpose of the investigation is to evaluate methodology and data requirements for remotely-assisted robotic traverse of extraterrestrial planetary surface to support human exploration program, assess opportunities for in-transit science operations, and validate landing site survey and selection techniques during planetary surface exploration mission analog demonstration at Haughton Crater on Devon Island, Nunavut, Canada. Additionally, 1) identify quality of remote observation data sets (i.e., surface imagery from orbit) required for effective pre-traverse route planning and determine if surface level data (i.e., onboard robotic imagery or other sensor data) is required for a successful traverse, and if additional surface level data can improve traverse efficiency or probability of success (TRPF Experiment). 2) Evaluate feasibility and techniques for conducting opportunistic science investigations during this type of traverse. (OSP Experiment). 3) Assess utility of remotely-assisted robotic vehicle for landing site validation survey. (LSV Experiment).

Robots to assist daily activities: views of older adults with Alzheimer's disease and their caregivers.

PubMed

Wang, Rosalie H; Sudhama, Aishwarya; Begum, Momotaz; Huq, Rajibul; Mihailidis, Alex

2017-01-01

Robots have the potential to both enable older adults with dementia to perform daily activities with greater independence, and provide support to caregivers. This study explored perspectives of older adults with Alzheimer's disease (AD) and their caregivers on robots that provide stepwise prompting to complete activities in the home. Ten dyads participated: Older adults with mild-to-moderate AD and difficulty completing activity steps, and their family caregivers. Older adults were prompted by a tele-operated robot to wash their hands in the bathroom and make a cup of tea in the kitchen. Caregivers observed interactions. Semi-structured interviews were conducted individually. Transcribed interviews were thematically analyzed. Three themes summarized responses to robot interactions: contemplating a future with assistive robots, considering opportunities with assistive robots, and reflecting on implications for social relationships. Older adults expressed opportunities for robots to help in daily activities, were open to the idea of robotic assistance, but did not want a robot. Caregivers identified numerous opportunities and were more open to robots. Several wanted a robot, if available. Positive consequences of robots in caregiving scenarios could include decreased frustration, stress, and relationship strain, and increased social interaction via the robot. A negative consequence could be decreased interaction with caregivers. Few studies have investigated in-depth perspectives of older adults with dementia and their caregivers following direct interaction with an assistive prompting robot. To fulfill the potential of robots, continued dialogue between users and developers, and consideration of robot design and caregiving relationship factors are necessary.

Intelligence for Human-Assistant Planetary Surface Robots

NASA Technical Reports Server (NTRS)

Hirsh, Robert; Graham, Jeffrey; Tyree, Kimberly; Sierhuis, Maarten; Clancey, William J.

2006-01-01

The central premise in developing effective human-assistant planetary surface robots is that robotic intelligence is needed. The exact type, method, forms and/or quantity of intelligence is an open issue being explored on the ERA project, as well as others. In addition to field testing, theoretical research into this area can help provide answers on how to design future planetary robots. Many fundamental intelligence issues are discussed by Murphy [2], including (a) learning, (b) planning, (c) reasoning, (d) problem solving, (e) knowledge representation, and (f) computer vision (stereo tracking, gestures). The new "social interaction/emotional" form of intelligence that some consider critical to Human Robot Interaction (HRI) can also be addressed by human assistant planetary surface robots, as human operators feel more comfortable working with a robot when the robot is verbally (or even physically) interacting with them. Arkin [3] and Murphy are both proponents of the hybrid deliberative-reasoning/reactive-execution architecture as the best general architecture for fully realizing robot potential, and the robots discussed herein implement a design continuously progressing toward this hybrid philosophy. The remainder of this chapter will describe the challenges associated with robotic assistance to astronauts, our general research approach, the intelligence incorporated into our robots, and the results and lessons learned from over six years of testing human-assistant mobile robots in field settings relevant to planetary exploration. The chapter concludes with some key considerations for future work in this area.

ROAD: domestic assistant and rehabilitation robot.

PubMed

Carrera, Isela; Moreno, Héctor A; Saltarén, Roque; Pérez, Carlos; Puglisi, Lisandro; Garcia, Cecilia

2011-10-01

This study introduces the concept design and analysis of a robotic system for the assistance and rehabilitation of disabled people. Based on the statistical data of the most common types of disabilities in Spain and other industrialized countries, the different tasks that the device must be able to perform have been determined. In this study, different robots for rehabilitation and assistance previously introduced have been reviewed. This survey is focused on those robots that assist with gait, balance and standing up. The structure of the ROAD robot presents various advantages over these robots, we discuss some of them. The performance of the proposed architecture is analyzed when it performs the sit to stand activity.

Customized Interactive Robotic Treatment for Stroke: EMG-Triggered Therapy

PubMed Central

Dipietro, Laura; Ferraro, Mark; Palazzolo, Jerome Joseph; Krebs, Hermano Igo; Volpe, Bruce T.; Hogan, Neville

2009-01-01

A system for electromyographic (EMG) triggering of robot-assisted therapy (dubbed the EMG game) for stroke patients is presented. The onset of a patient’s attempt to move is detected by monitoring EMG in selected muscles, whereupon the robot assists her or him to perform point-to-point movements in a horizontal plane. Besides delivering customized robot-assisted therapy, the system can record signals that may be useful to better understand the process of recovery from stroke. Preliminary experiments aimed at testing the proposed system and gaining insight into the potential of EMG-triggered, robot-assisted therapy are reported. PMID:16200756

Robot-assisted walking with the Lokomat: the influence of different levels of guidance force on thorax and pelvis kinematics.

PubMed

Swinnen, Eva; Baeyens, Jean-Pierre; Knaepen, Kristel; Michielsen, Marc; Clijsen, Ron; Beckwée, David; Kerckhofs, Eric

2015-03-01

Little attention has been devoted to the thorax and pelvis movements during gait. The aim of this study is to compare differences in the thorax and pelvis kinematics during unassisted walking on a treadmill and during walking with robot assistance (Lokomat-system (Hocoma, Volketswil, Switzerland)). 18 healthy persons walked on a treadmill with and without the Lokomat system at 2kmph. Three different conditions of guidance force (30%, 60% and 100%) were used during robot-assisted treadmill walking (30% body weight support). The maximal movement amplitudes of the thorax and pelvis were measured (Polhemus Liberty™ (Polhemus, Colchester, Vermont, USA) (240/16)). A repeated measurement ANOVA was conducted. Robot-assisted treadmill walking with different levels of guidance force showed significantly smaller maximal movement amplitudes for thorax and pelvis, compared to treadmill walking. Only the antero-posterior tilting of the pelvis was significantly increased during robot-assisted treadmill walking compared to treadmill walking. No significant changes of kinematic parameters were found between the different levels of guidance force. With regard to the thorax and pelvis movements, robot-assisted treadmill walking is significantly different compared to treadmill walking. It can be concluded that when using robot assistance, the thorax is stimulated in a different way than during walking without robot assistance, influencing the balance training during gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review.

PubMed

Nevis, Immaculate F; Vali, Bahareh; Higgins, Caroline; Dhalla, Irfan; Urbach, David; Bernardini, Marcus Q

2017-03-01

Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.

Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy.

PubMed

Miller, Javier; Smith, Angela; Kouba, Erik; Wallen, Eric; Pruthi, Raj S

2007-09-01

In the last few years there have been increasing claims that robotic assisted laparoscopic radical prostatectomy decreases short-term morbidity in patients undergoing surgical treatment for prostate cancer. However, there is surprisingly little objective evidence to support this point, which is often used to market the procedure to patients. To address this issue we prospectively evaluated patients undergoing open and robotic assisted laparoscopic radical prostatectomy at baseline and weekly through the postoperative period using a validated questionnaire. A total of 162 men undergoing radical prostatectomy, including open radical prostatectomy in 120 and robotic assisted laparoscopic radical prostatectomy in 42, for clinically localized prostate cancer completed the SF-12, version 2 Physical and Mental Health Survey Acute Form preoperatively and each week postoperatively for 6 weeks. Physical and Mental Component Scores were calculated from the questionnaires at each time point. Comparisons between the 2 surgical approaches were made at each time point. No significant differences were seen between the open and robotic assisted laparoscopic radical prostatectomy groups with regard to patient age, clinical stage or preoperative prostate specific antigen. Mean surgical blood loss was significantly higher in the open group compared to that in the robotic assisted laparoscopic group. Physical Component Scores in the robotic assisted laparoscopic group were significantly higher than those in the open cohort beginning postoperative week 1 and extending through week 6. On statistical extrapolation Physical Component Scores returned to baseline between weeks 5 and 6 postoperatively in the robotic assisted laparoscopic group and between weeks 6 and 7 in the open group. Mental Component Score scores were not statistically different between the groups except preoperatively. This study helps prospectively define short-term health related quality of life in patients undergoing robotic assisted laparoscopic vs open radical prostatectomy. Higher physical scores were seen in the robotic assisted laparoscopic group than the open group beginning postoperative week 1 and continuing weekly throughout the 6-week study period. Physical Component Score scores returned to baseline sooner in the robotic assisted laparoscopic group than in the open group.

Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach.

PubMed

Sammon, Jesse D; Karakiewicz, Pierre I; Sun, Maxine; Sukumar, Shyam; Ravi, Praful; Ghani, Khurshid R; Bianchi, Marco; Peabody, James O; Shariat, Shahrokh F; Perrotte, Paul; Hu, Jim C; Menon, Mani; Trinh, Quoc-Dien

2013-04-01

The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship. Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles. An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46-0.75), elevated hospital charges (OR 0.75, 95% CI 0.64-0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93-2.02) relative to the robot-assisted procedure at low volume centers. Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. Nonetheless, low volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. These findings demonstrate the importance of accounting for hospital volume when examining the benefit of a surgical technique. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Incidence and location of positive surgical margin among open, laparoscopic and robot-assisted radical prostatectomy in prostate cancer patients: a single institutional analysis.

PubMed

Koizumi, Atsushi; Narita, Shintaro; Nara, Taketoshi; Takayama, Koichiro; Kanda, Sohei; Numakura, Kazuyuki; Tsuruta, Hiroshi; Maeno, Atsushi; Huang, Mingguo; Saito, Mitsuru; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Nanjo, Hiroshi; Habuchi, Tomonori

2018-06-19

To evaluate the positive surgical margin rates and locations in radical prostatectomy among three surgical approaches, including open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. We retrospectively reviewed clinical outcomes at our institution of 450 patients who received radical prostatectomy. Multiple surgeons were involved in the three approaches, and a single pathologist conducted the histopathological diagnoses. Positive surgical margin rates and locations among the three approaches were statistically assessed, and the risk factors of positive surgical margin were analyzed. This study included 127, 136 and 187 patients in the open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy groups, respectively. The positive surgical margin rates were 27.6% (open radical prostatectomy), 18.4% (laparoscopic radical prostatectomy) and 13.4% (robot-assisted radical prostatectomy). In propensity score-matched analyses, the positive surgical margin rate in the robot-assisted radical prostatectomy was significantly lower than that in the open radical prostatectomy, whereas there was no significant difference in the positive surgical margin rates between robot-assisted radical prostatectomy and laparoscopic radical prostatectomy. In the multivariable analysis, PSA level at diagnosis and surgical approach (open radical prostatectomy vs robot-assisted radical prostatectomy) were independent risk factors for positive surgical margin. The apex was the most common location of positive surgical margin in the open radical prostatectomy and laparoscopic radical prostatectomy groups, whereas the bladder neck was the most common location in the robot-assisted radical prostatectomy group. The significant difference of positive surgical margin locations continued after the propensity score adjustment. Robot-assisted radical prostatectomy may potentially achieve the lowest positive surgical margin rate among three surgical approaches. The bladder neck was the most common location of positive surgical margin in robot-assisted radical prostatectomy and apex in open radical prostatectomy and laparoscopic radical prostatectomy. Although robot-assisted radical prostatectomy may contribute to the reduction of positive surgical margin, dissection of the bladder neck requires careful attention to avoid positive surgical margins.

Human-robot cooperative movement training: learning a novel sensory motor transformation during walking with robotic assistance-as-needed.

PubMed

Emken, Jeremy L; Benitez, Raul; Reinkensmeyer, David J

2007-03-28

A prevailing paradigm of physical rehabilitation following neurologic injury is to "assist-as-needed" in completing desired movements. Several research groups are attempting to automate this principle with robotic movement training devices and patient cooperative algorithms that encourage voluntary participation. These attempts are currently not based on computational models of motor learning. Here we assume that motor recovery from a neurologic injury can be modelled as a process of learning a novel sensory motor transformation, which allows us to study a simplified experimental protocol amenable to mathematical description. Specifically, we use a robotic force field paradigm to impose a virtual impairment on the left leg of unimpaired subjects walking on a treadmill. We then derive an "assist-as-needed" robotic training algorithm to help subjects overcome the virtual impairment and walk normally. The problem is posed as an optimization of performance error and robotic assistance. The optimal robotic movement trainer becomes an error-based controller with a forgetting factor that bounds kinematic errors while systematically reducing its assistance when those errors are small. As humans have a natural range of movement variability, we introduce an error weighting function that causes the robotic trainer to disregard this variability. We experimentally validated the controller with ten unimpaired subjects by demonstrating how it helped the subjects learn the novel sensory motor transformation necessary to counteract the virtual impairment, while also preventing them from experiencing large kinematic errors. The addition of the error weighting function allowed the robot assistance to fade to zero even though the subjects' movements were variable. We also show that in order to assist-as-needed, the robot must relax its assistance at a rate faster than that of the learning human. The assist-as-needed algorithm proposed here can limit error during the learning of a dynamic motor task. The algorithm encourages learning by decreasing its assistance as a function of the ongoing progression of movement error. This type of algorithm is well suited for helping people learn dynamic tasks for which large kinematic errors are dangerous or discouraging, and thus may prove useful for robot-assisted movement training of walking or reaching following neurologic injury.

Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

PubMed

Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre

2017-06-01

Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Rehabilitation robotics for the upper extremity: review with new directions for orthopaedic disorders.

PubMed

Hakim, Renée M; Tunis, Brandon G; Ross, Michael D

2017-11-01

The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand. Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks.

Adaptive model-based assistive control for pneumatic direct driven soft rehabilitation robots.

PubMed

Wilkening, Andre; Ivlev, Oleg

2013-06-01

Assistive behavior and inherent compliance are assumed to be the essential properties for effective robot-assisted therapy in neurological as well as in orthopedic rehabilitation. This paper presents two adaptive model-based assistive controllers for pneumatic direct driven soft rehabilitation robots that are based on separated models of the soft-robot and the patient's extremity, in order to take into account the individual patient's behavior, effort and ability during control, what is assumed to be essential to relearn lost motor functions in neurological and facilitate muscle reconstruction in orthopedic rehabilitation. The high inherent compliance of soft-actuators allows for a general human-robot interaction and provides the base for effective and dependable assistive control. An inverse model of the soft-robot with estimated parameters is used to achieve robot transparency during treatment and inverse adaptive models of the individual patient's extremity allow the controllers to learn on-line the individual patient's behavior and effort and react in a way that assist the patient only as much as needed. The effectiveness of the controllers is evaluated with unimpaired subjects using a first prototype of a soft-robot for elbow training. Advantages and disadvantages of both controllers are analyzed and discussed.

Control of a free-flying robot manipulator system

NASA Technical Reports Server (NTRS)

Alexander, H.

1986-01-01

The development of and test control strategies for self-contained, autonomous free flying space robots are discussed. Such a robot would perform operations in space similar to those currently handled by astronauts during extravehicular activity (EVA). Use of robots should reduce the expense and danger attending EVA both by providing assistance to astronauts and in many cases by eliminating altogether the need for human EVA, thus greatly enhancing the scope and flexibility of space assembly and repair activities. The focus of the work is to develop and carry out a program of research with a series of physical Satellite Robot Simulator Vehicles (SRSV's), two-dimensionally freely mobile laboratory models of autonomous free-flying space robots such as might perform extravehicular functions associated with operation of a space station or repair of orbiting satellites. It is planned, in a later phase, to extend the research to three dimensions by carrying out experiments in the Space Shuttle cargo bay.

Robotic-Assisted Thoracic Surgery for Early-Stage Lung Cancer: A Review.

PubMed

Brooks, Paula

2015-07-01

This review evaluates the benefits and disadvantages associated with the use of robotic-assisted technology in performing lobectomies in patients with early-stage lung cancer. The author conducted a literature search of Ovid®, MEDLINE®, PubMed®, and CINAHL® for articles published from 2005 to 2013. Search criteria included key terms such as robot, robotic, robotic-assisted lobectomy, and lung cancer. Of 922 articles, the author included a total of 12 research-based published studies in the analysis and incorporated the findings into an evidence table. Results showed that robotic-assisted lobectomies are feasible safe procedures for patients with stage 1A or 1B lung cancer; however, there is a steep learning curve and long-term randomized studies evaluating robotic-assisted lobectomy and conventional posterolateral thoracotomy or video-assisted thoracic lobectomy are needed. For patient safety, perioperative nurses should be aware of the length of time and experience required to perform these procedures, the costs, techniques, benefits, and disadvantages. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy?

PubMed

Yang, David Y; Monn, M Francesca; Bahler, Clinton D; Sundaram, Chandru P

2014-09-01

While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges. We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p <0.001). Median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p <0.001). There was no difference in perioperative complications or the incidence of death. Compared to the laparoscopic approach robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p <0.001). Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Acceptance and perceived usefulness of robots to assist with activities of daily living and healthcare tasks.

PubMed

Hall, Amanda K; Backonja, Uba; Painter, Ian; Cakmak, Maya; Sung, Minjung; Lau, Timothy; Thompson, Hilaire J; Demiris, George

2017-11-29

As the number of older adults living with chronic conditions continues to rise, they will require assistance with activities of daily living (ADL) and healthcare tasks to continue living independently in their homes. One proposed solution to assist with the care needs of an aging population and a shrinking healthcare workforce is robotic technology. Using a cross-sectional survey design, we purposively sampled adults (≥18 years old) to assess generational acceptance and perceived usefulness of robots to assist with ADLs, healthcare tasks, and evaluate acceptance of robotic healthcare assistance across different settings. A total of 499 adults (age range [years] 18-98, Mean = 38.7, SD = 22.7) responded to the survey. Significant differences were found among young, middle-aged, and older adults on perceived usefulness of robots for cleaning, escorting them around town, acting as companionship, delivering meals, assessing sadness and calling for help, providing medical advice, taking vital sign assessments, and assisting with personal care (p < 0.05). The majority of younger adults reported that they would like a robot to provide healthcare assistance in the hospital, compared to middle-aged and older adults (p < 0.001). Results of this study can guide the design of robots to assist adults of all ages with useful tasks.

Robotic assisted excision of a left ventricular myxoma.

PubMed

Hassan, Mohammed; Smith, J Michael

2012-01-01

We present a rare case of left ventricular myxoma discovered incidentally in an asymptomatic 16-year old male. The patient underwent the appropriate work-up and a robotic-assisted excision of the mass. The patient had an uneventful recovery and was discharged home at postoperative day 3. To our knowledge, this is the first case of robotic-assisted left ventricular myxoma excision in the literature. Robotic-assisted surgery of left ventricular myxomas is a safe and feasible method of excision.

Constellation Program Press Conference

NASA Image and Video Library

2006-06-04

NASA Administrator Michael Griffin, seated left, Scott Horowitz, NASA Associate Administrator for Exploration Systems and Jeff Hanley, Constellation Program Manager, right, are seen during a press conference outlining specific center responsibilities associated with the Constellation Program for robotic and human moon and Mars exploration, Monday, June 5, 2006, at NASA Headquarters in Washington. Dean Acosta, NASA Deputy Assistant Administrator and Press Secretary, far left, moderates the program. Photo Credit (NASA/Bill Ingalls)

Robot-assisted intersphincteric resection facilitates an efficient sphincter-saving in patients with low rectal cancer.

PubMed

Kim, Jin Cheon; Lee, Jong Lyul; Alotaibi, Abdulrahman Muaod; Yoon, Yong Sik; Kim, Chan Wook; Park, In Ja

2017-08-01

Few investigations of robot-assisted intersphincteric resection (ISR) are presently available to support this procedure as a safe and efficient procedure. We aimed to evaluate the utility of robot-assisted ISR by comparison between ISR and abdominoperineal resection (APR) using both robot-assisted and open approaches. The 558 patients with lower rectal cancer (LRC) who underwent curative operation was enrolled between July 2010 and June 2015 to perform either by robot-assisted (ISR vs. APR = 310 vs. 34) or open approaches (144 vs. 70). Perioperative and functional outcomes including urogenital and anorectal dysfunctions were measured. Recurrence and survival were examined in 216 patients in which >3 years had elapsed after the operation. The robot-assisted approach was the most significant parameter to determine ISR achievement among potent parameters (OR = 3.467, 95% CI = 2.095-5.738, p < 0.001). Early surgical complications occurred more frequently in the open ISR group (16 vs. 7.7%, p = 0.01). The voiding and male sexual dysfunctions were significantly more frequent in the open ISR (p < 0.05). The fecal incontinence and lifestyle alteration score was greater in the open ISR than in the robot-assisted ISR at 12 and 24 months, respectively (p < 0.05). However, the 3-year cumulative rates of local recurrence and survival did not differ between the two groups. The current procedure of robot-assisted ISR replaced a significant portion of APR to achieve successful SSO via mostly transabdominal approach and double-stapled anastomosis. The robot-assisted ISR with minimal invasiveness might be a help to reduce anorectal and urogenital dysfunctions.

A Comparison of Robotically Assisted Microsurgery versus Manual Microsurgery in Challenging Situations.

PubMed

Willems, Joost I P; Shin, Alexandra M; Shin, Delaney M; Bishop, Allen T; Shin, Alexander Y

2016-04-01

Microsurgery can be challenging secondary to orientation of the vessels, accessibility, or depth of the wound. Robotically assisted microsurgery reduces tremors and improves visualization and may improve the quality of anastomosis compared with traditional microsurgery. The purpose of this study was to compare robotically assisted microsurgery to traditional microsurgery in technically challenging situations with respect to time of anastomosis, quality of anastomosis, and Objective Structured Assessment of Technical Skills. Two investigators with no prior surgery or microsurgery experience performed 160 anastomoses on artificial microvessels after undergoing standardized traditional and robotically assisted microsurgery courses. Five different exposure groups were created with depths of 0, 10, and 20 cm and sidewall angles of 20 and 30 degrees. A comparison of 80 manual with 80 robotically assisted microsurgery anastomoses in different exposure groups was undertaken. The modified Objective Structured Assessment of Technical Skills scoring system, duration per anastomosis, and a subjective comfort scale were evaluated. In the most difficult exposure, Objective Structured Assessment of Technical Skills scores were similar in both groups (p = 0.98), the duration was higher in the manual group (p = 0.004), and the subjective comfort rating was higher in the robotically assisted microsurgery group (p < 0.001). In the easiest (0-cm depth, flat) exposure, Objective Structured Assessment of Technical Skills scores were higher in the manual group (p = 0.018) and the duration was longer in the robotically assisted microsurgery group (p = 0.008). Manual surgery was superior to robotically assisted microsurgery in technically easy exposures. In difficult exposures (greater depth and lower sidewall angles), however, robotically assisted microsurgery had a shorter surgery time and a higher comfort rating, with Objective Structured Assessment of Technical Skills scores similar to those assessing traditional microsurgery. Therapeutic, V.

Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial.

PubMed

Picelli, Alessandro; Melotti, Camilla; Origano, Francesca; Waldner, Andreas; Fiaschi, Antonio; Santilli, Valter; Smania, Nicola

2012-05-01

. Gait impairment is a common cause of disability in Parkinson disease (PD). Electromechanical devices to assist stepping have been suggested as a potential intervention. . To evaluate whether a rehabilitation program of robot-assisted gait training (RAGT) is more effective than conventional physiotherapy to improve walking. . A total of 41 patients with PD were randomly assigned to 45-minute treatment sessions (12 in all), 3 days a week, for 4 consecutive weeks of either robotic stepper training (RST; n = 21) using the Gait Trainer or physiotherapy (PT; n = 20) with active joint mobilization and a modest amount of conventional gait training. Participants were evaluated before, immediately after, and 1 month after treatment. Primary outcomes were 10-m walking speed and distance walked in 6 minutes. . Baseline measures revealed no statistical differences between groups, but the PT group walked 0.12 m/s slower; 5 patients withdrew. A statistically significant improvement was found in favor of the RST group (walking speed 1.22 ± 0.19 m/s [P = .035]; distance 366.06 ± 78.54 m [P < .001]) compared with the PT group (0.98 ± 0.32 m/s; 280.11 ± 106.61 m). The RAGT mean speed increased by 0.13 m/s, which is probably not clinically important. Improvements were maintained 1 month later. . RAGT may improve aspects of walking ability in patients with PD. Future trials should compare robotic assistive training with treadmill or equal amounts of overground walking practice.

Wireless intraoral tongue control of an assistive robotic arm for individuals with tetraplegia.

PubMed

Andreasen Struijk, Lotte N S; Egsgaard, Line Lindhardt; Lontis, Romulus; Gaihede, Michael; Bentsen, Bo

2017-11-06

For an individual with tetraplegia assistive robotic arms provide a potentially invaluable opportunity for rehabilitation. However, there is a lack of available control methods to allow these individuals to fully control the assistive arms. Here we show that it is possible for an individual with tetraplegia to use the tongue to fully control all 14 movements of an assistive robotic arm in a three dimensional space using a wireless intraoral control system, thus allowing for numerous activities of daily living. We developed a tongue-based robotic control method incorporating a multi-sensor inductive tongue interface. One abled-bodied individual and one individual with tetraplegia performed a proof of concept study by controlling the robot with their tongue using direct actuator control and endpoint control, respectively. After 30 min of training, the able-bodied experimental participant tongue controlled the assistive robot to pick up a roll of tape in 80% of the attempts. Further, the individual with tetraplegia succeeded in fully tongue controlling the assistive robot to reach for and touch a roll of tape in 100% of the attempts and to pick up the roll in 50% of the attempts. Furthermore, she controlled the robot to grasp a bottle of water and pour its contents into a cup; her first functional action in 19 years. To our knowledge, this is the first time that an individual with tetraplegia has been able to fully control an assistive robotic arm using a wireless intraoral tongue interface. The tongue interface used to control the robot is currently available for control of computers and of powered wheelchairs, and the robot employed in this study is also commercially available. Therefore, the presented results may translate into available solutions within reasonable time.

[Walking assist robot and its clinical application].

PubMed

Kakou, Hiroaki; Shitama, Hideo; Kimura, Yoshiko; Nakamoto, Yoko; Furuta, Nami; Honda, Kanae; Wada, Futoshi; Hachisuka, Kenji

2009-06-01

The walking assist robot was developed to improve gait disturbance in patients with severe disabilities. The robot had a trunk supporter, power generator and operating arms which held patient's lower extremities and simulated walking, a control unit, biofeedback system, and a treadmill. We applied the robot-aided gait training to three patients with severe gait disturbance induced by stroke, axonal Guillan-Barré syndrome or spinal cord injury, and the walking assist robot turned out to be effective in improving the gait disturbance.

A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.

PubMed

Rong, Wei; Li, Waiming; Pang, Mankit; Hu, Junyan; Wei, Xijun; Yang, Bibo; Wai, Honwah; Zheng, Xiaoxiang; Hu, Xiaoling

2017-04-26

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers. ClinicalTrials.gov. NCT02117089 ; date of registration: April 10, 2014.

RDT&E/Acquisition Management Guide. Revision.

DTIC Science & Technology

1987-01-01

libraries s , that rIaincd librai staff comprehensive, coordinated Scientif k, and lekh- ca.n assist RI)!& pets n~rnc, I e ri nical Information Program ( S ...A179 010 RDTAE/ACOUISITIOi MNAGEMENT GUIDE REVISIOI(U) 1/ N S --5-RDEPARTMENT OF THE AVY WASHINGTON DC JAN 87 UNCLASSIFIED F/ 5/ UL mmhhmmhhmhhhlm...DCASR Defense Contract Administration Sersices ASN (R.E& S ) Assistant Secretary of the Navy (Research, Region Engineering, and Systems) DCNO (- Deputy

The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications.

PubMed

Chang, Jun-Dong; Kim, In-Sung; Bhardwaj, Atul M; Badami, Ramachandra N

2017-03-01

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.

In Silico Investigation of a Surgical Interface for Remote Control of Modular Miniature Robots in Minimally Invasive Surgery

PubMed Central

Zygomalas, Apollon; Giokas, Konstantinos; Koutsouris, Dimitrios

2014-01-01

Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single site (LESS) surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures. PMID:25295187

In silico investigation of a surgical interface for remote control of modular miniature robots in minimally invasive surgery.

PubMed

Zygomalas, Apollon; Giokas, Konstantinos; Koutsouris, Dimitrios

2014-01-01

Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single site (LESS) surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.

The decisive role of the patient-side surgeon in robotic surgery.

PubMed

Sgarbura, Olivia; Vasilescu, Catalin

2010-12-01

Minimally invasive technology literature is mainly concerned about the feasibility of the robotic procedures and the performance of the console surgeon. However, few of these technologies could be applied without a well-trained team. Our goal was to demonstrate that robotic surgery depends more on the patient-side assistant surgeon's abilities than has been previously reported. In our department, 280 interventions in digestive, thoracic, and gynecological surgery were performed since the acquisition of the robotic equipment. There are three teams trained in robotic surgery with three console surgeons and four certified patient-side surgeons. Four more patient-side assistants were trained at our center. Trocar placement, docking and undocking of the robot, insertion of the laparoscopic instruments, and hemostatic maneuvers with various devices were quantified and compared. Assistants trained by using animal or cadaver surgery are more comfortable with the robotic instruments handling and with docking and undocking of the robot. Assistants who finalized their residency or attend their final year are more accurate with the insertion of the laparoscopic instrument to the targeted organ and more skillful with LigaSure or clip applier devices. Interventions that require vivid participation of the assistants have shorter assistant-depending time intervals at the end of the learning curve than at the beginning. Robotic surgery is a team effort and is greatly dependant on the performance of assistant surgeons. Interventions that have the benefit of a trained team are more rapid and secure.

Robotic bariatric surgery: A general review of the current status.

PubMed

Jung, Minoa K; Hagen, Monika E; Buchs, Nicolas C; Buehler, Leo H; Morel, Philippe

2017-12-01

While conventional laparoscopy is the gold standard for almost all bariatric procedures, robotic assistance holds promise for facilitating complex surgeries and improving clinical outcomes. Since the report of the first robotic-assisted bariatric procedure in 1999, numerous publications, including those reporting comparative trials and meta-analyses across bariatric procedures with a focus on robotic assistance, can be found. This article reviews the current literature and portrays the perspectives of robotic bariatric surgery. While there are substantial reports on robotic bariatric surgery currently in publication, most studies suffer from low levels of evidence. As such, although robotics technology is without a doubt superior to conventional laparoscopy, the precise role of robotics in bariatric surgery is not yet clear. Copyright © 2017 John Wiley & Sons, Ltd.

Robotic instrumentation: Evolution and microsurgical applications

PubMed Central

Parekattil, Sijo J.; Moran, Michael E.

2010-01-01

This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery. PMID:21116362

[Robotic laparoscopic cholecystectomy].

PubMed

Langer, D; Pudil, J; Ryska, M

2006-09-01

Laparoscopic approach profusely utilized in many surgical fields was enhanced by da Vinci robotic surgical system in range of surgery wards, imprimis in the United States today. There was multispecialized robotic centre program initiated in the Central Military Hospital in Prague in December 2005. Within the scope of implementing the da Vinci robotic system to clinical practice we executed robotic-assisted laparoscopic cholecystectomy. We have accomplished elective laparoscopic cholecystectomy using the da Vinci robotic surgical system. Operating working group (two doctors, two scrub nurses) had completed certificated foreign training. Both of the surgeons have many years experience of laparoscopic cholecystectomy. Operator controlled instruments from the surgeon's console, assistant placed clips on ends of cystic duct and cystic artery from auxiliary port after capnoperitoneum installation. We evacuated gallbladder in plastic bag from abdominal cavity in place of original paraumbilical port. We were exploiting three working arms in all our cases, holding surgical camera, electrocautery hook and Cadiere forceps. We had been observing procedure time, technical complications connected with robotic system, length of hospital stay and complication incidence rate. We managed to finish all operations in laparoscopic way. Group of our patients formed 11 male patients (35.5%) and 20 women (64.5%), mean aged 52.5 years in range of 27 77 years. The average operation procedure lasted 100 minutes, in the group of last 11 patients only 69 minutes. We recorded paraumbilical wound infections in 3 (9.7 %) patients. We had not experienced any technical problems with robotic surgical system. Length of hospital stay was 3 days. Considering our initial experience with robotic lasparoscopic cholecystectomy we evaluate da Vinci robotic surgical system to be safe and sophisticated operating manipulator which however does not substitute the surgeon key-role of controlling position and decision competences. Presented results of our group are comparable to conclusions of abroad published works.

Movement Anticipation and EEG: Implications for BCI-Contingent Robot Therapy

PubMed Central

Norman, Sumner L.; Dennison, Mark; Wolbrecht, Eric; Cramer, Steven C.; Srinivasan, Ramesh; Reinkensmeyer, David J.

2017-01-01

Brain-computer interfacing is a technology that has the potential to improve patient engagement in robot-assisted rehabilitation therapy. For example, movement intention reduces mu (8-13 Hz) oscillation amplitude over the sensorimotor cortex, a phenomenon referred to as event-related desynchronization (ERD). In an ERD-contingent assistance paradigm, initial BCI-enhanced robotic therapy studies have used ERD to provide robotic assistance for movement. Here we investigated how ERD changed as a function of audio-visual stimuli, overt movement from the participant, and robotic assistance. Twelve unimpaired subjects played a computer game designed for rehabilitation therapy with their fingers using the FINGER robotic exoskeleton. In the game, the participant and robot matched movement timing to audio-visual stimuli in the form of notes approaching a target on the screen set to the consistent beat of popular music. The audio-visual stimulation of the game alone did not cause ERD, before or after training. In contrast, overt movement by the subject caused ERD, whether or not the robot assisted the finger movement. Notably, ERD was also present when the subjects remained passive and the robot moved their fingers to play the game. This ERD occurred in anticipation of the passive finger movement with similar onset timing as for the overt movement conditions. These results demonstrate that ERD can be contingent on expectation of robotic assistance; that is, the brain generates an anticipatory ERD in expectation of a robot-imposed but predictable movement. This is a caveat that should be considered in designing BCIs for enhancing patient effort in roboticallyassisted therapy. PMID:26891487

Evaluation of upper extremity robot-assistances in subacute and chronic stroke subjects.

PubMed

Ziherl, Jaka; Novak, Domen; Olenšek, Andrej; Mihelj, Matjaž; Munih, Marko

2010-10-18

Robotic systems are becoming increasingly common in upper extremity stroke rehabilitation. Recent studies have already shown that the use of rehabilitation robots can improve recovery. This paper evaluates the effect of different modes of robot-assistances in a complex virtual environment on the subjects' ability to complete the task as well as on various haptic parameters arising from the human-robot interaction. The MIMICS multimodal system that includes the haptic robot HapticMaster and a dynamic virtual environment is used. The goal of the task is to catch a ball that rolls down a sloped table and place it in a basket above the table. Our study examines the influence of catching assistance, pick-and-place movement assistance and grasping assistance on the catching efficiency, placing efficiency and on movement-dependent parameters: mean reaching forces, deviation error, mechanical work and correlation between the grasping force and the load force. The results with groups of subjects (23 subacute hemiparetic subjects, 10 chronic hemiparetic subjects and 23 control subjects) showed that the assistance raises the catching efficiency and pick-and-place efficiency. The pick-and-place movement assistance greatly limits the movements of the subject and results in decreased work toward the basket. The correlation between the load force and the grasping force exists in a certain phase of the movement. The results also showed that the stroke subjects without assistance and the control subjects performed similarly. The robot-assistances used in the study were found to be a possible way to raise the catching efficiency and efficiency of the pick-and-place movements in subacute and chronic subjects. The observed movement parameters showed that robot-assistances we used for our virtual task should be improved to maximize physical activity.

Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients.

PubMed

Pila, Ophélie; Duret, Christophe; Gracies, Jean-Michel; Francisco, Gerard E; Bayle, Nicolas; Hutin, Émilie

2018-04-25

To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months. FM scores were stable from 5 to 54 months (+1[-2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p < 0.05). Group 2 showed decline vs. Group 1 (p < 0.001) in FM (Group 1, +3[1;5], p < 0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; p < 0.001). While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients. EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.

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. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

EVA Robotic Assistant Project: Platform Attitude Prediction

NASA Technical Reports Server (NTRS)

Nickels, Kevin M.

2003-01-01

The Robotic Systems Technology Branch is currently working on the development of an EVA Robotic Assistant under the sponsorship of the Surface Systems Thrust of the NASA Cross Enterprise Technology Development Program (CETDP). This will be a mobile robot that can follow a field geologist during planetary surface exploration, carry his tools and the samples that he collects, and provide video coverage of his activity. Prior experiments have shown that for such a robot to be useful it must be able to follow the geologist at walking speed over any terrain of interest. Geologically interesting terrain tends to be rough rather than smooth. The commercial mobile robot that was recently purchased as an initial testbed for the EVA Robotic Assistant Project, an ATRV Jr., is capable of faster than walking speed outside but it has no suspension. Its wheels with inflated rubber tires are attached to axles that are connected directly to the robot body. Any angular motion of the robot produced by driving over rough terrain will directly affect the pointing of the on-board stereo cameras. The resulting image motion is expected to make tracking of the geologist more difficult. This will either require the tracker to search a larger part of the image to find the target from frame to frame or to search mechanically in pan and tilt whenever the image motion is large enough to put the target outside the image in the next frame. This project consists of the design and implementation of a Kalman filter that combines the output of the angular rate sensors and linear accelerometers on the robot to estimate the motion of the robot base. The motion of the stereo camera pair mounted on the robot that results from this motion as the robot drives over rough terrain is then straightforward to compute. The estimates may then be used, for example, to command the robot s on-board pan-tilt unit to compensate for the camera motion induced by the base movement. This has been accomplished in two ways: first, a standalone head stabilizer has been implemented and second, the estimates have been used to influence the search algorithm of the stereo tracking algorithm. Studies of the image motion of a tracked object indicate that the image motion of objects is suppressed while the robot crossing rough terrain. This work expands the range of speed and surface roughness over which the robot should be able to track and follow a field geologist and accept arm gesture commands from the geologist.

Acceptance of an assistive robot in older adults: a mixed-method study of human-robot interaction over a 1-month period in the Living Lab setting.

PubMed

Wu, Ya-Huei; Wrobel, Jérémy; Cornuet, Mélanie; Kerhervé, Hélène; Damnée, Souad; Rigaud, Anne-Sophie

2014-01-01

There is growing interest in investigating acceptance of robots, which are increasingly being proposed as one form of assistive technology to support older adults, maintain their independence, and enhance their well-being. In the present study, we aimed to observe robot-acceptance in older adults, particularly subsequent to a 1-month direct experience with a robot. Six older adults with mild cognitive impairment (MCI) and five cognitively intact healthy (CIH) older adults were recruited. Participants interacted with an assistive robot in the Living Lab once a week for 4 weeks. After being shown how to use the robot, participants performed tasks to simulate robot use in everyday life. Mixed methods, comprising a robot-acceptance questionnaire, semistructured interviews, usability-performance measures, and a focus group, were used. Both CIH and MCI subjects were able to learn how to use the robot. However, MCI subjects needed more time to perform tasks after a 1-week period of not using the robot. Both groups rated similarly on the robot-acceptance questionnaire. They showed low intention to use the robot, as well as negative attitudes toward and negative images of this device. They did not perceive it as useful in their daily life. However, they found it easy to use, amusing, and not threatening. In addition, social influence was perceived as powerful on robot adoption. Direct experience with the robot did not change the way the participants rated robots in their acceptance questionnaire. We identified several barriers to robot-acceptance, including older adults' uneasiness with technology, feeling of stigmatization, and ethical/societal issues associated with robot use. It is important to destigmatize images of assistive robots to facilitate their acceptance. Universal design aiming to increase the market for and production of products that are usable by everyone (to the greatest extent possible) might help to destigmatize assistive devices.

Acceptance of an assistive robot in older adults: a mixed-method study of human–robot interaction over a 1-month period in the Living Lab setting

PubMed Central

Wu, Ya-Huei; Wrobel, Jérémy; Cornuet, Mélanie; Kerhervé, Hélène; Damnée, Souad; Rigaud, Anne-Sophie

2014-01-01

Background There is growing interest in investigating acceptance of robots, which are increasingly being proposed as one form of assistive technology to support older adults, maintain their independence, and enhance their well-being. In the present study, we aimed to observe robot-acceptance in older adults, particularly subsequent to a 1-month direct experience with a robot. Subjects and methods Six older adults with mild cognitive impairment (MCI) and five cognitively intact healthy (CIH) older adults were recruited. Participants interacted with an assistive robot in the Living Lab once a week for 4 weeks. After being shown how to use the robot, participants performed tasks to simulate robot use in everyday life. Mixed methods, comprising a robot-acceptance questionnaire, semistructured interviews, usability-performance measures, and a focus group, were used. Results Both CIH and MCI subjects were able to learn how to use the robot. However, MCI subjects needed more time to perform tasks after a 1-week period of not using the robot. Both groups rated similarly on the robot-acceptance questionnaire. They showed low intention to use the robot, as well as negative attitudes toward and negative images of this device. They did not perceive it as useful in their daily life. However, they found it easy to use, amusing, and not threatening. In addition, social influence was perceived as powerful on robot adoption. Direct experience with the robot did not change the way the participants rated robots in their acceptance questionnaire. We identified several barriers to robot-acceptance, including older adults’ uneasiness with technology, feeling of stigmatization, and ethical/societal issues associated with robot use. Conclusion It is important to destigmatize images of assistive robots to facilitate their acceptance. Universal design aiming to increase the market for and production of products that are usable by everyone (to the greatest extent possible) might help to destigmatize assistive devices. PMID:24855349

Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

PubMed Central

Wang, Myra; Xie, Xuanqian; Wells, David; Higgins, Caroline

2017-01-01

Background Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario. Methods We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost–utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information. Results Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes (low to moderate quality evidence). Compared with laparoscopic radical prostatectomy, robot-assisted radical prostatectomy had no difference in perioperative, functional, and oncological outcomes (low to moderate quality evidence). Compared with open radical prostatectomy, our best estimates suggested that robot-assisted prostatectomy was associated with higher costs ($6,234) and a small gain in quality-adjusted life-years (QALYs) (0.0012). The best estimate of the incremental cost-effectiveness ratio (ICER) was $5.2 million per QALY gained. However, if robot-assisted radical prostatectomy were assumed to have substantially better long-term functional and oncological outcomes, the ICER might be as low as $83,921 per QALY gained. We estimated the annual budget impact to be $0.8 million to $3.4 million over the next 5 years. Conclusions There is no high-quality evidence that robot-assisted radical prostatectomy improves functional and oncological outcomes compared with open and laparoscopic approaches. However, compared with open radical prostatectomy, the costs of using the robotic system are relatively large while the health benefits are relatively small. PMID:28744334

Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy?

PubMed

Tsai, Tsung-Yuan; Dimitriou, Dimitris; Li, Jing-Sheng; Kwon, Young-Min

2016-06-01

The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique. Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared. Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group. This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Human-robot cooperative movement training: Learning a novel sensory motor transformation during walking with robotic assistance-as-needed

PubMed Central

Emken, Jeremy L; Benitez, Raul; Reinkensmeyer, David J

2007-01-01

Background A prevailing paradigm of physical rehabilitation following neurologic injury is to "assist-as-needed" in completing desired movements. Several research groups are attempting to automate this principle with robotic movement training devices and patient cooperative algorithms that encourage voluntary participation. These attempts are currently not based on computational models of motor learning. Methods Here we assume that motor recovery from a neurologic injury can be modelled as a process of learning a novel sensory motor transformation, which allows us to study a simplified experimental protocol amenable to mathematical description. Specifically, we use a robotic force field paradigm to impose a virtual impairment on the left leg of unimpaired subjects walking on a treadmill. We then derive an "assist-as-needed" robotic training algorithm to help subjects overcome the virtual impairment and walk normally. The problem is posed as an optimization of performance error and robotic assistance. The optimal robotic movement trainer becomes an error-based controller with a forgetting factor that bounds kinematic errors while systematically reducing its assistance when those errors are small. As humans have a natural range of movement variability, we introduce an error weighting function that causes the robotic trainer to disregard this variability. Results We experimentally validated the controller with ten unimpaired subjects by demonstrating how it helped the subjects learn the novel sensory motor transformation necessary to counteract the virtual impairment, while also preventing them from experiencing large kinematic errors. The addition of the error weighting function allowed the robot assistance to fade to zero even though the subjects' movements were variable. We also show that in order to assist-as-needed, the robot must relax its assistance at a rate faster than that of the learning human. Conclusion The assist-as-needed algorithm proposed here can limit error during the learning of a dynamic motor task. The algorithm encourages learning by decreasing its assistance as a function of the ongoing progression of movement error. This type of algorithm is well suited for helping people learn dynamic tasks for which large kinematic errors are dangerous or discouraging, and thus may prove useful for robot-assisted movement training of walking or reaching following neurologic injury. PMID:17391527

Acceptance and Attitudes Toward a Human-like Socially Assistive Robot by Older Adults.

PubMed

Louie, Wing-Yue Geoffrey; McColl, Derek; Nejat, Goldie

2014-01-01

Recent studies have shown that cognitive and social interventions are crucial to the overall health of older adults including their psychological, cognitive, and physical well-being. However, due to the rapidly growing elderly population of the world, the resources and people to provide these interventions is lacking. Our work focuses on the use of social robotic technologies to provide person-centered cognitive interventions. In this article, we investigate the acceptance and attitudes of older adults toward the human-like expressive socially assistive robot Brian 2.1 in order to determine if the robot's human-like assistive and social characteristics would promote the use of the robot as a cognitive and social interaction tool to aid with activities of daily living. The results of a robot acceptance questionnaire administered during a robot demonstration session with a group of 46 elderly adults showed that the majority of the individuals had positive attitudes toward the socially assistive robot and its intended applications.

Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia.

PubMed

Herling, Suzanne F; Palle, Connie; Møller, Ann M; Thomsen, Thordis; Sørensen, Jan

2016-03-01

The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost-drivers, the analysis showed that the robotic-assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs. For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes.

PubMed

Suda, Koichi; Ishida, Yoshinori; Kawamura, Yuichiro; Inaba, Kazuki; Kanaya, Seiichiro; Teramukai, Satoshi; Satoh, Seiji; Uyama, Ichiro

2012-07-01

Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP. A single-institution nonrandomized prospective study was performed. The patients (n = 36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n = 16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n = 20, control group). These patients were observed for 30 days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration. Robot assistance significantly reduced the incidence of vocal cord palsy (p = 0.018) and hoarseness (p = 0.015) and the time on the ventilator (p = 0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted group

Artificial urinary sphincter implantation in women with stress urinary incontinence: preliminary comparison of robot-assisted and open approaches.

PubMed

Peyronnet, Benoit; Vincendeau, Sébastien; Tondut, Lauranne; Bensalah, Karim; Damphousse, Mireille; Manunta, Andréa

2016-03-01

We aimed to compare outcomes of open and robot-assisted artificial urinary sphincter (AUS) implantation in female patients. The charts of all female patients who underwent an AUS implantation between 2008 and 2014 in a single center were retrospectively reviewed. From 2008 to 2012, AUS were implanted using an open approach and from 2013 to 2014 using a robot-assisted approach. Perioperative and functional parameters were compared between groups. The primary endpoint was continence status. Twenty-four women were assessed: 16 in the open group and eight in the robot-assisted group. Three patients had neurogenic stress urinary incontinence. Most patients had undergone previous procedures for urinary incontinence (15 in the open group and seven in the robotic group). Mean operative time was similar in both groups (214 vs. 211 min; p = 0.90). Postoperative complicationsrate was lower in the robot-assisted group (25 vs. 75 %; p = 0.02). There was a trend toward a lower intraoperative complication rate (37.5 vs. 62.5 %; p = 0.25), decreased blood loss (17 ml vs. 275 ml; p = 0.22), and shorter length of stay (3.5 vs. 9.3 days; p = 0.09) in the robot-assisted group. Continence rates were comparable in both groups (75 vs. 68.8 %; p = 0.75). Three AUS explantations were needed in the open group (18.8 %) compared with one in the robot-assisted group (12.5 %; p = 0.70). In female patients, the robot-assisted approach compared with open AUS implantation could decrease intraoperative and postoperative complication rates, length of hospital stay, and blood loss.

Robot assistance of motor learning: A neuro-cognitive perspective.

PubMed

Heuer, Herbert; Lüttgen, Jenna

2015-09-01

The last several years have seen a number of approaches to robot assistance of motor learning. Experimental studies have produced a range of findings from beneficial effects through null-effects to detrimental effects of robot assistance. In this review we seek an answer to the question under which conditions which outcomes should be expected. For this purpose we derive tentative predictions based on a classification of learning tasks in terms of the products of learning, the mechanisms involved, and the modulation of these mechanisms by robot assistance. Consistent with these predictions, the learning of dynamic features of trajectories is facilitated and the learning of kinematic and dynamic transformations is impeded by robotic guidance, whereas the learning of dynamic transformations can profit from robot assistance with error-amplifying forces. Deviating from the predictions, learning of spatial features of trajectories is impeded by haptic guidance, but can be facilitated by divergent force fields. The deviations point to the existence of additional effects of robot assistance beyond the modulation of learning mechanisms, e.g., the induction of a passive role of the motor system during practice with haptic guidance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of robot assisted gait training in progressive supranuclear palsy (PSP): a preliminary report

PubMed Central

Sale, Patrizio; Stocchi, Fabrizio; Galafate, Daniele; De Pandis, Maria Francesca; Le Pera, Domenica; Sova, Ivan; Galli, Manuela; Foti, Calogero; Franceschini, Marco

2014-01-01

Background and Purpose: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease clinically characterized by prominent axial extrapyramidal motor symptoms with frequent falls. Over the last years the introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. This observational trial is aimed at investigating the changes in the main spatiotemporal following end-effector robot training in people with PSP. Method: Pilot observational trial. Participants: Five cognitively intact participants with PSP and gait disorders. Interventions: Patients were submitted to a rehabilitative program of robot-assisted walking sessions for 45 min, 5 times a week for 4 weeks. Main outcome measures: The spatiotemporal parameters at the beginning (T0) and at the end of treatment (T1) were recorded by a gait analysis laboratory. Results: Robot training was feasible, acceptable and safe and all participants completed the prescribed training sessions. All patients showed an improvement in the gait spatiotemporal index (Mean velocity, Cadence, Step length, and Step width) (T0 vs. T1). Conclusions: Robot training is a feasible and safe form of rehabilitation for cognitively intact people with PSP. The lack of side effects and the positive results in the gait parameter index in all patients support the recommendation to extend the trials of this treatment. Further investigation regarding the effectiveness of robot training in time is necessary. Trial registration: ClinicalTrials.gov NCT01668407. PMID:24860459

On the Utilization of Social Animals as a Model for Social Robotics

PubMed Central

Miklósi, Ádám; Gácsi, Márta

2012-01-01

Social robotics is a thriving field in building artificial agents. The possibility to construct agents that can engage in meaningful social interaction with humans presents new challenges for engineers. In general, social robotics has been inspired primarily by psychologists with the aim of building human-like robots. Only a small subcategory of “companion robots” (also referred to as robotic pets) was built to mimic animals. In this opinion essay we argue that all social robots should be seen as companions and more conceptual emphasis should be put on the inter-specific interaction between humans and social robots. This view is underlined by the means of an ethological analysis and critical evaluation of present day companion robots. We suggest that human–animal interaction provides a rich source of knowledge for designing social robots that are able to interact with humans under a wide range of conditions. PMID:22457658

Usefulness of robot-assisted thoracoscopic esophagectomy.

PubMed

Osaka, Yoshiaki; Tachibana, Shingo; Ota, Yoshihiro; Suda, Takeshi; Makuuti, Yosuke; Watanabe, Takafumi; Iwasaki, Kenichi; Katsumata, Kenji; Tsuchida, Akihiko

2018-04-01

We started robot-assisted thoracoscopic esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic esophagectomy and compared it with conventional esophagectomy by right thoracotomy. Patients requiring an invasion depth of up to the muscularis propria with preoperative diagnosis were considered for surgical adaptation, excluding bulky lymph node metastasis or salvage surgery cases. The outcomes of 30 patients who underwent robot-assisted surgery (robot group) and 30 patients who underwent conventional esophagectomy by right thoracotomy (thoracotomy group) up to December 2013 were retrospectively examined. Five ports were used in the robot-assisted thoracoscopic esophagectomy: 3rd intercostal (da Vinci right arm), 6th intercostal (da Vinci camera), 9th intercostal (da Vinci left arm), 4th and 8th intercostals (for assistance). There was no significant difference in patient characteristics. Robot group/right thoracotomy group: Operation time, 563/398 min; thoracic procedure bleeding volume, 21/135 ml; number of thoracic lymph node radical dissections, 25/23. Postoperative complications were recurrent nerve paralysis, 16.7/16.7%; pneumonia, 6.7%/10.0%; anastomotic leakage, 10.0/20.0%; surgical site infection, 0/10.0%; hospitalization, 17/30 days. For the robot group, the operation time was significantly longer, but the amount of intraoperative bleeding and postoperative hospitalization were significantly reduced. Robot-assisted thoracoscopic esophagectomy enables delicate surgical procedures owing to the 3D effect of the field of view and articulated forceps of the da Vinci. This procedure reduces bleeding and postoperative hospitalization and is less invasive than conventional esophagectomy by right thoracotomy.

Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

PubMed

Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

2017-07-01

To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P < 0.0001). The prevalence of Clavien-Dindo grade 3 complications and a negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and shorter postoperative length of hospital stay can be obtained with robot-assisted laparoscopic partial nephrectomy. © 2017 The Japanese Urological Association.

Knowledge assistant for robotic environmental characterization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feddema, J.; Rivera, J.; Tucker, S.

1996-08-01

A prototype sensor fusion framework called the {open_quotes}Knowledge Assistant{close_quotes} has been developed and tested on a gantry robot at Sandia National Laboratories. This Knowledge Assistant guides the robot operator during the planning, execution, and post analysis stages of the characterization process. During the planning stage, the Knowledge Assistant suggests robot paths and speeds based on knowledge of sensors available and their physical characteristics. During execution, the Knowledge Assistant coordinates the collection of data through a data acquisition {open_quotes}specialist.{close_quotes} During execution and postanalysis, the Knowledge Assistant sends raw data to other {open_quotes}specialists,{close_quotes} which include statistical pattern recognition software, a neural network,more » and model-based search software. After the specialists return their results, the Knowledge Assistant consolidates the information and returns a report to the robot control system where the sensed objects and their attributes (e.g., estimated dimensions, weight, material composition, etc.) are displayed in the world model. This report highlights the major components of this system.« less

Control of robot assistant for rehabilitation of upper extremities.

PubMed

Kostić, Miloš D; Popović, Mirjana B; Popović, Dejan B

2012-01-01

The assisted movement in humans with paresis of upper extremities is becoming popular for neurorehabilitation. We propose a novel method for trajectory selection and assistance control. This paper presents simulation of a planar two degrees of freedom robot that assists horizontal movement of the hand. The control assumes that during the exercise the hand needs to follow healthy alike trajectories. The robot is assumed to provide minimal assistance and operate as a teacher of the movement.

Robotic Assistance for Training Finger Movement Using a Hebbian Model: A Randomized Controlled Trial.

PubMed

Rowe, Justin B; Chan, Vicky; Ingemanson, Morgan L; Cramer, Steven C; Wolbrecht, Eric T; Reinkensmeyer, David J

2017-08-01

Robots that physically assist movement are increasingly used in rehabilitation therapy after stroke, yet some studies suggest robotic assistance discourages effort and reduces motor learning. To determine the therapeutic effects of high and low levels of robotic assistance during finger training. We designed a protocol that varied the amount of robotic assistance while controlling the number, amplitude, and exerted effort of training movements. Participants (n = 30) with a chronic stroke and moderate hemiparesis (average Box and Blocks Test 32 ± 18 and upper extremity Fugl-Meyer score 46 ± 12) actively moved their index and middle fingers to targets to play a musical game similar to GuitarHero 3 h/wk for 3 weeks. The participants were randomized to receive high assistance (causing 82% success at hitting targets) or low assistance (55% success). Participants performed ~8000 movements during 9 training sessions. Both groups improved significantly at the 1-month follow-up on functional and impairment-based motor outcomes, on depression scores, and on self-efficacy of hand function, with no difference between groups in the primary endpoint (change in Box and Blocks). High assistance boosted motivation, as well as secondary motor outcomes (Fugl-Meyer and Lateral Pinch Strength)-particularly for individuals with more severe finger motor deficits. Individuals with impaired finger proprioception at baseline benefited less from the training. Robot-assisted training can promote key psychological outcomes known to modulate motor learning and retention. Furthermore, the therapeutic effectiveness of robotic assistance appears to derive at least in part from proprioceptive stimulation, consistent with a Hebbian plasticity model.

Virtual modeling of robot-assisted manipulations in abdominal surgery.

PubMed

Berelavichus, Stanislav V; Karmazanovsky, Grigory G; Shirokov, Vadim S; Kubyshkin, Valeriy A; Kriger, Andrey G; Kondratyev, Evgeny V; Zakharova, Olga P

2012-06-27

To determine the effectiveness of using multidetector computed tomography (MDCT) data in preoperative planning of robot-assisted surgery. Fourteen patients indicated for surgery underwent MDCT using 64 and 256-slice MDCT. Before the examination, a specially constructed navigation net was placed on the patient's anterior abdominal wall. Processing of MDCT data was performed on a Brilliance Workspace 4 (Philips). Virtual vectors that imitate robotic and assistant ports were placed on the anterior abdominal wall of the 3D model of the patient, considering the individual anatomy of the patient and the technical capabilities of robotic arms. Sites for location of the ports were directed by projection on the roentgen-positive tags of the navigation net. There were no complications observed during surgery or in the post-operative period. We were able to reduce robotic arm interference during surgery. The surgical area was optimal for robotic and assistant manipulators without any need for reinstallation of the trocars. This method allows modeling of the main steps in robot-assisted intervention, optimizing operation of the manipulator and lowering the risk of injuries to internal organs.

Robotic assisted andrological surgery

PubMed Central

Parekattil, Sijo J; Gudeloglu, Ahmet

2013-01-01

The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE). PMID:23241637

Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.

PubMed

Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O

2017-06-01

Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Hand gesture guided robot-assisted surgery based on a direct augmented reality interface.

PubMed

Wen, Rong; Tay, Wei-Liang; Nguyen, Binh P; Chng, Chin-Boon; Chui, Chee-Kong

2014-09-01

Radiofrequency (RF) ablation is a good alternative to hepatic resection for treatment of liver tumors. However, accurate needle insertion requires precise hand-eye coordination and is also affected by the difficulty of RF needle navigation. This paper proposes a cooperative surgical robot system, guided by hand gestures and supported by an augmented reality (AR)-based surgical field, for robot-assisted percutaneous treatment. It establishes a robot-assisted natural AR guidance mechanism that incorporates the advantages of the following three aspects: AR visual guidance information, surgeon's experiences and accuracy of robotic surgery. A projector-based AR environment is directly overlaid on a patient to display preoperative and intraoperative information, while a mobile surgical robot system implements specified RF needle insertion plans. Natural hand gestures are used as an intuitive and robust method to interact with both the AR system and surgical robot. The proposed system was evaluated on a mannequin model. Experimental results demonstrated that hand gesture guidance was able to effectively guide the surgical robot, and the robot-assisted implementation was found to improve the accuracy of needle insertion. This human-robot cooperative mechanism is a promising approach for precise transcutaneous ablation therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Feasibility of robot-assisted modified radical neck dissection by post-auricular facelift approach.

PubMed

Tae, K; Ji, Y B; Song, C M; Sung, E S; Chung, J H; Lee, S H; Park, H J

2016-11-01

The aim of this study was to evaluate the technical feasibility and safety of robot-assisted modified radical neck dissection (MRND) for head and neck cancer patients with a clinically node-positive neck. The cases of 10 head and neck cancer patients who underwent unilateral therapeutic robot-assisted MRND by post-auricular facelift approach were analyzed. The robot-assisted MRND was completed successfully in all patients without any conversion to conventional neck dissection. The mean number of lymph nodes removed was 36.7±8.6. The mean duration of surgery for robot-assisted MRND was 274±65min (range 175-395min). Transient marginal nerve palsy occurred in two patients and partial necrosis of the skin flap occurred in one patient. In terms of cosmetic satisfaction, 70% of patients were very satisfied or satisfied with postoperative cosmesis. In conclusion, robot-assisted MRND by post-auricular facelift approach is technically feasible and safe in selected patients with head and neck cancer, and yields excellent postoperative cosmesis. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

EEG Analysis During Active and Assisted Repetitive Movements: Evidence for Differences in Neural Engagement.

PubMed

Tacchino, Giulia; Gandolla, Marta; Coelli, Stefania; Barbieri, Riccardo; Pedrocchi, Alessandra; Bianchi, Anna M

2017-06-01

Two key ingredients of a successful neuro-rehabilitative intervention have been identified as intensive and repetitive training and subject's active participation, which can be coupled in an active robot-assisted training. To exploit these two elements, we recorded electroencephalography, electromyography and kinematics signals from nine healthy subjects performing a 2×2 factorial design protocol, with subject's volitional intention and robotic glove assistance as factors. We quantitatively evaluated primary sensorimotor, premotor and supplementary motor areas activation during movement execution by computing event-related desynchronization (ERD) patterns associated to mu and beta rhythms. ERD patterns showed a similar behavior for all investigated regions: statistically significant ERDs began earlier in conditions requiring subject's volitional contribution; ERDs were prolonged towards the end of movement in conditions in which the robotic assistance was present. Our study suggests that the combination between subject volitional contribution and movement assistance provided by the robotic device (i.e., active robot-assisted modality) is able to provide early brain activation (i.e., earlier ERD) associated with stronger proprioceptive feedback (i.e., longer ERD). This finding might be particularly important for neurological patients, where movement cannot be completed autonomously and passive/active robot-assisted modalities are the only possibilities of execution.

NASA Research Announcement Phase 2 Final Report for the Development of a Power Assisted Space Suit Glove

NASA Technical Reports Server (NTRS)

Lingo, Robert; Cadogan, Dave; Sanner, Rob; Sorenson, Beth

1997-01-01

The main goal of this program was to develop an unobtrusive power-assisted EVA glove metacarpalphalangeal (MCP) joint that could provide the crew member with as close to nude body performance as possible, and to demonstrate the technology feasibility of power assisted space suit components in general. The MCP joint was selected due to its being representative of other space suit joints, such as the shoulder, hip and carpometacarpal joint, that would also greatly benefit from this technology. In order to meet this objective, a development team of highly skilled and experienced personnel was assembled. The team consisted of two main entities. The first was comprised of ILC's experienced EVA space suit glove designers, who had the responsibility of designing and fabricating a low torque MCP joint which would be compatible with power assisted technology. The second part of the team consisted of space robotics experts from the University of Maryland's Space Systems Laboratory. This team took on the responsibility of designing and building the robotics aspects of the power-assist system. Both parties addressed final system integration responsibilities.

The immediate effects of robot-assistance on energy consumption and cardiorespiratory load during walking compared to walking without robot-assistance: a systematic review.

PubMed

Lefeber, Nina; Swinnen, Eva; Kerckhofs, Eric

2017-10-01

The integration of sufficient cardiovascular stress into robot-assisted gait (RAG) training could combine the benefits of both RAG and aerobic training. The aim was to summarize literature data on the immediate effects of RAG compared to walking without robot-assistance on metabolic-, cardiorespiratory- and fatigue-related parameters. PubMed and Web of Science were searched for eligible articles till February 2016. Means, SDs and significance values were extracted. Effect sizes were calculated. Fourteen studies were included, concerning 155 participants (85 healthy subjects, 39 stroke and 31 spinal cord injury patients), 9 robots (2 end-effectors, 1 treadmill-based and 6 wearable exoskeletons), and 7 outcome parameters (mostly oxygen consumption and heart rate). Overall, metabolic and cardiorespiratory parameters were lower during RAG compared to walking without robot-assistance (moderate to large effect sizes). In healthy subjects, when no body-weight support (BWS) was provided, RAG with an end-effector device was more energy demanding than walking overground (p > .05, large effect sizes). Generally, results suggest that RAG is less energy-consuming and cardiorespiratory stressful than walking without robot-assistance, but results depend on factors such as robot type, walking speed, BWS and effort. Additional research is needed to draw firm conclusions. Implications for Rehabilitation Awareness of the energy consumption and cardiorespiratory load of robot-assisted gait (RAG) training is important in the rehabilitation of (neurological) patients with impaired cardiorespiratory fitness and patients who are at risk of cardiovascular diseases. On the other hand, the integration of sufficient cardiometabolic stress in RAG training could combine the effects of both RAG and aerobic training. Energy consumption and cardiorespiratory load during walking with robot-assistance seems to depend on factors such as robot type, walking speed, body-weight support or amount of effort. These parameters could be adjusted in RAG rehabilitation to make RAG more or less energy-consuming and cardiorespiratory stressful. Overall, short duration exoskeleton walking seems less energy-consuming and cardiorespiratory stressful than walking without robot-assistance. This might implicate that the exercise intensity is safe for (neurological) patients at risk of cardiovascular diseases. How this changes in extended walking time is unclear.

An EMG-Based Control for an Upper-Limb Power-Assist Exoskeleton Robot.

PubMed

Kiguchi, K; Hayashi, Y

2012-08-01

Many kinds of power-assist robots have been developed in order to assist self-rehabilitation and/or daily life motions of physically weak persons. Several kinds of control methods have been proposed to control the power-assist robots according to user's motion intention. In this paper, an electromyogram (EMG)-based impedance control method for an upper-limb power-assist exoskeleton robot is proposed to control the robot in accordance with the user's motion intention. The proposed method is simple, easy to design, humanlike, and adaptable to any user. A neurofuzzy matrix modifier is applied to make the controller adaptable to any users. Not only the characteristics of EMG signals but also the characteristics of human body are taken into account in the proposed method. The effectiveness of the proposed method was evaluated by the experiments.

A mobile robot therapist for under-supervised training with robot/computer assisted motivating systems.

PubMed

Shakya, Yuniya; Johnson, Michelle J

2008-01-01

Robot assisted therapy is a new and promising area in stroke rehabilitation and has shown to be effective in reducing motor impairment, but is a costly solution for home rehabilitation. High medical costs could be reduced if we could improve rehabilitation exercise in unsupervised environments such as the home. Hence, there is an augmented need for a cost effective rehabilitation system that can be used outside the clinic. This paper presents the design concept for an autonomous robotic assistant that is low-cost and effective in engaging the users while assisting them with therapy in any under-supervised area. We investigated how the robot assistant can support TheraDrive, our low-cost therapy system. We present the design methods and a case study demonstrating the arm and video collection system.

The role of robotic surgical system in the management of vascular disease.

PubMed

Lin, Judith C

2013-10-01

The evolution of minimally invasive treatment for aneurysms and occlusive disease has led to the development of endovascular, laparoscopic, and robot-assisted techniques. This article reviews the current literature on the clinical use of robotic surgical systems in the treatment of patients with aneurysms and occlusive disease. A MEDLINE search was performed using the keywords "robotic, vascular, AND surgery." All pertinent articles concerning the use of the robotic surgical system on aneurysms and occlusive disease were reviewed. The author's personal experience consisted of a retrospective review of a prospectively maintained confidential database on all procedures performed with the da Vinci(®) surgical system. Several robot-assisted laparoscopic series on the treatment of aortic disease were identified, including review articles of potential clinical applications in hybrid, laparoscopic vascular, and endovascular treatments for vascular patients using robotic technology. The use of computer-enhanced or robotic technology as a sole modality for bypass of occlusive disease and repair of abdominal aortic, splenic, and renal aneurysms was described in case series with satisfactory patient outcomes. Current robotic endovascular technology was also described. Minimally invasive techniques using endovascular, laparoscopic, or robot-assisted technology have revolutionized the treatment of aortoiliac, splanchnic, and renal aneurysms and occlusive disease. However, robot-assisted techniques for aortic disease may involve a learning curve and increased operating times. Although endovascular therapy is preferred because of faster recovery, this preference for improved short-term outcomes will be balanced with the superiority and durability of robot-assisted endoscopic methods as comparable to open surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

An Effective Division of Labor Between Human and Robotic Agents Performing a Cooperative Assembly Task

NASA Technical Reports Server (NTRS)

Rehnmark, Fredrik; Bluethmann, William; Rochlis, Jennifer; Huber, Eric; Ambrose, Robert

2003-01-01

NASA's Human Space Flight program depends heavily on spacewalks performed by human astronauts. These so-called extra-vehicular activities (EVAs) are risky, expensive and complex. Work is underway to develop a robotic astronaut's assistant that can help reduce human EVA time and workload by delivering human-like dexterous manipulation capabilities to any EVA worksite. An experiment is conducted to evaluate human-robot teaming strategies in the context of a simplified EVA assembly task in which Robonaut, a collaborative effort with the Defense Advanced Research Projects Agency (DARPA), an anthropomorphic robot works side-by-side with a human subject. Team performance is studied in an effort to identify the strengths and weaknesses of each teaming configuration and to recommend an appropriate division of labor. A shared control approach is developed to take advantage of the complementary strengths of the human teleoperator and robot, even in the presence of significant time delay.

Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer: A Phase II Open Label Prospective Randomized Controlled Trial.

PubMed

Kim, Min Jung; Park, Sung Chan; Park, Ji Won; Chang, Hee Jin; Kim, Dae Yong; Nam, Byung-Ho; Sohn, Dae Kyung; Oh, Jae Hwan

2018-02-01

The phase II randomized controlled trial aimed to compare the outcomes of robot-assisted surgery with those of laparoscopic surgery in the patients with rectal cancer. The feasibility of robot-assisted surgery over laparoscopic surgery for rectal cancer has not been established yet. Between February 21, 2012 and March 11, 2015, patients with rectal cancer (cT1-3NxM0) were enrolled. Patients were randomized 1:1 to either robot-assisted or laparoscopic surgery, and stratified per sex and administration of preoperative chemoradiotherapy. The primary outcome was the quality of total mesorectal excision (TME) specimen. Secondary outcomes were the circumferential and distal resection margins, the number of harvested lymph nodes, morbidity, bowel function recovery, and quality of life. A total of 163 patients were randomly assigned to the robot-assisted (n = 81) and laparoscopic (n = 82) surgery groups, and 139 patients were eligible for the analyses (73 vs 66, respectively). One patient (1.2%) in the robot-assisted group was converted to open surgery. The TME quality did not differ between the robot-assisted and laparoscopic groups (80.3% vs 78.1% complete TME, respectively; 18.2% vs 21.9% nearly complete TME, respectively; P = 0.599). The resection margins, number of harvested lymph nodes, morbidity, and bowel function recovery also were not significantly different. On analyzing quality of life, scores of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C30) and EORTC QLQ CR38 were similar in the 2 groups, but in the EORTC QLQ CR 38 questionnaire, sexual function 12 months postoperatively was better in the robot-assisted group than in the laparoscopic group (P = 0.03). Robot-assisted surgery in rectal cancer showed TME quality comparable with that of laparoscopic surgery, and it demonstrated similar postoperative morbidity, bowel function recovery, and quality of life.

Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population.

PubMed

Macke, Jeremy J; Woo, Raymund; Varich, Laura

2016-06-01

This is a retrospective review of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients under 18 years of age who underwent robot-assisted corrective surgery. Our primary objective was to characterize the accuracy of pedicle screw placement with evaluation by computed tomography (CT) after robot-assisted surgery in AIS patients. Screw malposition is the most frequent complication of pedicle screw placement and is more frequent in AIS. Given the potential for serious complications, the need for improved accuracy of screw placement has spurred multiple innovations including robot-assisted guidance devices. No studies to date have evaluated this robot-assisted technique using CT exclusively within the AIS population. Fifty patients were included in the study. All operative procedures were performed at a single institution by a single pediatric orthopedic surgeon. We evaluated the grade of screw breach, the direction of screw breach, and the positioning of the patient for preoperative scan (supine versus prone). Of 662 screws evaluated, 48 screws (7.2 %) demonstrated a breach of greater than 2 mm. With preoperative prone position CT scanning, only 2.4 % of screws were found to have this degree of breach. Medial malposition was found in 3 % of screws, a rate which decreased to 0 % with preoperative prone position scanning. Based on our results, we conclude that the proper use of image-guided robot-assisted surgery can improve the accuracy and safety of thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis. This is the first study to evaluate the accuracy of pedicle screw placement using CT assessment in robot-assisted surgical correction of patients with AIS. In our study, the robot-assisted screw misplacement rate was lower than similarly constructed studies evaluating conventional (non-robot-assisted) procedures. If patients are preoperatively scanned in the prone position, the misplacement rate is further decreased.

Robot-assisted laparoscopic intracorporeal hand-sewn bowel anastomosis during pediatric bladder reconstructive surgery.

PubMed

Gundeti, Mohan S; Wiltz, Aimee L; Zagaja, Gregory P; Shalhav, Arieh L

2010-08-01

Bowel anastomosis performed during robot-assisted laparoscopic surgery in both adult and pediatric populations has typically been performed using endoscopic staplers or with exteriorization of the bowel. In the pediatric population, no articles have been published that explore the possibility of a completely intracorporeal hand-sewn anastomosis during robot-assisted laparoscopic surgery. We report our series of six children who were undergoing robot-assisted laparoscopic intracorporeal hand-sewn bowel anastomosis during bladder reconstructive surgery for neurogenic bladder. The postoperative course was uncomplicated with regard to the bowel anastomosis, demonstrating the feasibility of the technique in experienced hands.

Technical features of the robot-assisted trans-axillary thyroidectomy.

PubMed

Axente, D D; Major, Z Z; Micu, C M; Constantea, N A

2013-01-01

Numerous minimally invasive techniques for thyroid surgery have been described in recent years. Technical disadvantages have led to low practicability, although these techniques proved to be safe and to deliver good results. The robotic system was developed to overcome the limits of endoscopic surgery.Recently, based on the advantages of this new technology, robot assisted endoscopic surgery was introduced for minimally invasive thyroid surgery as well. Our experience with robot-assisted transaxillary thyroid surgery begins in November 2010 when we have practiced our first unilateral total lobectomy. From November 2010 to March 2012, 50 patients underwent robot assisted endoscopic thyroid surgery using the transaxillary approach. The aim of this study is to present the technical details and particularities of this procedure, based on our experience.

Design and implementation of visual-haptic assistive control system for virtual rehabilitation exercise and teleoperation manipulation.

PubMed

Veras, Eduardo J; De Laurentis, Kathryn J; Dubey, Rajiv

2008-01-01

This paper describes the design and implementation of a control system that integrates visual and haptic information to give assistive force feedback through a haptic controller (Omni Phantom) to the user. A sensor-based assistive function and velocity scaling program provides force feedback that helps the user complete trajectory following exercises for rehabilitation purposes. This system also incorporates a PUMA robot for teleoperation, which implements a camera and a laser range finder, controlled in real time by a PC, were implemented into the system to help the user to define the intended path to the selected target. The real-time force feedback from the remote robot to the haptic controller is made possible by using effective multithreading programming strategies in the control system design and by novel sensor integration. The sensor-based assistant function concept applied to teleoperation as well as shared control enhances the motion range and manipulation capabilities of the users executing rehabilitation exercises such as trajectory following along a sensor-based defined path. The system is modularly designed to allow for integration of different master devices and sensors. Furthermore, because this real-time system is versatile the haptic component can be used separately from the telerobotic component; in other words, one can use the haptic device for rehabilitation purposes for cases in which assistance is needed to perform tasks (e.g., stroke rehab) and also for teleoperation with force feedback and sensor assistance in either supervisory or automatic modes.

The impact of marketing language on patient preference for robot-assisted surgery.

PubMed

Dixon, Peter R; Grant, Robert C; Urbach, David R

2015-02-01

Robot-assisted surgery is gaining momentum as a new trend in minimally invasive surgery. With limited evidence supporting its use in place of the far less expensive conventional laparoscopic surgery, it has been suggested that marketing pressure is partly responsible for its widespread adoption. The impact of phrases that promote the novelty of robot-assisted surgery on patient decision making has not been investigated. We conducted a discrete choice experiment to elicit preference of partial colectomy technique for a hypothetical diagnosis of colon cancer. A convenience sample of 38 participants in an ambulatory general surgery clinic consented to participate. Each participant made 2 treatment decisions between robot-assisted surgery and conventional laparoscopic surgery, with robot-assisted surgery described as "innovative" and "state-of-the-art" in one of the decisions (marketing frame), and by a disclosure of the uncertainty of available evidence in the other (evidence-based frame). The magnitude of the framing effect was large with 12 of 38 subjects (31.6%, P = .005) selecting robot-assisted surgery in the marketing frame and not the evidence-based frame. This is the first study to our knowledge to demonstrate that words that highlight novelty have an important influence on patient preference for robot-assisted surgery and that use of more neutral language can mitigate this effect. © The Author(s) 2014.

Robot-assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions - a systematic review.

PubMed

Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel; Dalsgaard, Tórur; Bjørn, Signe F; Frøding, Ligita P; Kehlet, Henrik; Høgdall, Claus K; Lajer, Henrik

2017-03-01

Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous surgical methods. Controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application. The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy.

PubMed

Yamada, Yuta; Fujimura, Tetsuya; Fukuhara, Hiroshi; Sugihara, Toru; Miyazaki, Hideyo; Nakagawa, Tohru; Kume, Haruki; Igawa, Yasuhiko; Homma, Yukio

2017-10-01

To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investigated, and relationships between factors and recovery of continence after robot-assisted radical prostatectomy were assessed. The presence of overactive bladder was defined as having urgency for more than once a week and having ≥3 points according to the Overactive Bladder Symptom Score. Age (≤66 years) was significantly associated with continence within 6 months after robot-assisted radical prostatectomy (P = 0.033). The absence of overactive bladder and lower Overactive Bladder Symptom Score (<3) were significantly associated with recovery of continence within 12 months after surgery (both variables P = 0.009). In terms of achieving recovery of continence after robot-assisted radical prostatectomy, Kaplan-Meier curves showed earlier recovery in "age ≤66 years," "prostate weight ≤40 g" and "overactive bladder symptom score <3" (P = 0.0072, 0.0172 and 0.0140, respectively). Multivariate analysis showed that the presence of overactive bladder was an independent negative predictor for recovery of continence within 12 months after surgery (P = 0.019). The presence of baseline overactive bladder seems to represent an independent negative predictor for recovery of continence at 12 months after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

Combined functional electrical stimulation (FES) and robotic system for wrist rehabiliation after stroke.

PubMed

Hu, Xiaoling; Tong, K Y; Li, R; Chen, M; Xue, J J; Ho, S K; Chen, P N

2010-01-01

Functional electrical stimulation (FES) and rehabilitation robots are techniques used to assist in post-stroke rehabilitation. However, FES and rehabilitation robots are still separate systems currently; and their combined training effects on persons after experiencing a stroke have not been well studied yet. In this work, a new combined FES-robot system driven by user's voluntary intention was developed for wrist joint training after stroke. The performance of the FES-robot assisted wrist tracking was evaluated on five subjects with chronic stroke. With simultaneous assistance from both the FES and robot parts of the system, the motion accuracy was improved and excessive activation in elbow flexor was reduced during wrist tracking.

Inducing self-selected human engagement in robotic locomotion training.

PubMed

Collins, Steven H; Jackson, Rachel W

2013-06-01

Stroke leads to severe mobility impairments for millions of individuals each year. Functional outcomes can be improved through manual treadmill therapy, but high costs limit patient exposure and, thereby, outcomes. Robotic gait training could increase the viable duration and frequency of training sessions, but robotic approaches employed thus far have been less effective than manual therapy. These shortcomings may relate to subconscious energy-minimizing drives, which might cause patients to engage less actively in therapy when provided with corrective robotic assistance. We have devised a new method for gait rehabilitation that harnesses, rather than fights, least-effort tendencies. Therapeutic goals, such as increased use of the paretic limb, are made easier than the patient's nominal gait through selective assistance from a robotic platform. We performed a pilot test on a healthy subject (N = 1) in which altered self-selected stride length was induced using a tethered robotic ankle-foot orthosis. The subject first walked on a treadmill while wearing the orthosis with and without assistance at unaltered and voluntarily altered stride length. Voluntarily increasing stride length by 5% increased metabolic energy cost by 4%. Robotic assistance decreased energy cost at both unaltered and voluntarily increased stride lengths, by 6% and 8% respectively. We then performed a test in which the robotic system continually monitored stride length and provided more assistance if the subject's stride length approached a target increase. This adaptive assistance protocol caused the subject to slowly adjust their gait patterns towards the target, leading to a 4% increase in stride length. Metabolic energy consumption was simultaneously reduced by 5%. These results suggest that selective-assistance protocols based on targets relevant to rehabilitation might lead patients to self-select desirable gait patterns during robotic gait training sessions, possibly facilitating better adherence and outcomes.

Effectiveness of robot-assisted therapy on ankle rehabilitation--a systematic review.

PubMed

Zhang, Mingming; Davies, T Claire; Xie, Shane

2013-03-21

The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. Thirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords 'ankle*', 'robot*', 'rehabilitat*' or 'treat*' and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation. Twenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II. All the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies.

Incremental learning of tasks from user demonstrations, past experiences, and vocal comments.

PubMed

Pardowitz, Michael; Knoop, Steffen; Dillmann, Ruediger; Zöllner, Raoul D

2007-04-01

Since many years the robotics community is envisioning robot assistants sharing the same environment with humans. It became obvious that they have to interact with humans and should adapt to individual user needs. Especially the high variety of tasks robot assistants will be facing requires a highly adaptive and user-friendly programming interface. One possible solution to this programming problem is the learning-by-demonstration paradigm, where the robot is supposed to observe the execution of a task, acquire task knowledge, and reproduce it. In this paper, a system to record, interpret, and reason over demonstrations of household tasks is presented. The focus is on the model-based representation of manipulation tasks, which serves as a basis for incremental reasoning over the acquired task knowledge. The aim of the reasoning is to condense and interconnect the data, resulting in more general task knowledge. A measure for the assessment of information content of task features is introduced. This measure for the relevance of certain features relies both on general background knowledge as well as task-specific knowledge gathered from the user demonstrations. Beside the autonomous information estimation of features, speech comments during the execution, pointing out the relevance of features are considered as well. The results of the incremental growth of the task knowledge when more task demonstrations become available and their fusion with relevance information gained from speech comments is demonstrated within the task of laying a table.

The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications

PubMed Central

Kim, In-Sung; Bhardwaj, Atul M.; Badami, Ramachandra N.

2017-01-01

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly. PMID:28316957

Effects of electromyography-driven robot-aided hand training with neuromuscular electrical stimulation on hand control performance after chronic stroke.

PubMed

Rong, Wei; Tong, Kai Yu; Hu, Xiao Ling; Ho, Sze Kit

2015-03-01

An electromyography-driven robot system integrated with neuromuscular electrical stimulation (NMES) was developed to investigate its effectiveness on post-stroke rehabilitation. The performance of this system in assisting finger flexion/extension with different assistance combinations was evaluated in five stroke subjects. Then, a pilot study with 20-sessions training was conducted to evaluate the training's effectiveness. The results showed that combined assistance from the NMES-robot could improve finger movement accuracy, encourage muscle activation of the finger muscles and suppress excessive muscular activities in the elbow joint. When assistances from both NMES and the robot were 50% of their maximum assistances, finger-tracking performance had the best results, with the lowest root mean square error, greater range of motion, higher voluntary muscle activations of the finger joints and lower muscle co-contraction in the finger and elbow joints. Upper limb function improved after the 20-session training, indicated by the increased clinical scores of Fugl-Meyer Assessment, Action Research Arm Test and Wolf Motor Function Test. Muscle co-contraction was reduced in the finger and elbow joints reflected by the Modified Ashworth Scale. The findings demonstrated that an electromyography-driven NMES-robot used for chronic stroke improved hand function and tracking performance. Further research is warranted to validate the method on a larger scale. Implications for Rehabilitation The hand robotics and neuromuscular electrical stimulation (NMES) techniques are still separate systems in current post-stroke hand rehabilitation. This is the first study to investigate the combined effects of the NMES and robot on hand rehabilitation. The finger tracking performance was improved with the combined assistance from the EMG-driven NMES-robot hand system. The assistance from the robot could improve the finger movement accuracy and the assistance from the NMES could reduce the muscle co-contraction on finger and elbow joints. The upper limb functions were improved on chronic stroke patients after the pilot study of 20-session hand training with the combined assistance from the EMG-driven NMES-robot. The muscle spasticity on finger and elbow joints was reduced after the training.

Robot-assisted lobectomy for non-small cell lung cancer in china: initial experience and techniques.

PubMed

Zhao, Xiaojing; Qian, Liqiang; Lin, Hao; Tan, Qiang; Luo, Qingquan

2010-03-01

To summarize our initial experience in robot-assisted thoracoscopic lobectomy. Methods Five patients underwent lobectomy using da Vinci S HD Surgical System (Intuitive Surgical, Sunnyvale, California). During the operation, we respectively made four ports over chest wall for positioning robotic endoscope, left and right robotic arms and auxiliary instruments without retracting ribs. The procedure followed sequential anatomy as complete video-assisted thoracoscopic surgery lobectomy did, and lymph node dissection followed international standard. All patients successfully underwent complete robot-assisted thoracoscopic lobectomy. Neither additional incisions nor emergent conversion to a thoracotomy happened. Frozen dissection during lobectomy showed non-small-cell lung cancer in four patients, who afterwards underwent systemic lymph node dissection, while the case left was with tuberculoma and didn't undergo lymph node dissection. Recurrent air leak occurred in one case, so chest tube was kept for drainage, and one week later, the patient was extubated due to improvement. All other patients recovered well postoperatively without obvious postoperative complications. Robot-assisted thoracoscopic surgery is feasible with good operability, clear visual field, reliable action and its supriority of trouble free; exquisite operative skills are required to ensure a stable and safe operation; robot-assisted surgery is efficiency and patients recover well postoperatively.

Application requirements for Robotic Nursing Assistants in hospital environments

NASA Astrophysics Data System (ADS)

Cremer, Sven; Doelling, Kris; Lundberg, Cody L.; McNair, Mike; Shin, Jeongsik; Popa, Dan

2016-05-01

In this paper we report on analysis toward identifying design requirements for an Adaptive Robotic Nursing Assistant (ARNA). Specifically, the paper focuses on application requirements for ARNA, envisioned as a mobile assistive robot that can navigate hospital environments to perform chores in roles such as patient sitter and patient walker. The role of a sitter is primarily related to patient observation from a distance, and fetching objects at the patient's request, while a walker provides physical assistance for ambulation and rehabilitation. The robot will be expected to not only understand nurse and patient intent but also close the decision loop by automating several routine tasks. As a result, the robot will be equipped with sensors such as distributed pressure sensitive skins, 3D range sensors, and so on. Modular sensor and actuator hardware configured in the form of several multi-degree-of-freedom manipulators, and a mobile base are expected to be deployed in reconfigurable platforms for physical assistance tasks. Furthermore, adaptive human-machine interfaces are expected to play a key role, as they directly impact the ability of robots to assist nurses in a dynamic and unstructured environment. This paper discusses required tasks for the ARNA robot, as well as sensors and software infrastructure to carry out those tasks in the aspects of technical resource availability, gaps, and needed experimental studies.

Will Robots Ever Replace Attendants? Exploring the Current Capabilities and Future Potential of Robots in Education and Rehabilitation.

ERIC Educational Resources Information Center

Lees, David; LePage, Pamela

1994-01-01

This article describes the current capabilities and future potential of robots designed as supplements or replacements for human assistants or as tools for education and rehabilitation of people with disabilities. Review of robots providing educational, vocational, or independent living assistance concludes that eventually effective, reliable…

Robotic Teaching Assistance for the "Tower of Hanoi" Problem

ERIC Educational Resources Information Center

Thien, Nguyen Duc; Terracina, Annalisa; Iocchi, Luca; Mecella, Massimo

2016-01-01

In this work the authors investigate the effectiveness of robotics in education. Rather than creating excitement for children when playing with robots in games, they are examining the overall learning environment where a robot acts as a teaching assistant. They designed a suitable lesson plan when groups of teenagers participate in activities…

Analysis of reaching movements of upper arm in robot assisted exercises. Kinematic assessment of robot assisted upper arm reaching single-joint movements.

PubMed

Iuppariello, Luigi; D'Addio, Giovanni; Romano, Maria; Bifulco, Paolo; Lanzillo, Bernardo; Pappone, Nicola; Cesarelli, Mario

2016-01-01

Robot-mediated therapy (RMT) has been a very dynamic area of research in recent years. Robotics devices are in fact capable to quantify the performances of a rehabilitation task in treatments of several disorders of the arm and the shoulder of various central and peripheral etiology. Different systems for robot-aided neuro-rehabilitation are available for upper limb rehabilitation but the biomechanical parameters proposed until today, to evaluate the quality of the movement, are related to the specific robot used and to the type of exercise performed. Besides, none study indicated a standardized quantitative evaluation of robot assisted upper arm reaching movements, so the RMT is still far to be considered a standardised tool. In this paper a quantitative kinematic assessment of robot assisted upper arm reaching movements, considering also the effect of gravity on the quality of the movements, is proposed. We studied a group of 10 healthy subjects and results indicate that our advised protocol can be useful for characterising normal pattern in reaching movements.

Investigation of human-robot interface performance in household environments

NASA Astrophysics Data System (ADS)

Cremer, Sven; Mirza, Fahad; Tuladhar, Yathartha; Alonzo, Rommel; Hingeley, Anthony; Popa, Dan O.

2016-05-01

Today, assistive robots are being introduced into human environments at an increasing rate. Human environments are highly cluttered and dynamic, making it difficult to foresee all necessary capabilities and pre-program all desirable future skills of the robot. One approach to increase robot performance is semi-autonomous operation, allowing users to intervene and guide the robot through difficult tasks. To this end, robots need intuitive Human-Machine Interfaces (HMIs) that support fine motion control without overwhelming the operator. In this study we evaluate the performance of several interfaces that balance autonomy and teleoperation of a mobile manipulator for accomplishing several household tasks. Our proposed HMI framework includes teleoperation devices such as a tablet, as well as physical interfaces in the form of piezoresistive pressure sensor arrays. Mobile manipulation experiments were performed with a sensorized KUKA youBot, an omnidirectional platform with a 5 degrees of freedom (DOF) arm. The pick and place tasks involved navigation and manipulation of objects in household environments. Performance metrics included time for task completion and position accuracy.

Toward a practical mobile robotic aid system for people with severe physical disabilities.

PubMed

Regalbuto, M A; Krouskop, T A; Cheatham, J B

1992-01-01

A simple, relatively inexpensive robotic system that can aid severely disabled persons by providing pick-and-place manipulative abilities to augment the functions of human or trained animal assistants is under development at Rice University and the Baylor College of Medicine. A stand-alone software application program runs on a Macintosh personal computer and provides the user with a selection of interactive windows for commanding the mobile robot via cursor action. A HERO 2000 robot has been modified such that its workspace extends from the floor to tabletop heights, and the robot is interfaced to a Macintosh SE via a wireless communications link for untethered operation. Integrated into the system are hardware and software which allow the user to control household appliances in addition to the robot. A separate Machine Control Interface device converts breath action and head or other three-dimensional motion inputs into cursor signals. Preliminary in-home and laboratory testing has demonstrated the utility of the system to perform useful navigational and manipulative tasks.

Federal Stafford Act Disaster Assistance: Presidential Declarations, Eligible Activities, and Funding

DTIC Science & Technology

2010-03-16

disaster preparation actions would be taken.14 Assistance for service animals and pets, pre-disaster authority, evacuation planning, and individual case...2006 authorizes grants to states for the improvement of emergency shelters to accommodate pets and service animals .21 • Expanded assistance to

Robotic salvage lymph node dissection for nodal-only recurrences after radical prostatectomy: Perioperative and early oncological outcomes.

PubMed

Linxweiler, Johannes; Saar, Matthias; Al-Kailani, Zaid; Janssen, Martin; Ezziddin, Samer; Stöckle, Michael; Siemer, Stefan; Ohlmann, Carsten-Henning

2018-06-01

Salvage lymph node dissection (sLND) - performed open or minimally-invasive - is a treatment modality that can be offered to patients with nodal recurrence after radical prostatectomy (RP), especially in times where modern imaging methods like choline- or PSMA-PET/CT are available. Yet, there are only very limited data on the safety and oncological effectiveness of robotic sLND. We retrospectively identified patients who underwent robotic sLND at our institution between 2013 and 2017 for nodal recurrence after RP, which had been diagnosed either by 18 F-choline- or 68 Ga-PSMA-PET/CT. We analyzed perioperative data and early oncological outcomes with a focus on the comparison of patients with preoperative choline- vs. those with preoperative PSMA-PET/CT. We identified 36 patients who underwent robotic sLND at a median time of 45.3 months [range 3.1;228.6] after RP, with nodal recurrences detected in 25 patients by PSMA- and in 11 by choline-PET/CT. Median preoperative PSA, operation time and blood loss were 1.98 ng/ml [range 0.09;35.15], 129.5 min [range 65;202] and 50 ml [range 0;400], respectively. No high-grade complications occurred. A median number of 6.5 [range 1;25] lymph nodes were removed with a median of 1 [range 0;9] tumor-occupied node. None of the patients received any adjuvant treatment. Median postoperative PSA-change was -57% [range -100; +58] in the PSMA- and +10% [range -91; +95] in the choline-group (p = 0.015). 44% of patients in the PSMA- and 18% of patients in the choline-group experienced complete biochemical response (cBCR; PSA <0.2 ng/ml). Median time from sLND to the initiation of further therapy was 12 months [range 2;21.5] in the PSMA-group and 4.7 months [range 2.2;18.9] in the choline-group (p = 0.001). This is the hitherto largest series on robotic sLND for nodal recurrence after RP. Robotic sLND is a feasible therapeutic option with low morbidity, which can at least delay the initiation of further therapy - in some patients up to several years. However, the extend of sLND has to be standardized and randomized trials are needed to finally define the oncological effectiveness of this approach. Copyright © 2018 Elsevier Ltd. All rights reserved.

Initial multicentre experience of 68 gallium-PSMA PET/CT guided robot-assisted salvage lymphadenectomy: acceptable safety profile but oncological benefit appears limited.

PubMed

Siriwardana, Amila; Thompson, James; van Leeuwen, Pim J; Doig, Shaela; Kalsbeek, Anton; Emmett, Louise; Delprado, Warick; Wong, David; Samaratunga, Hemamali; Haynes, Anne-Maree; Coughlin, Geoff; Stricker, Phillip

2017-11-01

To evaluate the safety and short-term oncological outcomes of 68 gallium-labelled prostate-specific membrane antigen ( 68 Ga-PSMA) positron-emission tomography (PET)/computed tomography (CT)-directed robot-assisted salvage node dissection (RASND) for prostate cancer oligometastatic nodal recurrence. Between February 2014 and April 2016, 35 patients across two centres underwent RASND for 68 Ga-PSMA PET/CT-detected oligometastatic nodal recurrence. RASND was performed using targeted pelvic dissection, unilateral extended pelvic template or bilateral extended pelvic template dissection, depending on previous pelvic treatment and extent/location of nodal disease. Complications were reported using the Clavien-Dindo classification system. Definitions of prostate-specific antigen (PSA) treatment response to RASND were defined as 6-week PSA <0.2 ng/mL (broad definition) or PSA <0.05 ng/mL (strict definition) in those who had undergone primary prostatectomy, and 6-week PSA level < post-radiotherapy nadir in those who had undergone primary radiotherapy. Biochemical recurrence (BCR) after RASND was defined as a PSA >0.2 ng/mL or PSA > nadir, for those who had undergone primary prostatectomy and primary radiotherapy, respectively. Predictors of treatment response were analysed using univariate binary logistic regression. A total of 58 lesions suspicious for lymph node metastases (LNM) in 35 patients were detected on 68 Ga-PSMA imaging. A total of 32 patients (91%) had histopathologically proven LNM at RASND, with a total of 87 LNM and a median (interquartile range) of 2 (1-3) LNM per patient. In all, eight patients (23%) experienced complications, all Clavien-Dindo grade ≤2. Treatment response was seen in 15 (43%) and 11 patients (31%), using the broad and strict definitions, respectively. BCR-free survival and clinical recurrence-free survival at a median follow-up of 12 months were 23% and 66%, respectively, for the entire cohort. Bilateral template dissection was the only significant univariate predictor of treatment response in our cohort. Although RASND appears safe and feasible, less than half of our cohort had a treatment response, and less than a quarter experienced BCR-free survival at 12-month median follow-up. 68 Ga-PSMA imaging underestimates micro-metastatic disease, therefore RASND will rarely be curative. Strict patient selection and restricting RASND to clinical trials is recommended. Long-term follow-up from such trials is required to further assess potential quality of life and mortality benefits. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs.

PubMed

Bogani, Giorgio; Multinu, Francesco; Dowdy, Sean C; Cliby, William A; Wilson, Timothy O; Gostout, Bobbie S; Weaver, Amy L; Borah, Bijan J; Killian, Jill M; Bijlani, Akash; Angioni, Stefano; Mariani, Andrea

2016-05-01

To evaluate how the introduction of robotic-assisted surgery affects treatment-related morbidity and cost of endometrial cancer (EC) staging. We retrospectively reviewed the records of consecutive patients with stage I-III EC undergoing surgical staging between 2007 and 2012 at our institution. Costs (from surgery to 30days after surgery) were set based on the Medicare cost-to-charge ratio for each year and inflated to 2014 values. Inverse probability weighting (IPW) was used to decrease the allocation bias when comparing outcomes between surgical groups. We focused our analysis on the 251 EC patients who had robotic-assisted surgery and the 384 who had open staging. During the study period, the use of robotic-assisted surgery increased and open staging decreased (P<0.001). Correcting group imbalances by using IPW methodology, we observed that patients undergoing robotic-assisted staging had a significantly lower postoperative complication rate, lower blood transfusion rate, longer median operating time, shorter median length of stay, and lower readmission rate than patients undergoing open staging (all P<0.001). Overall 30-day costs were similar between the 2 groups, with robotic-assisted surgery having significantly higher median operating room costs ($2820 difference; P<0.001) but lower median room and board costs ($2929 difference; P<0.001) than open surgery. Increasing experience with robotic-assisted staging was significantly associated with a decrease in median operating time (P=0.002) and length of stay (P=0.003). The implementation of robotic-assisted surgery for EC staging improves patient outcomes. It provides women the benefits of minimally invasive surgery without increasing costs and potentially improves patient turnover. Copyright © 2016 Elsevier Inc. All rights reserved.

Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique.

PubMed

Abel, Taylor J; Varela Osorio, René; Amorim-Leite, Ricardo; Mathieu, Francois; Kahane, Philippe; Minotti, Lorella; Hoffmann, Dominique; Chabardes, Stephan

2018-04-20

OBJECTIVE Robot-assisted stereoelectroencephalography (SEEG) is gaining popularity as a technique for localization of the epileptogenic zone (EZ) in children with pharmacoresistant epilepsy. Here, the authors describe their frameless robot-assisted SEEG technique and report preliminary outcomes and relative complications in children as compared to results with the Talairach frame-based SEEG technique. METHODS The authors retrospectively analyzed the results of 19 robot-assisted SEEG electrode implantations in 17 consecutive children (age < 17 years) with pharmacoresistant epilepsy, and compared these results to 19 preceding SEEG electrode implantations in 18 children who underwent the traditional Talairach frame-based SEEG electrode implantation. The primary end points were seizure-freedom rates, operating time, and complication rates. RESULTS Seventeen children (age < 17 years) underwent a total of 19 robot-assisted SEEG electrode implantations. In total, 265 electrodes were implanted. Twelve children went on to have EZ resection: 4 demonstrated Engel class I outcomes, whereas 2 had Engel class II outcomes, and 6 had Engel class III-IV outcomes. Of the 5 patients who did not have resection, 2 underwent thermocoagulation. One child reported transient paresthesia associated with 2 small subdural hematomas, and 3 other children had minor asymptomatic intracranial hemorrhages. There were no differences in complication rates, rates of resective epilepsy surgery, or seizure freedom rates between this cohort and the preceding 18 children who underwent Talairach frame-based SEEG. The frameless robot-assisted technique was associated with shorter operating time (p < 0.05). CONCLUSIONS Frameless robot-assisted SEEG is a safe and effective means of identifying the EZ in children with pharmacoresistant partial epilepsy. Robot-assisted SEEG is faster than the Talairach frame-based method, and has equivalent safety and efficacy. The former, furthermore, facilitates more electrode trajectory possibilities, which may improve the localization of epileptic networks.

Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume.

PubMed

Tachibana, Hidekazu; Takagi, Toshio; Kondo, Tsunenori; Ishida, Hideki; Tanabe, Kazunari

2018-04-01

To compare surgical outcomes, including renal function and the preserved renal parenchymal volume, between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy using propensity score-matched analyses. In total, 253 patients, with a normal contralateral kidney, who underwent laparoscopic partial nephrectomy (n = 131) or robot-assisted laparoscopic partial nephrectomy (n = 122) with renal arterial clamping between 2010 and 2015, were included. Patients' background and tumor factors were adjusted by propensity score matching. Surgical outcomes, including postoperative renal function, complications, warm ischemia time and preserved renal parenchymal volume, evaluated by volumetric analysis, were compared between the surgical procedures. After matching, 64 patients were assigned to each group. The mean age was 56-57 years, and the mean tumor size was 22 mm. Approximately 50% of patients had low complexity tumors (RENAL nephrometry score 4-7). The incidence rate of acute kidney failure was significantly lower in the robot-assisted laparoscopic partial nephrectomy (11%) than laparoscopic partial nephrectomy (23%) group (P = 0.049), and warm ischemia time shorter in the robot-assisted laparoscopic partial nephrectomy (17 min) than laparoscopic partial nephrectomy (25 min) group (P < 0.0001). The preservation rate of renal function, measured by the estimated glomerular filtration rate, at 6 months post-surgery was 96% for robot-assisted laparoscopic partial nephrectomy and 90% for laparoscopic partial nephrectomy (P < 0.0001). The preserved renal parenchymal volume was higher for robot-assisted laparoscopic partial nephrectomy (89%) than laparoscopic partial nephrectomy (77%; P < 0.0001). The rate of perioperative complications, surgical margin status and length of hospital stay were equivalent for both techniques. Robot-assisted laparoscopic partial nephrectomy allows to achieve better preservation of renal function and parenchymal volume than laparoscopic partial nephrectomy. © 2018 The Japanese Urological Association.

A Lower Limb Rehabilitation Robot in Sitting Position with a Review of Training Activities.

PubMed

Eiammanussakul, Trinnachoke; Sangveraphunsiri, Viboon

2018-01-01

Robots for stroke rehabilitation at the lower limbs in sitting/lying position have been developed extensively. Some of them have been applied in clinics and shown the potential of the recovery of poststroke patients who suffer from hemiparesis. These robots were developed to provide training at different joints of lower limbs with various activities and modalities. This article reviews the training activities that were realized by rehabilitation robots in literature, in order to offer insights for developing a novel robot suitable for stroke rehabilitation. The control system of the lower limb rehabilitation robot in sitting position that was introduced in the previous work is discussed in detail to demonstrate the behavior of the robot while training a subject. The nonlinear impedance control law, based on active assistive control strategy, is able to define the response of the robot with more specifications while the passivity property and the robustness of the system is verified. A preliminary experiment is conducted on a healthy subject to show that the robot is able to perform active assistive exercises with various training activities and assist the subject to complete the training with desired level of assistance.

IntelliTable: Inclusively-Designed Furniture with Robotic Capabilities.

PubMed

Prescott, Tony J; Conran, Sebastian; Mitchinson, Ben; Cudd, Peter

2017-01-01

IntelliTable is a new proof-of-principle assistive technology system with robotic capabilities in the form of an elegant universal cantilever table able to move around by itself, or under user control. We describe the design and current capabilities of the table and the human-centered design methodology used in its development and initial evaluation. The IntelliTable study has delivered robotic platform programmed by a smartphone that can navigate around a typical home or care environment, avoiding obstacles, and positioning itself at the user's command. It can also be configured to navigate itself to pre-ordained places positions within an environment using ceiling tracking, responsive optical guidance and object-based sonar navigation.

Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

PubMed

van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

2017-01-01

To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting.

PubMed

Kelly, Erin; Wu, Maria Y; MacMillan, J Barry

2018-03-01

Post-hysterectomy vesicovaginal fistula (VVF) is rare. In addition to conventional abdominal and vaginal approaches, robotic-assisted VVF repairs have recently been described. We present a case of an extravesical, robotic-assisted VVF repair, without placement of an interposition graft performed in a Canadian teaching center. A 51-year-old woman presented with urinary incontinence 5 days after laparoscopic hysterectomy. Computed tomography cystogram, cystoscopy, and methylene blue dye test, confirmed a VVF above the bladder trigone. The patient underwent a robotic-assisted VVF repair 3 months after presentation, without complication. An abdominal, extravesical approach was used. Operative time was 116 min and repeat CT cystogram showed no evidence of persistent. We have demonstrated that a VVF repair, using a robotic-assisted, extravesical approach without interposition graft placement, can be safe, less invasive and have a successful outcome at 1 year of follow-up.

Turning assistive machines into assistive robots

NASA Astrophysics Data System (ADS)

Argall, Brenna D.

2015-01-01

For decades, the potential for automation in particular, in the form of smart wheelchairs to aid those with motor, or cognitive, impairments has been recognized. It is a paradox that often the more severe a person's motor impairment, the more challenging it is for them to operate the very assistive machines which might enhance their quality of life. A primary aim of my lab is to address this confound by incorporating robotics autonomy and intelligence into assistive machines turning the machine into a kind of robot, and offloading some of the control burden from the user. Robots already synthetically sense, act in and reason about the world, and these technologies can be leveraged to help bridge the gap left by sensory, motor or cognitive impairments in the users of assistive machines. This paper overviews some of the ongoing projects in my lab, which strives to advance human ability through robotics autonomy.

Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization.

PubMed

Del Giudice, C; Pellerin, O; Nouri Neville, M; Amouyal, G; Fitton, I; Leré-Déan, C; Sapoval, M

2018-03-01

To compare outcomes of percutaneous robot-assisted uterine fibroid embolization (UFE) using two different endovascular robotic catheters. Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system. Fourteen patients were treated using a first generation steerable robotic catheter, version 1.0 (group 1), and seven were treated using the new version 1.1 (group 2). Demographic, pathologic, and procedural variables were recorded. Dose Area Product (DAP) and physician equivalent doses were registered for each procedure. Procedural related complications and clinical midterm outcomes were also evaluated. Successful robot-assisted UFE was obtained in eight patients (57.1%) in group 1 and 7 patients (100%) in group 2 (p = 0.01). A successful robot-assisted catheterization of the internal iliac artery anterior branch was performed in all patients of both groups. Median selective target vessel catheterization time was 21.0 ± 12.8 vs 13.4 ± 7 min (p = 0.04) and total fluoroscopy time was 30.3 ± 11.2 vs 19.3 ± 5.9 min, respectively, in group 1 and 2. Mean DAP decreased from 18472.6 ± 15622 to 5469.1 ± 4461.0 cGy·cm 2 (p = 0.04). All patients obtained a symptoms relief at 6 months follow-up. Robot-assisted uterine fibroid embolization is safe and effective. New version of steerable robotic catheter allows performing a faster procedure without related adverse events compared to old version.

Cost-effectiveness of robotic-assisted laparoscopic procedures in urologic surgery in the USA.

PubMed

Sleeper, Joshua; Lotan, Yair

2011-01-01

New technologies such as robotic-assisted surgery are constantly introduced clinically without a complete understanding of benefits and costs. This article will discuss general concepts of health economics and apply them to the application of robotic-assisted surgery to urologic procedures. Utilization of robotic surgery has increased dramatically in recent years. This has been most dramatic in the treatment of prostate cancer. The robot adds significant costs from acquisition, maintenance and recurrent instrument costs. These added costs, thus far, have not been associated with significant improvement in outcomes over 'pure' laparoscopy or open procedures. In order for the robot to be cost effective, there needs to be an improvement in efficacy over alternative approaches, and a decrease in costs of the robot or instrumentation. Robotic surgery has not been found to be cost effective in urology. Future studies may yet reveal indirect benefits that are not yet obvious.

Knowledge assistant: A sensor fusion framework for robotic environmental characterization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feddema, J.T.; Rivera, J.J.; Tucker, S.D.

1996-12-01

A prototype sensor fusion framework called the {open_quotes}Knowledge Assistant{close_quotes} has been developed and tested on a gantry robot at Sandia National Laboratories. This Knowledge Assistant guides the robot operator during the planning, execution, and post analysis stages of the characterization process. During the planning stage, the Knowledge Assistant suggests robot paths and speeds based on knowledge of sensors available and their physical characteristics. During execution, the Knowledge Assistant coordinates the collection of data through a data acquisition {open_quotes}specialist.{close_quotes} During execution and post analysis, the Knowledge Assistant sends raw data to other {open_quotes}specialists,{close_quotes} which include statistical pattern recognition software, a neuralmore » network, and model-based search software. After the specialists return their results, the Knowledge Assistant consolidates the information and returns a report to the robot control system where the sensed objects and their attributes (e.g. estimated dimensions, weight, material composition, etc.) are displayed in the world model. This paper highlights the major components of this system.« less

Laparoscopy vs robotics in surgical management of endometrial cancer: comparison of intraoperative and postoperative complications.

PubMed

Seror, Julien; Bats, Anne-Sophie; Huchon, Cyrille; Bensaïd, Chérazade; Douay-Hauser, Nathalie; Lécuru, Fabrice

2014-01-01

To compare the rates of intraoperative and postoperative complications of robotic surgery and laparoscopy in the surgical treatment of endometrial cancer. Unicentric retrospective study (Canadian Task Force classification II-2). Tertiary teaching hospital. The study was performed from January 2002 to December 2011 and included patients with endometrial cancer who underwent laparoscopic or robotically assisted laparoscopic surgical treatment. Data collected included preoperative data, tumor characteristics, intraoperative data (route of surgery, surgical procedures, and complications), and postoperative data (early and late complications according to the Clavien-Dindo classification, and length of hospital stay). Morbidity was compared between the 2 groups. The study included 146 patients, of whom 106 underwent laparoscopy and 40 underwent robotically assisted surgery. The 2 groups were comparable in terms of demographic and preoperative data. Intraoperative complications occurred in 9.4% of patients who underwent laparoscopy and in none who underwent robotically assisted surgery (p = .06). There was no difference between the 2 groups in terms of postoperative events. Robotically assisted surgery is not associated with a significant difference in intraoperative and postoperative complications, even when there were no intraoperative complications of robotically assisted surgery. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Robotic-assisted laparoscopic prostatectomy in umbilical hernia patients: University of California, Irvine, technique for port placement and repair.

PubMed

Kim, William; Abdelshehid, Corollos; Lee, Hak J; Ahlering, Thomas

2012-06-01

To discuss a technique currently used at our institution for the management of umbilical hernias during robot-assisted laparoscopic prostatectomy. As more patients undergo robot-assisted radical prostatectomy, there will be an increase in patients who qualify for robotic surgery with comorbidities. This technique has been utilized in clinically localized prostate cancer patients with umbilical hernias using the da Vinci Surgical System and standard laparoscopic instrumentation. Port placements and closures were performed by a resident assistant and a nurse at the operating table. The prostatectomy was performed by a single experienced surgeon at the console. Currently, no data are available regarding patients with umbilical hernias undergoing robotic prostatectomy. We reviewed our technique of port placement for patients with a pre-existing umbilical hernia undergoing robot-assisted laparoscopic prostatectomy. This technique allows for a reduction of the umbilical hernia, the use of the fascial defect as a robotic port, and the removal of the prostate by way of transverse incision and transverse repair. In our experience, this technique is feasible and reproducible for any small or large umbilical hernia. Copyright © 2012 Elsevier Inc. All rights reserved.

Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.

PubMed

Sooriakumaran, Prasanna; Pini, Giovannalberto; Nyberg, Tommy; Derogar, Maryam; Carlsson, Stefan; Stranne, Johan; Bjartell, Anders; Hugosson, Jonas; Steineck, Gunnar; Wiklund, Peter N

2018-04-01

Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. For prostate cancer surgery, an open operation reduces erection problems in high-risk cancers but has higher relapse rates than robotic surgery. Relapse rates appear similar in low/intermediate-risk cancers and the robot appears better at preserving erections in these cases. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy.

PubMed

Ellison, Jonathan S; Montgomery, Jeffrey S; Wolf, J Stuart; Hafez, Khaled S; Miller, David C; Weizer, Alon Z

2012-07-01

Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot-assisted partial nephrectomy likely improves surgeon and patient accessibility to minimally invasive nephron sparing surgery. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Commentary on "a matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy." Ellison JS, Montgomery JS, Wolf Jr JS, Hafez KS, Miller DC, Weizer AZ, Department of Urology, University of Michigan, Ann Arbor, MI, USA: J Urol 2012;188(1):45-50.

PubMed

Kane, Christopher

2013-02-01

Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot-assisted partial nephrectomy likely improves surgeon and patient accessibility to minimally invasive nephron sparing surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

Improvement of the insertion axis for cochlear implantation with a robot-based system.

PubMed

Torres, Renato; Kazmitcheff, Guillaume; De Seta, Daniele; Ferrary, Evelyne; Sterkers, Olivier; Nguyen, Yann

2017-02-01

It has previously reported that alignment of the insertion axis along the basal turn of the cochlea was depending on surgeon' experience. In this experimental study, we assessed technological assistances, such as navigation or a robot-based system, to improve the insertion axis during cochlear implantation. A preoperative cone beam CT and a mastoidectomy with a posterior tympanotomy were performed on four temporal bones. The optimal insertion axis was defined as the closest axis to the scala tympani centerline avoiding the facial nerve. A neuronavigation system, a robot assistance prototype, and software allowing a semi-automated alignment of the robot were used to align an insertion tool with an optimal insertion axis. Four procedures were performed and repeated three times in each temporal bone: manual, manual navigation-assisted, robot-based navigation-assisted, and robot-based semi-automated. The angle between the optimal and the insertion tool axis was measured in the four procedures. The error was 8.3° ± 2.82° for the manual procedure (n = 24), 8.6° ± 2.83° for the manual navigation-assisted procedure (n = 24), 5.4° ± 3.91° for the robot-based navigation-assisted procedure (n = 24), and 3.4° ± 1.56° for the robot-based semi-automated procedure (n = 12). A higher accuracy was observed with the semi-automated robot-based technique than manual and manual navigation-assisted (p < 0.01). Combination of a navigation system and a manual insertion does not improve the alignment accuracy due to the lack of friendly user interface. On the contrary, a semi-automated robot-based system reduces both the error and the variability of the alignment with a defined optimal axis.

Avoiding and managing vascular injury during robotic-assisted radical prostatectomy

PubMed Central

Nunez Bragayrac, Luciano A.; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A.

2015-01-01

There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented. PMID:25642293

Anesthetic Considerations in Robotic-Assisted Gynecologic Surgery

PubMed Central

Kaye, Alan D.; Vadivelu, Nalini; Ahuja, Nitin; Mitra, Sukanya; Silasi, Dan; Urman, Richard D.

2013-01-01

Background Robotic-assisted surgery has evolved over the past 2 decades with constantly improving technology that assists surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and lack of direct access to the patient all present management challenges in gynecologic surgery. Patient positioning requirements can have significant physiologic effects and can result in many complications. Methods This review focuses on the anesthetic and surgical implications of robot-assisted technology in gynecologic surgery. Conclusion Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce complications. PMID:24358000

Authoring Robot-Assisted Instructional Materials for Improving Learning Performance and Motivation in EFL Classrooms

ERIC Educational Resources Information Center

Hong, Zeng-Wei; Huang, Yueh-Min; Hsu, Marie; Shen, Wei-Wei

2016-01-01

Anthropomorphized robots are regarded as beneficial tools in education due to their capabilities of improving teaching effectiveness and learning motivation. Therefore, one major trend of research, known as Robot- Assisted Language Learning (RALL), is trying to develop robots to support teaching and learning English as a foreign language (EFL). As…

Knowing when to assist: developmental issues in lifelong assistive robotics.

PubMed

Demiris, Yiannis

2009-01-01

Children and adults with sensorimotor disabilities can significantly increase their autonomy through the use of assistive robots. As the field progresses from short-term, task-specific solutions to long-term, adaptive ones, new challenges are emerging. In this paper a lifelong methodological approach is presented, that attempts to balance the immediate context-specific needs of the user, with the long-term effects that the robot's assistance can potentially have on the user's developmental trajectory.

Navigating the pathway to robotic competency in general thoracic surgery.

PubMed

Seder, Christopher W; Cassivi, Stephen D; Wigle, Dennis A

2013-01-01

Although robotic technology has addressed many of the limitations of traditional videoscopic surgery, robotic surgery has not gained widespread acceptance in the general thoracic community. We report our initial robotic surgery experience and propose a structured, competency-based pathway for the development of robotic skills. Between December 2008 and February 2012, a total of 79 robot-assisted pulmonary, mediastinal, benign esophageal, or diaphragmatic procedures were performed. Data on patient characteristics and perioperative outcomes were retrospectively collected and analyzed. During the study period, one surgeon and three residents participated in a triphasic, competency-based pathway designed to teach robotic skills. The pathway consisted of individual preclinical learning followed by mentored preclinical exercises and progressive clinical responsibility. The robot-assisted procedures performed included lung resection (n = 38), mediastinal mass resection (n = 19), hiatal or paraesophageal hernia repair (n = 12), and Heller myotomy (n = 7), among others (n = 3). There were no perioperative mortalities, with a 20% complication rate and a 3% readmission rate. Conversion to a thoracoscopic or open approach was required in eight pulmonary resections to facilitate dissection (six) or to control hemorrhage (two). Fewer major perioperative complications were observed in the later half of the experience. All residents who participated in the thoracic surgery robotic pathway perform robot-assisted procedures as part of their clinical practice. Robot-assisted thoracic surgery can be safely learned when skill acquisition is guided by a structured, competency-based pathway.

An automation-assisted generic approach for biological sample preparation and LC-MS/MS method validation.

PubMed

Zhang, Jie; Wei, Shimin; Ayres, David W; Smith, Harold T; Tse, Francis L S

2011-09-01

Although it is well known that automation can provide significant improvement in the efficiency of biological sample preparation in quantitative LC-MS/MS analysis, it has not been widely implemented in bioanalytical laboratories throughout the industry. This can be attributed to the lack of a sound strategy and practical procedures in working with robotic liquid-handling systems. Several comprehensive automation assisted procedures for biological sample preparation and method validation were developed and qualified using two types of Hamilton Microlab liquid-handling robots. The procedures developed were generic, user-friendly and covered the majority of steps involved in routine sample preparation and method validation. Generic automation procedures were established as a practical approach to widely implement automation into the routine bioanalysis of samples in support of drug-development programs.

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.

Robotic-assisted cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

PubMed

Gabriel, Emmanuel; Elli, Enrique; Bagaria, Sanjay; Wasif, Nabil; Grotz, Travis; Stauffer, John; Kasi, Pashtoon M; Asbun, Horacio

2018-05-05

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an appropriate treatment for select patients with peritoneal carcinomatosis. While most commonly performed through an open incision, the laparoscopic approach has been reported and offers short-term benefits. A robotic-assisted approach for carcinomatosis of gastrointestinal origin, however, has not yet been described. We report our approach to robotic-assisted CRS-HIPEC for a patient with a perforated appendiceal mucocele. Our dynamic video highlights the advantages of this approach. Our patient was a 57-year-old woman with minimal residual disseminated peritoneal adenomucinosis (DPAM), having a peritoneal carcinomatosis index (PCI) score of 1. She had a previous surgical history of a Roux-en-Y gastric bypass. A robotic-assisted approach was utilized using the Intuitive daVinci Xi robotic surgical system through 4 ports. No laparoscopic assistant port was required. The operative time was 426 min, and the estimated blood loss was 50 cc. The greater omentum, falciform ligament, bilateral ovaries, and two small areas of tumor implant were resected. The post-operative length of stay was 4 days, and the patient had regained bowel function by post-operative day 2. Our video demonstrates the feasibility of a robotic-assisted CRS-HIPEC in a patient with minimal, residual DPAM. Similar to a laparoscopic approach, the short-term outcomes are improved as compared to an open approach. An MIS approach to CRS-HIPEC, now with the first-reported robotic-assisted approach, is a viable option for select patients with peritoneal tumors.

Constellation Program Update

NASA Image and Video Library

2006-06-04

NASA Administrator Michael Griffin is seen through a television camera at a NASA Update announcing to NASA employees and members of the media the responsibilities of the NASA centers associated with the Constellation Program for robotic and human Moon and Mars exploration on Wednesday, June 5, 2006, at NASA Headquarters in Washington. Griffin was joined by Scott J. Horowitz, NASA Associate Administrator for Exploration Systems and Jeff Hanley, Constellation Program Manager, right. Dean Acosta, NASA Deputy Assistant Administrator and Press Secretary, far left, moderates the program. Photo Credit: (NASA/Bill Ingalls)

Social skills training for children with autism spectrum disorder using a robotic behavioral intervention system.

PubMed

Yun, Sang-Seok; Choi, JongSuk; Park, Sung-Kee; Bong, Gui-Young; Yoo, HeeJeong

2017-07-01

We designed a robot system that assisted in behavioral intervention programs of children with autism spectrum disorder (ASD). The eight-session intervention program was based on the discrete trial teaching protocol and focused on two basic social skills: eye contact and facial emotion recognition. The robotic interactions occurred in four modules: training element query, recognition of human activity, coping-mode selection, and follow-up action. Children with ASD who were between 4 and 7 years old and who had verbal IQ ≥ 60 were recruited and randomly assigned to the treatment group (TG, n = 8, 5.75 ± 0.89 years) or control group (CG, n = 7; 6.32 ± 1.23 years). The therapeutic robot facilitated the treatment intervention in the TG, and the human assistant facilitated the treatment intervention in the CG. The intervention procedures were identical in both groups. The primary outcome measures included parent-completed questionnaires, the Autism Diagnostic Observation Schedule (ADOS), and frequency of eye contact, which was measured with the partial interval recording method. After completing treatment, the eye contact percentages were significantly increased in both groups. For facial emotion recognition, the percentages of correct answers were increased in similar patterns in both groups compared to baseline (P > 0.05), with no difference between the TG and CG (P > 0.05). The subjects' ability to play, general behavioral and emotional symptoms were significantly diminished after treatment (p < 0.05). These results showed that the robot-facilitated and human-facilitated behavioral interventions had similar positive effects on eye contact and facial emotion recognition, which suggested that robots are useful mediators of social skills training for children with ASD. Autism Res 2017,. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1306-1323. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

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.

Training and learning robotic surgery, time for a more structured approach: a systematic review.

PubMed

Schreuder, H W R; Wolswijk, R; Zweemer, R P; Schijven, M P; Verheijen, R H M

2012-01-01

Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed. We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism. Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation. We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme. Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

[Prostatectomy-pros and cons on open surgery/laparoscopic surgery/robot-assisted surgery].

PubMed

Abe, Mitsuhiro; Kawano, Yoshiyuki; Kameyama, Shuji

2011-12-01

We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.

Robotic-assisted real-time MRI-guided TAVR: from system deployment to in vivo experiment in swine model.

PubMed

Chan, Joshua L; Mazilu, Dumitru; Miller, Justin G; Hunt, Timothy; Horvath, Keith A; Li, Ming

2016-10-01

Real-time magnetic resonance imaging (rtMRI) guidance provides significant advantages during transcatheter aortic valve replacement (TAVR) as it provides superior real-time visualization and accurate device delivery tracking. However, performing a TAVR within an MRI scanner remains difficult due to a constrained procedural environment. To address these concerns, a magnetic resonance (MR)-compatible robotic system to assist in TAVR deployments was developed. This study evaluates the technical design and interface considerations of an MR-compatible robotic-assisted TAVR system with the purpose of demonstrating that such a system can be developed and executed safely and precisely in a preclinical model. An MR-compatible robotic surgical assistant system was built for TAVR deployment. This system integrates a 5-degrees of freedom (DoF) robotic arm with a 3-DoF robotic valve delivery module. A user interface system was designed for procedural planning and real-time intraoperative manipulation of the robot. The robotic device was constructed of plastic materials, pneumatic actuators, and fiber-optical encoders. The mechanical profile and MR compatibility of the robotic system were evaluated. The system-level error based on a phantom model was 1.14 ± 0.33 mm. A self-expanding prosthesis was successfully deployed in eight Yorkshire swine under rtMRI guidance. Post-deployment imaging and necropsy confirmed placement of the stent within 3 mm of the aortic valve annulus. These phantom and in vivo studies demonstrate the feasibility and advantages of robotic-assisted TAVR under rtMRI guidance. This robotic system increases the precision of valve deployments, diminishes environmental constraints, and improves the overall success of TAVR.

Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy.

PubMed

Hu, Jim C; O'Malley, Padraic; Chughtai, Bilal; Isaacs, Abby; Mao, Jialin; Wright, Jason D; Hershman, Dawn; Sedrakyan, Art

2017-01-01

Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer. Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify the higher cost relative to open surgery. We examined the comparative effectiveness of robot-assisted vs open radical prostatectomy in cancer control and survival in a nationally representative population. This population based observational cohort study of patients with prostate cancer undergoing robot-assisted radical prostatectomy and open radical prostatectomy during 2003 to 2012 used data captured in the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database. Propensity score matching and time to event analysis were used to compare all cause mortality, prostate cancer specific mortality and use of additional treatment after surgery. A total of 6,430 robot-assisted radical prostatectomies and 9,161 open radical prostatectomies performed during 2003 to 2012 were identified. The use of robot-assisted radical prostatectomy increased from 13.6% in 2003 to 2004 to 72.6% in 2011 to 2012. After a median followup of 6.5 years (IQR 5.2-7.9) robot-assisted radical prostatectomy was associated with an equivalent risk of all cause mortality (HR 0.85, 0.72-1.01) and similar cancer specific mortality (HR 0.85, 0.50-1.43) vs open radical prostatectomy. Robot-assisted radical prostatectomy was also associated with less use of additional treatment (HR 0.78, 0.70-0.86). Robot-assisted radical prostatectomy has comparable intermediate cancer control as evidenced by less use of additional postoperative cancer therapies and equivalent cancer specific and overall survival. Longer term followup is needed to assess for differences in prostate cancer specific survival, which was similar during intermediate followup. Our findings have significant quality and cost implications, and provide reassurance regarding the adoption of more expensive technology in the absence of randomized controlled trials. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Two-year analysis for predicting renal function and contralateral hypertrophy after robot-assisted partial nephrectomy: A three-dimensional segmentation technology study.

PubMed

Kim, Dae Keun; Jang, Yujin; Lee, Jaeseon; Hong, Helen; Kim, Ki Hong; Shin, Tae Young; Jung, Dae Chul; Choi, Young Deuk; Rha, Koon Ho

2015-12-01

To analyze long-term changes in both kidneys, and to predict renal function and contralateral hypertrophy after robot-assisted partial nephrectomy. A total of 62 patients underwent robot-assisted partial nephrectomy, and renal parenchymal volume was calculated using three-dimensional semi-automatic segmentation technology. Patients were evaluated within 1 month preoperatively, and postoperatively at 6 months, 1 year and continued up to 2-year follow up. Linear regression models were used to identify the factors predicting variables that correlated with estimated glomerular filtration rate changes and contralateral hypertrophy 2 years after robot-assisted partial nephrectomy. The median global estimated glomerular filtration rate changes were -10.4%, -11.9%, and -2.4% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The ipsilateral kidney median parenchymal volume changes were -24%, -24.4%, and -21% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The contralateral renal volume changes were 2.3%, 9.6% and 12.9%, respectively. On multivariable linear analysis, preoperative estimated glomerular filtration rate was the best predictive factor for global estimated glomerular filtration rate change on 2 years post-robot-assisted partial nephrectomy (B -0.452; 95% confidence interval -0.84 to -0.14; P = 0.021), whereas the parenchymal volume loss rate (B -0.43; 95% confidence interval -0.89 to -0.15; P = 0.017) and tumor size (B 5.154; 95% confidence interval -0.11 to 9.98; P = 0.041) were the significant predictive factors for the degree of contralateral renal hypertrophy on 2 years post-robot-assisted partial nephrectomy. Preoperative estimated glomerular filtration rate significantly affects post-robot-assisted partial nephrectomy renal function. Renal mass size and renal parenchyma volume loss correlates with compensatory hypertrophy of the contralateral kidney. Contralateral hypertrophy of the renal parenchyma compensates for the functional loss of the ipsilateral kidney. © 2015 The Japanese Urological Association.

Robotic Arm-Assisted Sonography: Review of Technical Developments and Potential Clinical Applications.

PubMed

Swerdlow, Daniel R; Cleary, Kevin; Wilson, Emmanuel; Azizi-Koutenaei, Bamshad; Monfaredi, Reza

2017-04-01

Ultrasound imaging requires trained personnel. Advances in robotics and data transmission create the possibility of telesonography. This review introduces clinicians to current technical work in and potential applications of this developing capability. Telesonography offers advantages in hazardous or remote environments. Robotically assisted ultrasound can reduce stress injuries in sonographers and has potential utility during robotic surgery and interventional procedures.

An economic analysis of robotically assisted hysterectomy.

PubMed

Wright, Jason D; Ananth, Cande V; Tergas, Ana I; Herzog, Thomas J; Burke, William M; Lewin, Sharyn N; Lu, Yu-Shiang; Neugut, Alfred I; Hershman, Dawn L

2014-05-01

To perform an econometric analysis to examine the influence of procedure volume, variation in hospital accounting methodology, and use of various analytic methodologies on cost of robotically assisted hysterectomy for benign gynecologic disease and endometrial cancer. A national sample was used to identify women who underwent laparoscopic or robotically assisted hysterectomy for benign indications or endometrial cancer from 2006 to 2012. Surgeon and hospital volume were classified as the number of procedures performed before the index surgery. Total costs as well as fixed and variable costs were modeled using multivariable quantile regression methodology. A total of 180,230 women, including 169,324 women who underwent minimally invasive hysterectomy for benign indications and 10,906 patients whose hysterectomy was performed for endometrial cancer, were identified. The unadjusted median cost of robotically assisted hysterectomy for benign indications was $8,152 (interquartile range [IQR] $6,011-10,932) compared with $6,535 (IQR $5,127-8,357) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing surgeon and hospital volume. The unadjusted median cost of robotically assisted hysterectomy for endometrial cancer was $9,691 (IQR $7,591-12,428) compared with $8,237 (IQR $6,400-10,807) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing hospital volume from $2,471 for the first 5 to 15 cases to $924 for more than 50 cases. Based on surgeon volume, robotically assisted hysterectomy for endometrial cancer was $1,761 more expensive than laparoscopy for those who had performed fewer than five cases; the differential declined to $688 for more than 50 procedures compared with laparoscopic hysterectomy. The cost of robotic gynecologic surgery decreases with increased procedure volume. However, in all of the scenarios modeled, robotically assisted hysterectomy remained substantially more costly than laparoscopic hysterectomy.

Evaluating the effect of three-dimensional visualization on force application and performance time during robotics-assisted mitral valve repair.

PubMed

Currie, Maria E; Trejos, Ana Luisa; Rayman, Reiza; Chu, Michael W A; Patel, Rajni; Peters, Terry; Kiaii, Bob B

2013-01-01

The purpose of this study was to determine the effect of three-dimensional (3D) binocular, stereoscopic, and two-dimensional (2D) monocular visualization on robotics-assisted mitral valve annuloplasty versus conventional techniques in an ex vivo animal model. In addition, we sought to determine whether these effects were consistent between novices and experts in robotics-assisted cardiac surgery. A cardiac surgery test-bed was constructed to measure forces applied during mitral valve annuloplasty. Sutures were passed through the porcine mitral valve annulus by the participants with different levels of experience in robotics-assisted surgery and tied in place using both robotics-assisted and conventional surgery techniques. The mean time for both the experts and the novices using 3D visualization was significantly less than that required using 2D vision (P < 0.001). However, there was no significant difference in the maximum force applied by the novices to the mitral valve during suturing (P = 0.7) and suture tying (P = 0.6) using either 2D or 3D visualization. The mean time required and forces applied by both the experts and the novices were significantly less using the conventional surgical technique than when using the robotic system with either 2D or 3D vision (P < 0.001). Despite high-quality binocular images, both the experts and the novices applied significantly more force to the cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery.

Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy.

PubMed

Choussein, Souzana; Srouji, Serene S; Farland, Leslie V; Gargiulo, Antonio R

2015-01-01

To compare the effectiveness and safety of a flexible carbon dioxide (CO2) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system. Retrospective cohort study. Level II-2 evidence. Reproductive surgery practice at an academic hospital. Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO2 laser (n = 85) or the ultrasonic scalpel (n = 151). Robot-assisted laparoscopic myomectomy employing either a flexible CO2 laser fiber or a robotic ultrasonic scalpel as the primary energy tool. Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups. Robot-assisted laparoscopic myomectomy with a flexible CO2 laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Intuitive adaptive orientation control of assistive robots for people living with upper limb disabilities.

PubMed

Vu, Dinh-Son; Allard, Ulysse Cote; Gosselin, Clement; Routhier, Francois; Gosselin, Benoit; Campeau-Lecours, Alexandre

2017-07-01

Robotic assistive devices enhance the autonomy of individuals living with physical disabilities in their day-to-day life. Although the first priority for such devices is safety, they must also be intuitive and efficient from an engineering point of view in order to be adopted by a broad range of users. This is especially true for assistive robotic arms, as they are used for the complex control tasks of daily living. One challenge in the control of such assistive robots is the management of the end-effector orientation which is not always intuitive for the human operator, especially for neophytes. This paper presents a novel orientation control algorithm designed for robotic arms in the context of human-robot interaction. This work aims at making the control of the robot's orientation easier and more intuitive for the user, in particular, individuals living with upper limb disabilities. The performance and intuitiveness of the proposed orientation control algorithm is assessed through two experiments with 25 able-bodied subjects and shown to significantly improve on both aspects.

Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center

PubMed Central

Cardenas-Goicoechea, Joel; Adams, Sarah; Bhat, Suneel B.; Randall, Thomas C.

2010-01-01

Objective To compare peri- and post-operative complications and outcomes of robotic-assisted surgical staging with traditional laparoscopic surgical staging for women with endometrial cancer. Methods A retrospective chart review of cases of women undergoing minimally invasive total hysterectomy and pelvic and para-aortic lymphadenectomy by a robotic-assisted approach or traditional laparoscopic approach was conducted. Major intraoperative complications, including vascular injury, enterotomy, cystotomy, or conversion to laparotomy, were measured. Secondary outcomes including operative time, blood loss, transfusion rate, number of lymph nodes retrieved, and the length of hospitalization were also measured. Results 275 cases were identified–102 patients with robotic-assisted staging and 173 patients with traditional laparoscopic staging. There was no significant difference in the rate of major complications between groups (p=0.13). The mean operative time was longer in cases of robotic-assisted staging (237 min vs. 178 min, p<0.0001); however, blood loss was significantly lower (109 ml vs. 187 ml, p<0.0001). The mean number of lymph nodes retrieved were similar between groups (p=0.32). There were no significant differences in the time to discharge, re-admission, or re-operation rates between the two groups. Conclusion Robotic-assisted surgery is an acceptable alternative to laparoscopy for minimally invasive staging of endometrial cancer. In addition to the improved ease of operation, visualization, and range of motion of the robotic instruments, robotic surgery results in a lower mean blood loss, although longer operative time. More data are needed to determine if the rates of urinary tract injuries and other surgical complications can be reduced with the use of robotic surgery. PMID:20144471

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.

Robot-Assisted Transoral Odontoidectomy : Experiment in New Minimally Invasive Technology, a Cadaveric Study

PubMed Central

Yang, Moon Sul; Yoon, Tae Ho; Yoon, Do Heum; Kim, Keung Nyun; Pennant, William

2011-01-01

Objective In the field of spinal surgery, a few laboratory results or clinical cases about robotic spinal surgery have been reported. In vivo trials and development of related surgical instruments for spinal surgery are required before its clinical application. We investigated the use of the da Vinci® Surgical System in spinal surgery at the craniovertebral junction in a human cadaver to demonstrate the efficacy and pitfalls of robotic surgery. Methods Dissection of pharyngeal wall to the exposure of C1 and odontoid process was performed with full robotic procedure. Although assistance of another surgeon was necessary for drilling and removal of odontoid process due to the lack of appropriate end-effectors, successful robotic procedures for dural sutures and exposing spinal cord proved its safety and dexterity. Results Robot-assisted odontoidectomy was successfully performed in a human cadaver using the da Vinci® Surgical System with few robotic arm collisions and minimal soft tissue damages. Da Vinci® Surgical System manifested more dexterous movement than human hands in the deep and narrow oral cavity. Furthermore, sutures with robotic procedure in the oral cavity demonstrated the advantage over conventional procedure. Conclusion Presenting cadaveric study proved the probability of robot-assisted transoral approach. However, the development of robotic instruments specific to spinal surgery must first precede its clinical application. PMID:21607188

Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

PubMed Central

Kibar, Yusuf; Yalcin, Serdar; Kopru, Burak; Topuz, Bahadir; Ebiloglu, Turgay

2016-01-01

Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option. PMID:27579435

Inguinal hernia repair: is there a benefit to using the robot?

PubMed

Charles, Eric J; Mehaffey, J Hunter; Tache-Leon, Carlos A; Hallowell, Peter T; Sawyer, Robert G; Yang, Zequan

2018-04-01

The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair. All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U. A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39-62], Lap: 57 [45-67], and Open: 56 [48-67] years, p = 0.03). Operative duration was also different (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] min, p < 0.001). There were no operative mortalities and all patients except one were discharged home the same day. Postoperative occurrences (adverse events, readmissions, and death) were similar between groups (Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942-8375] vs. Lap: $4527 [$2310-6003] vs. Open: $4264 [$3277-5143], p < 0.001). Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.

High level functions for the intuitive use of an assistive robot.

PubMed

Lebec, Olivier; Ben Ghezala, Mohamed Walid; Leynart, Violaine; Laffont, Isabelle; Fattal, Charles; Devilliers, Laurence; Chastagnol, Clement; Martin, Jean-Claude; Mezouar, Youcef; Korrapatti, Hermanth; Dupourqué, Vincent; Leroux, Christophe

2013-06-01

This document presents the research project ARMEN (Assistive Robotics to Maintain Elderly People in a Natural environment), aimed at the development of a user friendly robot with advanced functions for assistance to elderly or disabled persons at home. Focus is given to the robot SAM (Smart Autonomous Majordomo) and its new features of navigation, manipulation, object recognition, and knowledge representation developed for the intuitive supervision of the robot. The results of the technical evaluations show the value and potential of these functions for practical applications. The paper also documents the details of the clinical evaluations carried out with elderly and disabled persons in a therapeutic setting to validate the project.

Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique

PubMed Central

Wang, Jun-Qiang; Wang, Yu; Feng, Yun; Han, Wei; Su, Yong-Gang; Liu, Wen-Yong; Zhang, Wei-Jun; Wu, Xin-Bao; Wang, Man-Yi; Fan, Yu-Bo

2017-01-01

Background: Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique. Methods: Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws’ positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed. Results: Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093). Conclusions: Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible. PMID:29067950

Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique.

PubMed

Wang, Jun-Qiang; Wang, Yu; Feng, Yun; Han, Wei; Su, Yong-Gang; Liu, Wen-Yong; Zhang, Wei-Jun; Wu, Xin-Bao; Wang, Man-Yi; Fan, Yu-Bo

2017-11-05

Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique. Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws' positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed. Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093). Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.

Comparison of success rates, learning curves, and inter-subject performance variability of robot-assisted and manual ultrasound-guided nerve block needle guidance in simulation.

PubMed

Morse, J; Terrasini, N; Wehbe, M; Philippona, C; Zaouter, C; Cyr, S; Hemmerling, T M

2014-06-01

This study focuses on a recently developed robotic nerve block system and its impact on learning regional anaesthesia skills. We compared success rates, learning curves, performance times, and inter-subject performance variability of robot-assisted vs manual ultrasound (US)-guided nerve block needle guidance. The hypothesis of this study is that robot assistance will result in faster skill acquisition than manual needle guidance. Five co-authors with different experience with nerve blocks and the robotic system performed both manual and robot-assisted, US-guided nerve blocks on two different nerves of a nerve phantom. Ten trials were performed for each of the four procedures. Time taken to move from a shared starting position till the needle was inserted into the target nerve was defined as the performance time. A successful block was defined as the insertion of the needle into the target nerve. Average performance times were compared using analysis of variance. P<0.05 was considered significant. Data presented as mean (standard deviation). All blocks were successful. There were significant differences in performance times between co-authors to perform the manual blocks, either superficial (P=0.001) or profound (P=0.0001); no statistical difference between co-authors was noted for the robot-assisted blocks. Linear regression indicated that the average decrease in time between consecutive trials for robot-assisted blocks of 1.8 (1.6) s was significantly (P=0.007) greater than the decrease for manual blocks of 0.3 (0.3) s. Robot assistance of nerve blocks allows for faster learning of needle guidance over manual positioning and reduces inter-subject performance variability. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

PubMed Central

2013-01-01

Objective The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. Methods Thirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle*’, ‘robot*’, ‘rehabilitat*’ or ‘treat*’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation. Results Twenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II. Conclusion All the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies. PMID:23517734

Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis.

PubMed

Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf

2017-03-01

Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

Adding navigation, artificial audition and vital sign monitoring capabilities to a telepresence mobile robot for remote home care applications.

PubMed

Laniel, Sebastien; Letourneau, Dominic; Labbe, Mathieu; Grondin, Francois; Polgar, Janice; Michaud, Francois

2017-07-01

A telepresence mobile robot is a remote-controlled, wheeled device with wireless internet connectivity for bidirectional audio, video and data transmission. In health care, a telepresence robot could be used to have a clinician or a caregiver assist seniors in their homes without having to travel to these locations. Many mobile telepresence robotic platforms have recently been introduced on the market, bringing mobility to telecommunication and vital sign monitoring at reasonable costs. What is missing for making them effective remote telepresence systems for home care assistance are capabilities specifically needed to assist the remote operator in controlling the robot and perceiving the environment through the robot's sensors or, in other words, minimizing cognitive load and maximizing situation awareness. This paper describes our approach adding navigation, artificial audition and vital sign monitoring capabilities to a commercially available telepresence mobile robot. This requires the use of a robot control architecture to integrate the autonomous and teleoperation capabilities of the platform.

Functional assessment and performance evaluation for assistive robotic manipulators: Literature review.

PubMed

Chung, Cheng-Shiu; Wang, Hongwu; Cooper, Rory A

2013-07-01

The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to give the scope of current research and provide suggestions for future studies. We conducted a literature search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh Library System - PITTCat. Twenty relevant studies were identified. Studies were separated into two broad categories: user task preferences and user-interface performance measurements of commercialized and developing assistive robotic manipulators. The outcome measures and ICF codes associated with the performance evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the quantitative and qualitative evaluation of task efficiency and performance to build comparable measures between research groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical functional assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In addition, these outcome measures will help physicians and therapists build standardized tools while prescribing and assessing assistive robotic manipulators.

The place of robotics in gynecologic surgery.

PubMed

Quemener, J; Boulanger, L; Rubod, C; Cosson, M; Vinatier, D; Collinet, P

2012-10-01

Robot-assisted laparoscopic gynecologic surgery has undergone widespread development in recent years. The surgical literature on this subject continues to grow. The goal of this article is to summarize the principal indications for robotic assistance in gynecologic surgery and to offer a general overview of the principal articles dealing with robotic surgery for both benign and malignant disease. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

The Leipzig experience with robotic valve surgery.

PubMed

Autschbach, R; Onnasch, J F; Falk, V; Walther, T; Krüger, M; Schilling, L O; Mohr, F W

2000-01-01

The study describes the single-center experience using robot-assisted videoscopic mitral valve surgery and the early results with a remote telemanipulator-assisted approach for mitral valve repair. Out of a series of 230 patients who underwent minimally invasive mitral valve surgery, in 167 patients surgery was performed with the use of robotic assistance. A voice-controlled robotic arm was used for videoscopic guidance in 152 cases. Most recently, a computer-enhanced telemanipulator was used in 15 patients to perform the operation remotely. The mitral valve was repaired in 117 and replaced in all other patients. The voice-controlled robotic arm (AESOP 3000) facilitated videoscopic-assisted mitral valve surgery. The procedure was completed without the need for an additional assistant as "solo surgery." Additional procedures like radiofrequency ablation and tricuspid valve repair were performed in 21 and 4 patients, respectively. Duration of bypass and clamp time was comparable to conventional procedures (107 A 34 and 50 A 16 min, respectively). Hospital mortality was 1.2%. Using the da Vinci telemanipulation system, remote mitral valve repair was successfully performed in 13 of 15 patients. Robotic-assisted less invasive mitral valve surgery has evolved to a reliable technique with reproducible results for primary operations and for reoperations. Robotic assistance has enabled a solo surgery approach. The combination with radiofrequency ablation (Mini Maze) in patients with chronic atrial fibrillation has proven to be beneficial. The use of telemanipulation systems for remote mitral valve surgery is promising, but a number of problems have to be solved before the introduction of a closed chest mitral valve procedure.

[Robot-aided training in rehabilitation].

PubMed

Hachisuka, Kenji

2010-02-01

Recently, new training techniques that involve the use of robots have been used in the rehabilitation of patients with hemiplegia and paraplegia. Robots used for training the arm include the MIT-MANUS, Arm Trainer, mirror-image motion enabler (MIME) robot, and the assisted rehabilitation and measurement (ARM) Guide. Robots that are used for lower-limb training are the Rehabot, Gait Trainer, Lokomat, LOPES Exoskeleton Robot, and Gait Assist Robot. Robot-aided therapy has enabled the functional training of the arm and the lower limbs in an effective, easy, and comfortable manner. Therefore, with this type of therapy, the patients can repeatedly undergo sufficient and accurate training for a prolonged period. However, evidence of the benefits of robot-aided training has not yet been established.

Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis.

PubMed

Cheung, Eddy Y Y; Ng, Thomas K W; Yu, Kevin K K; Kwan, Rachel L C; Cheing, Gladys L Y

2017-11-01

To investigate the effects of robot-assisted training on the recovery of people with spinal cord injury (SCI). Randomized controlled trials (RCTs) or quasi-RCTs involving people with SCI that compared robot-assisted upper limbs or lower limbs training with a control of other treatment approach or no treatment. We included studies involving people with complete or incomplete SCIs. We searched MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (Cochrane Library), and Embase to August 2016. Bibliographies of relevant articles on the effect of body-weight-supported treadmill training on subjects with SCI were screened to avoid missing relevant articles from the search of databases. All kinds of objective assessments concerning physical ability, mobility, and/or functional ability were included. Assessments could be clinical tests (ie, 6-minute walk test, FIM) or laboratory tests (ie, gait analysis). Subjective outcome measures were excluded from this review. Eleven RCT studies involving 443 subjects were included in the study. Meta-analysis was performed on the included studies. Walking independence (3.73; 95% confidence interval [CI], -4.92 to -2.53; P<.00001; I 2 =38%) and endurance (53.32m; 95% CI, -73.15 to -33.48; P<.00001; I 2 =0%) were found to have better improvement in robot-assisted training groups. Lower limb robot-assisted training was also found to be as effective as other types of body-weight-supported training. There is a lack of upper limb robot-assisted training studies; therefore, performing a meta-analysis was not possible. Robot-assisted training is an adjunct therapy for physical and functional recovery for patients with SCI. Future high-quality studies are warranted to investigate the effects of robot-assisted training on functional and cardiopulmonary recovery of patients with SCI. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.

Tool actuation and force feedback on robot-assisted microsurgery system

NASA Technical Reports Server (NTRS)

Das, Hari (Inventor); Ohm, Tim R. (Inventor); Boswell, Curtis D. (Inventor); Steele, Robert D. (Inventor)

2002-01-01

An input control device with force sensors is configured to sense hand movements of a surgeon performing a robot-assisted microsurgery. The sensed hand movements actuate a mechanically decoupled robot manipulator. A microsurgical manipulator, attached to the robot manipulator, is activated to move small objects and perform microsurgical tasks. A force-feedback element coupled to the robot manipulator and the input control device provides the input control device with an amplified sense of touch in the microsurgical manipulator.

Development of a Wearable Assist Robot for Walk Rehabilitation After Knee Arthroplasty Surgery

NASA Astrophysics Data System (ADS)

Terada, H.; Zhu, Y.; Horiguchi, K.; Nakamura, M.; Takahashi, R.

In Japan, it is popular that the disease knee joints will be replaced to artificial joints by surgery. And we have to assist so many patients for walk rehabilitation. So, the wearable assist robot has been developed. This robot includes the knee motion assist mechanism and the hip joint support mechanism. Especially, the knee motion assist mechanism consists of a non-circular gear and grooved cams. This mechanism rotates and slides simultaneously, which has two degree-of-freedom. Also, the hip joint support mechanism consists of a hip brace and a ball-joint. This mechanism can avoid motion constraints which are the internal or external rotation and the adduction or abduction. Then, the control algorithm, which considers an assisting timing for the walk rehabilitation, has been proposed. A sensing system of a walk state for this control system uses a heel contacts sensor and knee and hip joint rotation angle sensors. Also, the prototype robot has been tested. And it is confirmed that the assisting system is useful.

Robot Tracking of Human Subjects in Field Environments

NASA Technical Reports Server (NTRS)

Graham, Jeffrey; Shillcutt, Kimberly

2003-01-01

Future planetary exploration will involve both humans and robots. Understanding and improving their interaction is a main focus of research in the Intelligent Systems Branch at NASA's Johnson Space Center. By teaming intelligent robots with astronauts on surface extra-vehicular activities (EVAs), safety and productivity can be improved. The EVA Robotic Assistant (ERA) project was established to study the issues of human-robot teams, to develop a testbed robot to assist space-suited humans in exploration tasks, and to experimentally determine the effectiveness of an EVA assistant robot. A companion paper discusses the ERA project in general, its history starting with ASRO (Astronaut-Rover project), and the results of recent field tests in Arizona. This paper focuses on one aspect of the research, robot tracking, in greater detail: the software architecture and algorithms. The ERA robot is capable of moving towards and/or continuously following mobile or stationary targets or sequences of targets. The contributions made by this research include how the low-level pose data is assembled, normalized and communicated, how the tracking algorithm was generalized and implemented, and qualitative performance reports from recent field tests.

Robotics in percutaneous cardiovascular interventions.

PubMed

Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

2017-11-01

The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

The University of Chicago technique of complete intracorporeal pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy.

PubMed

Gundeti, Mohan S; Acharya, Sujeet S; Zagaja, Gregory P

2009-06-01

We present the University of Chicago technique for complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy. The operative steps of the open procedure were replicated laparoscopically using robotic assistance. Initially, five transperitoneal laparoscopic ports are placed prior to docking the da Vinci S robotic system. A 20 cm ileal segment is isolated, and the gastrointestinal anastomosis is performed in an end-to-end fashion using intracorporeal suturing. The appendix is anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. Then, the bladder is incised in a coronal plane, and the simple detubularized ileal on-lay patch is anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain are placed. Finally, the Mitrofanoff stoma is then fashioned. Cystography is done at 4 weeks postoperatively. This report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in select patients. A large case series, however, is necessary to determine whether a robotic-assisted approach provides any significant advantages over conventional open procedures.

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

Walking with robot assistance: the influence of body weight support on the trunk and pelvis kinematics.

PubMed

Swinnen, Eva; Baeyens, Jean-Pierre; Knaepen, Kristel; Michielsen, Marc; Hens, Gerrit; Clijsen, Ron; Goossens, Maggie; Buyl, Ronald; Meeusen, Romain; Kerckhofs, Eric

2015-05-01

The goal was to assess in healthy participants the three-dimensional kinematics of the pelvis and the trunk during robot-assisted treadmill walking (RATW) at 0%, 30% and 50% body weight support (BWS), compared with treadmill walking (TW). 18 healthy participants walked (2 kmph) on a treadmill with and without robot assistance (Lokomat; 60% guidance force; 0%, 30% and 50% BWS). After an acclimatisation period (four minutes), trunk and pelvis kinematics were registered in each condition (Polhemus Liberty [240 Hz]). The results were analysed using a repeated measures analysis of variance with Bonferroni correction, with the level of suspension as within-subject factor. During RATW with BWS, there were significantly (1) smaller antero-posterior and lateral translations of the trunk and the pelvis; (2) smaller antero-posterior flexion and axial rotation of the trunk; (3) larger lateral flexion of the trunk; and (4) larger antero-posterior tilting of the pelvis compared with TW. There are significant differences in trunk and pelvis kinematics in healthy persons during TW with and without robot assistance. These data are relevant in gait rehabilitation, relating to normal balance regulation. Additional research is recommended to further assess the influence of robot assistance on human gait. The trunk and pelvis moves in a different way during walking with robot assistance. The data suggest that the change in movement is due to the robot device and the harness of the suspension system more than due to the level of suspension itself.

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

PubMed Central

Prasad, Sunil M.; Ducko, Christopher T.; Stephenson, Edward R.; Chambers, Charles E.; Damiano, Ralph J.

2001-01-01

Objective To follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. Summary Background Data Recently there has been an interest in using robotics and computers to enhance the surgeon’s ability to perform endoscopic cardiac surgery. This interest has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instruments, it has not been possible to perform coronary surgery. Methods Nineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to construct the LITA–LAD anastomosis. All other required grafts were completed by conventional techniques. Results Seventeen LITA–LAD grafts (89%) had adequate intraoperative flow. The mean LITA–LAD graft flow was 38.5 ± 5 mL/min. At 8 weeks, LITA–LAD grafts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 ± 4.2 months, all patients were NYHA class I and there were no adverse cardiac events. Conclusions The results from the first prospective clinical trial of robotically assisted endoscopic coronary bypass surgery in the United States showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabling technology allowing the performance of endoscopic coronary anastomoses. PMID:11371730

Transoral robotic-assisted laryngeal cleft repair in the pediatric patient.

PubMed

Leonardis, Rachel L; Duvvuri, Umamaheswar; Mehta, Deepak

2014-09-01

To assess the feasibility of performing robotic-assisted laryngeal cleft repair in the pediatric population. Retrospective chart review at a tertiary academic children's hospital. All patients underwent transoral robotic-assisted laryngeal cleft repair from March 2011 to June 2013. Demographics, robotic docking time, operative time, and postoperative course and swallowing function were collected and analyzed. Five children, three male and two female, underwent successful transoral robotic-assisted laryngeal cleft repair for closure of a type I laryngeal cleft. Mean age at time of surgery was 21.6 months (standard deviation 6.1 months; range, 15-29 months). From case 1 to case 5, robotic docking time (18-10 minutes), robotic operative time (102-36 minutes), and total operating room time (173-105 minutes) decreased. There were no complications with time until extubation (range, 2-3 days), length of intensive care unit stay (range, 3-4 days), and total hospital stay (range, 3-5 days) within acceptable range following laryngeal cleft repair. Modified barium swallow (two patients) or fiberoptic endoscopic evaluation of swallowing (three patients) was performed postoperatively, with all patients showing complete resolution of penetration and aspiration. In addition, all patients experienced subjective resolution of dysphagia and/or choking with feeds postoperatively. Transoral robotic-assisted laryngeal cleft repair may offer specific advantages over a traditional endoscopic approach. In our experience, the procedure was well tolerated and associated with definitive surgical cure in all patients. The scope of robotic technology continually expands and should be considered a feasible tool at an institution-based level. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

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.

Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload.

PubMed

Stefanidis, Dimitrios; Wang, Fikre; Korndorffer, James R; Dunne, J Bruce; Scott, Daniel J

2010-02-01

Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room. Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant. Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001). Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.

HiMoP: A three-component architecture to create more human-acceptable social-assistive robots : Motivational architecture for assistive robots.

PubMed

Rodríguez-Lera, Francisco J; Matellán-Olivera, Vicente; Conde-González, Miguel Á; Martín-Rico, Francisco

2018-05-01

Generation of autonomous behavior for robots is a general unsolved problem. Users perceive robots as repetitive tools that do not respond to dynamic situations. This research deals with the generation of natural behaviors in assistive service robots for dynamic domestic environments, particularly, a motivational-oriented cognitive architecture to generate more natural behaviors in autonomous robots. The proposed architecture, called HiMoP, is based on three elements: a Hierarchy of needs to define robot drives; a set of Motivational variables connected to robot needs; and a Pool of finite-state machines to run robot behaviors. The first element is inspired in Alderfer's hierarchy of needs, which specifies the variables defined in the motivational component. The pool of finite-state machine implements the available robot actions, and those actions are dynamically selected taking into account the motivational variables and the external stimuli. Thus, the robot is able to exhibit different behaviors even under similar conditions. A customized version of the "Speech Recognition and Audio Detection Test," proposed by the RoboCup Federation, has been used to illustrate how the architecture works and how it dynamically adapts and activates robots behaviors taking into account internal variables and external stimuli.

Robotic-Assisted Videothoracoscopic Surgery of the Lung.

PubMed

Velez-Cubian, Frank O; Ng, Emily P; Fontaine, Jacques P; Toloza, Eric M

2015-07-01

Despite initial concerns about the general safety of videothoracoscopic surgery, minimally invasive videothoracoscopic surgical procedures have advantages over traditional open thoracic surgery via thoracotomy. Robotic-assisted minimally invasive surgery has expanded to almost every surgical specialty, including thoracic surgery. Adding a robotic-assisted surgical system to a videothoracoscopic surgical procedure corrects several shortcomings of videothoracoscopic surgical cameras and instruments. We performed a literature search on robotic-assisted pulmonary resections and compared the published robotic series data with our experience at the H. Lee Moffitt Cancer Center & Research Institute. All perioperative outcomes, such as intraoperative data, postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality rates were noted. Our literature search found 23 series from multiple surgical centers. We divided the literature into 2 groups based on the year published (2005-2010 and 2011-2014). Operative times from earlier studies ranged from 150 to 240 minutes compared with 90 to 242 minutes for later studies. Conversion rates (to open lung resection) from the earlier studies ranged from 0% to 19% compared with 0% to 11% in the later studies. Mortality rates for the earlier studies ranged from 0% to 5% compared with 0% to 2% for the later studies. Since 2010, our group has performed more than 600 robotic-assisted thoracic surgical procedures, including more than 200 robotic-assisted pulmonary lobectomies, which we also divided into 2 groups. Our median skin-to-skin operative time improved from 179 minutes for our early group (n = 104) to 172 minutes for our later group (n = 104). The overall conversion rate was 9.6% and the emergent conversion rate (for bleeding) was 5% for our robotic-assisted lobectomies. The most common postoperative complications in our cohort were prolonged air leak (> 7 days; 16.8%) and atrial fibrillation (12%). Hospital LOS for the early series ranged from 3 to 11 days compared with 2 to 6 days for the later series. Median hospital LOS decreased from 6 to 4 days. Our mortality rate was 1.4%; 3 in-hospital deaths occurred in the early 40 cases. Mediastinal lymph node (LN) dissection and detection of occult mediastinal LN metastases were improved during robotic-assisted lobectomy for non-small-cell lung cancer, as demonstrated by an overall 30% upstaging rate, including a 19% nodal upstaging rate, in our cohort. Robotic-assisted videothoracoscopic pulmonary lobectomy appears to be as safe as conventional videothoracoscopic surgical lobectomy, which has decreased perioperative complications and a shorter hospital LOS than open lobectomy. Both mediastinal LN dissection and the early detection of occult mediastinal LN metastatic disease were improved by robotic-assisted videothoracoscopic surgical compared with conventional videothoracoscopic surgical or open thoracotomy.

Role of robotics in managing mesh and suture complications of prior pelvic organ prolapse surgery.

PubMed

Wilkinson, Michael N; O'Sullivan, Orfhlaith E; O'Reilly, Barry A

2017-03-01

Robotic surgery is proving essential in providing a minimally invasive approach to complex urogynaecological cases. This video highlights the diversity and complexity of cases performed using the robot-assisted approach. The robot-assisted approach was utilised for excellent effect in two complex urogynaecological cases. In the first case the entire left arm of an intravesically placed TVT was removed using a combined vaginal and robotic approach. The second case involved removing four paravaginal sutures, one of which breeched the bladder and was encrusted with calculus. These were placed during a laparoscopic paravaginal repair 2 years previously. She had a concomitant vaginal hysterectomy, Mc Calls culdoplasty and anterior wall repair. The robot-assisted approach allows for excellent access to the pelvis and retropubic space facilitating the surgical management of complex urogynaecology cases.

Towards using musculoskeletal models for intelligent control of physically assistive robots.

PubMed

Carmichael, Marc G; Liu, Dikai

2011-01-01

With the increasing number of robots being developed to physically assist humans in tasks such as rehabilitation and assistive living, more intelligent and personalized control systems are desired. In this paper we propose the use of a musculoskeletal model to estimate the strength of the user, from which information can be utilized to improve control schemes in which robots physically assist humans. An optimization model is developed utilizing a musculoskeletal model to estimate human strength in a specified dynamic state. Results of this optimization as well as methods of using it to observe muscle-based weaknesses in task space are presented. Lastly potential methods and problems in incorporating this model into a robot control system are discussed.

Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke.

PubMed

Waldman, Genna; Yang, Chung-Yong; Ren, Yupeng; Liu, Lin; Guo, Xin; Harvey, Richard L; Roth, Elliot J; Zhang, Li-Qun

2013-01-01

To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke.

The 1991-1992 walking robot design

NASA Technical Reports Server (NTRS)

Azarm, Shapour; Dayawansa, Wijesurija; Tsai, Lung-Wen; Peritt, Jon

1992-01-01

The University of Maryland Walking Machine team designed and constructed a robot. This robot was completed in two phases with supervision and suggestions from three professors and one graduate teaching assistant. Bob was designed during the Fall Semester 1991, then machined, assembled, and debugged in the Spring Semester 1992. The project required a total of 4,300 student hours and cost under $8,000. Mechanically, Bob was an exercise in optimization. The robot was designed to test several diverse aspects of robotic potential, including speed, agility, and stability, with simplicity and reliability holding equal importance. For speed and smooth walking motion, the footpath contained a long horizontal component; a vertical aspect was included to allow clearance of obstacles. These challenges were met with a leg design that utilized a unique multi-link mechanism which traveled a modified tear-drop footpath. The electrical requirements included motor, encoder, and voice control circuitry selection, manual controller manufacture, and creation of sensors for guidance. Further, there was also a need for selection of the computer, completion of a preliminary program, and testing of the robot.

Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

PubMed

Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

2010-01-19

To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, p<0.05). Not all of the subjects reached a steady-state gait pattern within the two sessions, in contrast to a previous study using a weaker robotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. Copyright 2009 Elsevier Ltd. All rights reserved.

Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis.

PubMed

Memon, Sameer; Heriot, Alexander G; Murphy, Declan G; Bressel, Mathias; Lynch, A Craig

2012-07-01

Robot-assisted laparoscopic surgery is being performed more frequently for the minimally invasive management of rectal cancer. The objective of this meta-analysis was to compare the clinical and oncologic safety and efficacy of robot-assisted versus conventional laparoscopic surgery. A search of the Medline and Embase databases was performed for studies that compared clinical or oncologic outcomes of conventional laparoscopic proctectomy with robot-assisted laparoscopic proctectomy for rectal cancer. The methodological quality of the selected studies was critically assessed to identify studies suitable for inclusion. Meta-analysis was performed by a random effects model and analyzed by Review Manager. Clinical outcomes evaluated were conversion rates, operation times, length of hospital stay, and complications. Oncologic outcomes evaluated were circumferential margin status, number of lymph nodes collected, and distal resection margin lengths. Eight comparative studies were assessed for quality, and seven studies were included in the meta-analysis. Two studies were matched case-control studies, and five were unmatched. A total of 353 robot-assisted laparoscopic surgery proctectomy cases and 401 conventional laparoscopic surgery proctectomy cases were analyzed. Robotic surgery was associated with a significantly lower conversion rate (P=0.03; 95% confidence interval 1-12). There was no difference in complications, circumferential margin involvement, distal resection margin, lymph node yield, or hospital stay (P=NS). Robot-assisted surgery decreased the conversion rate compared to conventional laparoscopic surgery. Other clinical outcomes and oncologic outcomes were equivalent. The benefits of robotic rectal cancer surgery may differ between population groups.

Multidisciplinary approach for developing a new robotic system for domiciliary assistance to elderly people.

PubMed

Cavallo, F; Aquilano, M; Bonaccorsi, M; Mannari, I; Carrozza, M C; Dario, P

2011-01-01

This paper aims to show the effectiveness of a (inter / multi)disciplinary team, based on the technology developers, elderly care organizations, and designers, in developing the ASTRO robotic system for domiciliary assistance to elderly people. The main issues presented in this work concern the improvement of robot's behavior by means of a smart sensor network able to share information with the robot for localization and navigation, and the design of the robot's appearance and functionalities by means of a substantial analysis of users' requirements and attitude to robotic technology to improve acceptability and usability.

An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

NASA Astrophysics Data System (ADS)

Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

Robot-assisted surgery: the future is here.

PubMed

Gerhardus, Diana

2003-01-01

According to L. Wiley Nifong, director of robotic surgery at East Carolina University's Brody School of Medicine, "Nationally, only one-fourth of the 15 million surgeries performed each year are done with small incisions or what doctors call 'minimally invasive surgery'." Robots could raise that number substantially (Stark 2002). Currently, healthcare organizations use robot technology for thoracic, abdominal, pelvic, and neurological surgical procedures. Minimally invasive surgery reduces the amount of inpatient hospital days, and the computer in the system filters any hand tremors a physician may have during the surgery. The use of robot-assisted surgery improves quality of care because the patient experiences less pain after the surgery. Robot-assisted surgery demonstrates definite advantages for the patient, physician, and hospital; however, healthcare organizations in the United States have yet to acquire the technology because of implementation costs and the lack of FDA (Food and Drug Administration) approval for using the technology for certain types of heart procedures. This article focuses on robot-assisted surgery advantages to patients, physicians, and hospitals as well as on the disadvantages to physicians. In addition, the article addresses implementation costs, which creates financial hurdles for most healthcare organizations; offers recommendations for administrators to embrace this technology for strategic positioning; and enumerates possible roles for robots in medicine.

Pilot Validation Study of the European Association of Urology Robotic Training Curriculum.

PubMed

Volpe, Alessandro; Ahmed, Kamran; Dasgupta, Prokar; Ficarra, Vincenzo; Novara, Giacomo; van der Poel, Henk; Mottrie, Alexandre

2015-08-01

The development of structured and validated training curricula is one of the current priorities in robot-assisted urological surgery. To establish the feasibility, acceptability, face validity, and educational impact of a structured training curriculum for robot-assisted radical prostatectomy (RARP), and to assess improvements in performance and ability to perform RARP after completion of the curriculum. A 12-wk training curriculum was developed based on an expert panel discussion and used to train ten fellows from major European teaching institutions. The curriculum included: (1) e-learning, (2) 1 wk of structured simulation-based training (virtual reality synthetic, animal, and cadaveric platforms), and (3) supervised modular training for RARP. The feasibility, acceptability, face validity, and educational impact were assessed using quantitative surveys. Improvement in the technical skills of participants over the training period was evaluated using the inbuilt validated assessment metrics on the da Vinci surgical simulator (dVSS). A final RARP performed by fellows on completion of their training was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) score and generic and procedure-specific scoring criteria. The median baseline experience of participants as console surgeon was 4 mo (interquartile range [IQR] 0-6.5 mo). All participants completed the curriculum and were involved in a median of 18 RARPs (IQR 14-36) during modular training. The overall score for dVSS tasks significantly increased over the training period (p<0.001-0.005). At the end of the curriculum, eight fellows (80%) were deemed able by their mentors to perform a RARP independently, safely, and effectively. At assessment of the final RARP, the participants achieved an average score ≥4 (scale 1-5) for all domains using the GEARS scale and an average score >10 (scale 4-16) for all procedural steps using a generic dedicated scoring tool. In performance comparison using this scoring tool, the experts significantly outperformed the fellows (mean score for all steps 13.6 vs 11). The European robot-assisted urologic training curriculum is acceptable, valid, and effective for training in RARP. This study shows that a 12-wk structured training program including simulation-based training and mentored training in the operating room allows surgeons with limited robotic experience to increase their robotic skills and their ability to perform the surgical steps of robot-assisted radical prostatectomy. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Caregiver and social assistant robot for rehabilitation and coaching for the elderly.

PubMed

Pérez, P J; Garcia-Zapirain, B; Mendez-Zorrilla, A

2015-01-01

Socially assistive robotics (SAR) has been a major field of investigation during the last decade and, as it develops, the groups the technology can be applied to and all ways in which these can be assisted are rapidly increasing. The main objective is to design and develop a complete robotic agent, so that it performs physical and mental activities for elderly people to maintain their healthy life habits and, as a final result, improve their quality of life. LEGO Mindstorms NXT® robot's unique capacity for adaptability and engaging its users to develop coaching activities and assistive rehabilitation for the elderly. Such activities will aim to enhance healthy habits and provide training in physical and mental rehabilitation. The robot is attached to an iPod Touch that acts as its interface. The robot has been tested by a voluntary group of residents, also from that retirement home. Results in the variables of the questionnaire show scores above 4 points out of 5 for all the categories. Based on the tests, an easy to use Robot is prepared to deliver basic coaching for physical activities as proposed by the client, the staff of La Misericordia, who confirmed their satisfaction regarding this aspect.

Review of control strategies for robotic movement training after neurologic injury.

PubMed

Marchal-Crespo, Laura; Reinkensmeyer, David J

2009-06-16

There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.

Review of control strategies for robotic movement training after neurologic injury

PubMed Central

Marchal-Crespo, Laura; Reinkensmeyer, David J

2009-01-01

There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies. PMID:19531254

Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

PubMed

Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

2009-10-01

Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis.

PubMed

Bagla, Sandeep; Smirniotopoulos, John; Orlando, Julie C; Piechowiak, Rachel

2017-03-01

Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH. IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months. No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm 2 vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred. Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.

Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS

PubMed Central

Lo, Albert C.; Guarino, Peter; Krebs, Hermano I.; Volpe, Bruce T.; Bever, Christopher T.; Duncan, Pamela W.; Ringer, Robert J.; Wagner, Todd H.; Richards, Lorie G.; Bravata, Dawn M.; Haselkorn, Jodie K.; Wittenberg, George F.; Federman, Daniel G.; Corn, Barbara H.; Maffucci, Alysia D.; Peduzzi, Peter

2017-01-01

Background Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9. Conclusions VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010. PMID:19541917

Use of the robot assisted gait therapy in rehabilitation of patients with stroke and spinal cord injury.

PubMed

Sale, P; Franceschini, M; Waldner, A; Hesse, S

2012-03-01

Difficulty in walking is a major feature of neurological disease, and loss of mobility is the activity of daily living on which patients place the greatest value. The impact on patients is enormous, with negative ramifications on their participation in social, vocational, and recreational activities. In current clinical practice the gait restoration with robotic device is an integral part of rehabilitation program. Robot therapy involves the use of a robot exoskeleton device or end-effector device to help the patient retrain motor coordination by performing well-focused and carefully directed repetitive practice. The exoskeleton, as an assistive device, is also an external structural mechanism with joints and links corresponding to those of the human body. These robots use joint trajectories of the entire gait cycle and offer a uniform (more or less) stiff control along this trajectory. In this field the new powered exoskeleton ReWalk (Argo Medical Technologies Ltd) was developed to have an alternative mobility solution to the wheelchair and rehabilitation treatment for individuals with severe walking impairments, enabling them to stand, walk, ascend/descent stairs and more. The end-effector-based robot is a device with footplates placed on a double crank and rocker gear system. Alternatives to powered exoskeletons are devices that use movable footplates to which the patient's feet are attached. All devices include some form of body weight support. Prominent goals in the field include: developing implementable technologies that can be easily used by patients, therapists, and clinicians; enhancing the efficacy of clinician's therapies and increasing the ease of activities in the daily lives of patients.

Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: Exploratory secondary analysis of a randomised controlled trial.

PubMed

Blyth, M J G; Anthony, I; Rowe, P; Banger, M S; MacLean, A; Jones, B

2017-11-01

This study reports on a secondary exploratory analysis of the early clinical outcomes of a randomised clinical trial comparing robotic arm-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis of the knee with manual UKA performed using traditional surgical jigs. This follows reporting of the primary outcomes of implant accuracy and gait analysis that showed significant advantages in the robotic arm-assisted group. A total of 139 patients were recruited from a single centre. Patients were randomised to receive either a manual UKA implanted with the aid of traditional surgical jigs, or a UKA implanted with the aid of a tactile guided robotic arm-assisted system. Outcome measures included the American Knee Society Score (AKSS), Oxford Knee Score (OKS), Forgotten Joint Score, Hospital Anxiety Depression Scale, University of California at Los Angeles (UCLA) activity scale, Short Form-12, Pain Catastrophising Scale, somatic disease (Primary Care Evaluation of Mental Disorders Score), Pain visual analogue scale, analgesic use, patient satisfaction, complications relating to surgery, 90-day pain diaries and the requirement for revision surgery. From the first post-operative day through to week 8 post-operatively, the median pain scores for the robotic arm-assisted group were 55.4% lower than those observed in the manual surgery group (p = 0.040).At three months post-operatively, the robotic arm-assisted group had better AKSS (robotic median 164, interquartile range (IQR) 131 to 178, manual median 143, IQR 132 to 166), although no difference was noted with the OKS.At one year post-operatively, the observed differences with the AKSS had narrowed from a median of 21 points to a median of seven points (p = 0.106) (robotic median 171, IQR 153 to 179; manual median 164, IQR 144 to 182). No difference was observed with the OKS, and almost half of each group reached the ceiling limit of the score (OKS > 43). A greater proportion of patients receiving robotic arm-assisted surgery improved their UCLA activity score.Binary logistic regression modelling for dichotomised outcome scores predicted the key factors associated with achieving excellent outcome on the AKSS: a pre-operative activity level > 5 on the UCLA activity score and use of robotic-arm surgery. For the same regression modelling, factors associated with a poor outcome were manual surgery and pre-operative depression. Robotic arm-assisted surgery results in improved early pain scores and early function scores in some patient-reported outcomes measures, but no difference was observed at one year post-operatively. Although improved results favoured the robotic arm-assisted group in active patients (i.e. UCLA ⩾ 5), these do not withstand adjustment for multiple comparisons. Cite this article : M. J. G. Blyth, I. Anthony, P. Rowe, M. S. Banger, A. MacLean, B. Jones. Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: Exploratory secondary analysis of a randomised controlled trial. Bone Joint Res 2017;6:631-639. DOI: 10.1302/2046-3758.611.BJR-2017-0060.R1. © 2017 Blyth et al.

Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact.

PubMed

Prange-Lasonder, Gerdienke B; Radder, Bob; Kottink, Anke I R; Melendez-Calderon, Alejandro; Buurke, Jaap H; Rietman, Johan S

2017-07-01

Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance 'lifting full cans' in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.

Robots for use in autism research.

PubMed

Scassellati, Brian; Admoni, Henny; Matarić, Maja

2012-01-01

Autism spectrum disorders are a group of lifelong disabilities that affect people's ability to communicate and to understand social cues. Research into applying robots as therapy tools has shown that robots seem to improve engagement and elicit novel social behaviors from people (particularly children and teenagers) with autism. Robot therapy for autism has been explored as one of the first application domains in the field of socially assistive robotics (SAR), which aims to develop robots that assist people with special needs through social interactions. In this review, we discuss the past decade's work in SAR systems designed for autism therapy by analyzing robot design decisions, human-robot interactions, and system evaluations. We conclude by discussing challenges and future trends for this young but rapidly developing research area.

Biomechanical effects of robot assisted walking on knee joint kinematics and muscle activation pattern.

PubMed

Thangavel, Pavithra; Vidhya, S; Li, Junhua; Chew, Effie; Bezerianos, Anastasios; Yu, Haoyong

2017-07-01

Since manual rehabilitation therapy can be taxing for both the patient and the physiotherapist, a gait rehabilitation robot has been built to reduce the physical strain and increase the efficacy of the rehabilitation therapy. The prototype of the gait rehabilitation robot is designed to provide assistance while walking for patients with abnormal gait pattern and it can also be used for rehabilitation therapy to restore an individual's normal gait pattern by aiding motor recovery. The Gait Rehabilitation Robot uses gait event based synchronization, which enables the exoskeleton to provide synchronous assistance during walking that aims to reduce the lower-limb muscle activation. This study emphasizes on the biomechanical effects of assisted walking on the lower limb by analyzing the EMG signal, knee joint kinematics data that was collected from the right leg during the various experimental conditions. The analysis of the measured data shows an improved knee joint trajectory and reduction in muscle activity with assistance. The result of this study does not only assess the functionality of the exoskeleton but also provides a profound understanding of the human-robot interaction by studying the effects of assistance on the lower limb.

Impact of metabolic syndrome on early recovery of continence after robot-assisted radical prostatectomy.

PubMed

Nishikawa, Masatomo; Watanabe, Hiromitsu; Kurahashi, Toshifumi

2017-09-01

To evaluate the impact of metabolic syndrome on the early recovery of urinary continence after robot-assisted radical prostatectomy. The present study included a total of 302 consecutive Japanese patients with clinically localized prostate cancer who underwent robot-assisted radical prostatectomy. In this study, postoperative urinary continence was defined as no leak or the use of a security pad. The continence status was assessed by interviews before and 1 and 3 months after robot-assisted radical prostatectomy. Metabolic syndrome was defined as follows: body mass index ≥25 kg/m 2 and two or more of the following: hypertension, diabetes mellitus and dyslipidemia. The effect of the presence of metabolic syndrome on the continence status of these patients was retrospectively examined. A total of 116 (38.4%) and 203 (67.2%) of the 302 patients were continent at 1 and 3 months after robot-assisted radical prostatectomy, respectively. A total of 31 (10.3%) patients were judged to have metabolic syndrome. Despite the operative time being longer in patients with metabolic syndrome, no significant differences were observed in the remaining preoperative, intraoperative or postoperative variables between patients with or without metabolic syndrome. On multivariate logistic regression analysis, metabolic syndrome and the duration of hospitalization were significantly correlated with the 1-month continence status. Similarly, metabolic syndrome and estimated blood loss during surgery were independent predictors of continence rates at 3 months after robot-assisted radical prostatectomy. These findings suggest that the presence of metabolic syndrome could have a significant impact on the early recovery of urinary continence after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up.

PubMed

Pearle, Andrew D; van der List, Jelle P; Lee, Lily; Coon, Thomas M; Borus, Todd A; Roche, Martin W

2017-03-01

Successful clinical outcomes following unicompartmental knee arthroplasty (UKA) depend on lower limb alignment, soft tissue balance and component positioning, which can be difficult to control using manual instrumentation. Although robotic-assisted surgery more reliably controls these surgical factors, studies assessing outcomes of robotic-assisted UKA are lacking. Therefore, a prospective multicenter study was performed to assess outcomes of robotic-assisted UKA. A total of 1007 consecutive patients (1135 knees) underwent robotic-assisted medial UKA surgery from six surgeons at separate institutions between March 2009 and December 2011. All patients received a fixed-bearing metal-backed onlay implant as tibial component. Each patient was contacted at minimum two-year follow-up and asked a series of five questions to determine survivorship and patient satisfaction. Worst-case scenario analysis was performed whereby all patients were considered as revision when they declined participation in the study. Data was collected for 797 patients (909 knees) with average follow-up of 29.6months (range: 22-52months). At 2.5-years of follow-up, 11 knees were reported as revised, which resulted in a survivorship of 98.8%. Thirty-five patients declined participation in the study yielding a worst-case survivorship of 96.0%. Of all patients without revision, 92% was either very satisfied or satisfied with their knee function. In this multicenter study, robotic-assisted UKA was found to have high survivorship and satisfaction rate at short-term follow-up. Prospective comparison studies with longer follow-up are necessary in order to compare survivorship and satisfaction rates of robotic-assisted UKA to conventional UKA and total knee arthroplasty. Copyright © 2016 Elsevier B.V. All rights reserved.

Automating CapCom Using Mobile Agents and Robotic Assistants

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten; Alena, Richard L.; Graham, Jeffrey S.; Tyree, Kim S.; Hirsh, Robert L.; Garry, W. Brent; Semple, Abigail; Shum, Simon J. Buckingham; Shadbolt, Nigel;

A case of robot-assisted laparoscopic radical prostatectomy in primary small cell prostate cancer.

PubMed

Kim, Ki Hong; Park, Sang Un; Jang, Jee Young; Park, Won Kyu; Oh, Chul Kyu; Rha, Koon Ho

2010-12-01

Primary small cell carcinoma of the prostate is a rare and very aggressive disease with a poor prognosis, even in its localized form. We managed a case of primary small cell carcinoma of the prostate. The patient was treated with robot-assisted laparoscopic radical prostatectomy and adjuvant chemotherapy. Herein we report this first case of robot-assisted laparoscopic radical prostatectomy performed in a patient with primary small cell carcinoma of the prostate.

Functional assessment and performance evaluation for assistive robotic manipulators: Literature review

PubMed Central

Chung, Cheng-Shiu; Wang, Hongwu; Cooper, Rory A.

2013-01-01

Context The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to give the scope of current research and provide suggestions for future studies. Methods We conducted a literature search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh Library System – PITTCat. Results Twenty relevant studies were identified. Conclusion Studies were separated into two broad categories: user task preferences and user-interface performance measurements of commercialized and developing assistive robotic manipulators. The outcome measures and ICF codes associated with the performance evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the quantitative and qualitative evaluation of task efficiency and performance to build comparable measures between research groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical functional assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In addition, these outcome measures will help physicians and therapists build standardized tools while prescribing and assessing assistive robotic manipulators. PMID:23820143

Interactive Games with an Assistive Robotic System for Hearing-Impaired Children.

PubMed

Uluer, Pinar; Akalin, Neziha; Gurpinar, Cemal; Kose, Hatice

2017-01-01

This paper presents an assistive robotic system, which can recognize and express sign language words from a predefined set, within interactive games to communicate with and teach hearing-impaired children sign language. The robotic system uses audio, visual and tactile feedback for interaction with the children and the teacher/researcher.

Hysterectomy

MedlinePlus

... which is called a laparoscopic vaginal hysterectomy). A robot-assisted laparoscopic hysterectomy is performed with the help ... In general, it has not been shown that robot-assisted laparoscopy results in a better outcome than ...

Direct interaction with an assistive robot for individuals with chronic stroke.

PubMed

Kmetz, Brandon; Markham, Heather; Brewer, Bambi R

2011-01-01

Many robotic systems have been developed to provide assistance to individuals with disabilities. Most of these systems require the individual to interact with the robot via a joystick or keypad, though some utilize techniques such as speech recognition or selection of objects with a laser pointer. In this paper, we describe a prototype system using a novel method of interaction with an assistive robot. A touch-sensitive skin enables the user to directly guide a robotic arm to a desired position. When the skin is released, the robot remains fixed in position. The target population for this system is individuals with hemiparesis due to chronic stroke. The system can be used as a substitute for the paretic arm and hand in bimanual tasks such as holding a jar while removing the lid. This paper describes the hardware and software of the prototype system, which includes a robotic arm, the touch-sensitive skin, a hook-style prehensor, and weight compensation and speech recognition software.

[Robotic assistance in gynaecological surgery: State-of-the-art].

PubMed

Monsarrat, N; Collinet, P; Narducci, F; Leblanc, E; Vinatier, D

2009-05-01

From the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm which operates the laparoscope, to the robots Zeus and da Vinci, robotic assistance in gynaecological endoscopic surgery has continuously evolved for the last fifteen years or so. It has brought about new technical advancements: the last generation robots offer a steady three-dimensional image, improved instrument dexterity and precision, higher ergonomics and comfort for the surgeon. The da Vinci robotic system has been used without evincing any specific morbidity in various cases, notably for tubal reanastomosis, myomectomy, hysterectomy, pelvic and para-aortic lymphadenectomy or sacrocolpopexy amongst others. Robotic assistance in gynaecology is thus feasible. Like conventional laparoscopic surgery, it allows decreased blood loss and morbidity as well as shorter hospital stay, as compared to laparotomy. It might indeed allow many surgical teams to perform minimally invasive surgical procedures which they were not used to performing by laparoscopy. Randomized prospective studies are needed to define its indications more precisely. Besides, its medico-financial impact should be evaluated too.

Robotic microsurgery in male infertility and urology-taking robotics to the next level.

PubMed

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

2014-03-01

The initial reports of robotic assisted microsurgery began to appear in the early 1990s. Animal and early human studies were the initial publications. Larger series papers have recently been published from a few institutions. The field of robotic assisted microsurgery is still in evolution and so are adjunctive tools and instruments. It is clearly a different and unique skill set-is it microsurgery or is it robotic surgery, or both. It is clear from history that the art of surgery evolves over time to encompass new technology as long as the outcomes are better for the patient. Our current robotic platforms may not be ideal for microsurgery, however, the use of adjunctive tools and instrument refinement will further its future potential. This review article presents the current state of the art in various robotic assisted microsurgical procedures in male infertility and urology. Some novel applications of taking microsurgery to areas not classically accessible (intra-abdominal vasovasostomy) and adjunctive tools will also be presented.

Preclinical study of transcervical upper mediastinal dissection for esophageal malignancy by robot-assisted surgery.

PubMed

Mori, Kazuhiko; Yoshimura, Shuntaro; Yamagata, Yukinori; Aikou, Susumu; Seto, Yasuyuki

2017-06-01

Robotic surgical systems are potentially applicable to transcervical mediastinal lymph dissection for esophageal malignancy. Robot-assisted surgery was performed on a male fresh-frozen human cadaver. Devices for single-port laparoscopic surgery were deployed via one small incision in the left clavicular area. The task for the robot-assisted surgery was the upper mediastinal dissection to the level of the left main bronchus and en bloc harvest of the lymph nodes adherent to the left recurrent laryngeal nerve. An up-angled 30° scope in the 6 o'clock port and two robotic arms from the 3 and 9 o'clock ports worked effectively together. No collisions of the devices inside the cadaveric body or unexpected traumatic events occurred. The robotic surgical system can be used safely for the upper mediastinal dissection. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

PubMed

Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

2009-03-01

Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

Robot-assisted antegrade in-situ fenestrated stent grafting.

PubMed

Riga, Celia V; Bicknell, Colin D; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas

2009-05-01

To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure.

ACOG Technology Assessment in Obstetrics and Gynecology No. 6: Robot-assisted surgery.

PubMed

2009-11-01

The field of robotic surgery is developing rapidly, but experience with this technology is currently limited. In response to increasing interest in robotics technology, the Committee on Gynecologic Practice's Technology Assessment was developed to describe the robotic surgical system,potential advantages and disadvantages, gynecologic applications, and the current state of the evidence. Randomized trials comparing robot-assisted surgery with traditional laparoscopic, vaginal, or abdominal surgery are needed to evaluate long-term clinical outcomes and cost-effectiveness, as well as to identify the best applications of this technology.

Atypical autonomic dysreflexia during robotic-assisted body weight supported treadmill training in an individual with motor incomplete spinal cord injury.

PubMed

Geigle, Paula R; Frye, Sara Kate; Perreault, John; Scott, William H; Gorman, Peter H

2013-03-01

A 41-year-old man with a history of C6 American Spinal Injury Association (ASIA) Impairment Scale (AIS) C spinal cord injury (SCI), enrolled in an Institutional Review Board (IRB)-approved, robotic-assisted body weight-supported treadmill training (BWSTT), and aquatic exercise research protocol developed asymptomatic autonomic dysreflexia (AD) during training. Little information is available regarding the relationship of robotic-assisted BWSTT and AD. After successfully completing 36 sessions of aquatic exercise, he reported exertional fatigue during his 10th Lokomat intervention and exhibited asymptomatic or silent AD during this and the three subsequent BWSTT sessions. Standard facilitators of AD were assessed and no obvious irritant identified other than the actual physical exertion and positioning required during robotic-assisted BWSTT. Increased awareness of potential silent AD presenting during robotic assisted BWSTT training for individuals with motor incomplete SCI is required as in this case AD clinical signs were not concurrent with occurrence. Frequent vital sign assessment before, during, and at conclusion of each BWSTT session is strongly recommended.

New suturing technique for robotic-assisted vaginal cuff closure during single-site hysterectomy.

PubMed

Shin, So-Jin; Chung, Hyewon; Kwon, Sang-Hoon; Cha, Soon-Do; Cho, Chi-Heum

2017-06-01

To describe a simple and efficient technique for suturing the vaginal cuff in robotic-assisted single-site hysterectomy using barbed suture and a straight needle. Consecutive patients undergoing robotic-assisted single-site hysterectomy from February 2014 to August 2015 at Dong San Hospital, Keimyung University were included. Surgeons used two barbed sutures in a running fashion to close the vaginal cuff. A barbed suture was exclusively used with a straightened needle in upward direction from posterior vaginal cuff to anterior vaginal cuff which played a pivotal role for closure. A total of 100 patients underwent robotic-assisted single-site hysterectomy. The total operation time was 132.5 min and vaginal cuff closure time was 12.0 min. There were no postoperative complications; vaginal cuff dehiscence, vaginal cuff infection, and vaginal bleeding that require surgical intervention or admission. The use of barbed suture with straightened needle to close the vaginal cuff in robotic-assisted single-site hysterectomy is easy to perform and demonstrates safety and efficacy. This technique offers secure, fast, and effective incision closure.

A New Approach for Human Forearm Motion Assist by Actuated Artificial Joint-An Inner Skeleton Robot

NASA Astrophysics Data System (ADS)

Kundu, Subrata Kumar; Kiguchi, Kazuo; Teramoto, Kenbu

In order to help the physical activities of the elderly or physically disabled persons, we propose a new concept of a power-assist inner skeleton robot (i.e., actuated artificial joint) that is supposed to assist the human daily life motion from inside of the human body. This paper presents an implantable 2 degree of freedom (DOF) inner skeleton robot that is designed to assist human elbow flexion-extension motion and forearm supination-pronation motion for daily life activities. We have developed a prototype of the inner skeleton robot that is supposed to assist the motion from inside of the body and act as an actuated artificial joint. The proposed system is controlled based on the activation patterns of the electromyogram (EMG) signals of the user's muscles by applying fuzzy-neuro control method. A joint actuator with angular position sensor is designed for the inner skeleton robot and a T-Mechanism is proposed to keep the bone arrangement similar to the normal human articulation after the elbow arthroplasty. The effectiveness of the proposed system has been evaluated by experiment.

Conventional versus robot-assisted laparoscopic Nissen fundoplication: a comparison of postoperative acid reflux parameters.

PubMed

Frazzoni, Marzio; Conigliaro, Rita; Colli, Giovanni; Melotti, Gianluigi

2012-06-01

Laparoscopic Nissen fundoplication (LNF) is a technically demanding surgical procedure designed to cure gastroesophageal reflux disease (GERD). It represents an alternative to life-long medical therapy and the only recommended treatment modality to overcome refractoriness to proton pump inhibitor (PPI) therapy. The recent development of robotic systems prompted evaluation of their use in antireflux surgery. Between 1997 and 2000, in a PPI-responsive series we found postoperative normalization of esophageal acid exposure time (EAET) in most but not all cases. Between 2007 and 2009, in a PPI-refractory series we found postoperative normalization of EAET in all cases. We decided to analyze retrospectively our prospectively collected data to evaluate whether differences other than the conventional or robot-assisted technique could justify postoperative differences in acid reflux parameters. Baseline demographic, endoscopic, and manometric parameters were compared between the two series of patients, as well as postoperative manometric and acid reflux parameters. There were no significant differences in the baseline demographic, endoscopic, and manometric characteristics between the two groups of patients. The median lower esophageal sphincter tone increased significantly, and the median EAET decreased significantly after conventional as well as after robot-assisted LNF. The median postoperative EAET was significantly lower in the robot-assisted (0.2%) than in the conventional LNF group (1%; P = 0.001). Abnormal EAET values were found in 6 of 44 (14%) and in 0 of 44 cases after conventional and robot-assisted LNF, respectively (P = 0.026). Robot-assisted LNF provided a significant gain in postoperative acid reflux parameters compared with the conventional technique. In a challenging clinical setting, such as PPI-refractoriness, in which the efficacy of endoscopic or pharmacological treatment modalities is only moderate, even a small therapeutic gain can be clinically relevant. In centers where robot-assisted LNF is available, it should be preferred to conventional LNF in PPI-refractory GERD.

Gait performance and foot pressure distribution during wearable robot-assisted gait in elderly adults.

PubMed

Lee, Su-Hyun; Lee, Hwang-Jae; Chang, Won Hyuk; Choi, Byung-Ok; Lee, Jusuk; Kim, Jeonghun; Ryu, Gyu-Ha; Kim, Yun-Hee

2017-11-28

A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assisted gait devices were developed to enhance gait function and activities of daily living in elderly adults and patients with gait disorders. In this study, we investigated the effects of the Gait-enhancing Mechatronic System (GEMS), a new wearable robotic hip-assist device developed by Samsung Electronics Co, Ltd., Korea, on gait performance and foot pressure distribution in elderly adults. Thirty elderly adults who had no neurological or musculoskeletal abnormalities affecting gait participated in this study. A three-dimensional (3D) motion capture system, surface electromyography and the F-Scan system were used to collect data on spatiotemporal gait parameters, muscle activity and foot pressure distribution under three conditions: free gait without robot assistance (FG), robot-assisted gait with zero torque (RAG-Z) and robot-assisted gait (RAG). We found increased gait speed, cadence, stride length and single support time in the RAG condition. Reduced rectus femoris and medial gastrocnemius muscle activity throughout the terminal stance phase and reduced effort of the medial gastrocnemius muscle throughout the pre-swing phase were also observed in the RAG condition. In addition, walking with the assistance of GEMS resulted in a significant increase in foot pressure distribution, specifically in maximum force and peak pressure of the total foot, medial masks, anterior masks and posterior masks. The results of the present study reveal that GEMS may present an alternative way of restoring age-related changes in gait such as gait instability with muscle weakness, reduced step force and lower foot pressure in elderly adults. In addition, GEMS improved gait performance by improving push-off power and walking speed and reducing muscle activity in the lower extremities. NCT02843828 .

Control of robotic assistance using poststroke residual voluntary effort.

PubMed

Makowski, Nathaniel S; Knutson, Jayme S; Chae, John; Crago, Patrick E

2015-03-01

Poststroke hemiparesis limits the ability to reach, in part due to involuntary muscle co-activation (synergies). Robotic approaches are being developed for both therapeutic benefit and continuous assistance during activities of daily living. Robotic assistance may enable participants to exert less effort, thereby reducing expression of the abnormal co-activation patterns, which could allow participants to reach further. This study evaluated how well participants could perform a reaching task with robotic assistance that was either provided independent of effort in the vertical direction or in the sagittal plane in proportion to voluntary effort estimated from electromyograms (EMG) on the affected side. Participants who could not reach targets without assistance were enabled to reach further with assistance. Constant anti-gravity force assistance that was independent of voluntary effort did not reduce the quality of reach and enabled participants to exert less effort while maintaining different target locations. Force assistance that was proportional to voluntary effort on the affected side enabled participants to exert less effort and could be controlled to successfully reach targets, but participants had increased difficulty maintaining a stable position. These results suggest that residual effort on the affected side can produce an effective command signal for poststroke assistive devices.

Robot-assisted partial cystectomy of a bladder pheochromocytoma.

PubMed

Kang, Sung Gu; Kang, Seok Ho; Choi, Hoon; Ko, Young Hwii; Park, Hong Seok; Cheon, Jun

2011-01-01

Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report here an unusual case of bladder pheochromocytoma that was treated by robotic-assisted laparoscopic partial cystectomy. A 35-year-old male patient presented with headache and hypertension related to micturition. The patient, who had a 3.5 × 4 cm solitary bladder tumor in the bladder dome, underwent robot-assisted partial cystectomy. The whole procedure was successfully performed using the robot without conversion to open surgery. The total operative time was 120 min and the estimated blood loss was 30 ml. Copyright © 2011 S. Karger AG, Basel.

Perioperative pain after robot-assisted versus laparoscopic rectal resection.

PubMed

Tolstrup, Rikke; Funder, Jonas Amstrup; Lundbech, Liselotte; Thomassen, Niels; Iversen, Lene Hjerrild

2018-03-01

In order to improve the surgical treatment of rectal cancer, robot-assisted laparoscopy has been introduced. The robot has gained widespread use; however, the scientific basis for treatment of rectal cancer is still unclear. The aim of this study was to investigate whether robot-assisted laparoscopic rectal resection cause less perioperative pain than standard laparoscopic resection measured by the numerical rating scale (NRS score) as well as morphine consumption. Fifty-one patients were randomized to either laparoscopic or robot-assisted rectal resection at the Department of Surgery at Aarhus University Hospital in Denmark. The intra-operative analgetic consumption was recorded prospectively and registered in patient records. Likewise all postoperative medicine administration including analgesia was recorded prospectively at the hospital medical charts. All morphine analogues were converted into equivalent oral morphine by a converter. Postoperative pain where measured by numeric rating scale (NRS) every hour at the postoperative care unit and three times a day at the ward. Opioid consumption during operation was significantly lower during robotic-assisted surgery than during laparoscopic surgery (p=0.0001). However, there were no differences in opioid consumption or NRS in the period of recovery. We found no differences in length of surgery between the two groups; however, ten patients from the laparoscopic group underwent conversion to open surgery compared to one from the robotic group (p=0.005). No significant difference between groups with respect to complications where found. In the present study, we found that patients who underwent rectal cancer resection by robotic technique needed less analgetics during surgery than patients operated laparoscopically. We did, however, not find any difference in postoperative pain score or morphine consumption postoperatively between the robotic and laparoscopic group.

Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review.

PubMed

Singh, Hardeep; Unger, Janelle; Zariffa, José; Pakosh, Maureen; Jaglal, Susan; Craven, B Catharine; Musselman, Kristin E

2018-01-15

Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.

Another breed of "service" animals: STARS study findings about pet ownership and recovery from serious mental illness.

PubMed

Wisdom, Jennifer P; Saedi, Goal Auzeen; Green, Carla A

2009-07-01

This study elucidates the role of pets in recovery processes among adults with serious mental illness. Data derive from interviews with 177 HMO members with serious mental illness (52.2% women, average age 48.8 years) in the Study of Transitions and Recovery Strategies (STARS). Interviews and questionnaires addressed factors affecting recovery processes and included questions about pet ownership. Data were analyzed using a modified grounded theory method to identify the roles pets play in the recovery process. Primary themes indicate pets assist individuals in recovery from serious mental illness by (a) providing empathy and "therapy"; (b) providing connections that can assist in redeveloping social avenues; (c) serving as "family" in the absence of or in addition to human family members; and (d) supporting self-efficacy and strengthening a sense of empowerment. Pets appear to provide more benefits than merely companionship. Participants' reports of pet-related contributions to their well-being provide impetus to conduct more formal research on the mechanisms by which pets contribute to recovery and to develop pet-based interventions.

Another Breed of “Service” Animals: STARS Study Findings about Pet Ownership and Recovery from Serious Mental Illness

PubMed Central

Wisdom, Jennifer P.; Saedi, Goal Auzeen; Green, Carla A.

2010-01-01

This study elucidates the role of pets in recovery processes among adults with serious mental illness. Data derive from interviews with 177 HMO members with serious mental illness (52.2% women, average age 48.8). Interviews and questionnaires addressed factors affecting recovery processes and included questions about pet ownership. Data were analyzed using a modified grounded theory method to identify the roles pets play in the recovery process. Primary themes indicate pets assist individuals in recovery from serious mental illness by (a) providing empathy and “therapy”; (b) providing connections that can assist in redeveloping social avenues; (c) serving as “family” in the absence of or in addition to human family members; and (d) supporting self-efficacy and strengthening a sense of empowerment. Pets appear to provide more benefits than merely companionship. Participants’ reports of pet-related contributions to their well-being provide impetus to conduct more formal research on the mechanisms by which pets contribute to recovery and to develop pet-based interventions. PMID:19839680

Design and control of RUPERT: a device for robotic upper extremity repetitive therapy.

PubMed

Sugar, Thomas G; He, Jiping; Koeneman, Edward J; Koeneman, James B; Herman, Richard; Huang, H; Schultz, Robert S; Herring, D E; Wanberg, J; Balasubramanian, Sivakumar; Swenson, Pete; Ward, Jeffrey A

2007-09-01

The structural design, control system, and integrated biofeedback for a wearable exoskeletal robot for upper extremity stroke rehabilitation are presented. Assisted with clinical evaluation, designers, engineers, and scientists have built a device for robotic assisted upper extremity repetitive therapy (RUPERT). Intense, repetitive physical rehabilitation has been shown to be beneficial overcoming upper extremity deficits, but the therapy is labor intensive and expensive and difficult to evaluate quantitatively and objectively. The RUPERT is developed to provide a low cost, safe and easy-to-use, robotic-device to assist the patient and therapist to achieve more systematic therapy at home or in the clinic. The RUPERT has four actuated degrees-of-freedom driven by compliant and safe pneumatic muscles (PMs) on the shoulder, elbow, and wrist. They are programmed to actuate the device to extend the arm and move the arm in 3-D space. It is very important to note that gravity is not compensated and the daily tasks are practiced in a natural setting. Because the device is wearable and lightweight to increase portability, it can be worn standing or sitting providing therapy tasks that better mimic activities of daily living. The sensors feed back position and force information for quantitative evaluation of task performance. The device can also provide real-time, objective assessment of functional improvement. We have tested the device on stroke survivors performing two critical activities of daily living (ADL): reaching out and self feeding. The future improvement of the device involves increased degrees-of-freedom and interactive control to adapt to a user's physical conditions.

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.

A real-time computational model for estimating kinematics of ankle ligaments.

PubMed

Zhang, Mingming; Davies, T Claire; Zhang, Yanxin; Xie, Sheng Quan

2016-01-01

An accurate assessment of ankle ligament kinematics is crucial in understanding the injury mechanisms and can help to improve the treatment of an injured ankle, especially when used in conjunction with robot-assisted therapy. A number of computational models have been developed and validated for assessing the kinematics of ankle ligaments. However, few of them can do real-time assessment to allow for an input into robotic rehabilitation programs. An ankle computational model was proposed and validated to quantify the kinematics of ankle ligaments as the foot moves in real-time. This model consists of three bone segments with three rotational degrees of freedom (DOFs) and 12 ankle ligaments. This model uses inputs for three position variables that can be measured from sensors in many ankle robotic devices that detect postures within the foot-ankle environment and outputs the kinematics of ankle ligaments. Validation of this model in terms of ligament length and strain was conducted by comparing it with published data on cadaver anatomy and magnetic resonance imaging. The model based on ligament lengths and strains is in concurrence with those from the published studies but is sensitive to ligament attachment positions. This ankle computational model has the potential to be used in robot-assisted therapy for real-time assessment of ligament kinematics. The results provide information regarding the quantification of kinematics associated with ankle ligaments related to the disability level and can be used for optimizing the robotic training trajectory.

AAL robotics: state of the field and challenges.

PubMed

Payr, Sabine; Werner, Franz; Werner, Katharina

2015-01-01

The field of "AAL Robotics", combining AAL and robotics as disciplines, has not yet been precisely defined and does not present accepted structures and concepts that would allow to communicate unequivocally its methods, projects, and approaches. The paper presents a method of defining and categorizing AAL robots and presents the resulting classes of robots with regard to the activities they assist. The classification is useful in that it is able to cover the breadth of the field, but a more fine-grained description of functionalities will be needed in further research to establish the potential of robots to assist independent living of older adults.

Robotic Lung Resection for Non-Small Cell Lung Cancer.

PubMed

Wei, Benjamin; Eldaif, Shady M; Cerfolio, Robert J

2016-07-01

Robotic-assisted pulmonary lobectomy can be considered for patients able to tolerate conventional lobectomy. Contraindications to resection via thoracotomy apply to patients undergoing robotic lobectomy. Team training, familiarity with equipment, troubleshooting, and preparation are critical for successful robotic lobectomy. Robotic lobectomy is associated with decreased rates of blood loss, blood transfusion, air leak, chest tube duration, length of stay, and mortality compared with thoracotomy. Robotic lobectomy offers many of the same benefits in perioperative morbidity and mortality, and additional advantages in optics, dexterity, and surgeon ergonomics as video-assisted thoracic lobectomy. Long-term oncologic efficacy and cost implications remain areas of study. Copyright © 2016 Elsevier Inc. All rights reserved.

Value of Robotically Assisted Surgery for Mitral Valve Disease

PubMed Central

Mihaljevic, Tomislav; Koprivanac, Marijan; Kelava, Marta; Goodman, Avi; Jarrett, Craig; Williams, Sarah J.; Gillinov, A. Marc; Bajwa, Gurjyot; Mick, Stephanie L.; Bonatti, Johannes; Blackstone, Eugene H.

2014-01-01

Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotic surgery mitigate high technology costs. Design Clinical cohort study comparing costs of robotic vs. three contemporaneous conventional surgical approaches for degenerative mitral disease. Surgery was performed from 2006–2011, and comparisons were based on intent-to-treat, with propensity-matching used to reduce selection bias. Setting Large multi-specialty academic medical center. Participants 1,290 patients aged 57±11 years, 27% women, underwent mitral repair for regurgitation from posterior leaflet prolapse. Robotic surgery was used in 473, complete sternotomy in 227, partial sternotomy in 349, and anterolateral thoracotomy in 241. Three propensity-matched groups were formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiology, and echocardiographic measurements: robotic vs. sternotomy (n=198 pairs) vs. partial sternotomy (n=293 pairs) vs. thoracotomy (n=224 pairs). Interventions Mitral valve repair. Main Outcome Measures Cost of care, expressed as robotic capital investment, maintenance, and direct technical hospital cost, and benefit of care, based on differences in recovery time. Results Median cost of care for robotically assisted surgery exceeded the cost of alternative approaches by 27% (−5%, 68%), 32% (−6%, 70%), and 21% (−2%, 54%) (median [15th, 85th percentiles]) for complete sternotomy, partial sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: median 35 days for robotic surgery, 49 for complete sternotomy, 56 for partial sternotomy, and 42 for anterolateral thoracotomy. Resulting net differences in cost of robotic surgery vs. the three alternatives were 16% (−15%, 55%), 16% (−19%, 51%), and 15% (−7%, 49%), respectively. Beyond a volume threshold of 55–100 robotic cases per year, confidence limits for the cost of robotic surgery broadly overlapped those of conventional approaches. Conclusions In exchange for higher procedural costs, robotically assisted mitral valve surgery offers the clinical benefit of least invasive surgery, lowest postoperative cost, and fastest return to work. The value of robotically assisted surgery comparable to conventional approaches can only be realized in high-volume centers. PMID:24848944

Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report.

PubMed

Gundeti, Mohan S; Eng, Michael K; Reynolds, W Stuart; Zagaja, Gregory P

2008-11-01

To the best of our knowledge, we report the first case of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric patient, outlining the surgical technique and short-term results. The operative steps of the open procedure were replicated laparoscopically using robotic-assistance. In brief, 5 transperitoneal laparoscopic ports were placed before docking the da Vinci S robotic system. A 20-cm ileal segment was isolated, and the gastrointestinal anastomosis was performed in an end-to-end fashion using intracorporeal suturing. The appendix was anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. The bladder was incised in a coronal plane, and the simple ileal on-lay patch was anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain were placed, and the Mitrofanoff stoma was then fashioned. Cystography was performed at 4 weeks postoperatively. This preliminary first successful report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in selected patients. However, whether a robotic-assisted approach provides any significant advantages over conventional open procedures is yet to be determined with a large case series.

[Robotic-assisted laparoscopy for deep infiltrating endometriosis: the Register of the Society of European Robotic Gynaecological Surgery].

PubMed

Hanssens, S; Nisolle, M; Leguevaque, P; Neme, R M; Cela, V; Barton-Smith, P; Hébert, T; Collinet, P

2014-11-01

To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The Arrival of Robotics in Spine Surgery: A Review of the Literature.

PubMed

Ghasem, Alexander; Sharma, Akhil; Greif, Dylan N; Alam, Milad; Maaieh, Motasem Al

2018-04-18

Systematic Review. The authors aim to review comparative outcome measures between robotic and free-hand spine surgical procedures including: accuracy of spinal instrumentation, radiation exposure, operative time, hospital stay, and complication rates. Misplacement of pedicle screws in conventional open as well as minimally invasive surgical procedures has prompted the need for innovation and allowed the emergence of robotics in spine surgery. Prior to incorporation of robotic surgery in routine practice, demonstration of improved instrumentation accuracy, operative efficiency, and patient safety is required. A systematic search of the PubMed, OVID-MEDLINE, and Cochrane databases was performed for papers relevant to robotic assistance of pedicle screw placement. Inclusion criteria were constituted by English written randomized control trials, prospective and retrospective cohort studies involving robotic instrumentation in the spine. Following abstract, title, and full-text review, 32 articles were selected for study inclusion. Intrapedicular accuracy in screw placement and subsequent complications were at least comparable if not superior in the robotic surgery cohort. There is evidence supporting that total operative time is prolonged in robot assisted surgery compared to conventional free-hand. Radiation exposure appeared to be variable between studies; radiation time did decrease in the robot arm as the total number of robotic cases ascended, suggesting a learning curve effect. Multi-level procedures appeared to tend toward earlier discharge in patients undergoing robotic spine surgery. The implementation of robotic technology for pedicle screw placement yields an acceptable level of accuracy on a highly consistent basis. Surgeons should remain vigilant about confirmation of robotic assisted screw trajectory, as drilling pathways have been shown to be altered by soft tissue pressures, forceful surgical application, and bony surface skiving. However, the effective consequence of robot-assistance on radiation exposure, length of stay, and operative time remains unclear and requires meticulous examination in future studies. 4.

A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions.

PubMed

Tapper, Anna-Maija; Hannola, Mikko; Zeitlin, Rainer; Isojärvi, Jaana; Sintonen, Harri; Ikonen, Tuija S

2014-06-01

In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Using robot fully assisted functional movements in upper-limb rehabilitation of chronic stroke patients: preliminary results.

PubMed

Caimmi, Marco; Chiavenna, Andrea; Scano, Alessandro; Gasperini, Giulio; Giovanzana, Chiara; Molinari Tosatti, Lorenzo; Molteni, Franco

2017-06-01

Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. Cohort study. Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, P<0.008). This preliminary study shows that a robotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. This intervention could be extended even to subacute stroke and other neurological disorders.

Cost-effectiveness of open versus laparoscopic versus robotic-assisted laparoscopic cystectomy and urinary diversion.

PubMed

Zehnder, Pascal; Gill, Inderbir S

2011-09-01

To provide insight into the recently published cost comparisons in the context of open, laparoscopic, and robotic-assisted laparoscopic radical cystectomy and to demonstrate the complexity of such economic analyses. Most economic evaluations are from a hospital perspective and summarize short-term perioperative therapeutic costs. However, the contributing factors (e.g. study design, included variables, robotic amortization plan, supply contract, surgical volume, surgeons' experience, etc.) vary substantially between the institutions. In addition, a real cost-effective analysis considering cost per quality-adjusted life-year gained is not feasible because of the lack of long-term oncologic and functional outcome data with the robotic procedure. On the basis of a modeled cost analysis using results from published series, robotic-assisted cystectomy was - with few exceptions - found to be more expensive when compared with the open approach. Immediate costs are affected most by operative time, followed by length of hospital stay, robotic supply, case volume, robotic cost, and transfusion rate. Any complication substantially impacts overall costs. Economic cost evaluations are complex analyses influenced by numerous factors that hardly allow an interinstitutional comparison. Robotic-assisted cystectomy is constantly refined with many institutions being somewhere on their learning curve. Transparent reports of oncologic and functional outcome data from centers of expertise applying standardized methods will help to properly analyze the real long-term benefits of robotic surgery and successor technologies and prevent us from becoming slaves of successful marketing strategies.

A multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors: a preclinical study.

PubMed

Li, Dongrui; Cheng, Zhigang; Chen, Gang; Liu, Fangyi; Wu, Wenbo; Yu, Jie; Gu, Ying; Liu, Fengyong; Ren, Chao; Liang, Ping

2018-04-03

To test the accuracy and efficacy of the multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors in phantom and animal models. To evaluate and compare the influences of intervention experience on robot-assisted and ultrasound-controlled ablation procedures. Accuracy tests on rigid body/phantom model with a respiratory movement simulation device and microwave ablation tests on porcine liver tumor/rabbit liver cancer were performed with the robot we designed or with the traditional ultrasound-guidance by physicians with or without intervention experience. In the accuracy tests performed by the physicians without intervention experience, the insertion accuracy and efficiency of robot-assisted group was higher than those of ultrasound-guided group with statistically significant differences. In the microwave ablation tests performed by the physicians without intervention experience, better complete ablation rate was achieved when applying the robot. In the microwave ablation tests performed by the physicians with intervention experience, there was no statistically significant difference of the insertion number and total ablation time between the robot-assisted group and the ultrasound-controlled group. The evaluation by the NASA-TLX suggested that the robot-assisted insertion and microwave ablation process performed by physicians with or without experience were more comfortable. The multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors could increase the insertion accuracy and ablation efficacy, and minimize the influence of the physicians' experience. The ablation procedure could be more comfortable with less stress with the application of the robot.

Evacuating People and Their Pets: Older Floridians' Need for and Proximity to Pet-Friendly Shelters.

PubMed

Douglas, Rachel; Kocatepe, Ayberk; Barrett, Anne E; Ozguven, Eren Erman; Gumber, Clayton

2017-10-04

Pets influence evacuation decisions, but little is known about pet-friendly emergency shelters' availability or older adults' need for them. Our study addresses this issue, focusing on the most densely populated area of Florida (Miami-Dade)-the state with the oldest population and greatest hurricane susceptibility. We use Geographic Information Systems (GIS)-based methodology to identify the shortest paths to pet-friendly shelters, based on distance and congested and uncongested travel times-taking into account the older population's spatial distribution. Logistic regression models using the 2013 American Housing Survey's Disaster Planning Module examine anticipated shelter use as a function of pet ownership and requiring pet evacuation assistance. Thirty-four percent of older adults in the Miami-Dade area have pets-35% of whom report needing pet evacuation assistance. However, GIS accessibility measures show that travel time factors are likely to impede older adults' use of the area's few pet-friendly shelters. Logistic regression results reveal that pet owners are less likely to report anticipating shelter use; however, the opposite holds for pet owners reporting they would need help evacuating their pets-they anticipate using shelters. High pet shelter need coupled with low availability exacerbates older adults' heightened vulnerability during Florida's hurricane season. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Robot-assisted bronchoplasty using continuous barbed sutures.

PubMed

Sarsam, Omar Matthieu; Dunning, Joel; Pochulu, Bruno; Baste, Jean-Marc

2018-01-01

We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors.

Surgery Videos: MedlinePlus

MedlinePlus Videos and Cool Tools

... 2009) Mitral Valve Prolapse Minimally Invasive Heart Surgery: Robot Assisted Mitral Valve Repair (Baptist Health South Florida, ... Center, Merriam, KS, 05/04/2012) Kidney Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee Mission Medical ...

Long-term penile morphometric alterations in patients treated with robot-assisted versus open radical prostatectomy.

PubMed

Capogrosso, P; Ventimiglia, E; Cazzaniga, W; Stabile, A; Pederzoli, F; Boeri, L; Gandaglia, G; Dehò, F; Briganti, A; Montorsi, F; Salonia, A

2018-01-01

Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been assessed in robot-assisted radical prostatectomy series. We aimed to assess prevalence of and predictors of penile morphometric alterations (i.e. penile shortening or penile morphometric deformation) at long-term follow-up in patients submitted to either robot-assisted (robot-assisted radical prostatectomy) or open radical prostatectomy. Sexually active patients after either robot-assisted radical prostatectomy or open radical prostatectomy prospectively completed a 28-item questionnaire, with sensitive issues regarding sexual function, namely orgasmic functioning, climacturia and changes in morphometric characteristics of the penis. Only patients with a post-operative follow-up ≥ 24 months were included. Patients submitted to either adjuvant or salvage therapies or those who refused to comprehensively complete the questionnaire were excluded from the analyses. A propensity-score matching analysis was implemented to control for baseline differences between groups. Logistic regression models tested potential predictors of penile morphometric alterations at long-term post-operative follow-up. Overall, 67 (50%) and 67 (50%) patients were included after open radical prostatectomy or robot-assisted radical prostatectomy, respectively. Self-rated post-operative penile shortening and penile morphometric deformation were reported by 75 (56%) and 29 (22.8%) patients, respectively. Rates of penile shortening and penile morphometric deformation were not different after open radical prostatectomy and robot-assisted radical prostatectomy [all p > 0.5]. At univariable analysis, self-reported penile morphometric alterations (either penile shortening or penile morphometric deformation) were significantly associated with baseline international index of erectile function-erectile function scores, body mass index, post-operative erectile function recovery, year of surgery and type of surgery (all p < 0.05). At multivariable analysis, robot-assisted radical prostatectomy was independently associated with a lower risk of post-operative penile morphometric alterations (OR: 0.38; 95% CI: 0.16-0.93). Self-perceived penile morphometric alterations were reported in one of two patients after radical prostatectomy at long-term follow-up, with open surgery associated with a potential higher risk of this self-perception. © 2017 American Society of Andrology and European Academy of Andrology.

Report on First International Workshop on Robotic Surgery in Thoracic Oncology.

PubMed

Veronesi, Giulia; Cerfolio, Robert; Cingolani, Roberto; Rueckert, Jens C; Soler, Luc; Toker, Alper; Cariboni, Umberto; Bottoni, Edoardo; Fumagalli, Uberto; Melfi, Franca; Milli, Carlo; Novellis, Pierluigi; Voulaz, Emanuele; Alloisio, Marco

2016-01-01

A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly.

Randomized, sham-controlled trial based on transcranial direct current stimulation and wrist robot-assisted integrated treatment on subacute stroke patients: Intermediate results.

PubMed

Mazzoleni, Stefano; Tran, Vi Do; Iardella, Laura; Dario, Paolo; Posteraro, Federico

2017-07-01

The main goal of this study is to analyse the effects of combined transcranial direct current stimulation (tDCS) and wrist robot-assisted therapy in subacute stroke patients. Twenty-four patients were included in this study and randomly assigned to the experimental (EG) or control group (CG). All participants performed wrist robot-assisted training a) in conjunction with tDCS (real stimulation for patients in EG) or b) without tDCS (sham stimulation for patients in CG). Clinical scales and kinematic parameters recorded by the robot were used for the assessment. Clinical outcome measures show a significant decrease in motor impairment after the treatment in both groups. Kinematic data show several significant improvements after the integrated therapy in both groups. However, no significant differences in both clinical outcome measures and kinematic parameters was found between two groups. The potential advantages of combined tDCS and wrist robot-assisted therapy in subacute stroke patients are still unclear.

Robotic-assisted percutaneous coronary intervention--filling an unmet need.

PubMed

Carrozza, Joseph P

2012-02-01

Percutaneous coronary intervention (PCI) has undergone a remarkable evolution over the past 25 years. Initially, the procedure was limited to relatively straightforward lesions and was associated with significant risk and unpredictable long-term efficacy. With the incorporation of new technologies such as stents, the safety and efficacy of the procedure has improved dramatically. However, the fundamental way in which the procedure is performed has changed little since the time of Gruntzig's first successful case. Cumulative exposure to ionizing radiation, orthopedic injuries resulting from wearing shielding aprons, and fatigue from standing for hours at the table have made the catheterization laboratory a "high-risk workplace" for the interventional cardiologist. Robotic-assisted PCI was developed to allow the operator to precisely manipulate angioplasty guidewires, balloons, and stents from a radiation-shielded cockpit. A small first-in-man study demonstrated that PCI can be performed with robotic assistance. The pivotal Percutaneous Robotically Enhanced Coronary Intervention Study trial is currently enrolling patients and evaluating the safety and efficacy of the CorPath® robotically assisted PCI system.

Multipurpose surgical robot as a laparoscope assistant.

PubMed

Nelson, Carl A; Zhang, Xiaoli; Shah, Bhavin C; Goede, Matthew R; Oleynikov, Dmitry

2010-07-01

This study demonstrates the effectiveness of a new, compact surgical robot at improving laparoscope guidance. Currently, the assistant guiding the laparoscope camera tends to be less experienced and requires physical and verbal direction from the surgeon. Human guidance has disadvantages of fatigue and shakiness leading to inconsistency in the field of view. This study investigates whether replacing the assistant with a compact robot can improve the stability of the surgeon's field of view and also reduce crowding at the operating table. A compact robot based on a bevel-geared "spherical mechanism" with 4 degrees of freedom and capable of full dexterity through a 15-mm port was designed and built. The robot was mounted on the standard railing of the operating table and used to manipulate a laparoscope through a supraumbilical port in a porcine model via a joystick controlled externally by a surgeon. The process was videotaped externally via digital video recorder and internally via laparoscope. Robot position data were also recorded within the robot's motion control software. The robot effectively manipulated the laparoscope in all directions to provide a clear and consistent view of liver, small intestine, and spleen. Its range of motion was commensurate with typical motions executed by a human assistant and was well controlled with the joystick. Qualitative analysis of the video suggested that this method of laparoscope guidance provides highly stable imaging during laparoscopic surgery, which was confirmed by robot position data. Because the robot was table-mounted and compact in design, it increased standing room around the operation table and did not interfere with the workspace of other surgical instruments. The study results also suggest that this robotic method may be combined with flexible endoscopes for highly dexterous visualization with more degrees of freedom.

Designing a social and assistive robot for seniors.

PubMed

Eftring, H; Frennert, S

2016-06-01

The development of social assistive robots is an approach with the intention of preventing and detecting falls among seniors. There is a need for a relatively low-cost mobile robot with an arm and a gripper which is small enough to navigate through private homes. User requirements of a social assistive robot were collected using workshops, a questionnaire and interviews. Two prototype versions of a robot were designed, developed and tested by senior citizens (n = 49) in laboratory trials for 2 h each and in the private homes of elderly persons (n = 18) for 3 weeks each. The user requirement analysis resulted in a specification of tasks the robot should be able to do to prevent and detect falls. It was a challenge but possible to design and develop a robot where both the senior and the robot arm could reach the necessary interaction points of the robot. The seniors experienced the robot as happy and friendly. They wanted the robot to be narrower so it could pass through narrow passages in the home and they also wanted it to be able to pass over thresholds without using ramps and to drive over carpets. User trials in seniors' homes are very important to acquire relevant knowledge for developing robots that can handle real life situations in the domestic environment. Very high reliability of a robot is needed to get feedback about how seniors experience the overall behavior of the robot and to find out if the robot could reduce falls and improve the feeling of security for seniors living alone.

Adhesion of nitrile rubber to UV-assisted surface chemical modified PET fabric, part II: Interfacial characterization of MDI grafted PET

NASA Astrophysics Data System (ADS)

Razavizadeh, Mahmoud; Jamshidi, Masoud

2016-08-01

Fiber to rubber adhesion is an important subject in rubber industry. It is well known that surface treatment (i.e. physical, mechanical and chemical) is an effective method to improve interfacial bonding of fibers and/or fabrics to rubbers. UV irradiation is an effective method which has been used to increase fabric-rubber interfacial interactions. In this research UV assisted chemical modification of PET fabrics was used to increase PET to nitrile rubber (NBR) adhesion. Nitrile rubber is a perfect selection as fuel and oil resistant rubber. However it has weak bonding to PET fabric. For this purpose PET fabric was carboxylated under UV irradiation and then methylenediphenyl diisocyanate (MDI) was grafted on carboxylated PET. The chemical composition of the fabric before and after surface treatment was investigated by X-ray photoelectron spectroscopy (XPS). The sectional morphology of the experimental PET fibers and the interface between rubber compound and PET fabric was studied using scanning electron microscope (SEM). The morphology and structure of the product were analyzed by an energy dispersive X-ray spectrometer (EDX). FTIR-ATR and H NMR analysis were used to assess surface modifications on the PET irradiated fabrics.

A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick.

PubMed

Kim, Myungjoon; Lee, Chiwon; Park, Woo Jung; Suh, Yun Suhk; Yang, Han Kwang; Kim, H Jin; Kim, Sungwan

2016-05-20

Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. The NMI was operated for 185 min and reflected the surgeon's decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. Various experiments were conducted and it is verified that the proposed assistant surgical robot system enables collision-free and simultaneous operation of the dVRK's robot arm and the proposed assistant robot arm. The workspace is appropriate for the performance of various kinds of surgeries. Therefore, the proposed system is expected to provide higher safety and effectiveness for the current surgical robot system.

Da Vinci Xi Robot–Assisted Penetrating Keratoplasty

PubMed Central

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

2017-01-01

Purpose 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. Methods 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). Results 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. Conclusions 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. Translational Relevance Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use. PMID:28660096

Assist-as-needed robotic trainer based on reinforcement learning and its application to dart-throwing.

PubMed

Obayashi, Chihiro; Tamei, Tomoya; Shibata, Tomohiro

2014-05-01

This paper proposes a novel robotic trainer for motor skill learning. It is user-adaptive inspired by the assist-as-needed principle well known in the field of physical therapy. Most previous studies in the field of the robotic assistance of motor skill learning have used predetermined desired trajectories, and it has not been examined intensively whether these trajectories were optimal for each user. Furthermore, the guidance hypothesis states that humans tend to rely too much on external assistive feedback, resulting in interference with the internal feedback necessary for motor skill learning. A few studies have proposed a system that adjusts its assistive strength according to the user's performance in order to prevent the user from relying too much on the robotic assistance. There are, however, problems in these studies, in that a physical model of the user's motor system is required, which is inherently difficult to construct. In this paper, we propose a framework for a robotic trainer that is user-adaptive and that neither requires a specific desired trajectory nor a physical model of the user's motor system, and we achieve this using model-free reinforcement learning. We chose dart-throwing as an example motor-learning task as it is one of the simplest throwing tasks, and its performance can easily be and quantitatively measured. Training experiments with novices, aiming at maximizing the score with the darts and minimizing the physical robotic assistance, demonstrate the feasibility and plausibility of the proposed framework. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments.

PubMed

Gerłowska, Justyna; Skrobas, Urszula; Grabowska-Aleksandrowicz, Katarzyna; Korchut, Agnieszka; Szklener, Sebastian; Szczęśniak-Stańczyk, Dorota; Tzovaras, Dimitrios; Rejdak, Konrad

2018-01-01

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments

PubMed Central

Gerłowska, Justyna; Skrobas, Urszula; Grabowska-Aleksandrowicz, Katarzyna; Korchut, Agnieszka; Szklener, Sebastian; Szczęśniak-Stańczyk, Dorota; Tzovaras, Dimitrios; Rejdak, Konrad

2018-01-01

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Control strategies for effective robot assisted gait rehabilitation: the state of art and future prospects.

PubMed

Cao, Jinghui; Xie, Sheng Quan; Das, Raj; Zhu, Guo L

2014-12-01

A large number of gait rehabilitation robots, together with a variety of control strategies, have been developed and evaluated during the last decade. Initially, control strategies applied to rehabilitation robots were adapted from those applied to traditional industrial robots. However, these strategies cannot optimise effectiveness of gait rehabilitation. As a result, researchers have been investigating control strategies tailored for the needs of rehabilitation. Among these control strategies, assisted-as-needed (AAN) control is one of the most popular research topics in this field. AAN training strategies have gained the theoretical and practical evidence based backup from motor learning principles and clinical studies. Various approaches to AAN training have been proposed and investigated by research groups all around the world. This article presents a review on control algorithms of gait rehabilitation robots to summarise related knowledge and investigate potential trends of development. There are existing review papers on control strategies of rehabilitation robots. The review by Marchal-Crespo and Reinkensmeyer (2009) had a broad cover of control strategies of all kinds of rehabilitation robots. Hussain et al. (2011) had specifically focused on treadmill gait training robots and covered a limited number of control implementations on them. This review article encompasses more detailed information on control strategies for robot assisted gait rehabilitation, but is not limited to treadmill based training. It also investigates the potential to further develop assist-as-needed gait training based on assessments of patients' ability. In this paper, control strategies are generally divided into the trajectory tracking control and AAN control. The review covers these two basic categories, as well as other control algorithm and technologies derived from them, such as biofeedback control. Assessments on human gait ability are also included to investigate how to further develop implementations based on assist-as-needed concept. For the consideration of effectiveness, clinical studies on robotic gait rehabilitation are reviewed and analysed from the viewpoint of control algorithm. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Feasibility of Synergy-Based Exoskeleton Robot Control in Hemiplegia.

PubMed

Hassan, Modar; Kadone, Hideki; Ueno, Tomoyuki; Hada, Yasushi; Sankai, Yoshiyuki; Suzuki, Kenji

2018-06-01

Here, we present a study on exoskeleton robot control based on inter-limb locomotor synergies using a robot control method developed to target hemiparesis. The robot control is based on inter-limb locomotor synergies and kinesiological information from the non-paretic leg and a walking aid cane to generate motion patterns for the assisted leg. The developed synergy-based system was tested against an autonomous robot control system in five patients with hemiparesis and varying locomotor abilities. Three of the participants were able to walk using the robot. Results from these participants showed an improved spatial symmetry ratio and more consistent step length with the synergy-based method compared with that for the autonomous method, while the increase in the range of motion for the assisted joints was larger with the autonomous system. The kinematic synergy distribution of the participants walking without the robot suggests a relationship between each participant's synergy distribution and his/her ability to control the robot: participants with two independent synergies accounting for approximately 80% of the data variability were able to walk with the robot. This observation was not consistently apparent with conventional clinical measures such as the Brunnstrom stages. This paper contributes to the field of robot-assisted locomotion therapy by introducing the concept of inter-limb synergies, demonstrating performance differences between synergy-based and autonomous robot control, and investigating the range of disability in which the system is usable.

Maximizing Use of Robot-Arm No. 3 in Da Vinci–Assisted Thoracic Surgery

PubMed Central

Kajiwara, Naohiro; Maeda, Junichi; Yoshida, Koichi; Kato, Yasufumi; Hagiwara, Masaru; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2015-01-01

We have previously reported on the importance of appropriate robot-arm settings and replacement of instrument ports in robot-assisted thoracic surgery, because the thoracic cavity requires a large space to access all lesions in various areas of the thoracic cavity from the apex to the diaphragm and mediastinum and the chest wall.1–3 Moreover, it can be difficult to manipulate the da Vinci Surgical System using only arms No. 1 and No. 2 depending on the tumor location. However, arm No. 3 is usually positioned on the same side as arm No. 2, and sometimes it is only used as an assisting-arm to avoid conflict with other arms (Fig. 1). In this report, we show how robot-arm No. 3 can be used with maximum effectiveness in da Vinci-assisted thoracic surgery. PMID:26011219

Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute.

PubMed

Guru, Khurshid A; Kim, Hyung L; Piacente, Pamela M; Mohler, James L

2007-03-01

One series of robot-assisted radical cystectomy with pelvic lymph node dissection has been reported. We report our operative technique and initial experience. Twenty consecutive patients underwent robot-assisted radical cystectomy, pelvic lymph node dissection, and open urinary diversion for operable bladder cancer from October 2005 to June 2006. Data were collected prospectively on patient demographics, intraoperative parameters, pathologic staging, and postoperative outcomes. The mean patient age was 70 years (range 56 to 90). The mean body mass index was 26 kg/m2 (range 17.3 to 36). Fourteen patients had undergone previous abdominal surgery. The mean operative time was 197 minutes for robot-assisted radical cystectomy, 44 minutes for pelvic lymph node dissection, and 133 minutes for urinary diversion. The mean blood loss was 555 mL. One case was converted to an open procedure because of the patient's inability to tolerate the Trendelenburg position. The mean hospital stay was 10 days. Two patients had major complications. One patient had positive vaginal margins and 9 of 26 nodes were positive. Four patients had incidental prostate cancer. The mean time to the return to nonstrenuous activity was 4 weeks and to strenuous activity was 10 weeks. Robot-assisted radical cystectomy and pelvic lymph node dissection can be performed safely in patients who are considered candidates for open cystectomy. Long-term oncologic control data and functional outcomes are needed to assess the true benefits of robot-assisted radical cystectomy.

Robot-assisted pancreatic surgery: a systematic review of the literature.

PubMed

Strijker, Marin; van Santvoort, Hjalmar C; Besselink, Marc G; van Hillegersberg, Richard; Borel Rinkes, Inne H M; Vriens, Menno R; Molenaar, I Quintus

2013-01-01

To potentially improve outcomes in pancreatic resection, robot-assisted pancreatic surgery has been introduced. This technique has possible advantages over laparoscopic surgery, such as its affordance of three-dimensional vision and increased freedom of movement of instruments. A systematic review was performed to assess the safety and feasibility of robot-assisted pancreatic surgery. The literature published up to 30 September 2011 was systematically reviewed, with no restrictions on publication date. Studies reporting on over five patients were included. Animal studies, studies not reporting morbidity and mortality, review articles and conference abstracts were excluded. Data were extracted and weighted means were calculated. A total of 499 studies were screened, after which eight cohort studies reporting on a total of 251 patients undergoing robot-assisted pancreatic surgery were retained for analysis. Weighted mean operation time was 404 ± 102 min (510 ± 107 min for pancreatoduodenectomy only). The rate of conversion was 11.0% (16.4% for pancreatoduodenectomy only). Overall morbidity was 30.7% (n = 77), most frequently involving pancreatic fistulae (n = 46). Mortality was 1.6%. Negative surgical margins were obtained in 92.9% of patients. The rate of spleen preservation in distal pancreatectomy was 87.1%. Robot-assisted pancreatic surgery seems to be safe and feasible in selected patients and, in left-sided resections, may increase the rate of spleen preservation. Randomized studies should compare the respective outcomes of robot-assisted, laparoscopic and open pancreatic surgery. © 2012 International Hepato-Pancreato-Biliary Association.

Robot-assisted pancreatic surgery: a systematic review of the literature

PubMed Central

Strijker, Marin; van Santvoort, Hjalmar C; Besselink, Marc G; van Hillegersberg, Richard; Borel Rinkes, Inne HM; Vriens, Menno R; Molenaar, I Quintus

2013-01-01

Background To potentially improve outcomes in pancreatic resection, robot-assisted pancreatic surgery has been introduced. This technique has possible advantages over laparoscopic surgery, such as its affordance of three-dimensional vision and increased freedom of movement of instruments. A systematic review was performed to assess the safety and feasibility of robot-assisted pancreatic surgery. Methods The literature published up to 30 September 2011 was systematically reviewed, with no restrictions on publication date. Studies reporting on over five patients were included. Animal studies, studies not reporting morbidity and mortality, review articles and conference abstracts were excluded. Data were extracted and weighted means were calculated. Results A total of 499 studies were screened, after which eight cohort studies reporting on a total of 251 patients undergoing robot-assisted pancreatic surgery were retained for analysis. Weighted mean operation time was 404 ± 102 min (510 ± 107 min for pancreatoduodenectomy only). The rate of conversion was 11.0% (16.4% for pancreatoduodenectomy only). Overall morbidity was 30.7% (n = 77), most frequently involving pancreatic fistulae (n = 46). Mortality was 1.6%. Negative surgical margins were obtained in 92.9% of patients. The rate of spleen preservation in distal pancreatectomy was 87.1%. Conclusions Robot-assisted pancreatic surgery seems to be safe and feasible in selected patients and, in left-sided resections, may increase the rate of spleen preservation. Randomized studies should compare the respective outcomes of robot-assisted, laparoscopic and open pancreatic surgery. PMID:23216773

Kinematic, muscular, and metabolic responses during exoskeletal-, elliptical-, or therapist-assisted stepping in people with incomplete spinal cord injury.

PubMed

Hornby, T George; Kinnaird, Catherine R; Holleran, Carey L; Rafferty, Miriam R; Rodriguez, Kelly S; Cain, Julie B

2012-10-01

Robotic-assisted locomotor training has demonstrated some efficacy in individuals with neurological injury and is slowly gaining clinical acceptance. Both exoskeletal devices, which control individual joint movements, and elliptical devices, which control endpoint trajectories, have been utilized with specific patient populations and are available commercially. No studies have directly compared training efficacy or patient performance during stepping between devices. The purpose of this study was to evaluate kinematic, electromyographic (EMG), and metabolic responses during elliptical- and exoskeletal-assisted stepping in individuals with incomplete spinal cord injury (SCI) compared with therapist-assisted stepping. Design A prospective, cross-sectional, repeated-measures design was used. Participants with incomplete SCI (n=11) performed 3 separate bouts of exoskeletal-, elliptical-, or therapist-assisted stepping. Unilateral hip and knee sagittal-plane kinematics, lower-limb EMG recordings, and oxygen consumption were compared across stepping conditions and with control participants (n=10) during treadmill stepping. Exoskeletal stepping kinematics closely approximated normal gait patterns, whereas significantly greater hip and knee flexion postures were observed during elliptical-assisted stepping. Measures of kinematic variability indicated consistent patterns in control participants and during exoskeletal-assisted stepping, whereas therapist- and elliptical-assisted stepping kinematics were more variable. Despite specific differences, EMG patterns generally were similar across stepping conditions in the participants with SCI. In contrast, oxygen consumption was consistently greater during therapist-assisted stepping. Limitations Limitations included a small sample size, lack of ability to evaluate kinetics during stepping, unilateral EMG recordings, and sagittal-plane kinematics. Despite specific differences in kinematics and EMG activity, metabolic activity was similar during stepping in each robotic device. Understanding potential differences and similarities in stepping performance with robotic assistance may be important in delivery of repeated locomotor training using robotic or therapist assistance and for consumers of robotic devices.

How robotic-assisted surgery can decrease the risk of mucosal tear during Heller myotomy procedure?

PubMed

Ballouhey, Quentin; Dib, Nabil; Binet, Aurélien; Carcauzon-Couvrat, Véronique; Clermidi, Pauline; Longis, Bernard; Lardy, Hubert; Languepin, Jane; Cros, Jérôme; Fourcade, Laurent

2017-06-01

We report the first description of robotic-assisted Heller myotomy in children. The purpose of this study was to improve the safety of Heller myotomy by demonstrating, in two adolescent patients, the contribution of the robot to the different steps of this procedure. Due to the robot's freedom of movement and three-dimensional vision, there was an improvement in the accuracy, a gain in the safety regarding different key-points, decreasing the risk of mucosal perforation associated with this procedure.

Robot-assisted thoracoscopic surgery with simple laparoscopy for diaphragm eventration.

PubMed

Ahn, Joong Hyun; Suh, Jong Hui; Jeong, Jin Yong

2013-09-01

Robot-assisted thoracoscopic surgery has been applied for general thoracic operations. Its advantages include not only those of minimally invasive surgery but also those of magnified three-dimensional vision and angulation of the robotic arm. However, there are no direct tactile sensation and force feedback, which can cause unwanted organ damage. We therefore used laparoscopy simultaneously to avoid a blind intraperitoneal area during robotic surgery for diaphragmatic eventration via transthoracic approach and describe the technique herein. Georg Thieme Verlag KG Stuttgart · New York.

Electrically controllable twisted-coiled artificial muscle actuators using surface-modified polyester fibers

NASA Astrophysics Data System (ADS)

Park, Jungwoo; Yoo, Ji Wang; Seo, Hee Won; Lee, Youngkwan; Suhr, Jonghwan; Moon, Hyungpil; Koo, Ja Choon; Ryeol Choi, Hyouk; Hunt, Robert; Kim, Kwang Jin; Kim, Soo Hyun; Nam, Jae-Do

2017-03-01

As a new class of thermally activated actuators based on polymeric fibers, we investigated polyethylene terephthalate (PET) yarns for the development of a twisted-coiled polymer fiber actuator (TCA). The PET yarn TCA exhibited the maximum linear actuation up to 8.9% by external heating at above the glass transition temperature, 160 °C-180 °C. The payload of the actuator was successfully correlated with the preload and training-load conditions by an empirical equation. Furthermore, the PET-based TCA was electrically driven by Joule heating after the PET surface was metallization with silver. For the fast and precise control of PET yarn TCA, electroless silver plating was conducted to form electrical conductive layers on the PET fiber surface. The silver plated PET-based TCA was tested by Joule heating and the tensile actuation was increased up to 12.1% (6 V) due to the enhanced surface hardness and slippage of PET fibers. Overall, silver plating of the polymeric yarn provided a fast actuation speed and enhanced actuation performance of the TCA actuator by Joule heating, providing a great potential for being used in artificial muscle for biomimetic machines including robots, industrial actuators and powered exoskeletons.

Robotic Technology Efforts at the NASA/Johnson Space Center

NASA Technical Reports Server (NTRS)

Diftler, Ron

2017-01-01

The NASA/Johnson Space Center has been developing robotic systems in support of space exploration for more than two decades. The goal of the Center’s Robotic Systems Technology Branch is to design and build hardware and software to assist astronauts in performing their mission. These systems include: rovers, humanoid robots, inspection devices and wearable robotics. Inspection systems provide external views of space vehicles to search for surface damage and also maneuver inside restricted areas to verify proper connections. New concepts in human and robotic rovers offer solutions for navigating difficult terrain expected in future planetary missions. An important objective for humanoid robots is to relieve the crew of “dull, dirty or dangerous” tasks allowing them more time to perform their important science and exploration missions. Wearable robotics one of the Center’s newest development areas can provide crew with low mass exercise capability and also augment an astronaut’s strength while wearing a space suit.This presentation will describe the robotic technology and prototypes developed at the Johnson Space Center that are the basis for future flight systems. An overview of inspection robots will show their operation on the ground and in-orbit. Rovers with independent wheel modules, crab steering, and active suspension are able to climb over large obstacles, and nimbly maneuver around others. Humanoid robots, including the First Humanoid Robot in Space: Robonaut 2, demonstrate capabilities that will lead to robotic caretakers for human habitats in space, and on Mars. The Center’s Wearable Robotics Lab supports work in assistive and sensing devices, including exoskeletons, force measuring shoes, and grasp assist gloves.

Robotic Technology Efforts at the NASA/Johnson Space Center

NASA Technical Reports Server (NTRS)

Diftler, Ron

2017-01-01

The NASA/Johnson Space Center has been developing robotic systems in support of space exploration for more than two decades. The goal of the Center's Robotic Systems Technology Branch is to design and build hardware and software to assist astronauts in performing their mission. These systems include: rovers, humanoid robots, inspection devices and wearable robotics. Inspection systems provide external views of space vehicles to search for surface damage and also maneuver inside restricted areas to verify proper connections. New concepts in human and robotic rovers offer solutions for navigating difficult terrain expected in future planetary missions. An important objective for humanoid robots is to relieve the crew of "dull, dirty or dangerous" tasks allowing them more time to perform their important science and exploration missions. Wearable robotics one of the Center's newest development areas can provide crew with low mass exercise capability and also augment an astronaut's strength while wearing a space suit. This presentation will describe the robotic technology and prototypes developed at the Johnson Space Center that are the basis for future flight systems. An overview of inspection robots will show their operation on the ground and in-orbit. Rovers with independent wheel modules, crab steering, and active suspension are able to climb over large obstacles, and nimbly maneuver around others. Humanoid robots, including the First Humanoid Robot in Space: Robonaut 2, demonstrate capabilities that will lead to robotic caretakers for human habitats in space, and on Mars. The Center's Wearable Robotics Lab supports work in assistive and sensing devices, including exoskeletons, force measuring shoes, and grasp assist gloves.

[Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor].

PubMed

Abd El Fattah, V; Chevrot, A; Meusy, A; Mercier, G; Wagner, L; Soustelle, L; Boukaram, M; Thuret, R; Costa, P; Droupy, S

2016-04-01

Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system. To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy. From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed. Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04). To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Gao, Shutao; Lv, Zhengtao; Fang, Huang

2018-04-01

Several studies have revealed that robot-assisted technique might improve the pedicle screw insertion accuracy, but owing to the limited sample sizes in the individual study reported up to now, whether or not robot-assisted technique is superior to conventional freehand technique is indefinite. Thus, we performed this systematic review and meta-analysis based on randomized controlled trials to assess which approach is better. Electronic databases including PubMed, EMBASE, CENTRAL, ISI Web of Science, CNKI and WanFang were systematically searched to identify potentially eligible articles. Main endpoints containing the accuracy of pedicle screw implantation and proximal facet joint violation were evaluated as risk ratio (RR) and the associated 95% confidence intervals (95% CIs), while radiation exposure and surgical duration were presented as mean difference (MD) or standard mean difference (SMD). Meta-analyses were performed using RevMan 5.3 software. Six studies involving 158 patients (688 pedicle screws) in robot-assisted group and 148 patients (672 pedicle screws) in freehand group were identified matching our study. The Grade A accuracy rate in robot-assisted group was superior to freehand group (RR 1.03, 95% CI 1.00, 1.06; P = 0.04), but the Grade A + B accuracy rate did not differ between the two groups (RR 1.01, 95% CI 0.99, 1.02; P = 0.29). With regard to proximal facet joint violation, the combined results suggested that robot-assisted group was associated with significantly fewer proximal facet joint violation than freehand group (RR 0.07, 95% CI 0.01, 0.55; P = 0.01). As was the radiation exposure, our findings suggested that robot-assisted technique could significantly reduce the intraoperative radiation time (MD - 12.38, 95% CI - 17.95, - 6.80; P < 0.0001) and radiation dosage (SMD - 0.64, 95% CI - 0.85, - 0.43; P < 0.00001). But the overall surgical duration was longer in robot-assisted group than conventional freehand group (MD 20.53, 95% CI 5.17, 35.90; P = 0.009). The robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violation, less intraoperative radiation exposure but longer surgical duration than freehand technique. Powerful evidence relies on more randomized controlled trials with high quality and larger sample size in the future.

Cost-effectiveness of robotic surgery in gynecologic oncology.

PubMed

Xie, Yue

2015-02-01

Robotically assisted surgeries have flourished in the United States, especially in gynecological procedures. Current robotic systems have high upfront and procedure costs that have led many in the medical community to question the new technology's cost-effectiveness. Recent research continues to find that robotically assisted gynecological cancer treatments have comparable outcomes to traditional laparoscopy and similar or better outcomes than that of laparotomy in the cases studied. However, robotic surgery costs remain higher than that of traditional laparoscopy. Under the current reimbursement climate, practicing physicians and hospitals should collaborate on identifying cost-effective uses of robotic systems and pushing manufacturers to lower purchase and procedure costs to a level that may be accepted by all stakeholders.

The robotic appendicovesicostomy and bladder augmentation: the next frontier in robotics, are we there?

PubMed

Cohen, Andrew J; Pariser, Joseph J; Anderson, Blake B; Pearce, Shane M; Gundeti, Mohan S

2015-02-01

There is growing interest in applying robotic-assisted laparoscopic techniques to complex reconstructive pelvic surgery owing to inherent benefits of precision, tissue handling, and articulating instruments for suturing. This review examines preliminary experiences with robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA) as either an isolated or combined procedure. These series suggest RALIMA is feasible, with the benefit of early recovery and improved cosmetic results in selected patients. The robotic approach incurs functional outcomes and complication rates similar to those of open techniques. Given the steep learning curve, only surgeons with extensive robotic experience are currently adopting this technique. Copyright © 2015 Elsevier Inc. All rights reserved.

Da Vinci-assisted abdominal cerclage.

PubMed

Barmat, Larry; Glaser, Gretchen; Davis, George; Craparo, Frank

2007-11-01

To report the first placement of an abdominal cervicoisthmic cerclage using the da Vinci robot. Case report. Tertiary-care hospital. A 39-year-old female with a history of cervical insufficiency who required a cerclage and was not a candidate for transvaginal cerclage placement. Abdominal cervicoisthmic cerclage placement using the da Vinci robot. Ability to safely and successfully place an abdominal cerclage using the da Vinci robot. Abdominal cerclage was successfully placed using the da Vinci robot. The patient had minimal blood loss and was discharged to home on the same day as surgery. Da Vinci robot-assisted abdominal cerclage placement is an innovative application of robotic surgery and may alter the standard of care for women who require this surgery.

Robot-assisted bronchoplasty using continuous barbed sutures

PubMed Central

Sarsam, Omar Matthieu; Dunning, Joel; Pochulu, Bruno

2018-01-01

We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors. PMID:29445589

Preliminary results of BRAVO project: brain computer interfaces for Robotic enhanced Action in Visuo-motOr tasks.

PubMed

Bergamasco, Massimo; Frisoli, Antonio; Fontana, Marco; Loconsole, Claudio; Leonardis, Daniele; Troncossi, Marco; Foumashi, Mohammad Mozaffari; Parenti-Castelli, Vincenzo

2011-01-01

This paper presents the preliminary results of the project BRAVO (Brain computer interfaces for Robotic enhanced Action in Visuo-motOr tasks). The objective of this project is to define a new approach to the development of assistive and rehabilitative robots for motor impaired users to perform complex visuomotor tasks that require a sequence of reaches, grasps and manipulations of objects. BRAVO aims at developing new robotic interfaces and HW/SW architectures for rehabilitation and regain/restoration of motor function in patients with upper limb sensorimotor impairment through extensive rehabilitation therapy and active assistance in the execution of Activities of Daily Living. The final system developed within this project will include a robotic arm exoskeleton and a hand orthosis that will be integrated together for providing force assistance. The main novelty that BRAVO introduces is the control of the robotic assistive device through the active prediction of intention/action. The system will actually integrate the information about the movement carried out by the user with a prediction of the performed action through an interpretation of current gaze of the user (measured through eye-tracking), brain activation (measured through BCI) and force sensor measurements. © 2011 IEEE

Ethical challenges in the use of social service robots for elderly people.

PubMed

Körtner, T

2016-06-01

Socially assistive robots are increasingly discussed as solutions in care and domestic use for the support of senior adults; however, this raises ethical questions which hitherto have not been considered or were not predictable. The most important questions are those of privacy and data protection, safety and responsibility as well as involvement of vulnerable persons and deception. Consequently, the ethical principles of nonmaleficence, beneficence, autonomy and fairness should be transposed to robotics. Clear answers and solutions are not yet available for every ethical challenge in robotics; however, the development of ethical guidelines for deployment of robots and research in the field of social service robots (SSR) are essential steps in order to embed ethics into dealing with socially assistive robots. This article provides some practical suggestions on this issue from a robotics project.

Robotics in urological surgery: evolution, current status and future perspectives.

PubMed

Sivaraman, A; Sanchez-Salas, R; Prapotnich, D; Barret, E; Mombet, A; Cathala, N; Rozet, F; Galiano, M; Cathelineau, X

2015-09-01

Robotic surgery is rapidly evolving and has become an essential part of surgical practice in several parts of the world. Robotic technology will expand globally and most of the surgeons around the world will have access to surgical robots in the future. It is essential that we are updated about the outcomes of robot assisted surgeries which will allow everyone to develop an unbiased opinion on the clinical utility of this innovation. In this review we aim to present the evolution, objective evaluation of clinical outcomes and future perspectives of robot assisted urologic surgeries. A systematic literature review of clinical outcomes of robotic urological surgeries was made in the PUBMED. Randomized control trials, cohort studies and review articles were included. Moreover, a detailed search in the web based search engine was made to acquire information on evolution and evolving technologies in robotics. The present evidence suggests that the clinical outcomes of the robot assisted urologic surgeries are comparable to the conventional open surgical and laparoscopic results and are associated with fewer complications. However, long term results are not available for all the common robotic urologic surgeries. There are plenty of novel developments in robotics to be available for clinical use in the future. Robotic urologic surgery will continue to evolve in the future. We should continue to critically analyze whether the advances in technology and the higher cost eventually translates to improved overall surgical performance and outcomes. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery.

PubMed

Kim, Ho-Joong; Jung, Whan-Ik; Chang, Bong-Soon; Lee, Choon-Ki; Kang, Kyoung-Tak; Yeom, Jin S

2017-09-01

The purpose of this study was to compare the accuracy and safety of an instrumented posterior lumbar interbody fusion (PLIF) using a robot-assisted minimally invasive (Robot-PLIF) or a conventional open approach (Freehand-PLIF). Patients undergoing an instrumented PLIF were randomly assigned to be treated using a Robot-PLIF (37 patients) and a Freehand-PLIF (41 patients). For intrapedicular accuracy, there was no significant difference between the groups (P = 0.534). For proximal facet joint accuracy, none of the 74 screws in the Robot-PLIF group violated the proximal facet joint, while 13 of 82 in the Freehand-PLIF group violated the proximal facet joint (P < 0.001). The average distance of the screws from the facets was 5.2 ± 2.1 mm and 2.7 ± 1.6 mm in the Robot-PLIF and Freehand-PLIF groups, respectively (P < 0.001). Robotic-assisted pedicle screw placement was associated with fewer proximal facet joint violations and better convergence orientations. Copyright © 2016 John Wiley & Sons, Ltd.

Does robot-assisted gait training ameliorate gait abnormalities in multiple sclerosis? A pilot randomized-control trial.

PubMed

Straudi, S; Benedetti, M G; Venturini, E; Manca, M; Foti, C; Basaglia, N

2013-01-01

Gait disorders are common in multiple sclerosis (MS) and lead to a progressive reduction of function and quality of life. Test the effects of robot-assisted gait rehabilitation in MS subjects through a pilot randomized-controlled study. We enrolled MS subjects with Expanded Disability Status Scale scores within 4.5-6.5. The experimental group received 12 robot-assisted gait training sessions over 6 weeks. The control group received the same amount of conventional physiotherapy. Outcomes measures were both biomechanical assessment of gait, including kinematics and spatio-temporal parameters, and clinical test of walking endurance (six-minute walk test) and mobility (Up and Go Test). 16 subjects (n = 8 experimental group, n = 8 control group) were included in the final analysis. At baseline the two groups were similar in all variables, except for step length. Data showed walking endurance, as well as spatio-temporal gait parameters improvements after robot-assisted gait training. Pelvic antiversion and reduced hip extension during terminal stance ameliorated after aforementioned intervention. Robot-assisted gait training seems to be effective in increasing walking competency in MS subjects. Moreover, it could be helpful in restoring the kinematic of the hip and pelvis.

Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial

PubMed Central

Scott, William; York, Henry; Theyagaraj, Melita; Price-Miller, Naomi; McQuaid, Jean; Eyvazzadeh, Megan; Ivey, Frederick M.; Macko, Richard F.

2016-01-01

Objective To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI). Design Pilot prospective randomized, controlled clinical trial. Setting Outpatient rehabilitation specialty hospital. Participants Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury. Interventions CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase. Outcome measures Peak oxygen consumption (peak VO2) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (post-training). Peak VO2 values were normalized for body mass. Results The RABWSTT group improved peak VO2 by 12.3% during robotic treadmill walking (20.2 ± 7.4 to 22.7 ± 7.5 ml/kg/min, P = 0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P = 0.37). Neither group displayed a significant change in peak VO2 during arm cycle ergometry (RABWSTT, 8.5% (P = 0.25); HSP, 1.76% (P = 0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO2 during both robotic treadmill walking (P = 0.002) and arm cycle ergometry (P = 0.001). Conclusion RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI. PMID:25520035

A comparison of the robotic-assisted versus retropubic radical prostatectomy.

PubMed

Laviana, A A; Hu, J C

2013-09-01

After Walsh's detailed anatomic description of pelvic anatomy in 1979, the retropubic radical prostatectomy (RRP) was the predominant surgical treatment for prostate cancer for more than twenty-five years. Over the past decade, however, the robotic-assisted radical prostatectomy (RARP) has grown increasingly popular and now is the most used surgical modality. Willingness to adopt this approach has been confounded by the novelty of technology and widespread marketing campaigns. In this article, we performed a literature search comparing radical retropubic prostatectomy to robotic-assisted radical prostetectomy with regard to perioperative, oncologic, and quality-of-life outcomes. We performed a PubMed literature search for a review of articles published between 2000 and 2013. Relevant articles were highlighted using the following keywords: robot or robotic prostatectomy, open or retropubic prostatectomy. Perioperative outcomes including decreased blood loss, fewer blood transfusions, and decreased length of hospital stay tend to favor RARP, while perioperative mortality is near negligible in both. Short-term positive surgical margins, prostate-specific antigen recurrence free survival, and need for salvage therapy following RARP are similar to RRP, though data at greater than ten years is limited. Preservation of urinary and sexual function and quality of life favored RARP, though this is dependent on surgeon technique. Finally, cost, though evolving, favors RRP. In our current state, most prostatectomies will continue to be perfromed robotically. Though there is evidence the robotic-assisted radical prostatectomy offers shorter lengths of stay, decreased intraoperative blood loss, faster return of sexual function and continence, there is a paucity on long-term oncologic outcomes. Rigorous, prospective randomized-controlled trials need to be performed to determine the long-term success of the robotic-assisted radical prostatectomy and whether it is cost-effective when its potential advantages are taken into consideration.

Comparison of precision and speed in laparoscopic and robot-assisted surgical task performance.

PubMed

Zihni, Ahmed; Gerull, William D; Cavallo, Jaime A; Ge, Tianjia; Ray, Shuddhadeb; Chiu, Jason; Brunt, L Michael; Awad, Michael M

2018-03-01

Robotic platforms have the potential advantage of providing additional dexterity and precision to surgeons while performing complex laparoscopic tasks, especially for those in training. Few quantitative evaluations of surgical task performance comparing laparoscopic and robotic platforms among surgeons of varying experience levels have been done. We compared measures of quality and efficiency of Fundamentals of Laparoscopic Surgery task performance on these platforms in novices and experienced laparoscopic and robotic surgeons. Fourteen novices, 12 expert laparoscopic surgeons (>100 laparoscopic procedures performed, no robotics experience), and five expert robotic surgeons (>25 robotic procedures performed) performed three Fundamentals of Laparoscopic Surgery tasks on both laparoscopic and robotic platforms: peg transfer (PT), pattern cutting (PC), and intracorporeal suturing. All tasks were repeated three times by each subject on each platform in a randomized order. Mean completion times and mean errors per trial (EPT) were calculated for each task on both platforms. Results were compared using Student's t-test (P < 0.05 considered statistically significant). Among novices, greater errors were noted during laparoscopic PC (Lap 2.21 versus Robot 0.88 EPT, P < 0.001). Among expert laparoscopists, greater errors were noted during laparoscopic PT compared with robotic (PT: Lap 0.14 versus Robot 0.00 EPT, P = 0.04). Among expert robotic surgeons, greater errors were noted during laparoscopic PC compared with robotic (Lap 0.80 versus Robot 0.13 EPT, P = 0.02). Among expert laparoscopists, task performance was slower on the robotic platform compared with laparoscopy. In comparisons of expert laparoscopists performing tasks on the laparoscopic platform and expert robotic surgeons performing tasks on the robotic platform, expert robotic surgeons demonstrated fewer errors during the PC task (P = 0.009). Robotic assistance provided a reduction in errors at all experience levels for some laparoscopic tasks, but no benefit in the speed of task performance. Robotic assistance may provide some benefit in precision of surgical task performance. Copyright © 2017 Elsevier Inc. All rights reserved.

Facilitators and Barriers to Adopting Robotic-Assisted Surgery: Contextualizing the Unified Theory of Acceptance and Use of Technology

PubMed Central

BenMessaoud, Christine; Kharrazi, Hadi; MacDorman, Karl F.

2011-01-01

Robotic-assisted surgical techniques are not yet well established among surgeon practice groups beyond a few surgical subspecialties. To help identify the facilitators and barriers to their adoption, this belief-elicitation study contextualized and supplemented constructs of the unified theory of acceptance and use of technology (UTAUT) in robotic-assisted surgery. Semi-structured individual interviews were conducted with 21 surgeons comprising two groups: users and nonusers. The main facilitators to adoption were Perceived Usefulness and Facilitating Conditions among both users and nonusers, followed by Attitude Toward Using Technology among users and Extrinsic Motivation among nonusers. The three main barriers to adoption for both users and nonusers were Perceived Ease of Use and Complexity, Perceived Usefulness, and Perceived Behavioral Control. This study's findings can assist surgeons, hospital and medical school administrators, and other policy makers on the proper adoption of robotic-assisted surgery and can guide future research on the development of theories and framing of hypotheses. PMID:21283719

Comparison of tongue interface with keyboard for control of an assistive robotic arm.

PubMed

Struijk, Lotte N S Andreasen; Lontis, Romulus

2017-07-01

This paper demonstrates how an assistive 6 DoF robotic arm with a gripper can be controlled manually using a tongue interface. The proposed method suggests that it possible for a user to manipulate the surroundings with his or her tongue using the inductive tongue control system as deployed in this study. The sensors of an inductive tongue-computer interface were mapped to the Cartesian control of an assistive robotic arm. The resulting control system was tested manually in order to compare manual control of the robot using a standard keyboard and using the tongue interface. Two healthy subjects controlled the robotic arm to precisely move a bottle of water from one location to another. The results shows that the tongue interface was able to fully control the robotic arm in a similar manner as the standard keyboard resulting in the same number of successful manipulations and an average increase in task duration of up to 30% as compared with the standard keyboard.

Robot-assisted radical prostatectomy: advances since 2005.

PubMed

Su, Li-Ming

2010-03-01

To provide an update of recent studies relevant to robot-assisted radical prostatectomy, highlighting technical modifications and associated functional outcomes, mid-term oncologic results and patient perception and satisfaction. Several recent studies have investigated methods of further reducing the morbidities associated with prostatectomy, namely erectile dysfunction and incontinence. These studies provide important anatomic insights into additional mechanisms responsible for potency and incontinence and measures for preserving both. Mid-term oncologic outcomes have also been reported; further substantiating the role of robotics in the treatment of clinically localized prostate cancer. The technique of robotic prostatectomy has evolved over the last decade with significant efforts in improving functional outcomes following surgery. However, aggressive-marketing campaigns and lack of regulation of hospital websites may be contributing to unrealistic expectations in patients who choose to undergo robotic prostatectomy, resulting in dissatisfaction for some patients. National interests in this topic will likely result in the mandate for more stringent studies to assess the comparative effectiveness of robot-assisted prostatectomy with other competing therapies for clinically localized prostate cancer.

Robot-Assisted Antegrade In-Situ Fenestrated Stent Grafting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riga, Celia V., E-mail: c.riga@imperial.ac.uk; Bicknell, Colin D.; Wallace, Daniel

2009-05-15

To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged formore » a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure.« less

The current status of robot-assisted radical prostatectomy

PubMed Central

Dasgupta, Prokar; Kirby, Roger S.

2009-01-01

Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes–the so-called 'trifecta'. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser-guided robotics, catheter-free prostatectomy and image-guided robotics are discussed. PMID:19050687

Novel uses of surgical robotics in head and neck surgery.

PubMed

Lobe, Thom E; Wright, Simon K; Irish, Michael S

2005-12-01

To demonstrate the utility of robotically assisted approaches in head and neck surgery. Two teenage patients, one with a solitary thyroid nodule who was scheduled for a right thyroid lobectomy and the other with intractable seizures who was scheduled for placement of a vagal nerve stimulator were offered the option of a robotically assisted technique using a transaxillary endoscopic approach. Both procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California). A 12 mm telescope and 5 mm instruments were used. There was sufficient mobility of the robotic arms despite the small working space. There were no complications, minimal pain in the axillary incisions, and patient satisfaction was high. Operative times were 4.5 and 4.2 hours, respectively. Transaxillary, endoscopic, robotically assisted approaches to the head and neck are feasible. The addition of robotics improves surgical dexterity in a difficult-to-reach anatomic region. Patient satisfaction appears high because of the avoidance of a cervical incision.

Robotic hepatobiliary and pancreatic surgery: lessons learned and predictors for conversion.

PubMed

Hanna, Erin M; Rozario, Nigel; Rupp, Christopher; Sindram, David; Iannitti, David A; Martinie, John B

2013-06-01

The use of surgical robots has slowly gained an increasing presence in the realm of hepatobiliary and pancreatic (HPB) surgery. With additional experience, anecdotal evidence has been useful in guiding patient selection for complex robotic procedures. In the following analysis, we reviewed our case series and looked for predictors of conversion in robotic HPB surgery. We retrospectively reviewed all patients who underwent robotic HPB procedures by a single surgeon at two institutions during March 2006-June 2012. Patient demographics, operative data, procedure type and conversion information were recorded. Trends were analysed for indications for conversion. A subset analysis of robotic-assisted laparoscopic distal pancreatomy was performed and compared with laparoscopic and open distal pancreatectomy during the same time period by the same surgeon. During this time period, 77 patients underwent robotic hepatobiliary and pancreatic procedures. All procedures were performed by a single surgeon (J.M.) and included 38 males (49%) and 39 females (51%). Median age was 59 and the majority of patients were ASA class III. There were 24 conversions, which decreased in frequency from 2009 (7) to 2011 (3). Reasons for conversion included significant obesity and technical difficulty. Patients with conversions had more intraoperative blood loss (966 vs 176 ml), more frequently received transfusion (29% vs 2%) and were more likely to have postoperative intensive care. Overall length of stay was longer following conversion (8.3 vs 5.6 days). Robotic-assisted hepatobiliary and pancreatic procedures are often extremely complex, with a significant learning curve. Recognizing factors that prohibit successful completion of a robotic-assisted surgical procedure is key for patient safety. Careful patient selection in the appropriate settings facilitates the maximal benefit of robotic-assisted complex HPB surgery. Copyright © 2013 John Wiley & Sons, Ltd.

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.

Myoelectrically controlled wrist robot for stroke rehabilitation

PubMed Central

2013-01-01

Background Robot-assisted rehabilitation is an advanced new technology in stroke rehabilitation to provide intensive training. Post-stroke motor recovery depends on active rehabilitation by voluntary participation of patient’s paretic motor system as early as possible in order to promote reorganization of brain. However, voluntary residual motor efforts to the affected limb have not been involved enough in most robot-assisted rehabilitation for patients after stroke. The objective of this study is to evaluate the feasibility of robot-assisted rehabilitation using myoelectric control on upper limb motor recovery. Methods In the present study, an exoskeleton-type rehabilitation robotic system was designed to provide voluntarily controlled assisted torque to the affected wrist. Voluntary intention was involved by using the residual surface electromyography (EMG) from flexor carpi radialis(FCR) and extensor carpi radialis (ECR)on the affected limb to control the mechanical assistance provided by the robotic system during wrist flexion and extension in a 20-session training. The system also applied constant resistant torque to the affected wrist during the training. Sixteen subjects after stroke had been recruited for evaluating the tracking performance and therapeutical effects of myoelectrically controlled robotic system. Results With the myoelectrically-controlled assistive torque, stroke survivors could reach a larger range of motion with a significant decrease in the EMG signal from the agonist muscles. The stroke survivors could be trained in the unreached range with their voluntary residual EMG on the paretic side. After 20-session rehabilitation training, there was a non-significant increase in the range of motion and a significant decrease in the root mean square error (RMSE) between the actual wrist angle and target angle. Significant improvements also could be found in muscle strength and clinical scales. Conclusions These results indicate that robot-aided therapy with voluntary participation of patient’s paretic motor system using myoelectric control might have positive effect on upper limb motor recovery. PMID:23758925

The first national examination of outcomes and trends in robotic surgery in the United States.

PubMed

Anderson, Jamie E; Chang, David C; Parsons, J Kellogg; Talamini, Mark A

2012-07-01

There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95% CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95% CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95% CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95% CI, 519-2,099; p = 0.001). Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bagla, Sandeep, E-mail: sandeep.bagla@gmail.com; Smirniotopoulos, John; Orlando, Julie C.

PurposeProstatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH.Materials and MethodsIRB-approved retrospective study of 40 consecutive patients 49–81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performedmore » within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months.ResultsNo significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm{sup 2} vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred.ConclusionsRobotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.« less

Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis.

PubMed

Elliott, Christopher S; Hsieh, Michael H; Sokol, Eric R; Comiter, Craig V; Payne, Christopher K; Chen, Bertha

2012-02-01

Abdominal sacrocolpopexy is considered a standard of care operation for apical vaginal vault prolapse repair. Using outcomes at our center we evaluated whether the robotic approach to sacrocolpopexy is as cost-effective as the open approach. After obtaining institutional review board approval we performed cost-minimization analysis in a retrospective cohort of patients who underwent sacrocolpopexy at our institution between 2006 and 2010. Threshold values, that is model variable values at which the most cost effective approach crosses over to an alternative approach, were determined by testing model variables over realistic ranges using sensitivity analysis. Hospital billing data were also evaluated to confirm our findings. Operative time was similar for robotic and open surgery (226 vs 221 minutes) but postoperative length of stay differed significantly (1.0 vs 3.3 days, p <0.001). Base case analysis revealed an overall 10% cost savings for robot-assisted vs open sacrocolpopexy ($10,178 vs $11,307). Tornado analysis suggested that the number of institutional robotic cases done annually, length of stay and cost per hospitalization day in the postoperative period were the largest drivers of cost. Analysis of our hospital billing data showed a similar trend with robotic surgery costing 4.2% less than open surgery. A robot-assisted approach to sacrocolpopexy can be equally or less costly than an open approach. This depends on a sufficient institutional robotic case volume and a shorter postoperative stay for patients who undergo the robot-assisted procedure. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Effects of Visual Force Feedback on Robot-Assisted Surgical Task Performance

PubMed Central

Reiley, Carol E.; Akinbiyi, Takintope; Burschka, Darius; Chang, David C.; Okamura, Allison M.; Yuh, David D.

2009-01-01

Background Direct haptic (force or tactile) feedback is negligible in current surgical robotic systems. The relevance of haptic feedback in robot-assisted performances of surgical tasks is controversial. We studied the effects of visual force feedback (VFF), a haptic feedback surrogate, on tying surgical knots with fine sutures similar to those used in cardiovascular surgery. Methods Using a modified da Vinci robotic system (Intuitive Surgical, Inc.) equipped with force-sensing instrument tips and real-time VFF overlays in the console image, ten surgeons each tied 10 knots with and 10 knots without VFF. Four surgeons had significant prior da Vinci experience while the remaining six surgeons did not. Performance parameters, including suture breakage and secure knots, peak and standard deviation of applied forces, and completion times using 5-0 silk sutures were recorded. Chi-square and Student’s t-test analyses determined differences between groups. Results Among surgeon subjects with robotic experience, no differences in measured performance parameters were found between robot-assisted knot ties executed with and without VFF. Among surgeons without robotic experience, however, VFF was associated with lower suture breakage rates, peak applied forces, and standard deviations of applied forces. VFF did not impart differences in knot completion times or loose knots for either surgeon group. Conclusions VFF resulted in reduced suture breakage, lower forces, and decreased force inconsistencies among novice robotic surgeons, although elapsed time and knot quality were unaffected. In contrast, VFF did not affect these metrics among experienced da Vinci surgeons. These results suggest that VFF primarily benefits novice robot-assisted surgeons, with diminishing benefits among experienced surgeons. PMID:18179942

Robotic surgery: current perceptions and the clinical evidence.

PubMed

Ahmad, Arif; Ahmad, Zoha F; Carleton, Jared D; Agarwala, Ashish

2017-01-01

It appears that a discrepancy exists between the perception of robotic-assisted surgery (RAS) and the current clinical evidence regarding robotic-assisted surgery among patients, healthcare providers, and hospital administrators. The purpose of this study was to assess whether or not such a discrepancy exists. We administered survey questionnaires via face-to-face interviews with surgical patients (n = 101), healthcare providers (n = 58), and senior members of hospital administration (n = 6) at a community hospital that performs robotic surgery. The respondents were asked about their perception regarding the infection rate, operative time, operative blood loss, incision size, cost, length of hospital stay (LOS), risk of complications, precision and accuracy, tactile sensation, and technique of robotic-assisted surgery as compared with conventional laparoscopic surgery. We then performed a comprehensive literature review to assess whether or not these perceptions could be corroborated with clinical evidence. The majority of survey respondents perceived RAS as modality to decrease infection rate, increase operative time, decrease operative blood loss, smaller incision size, a shorter LOS, and a lower risk of complications, while increasing the cost. Respondents also believed that robotic surgery provides greater precision, accuracy, and tactile sensation, while improving intra-operative access to organs. A comprehensive literature review found little-to-no clinical evidence that supported the respondent's favorable perceptions of robotic surgery except for the increased costs, and precision and accuracy of the robotic-assisted technique. There is a discrepancy between the perceptions of robotic surgery and the clinical evidence among patients, healthcare providers, and hospital administrators surveyed.

RACE pulls for shared control

NASA Astrophysics Data System (ADS)

Leahy, M. B., Jr.; Cassiday, B. K.

1993-02-01

Maintaining and supporting an aircraft fleet, in a climate of reduced manpower and financial resources, dictates effective utilization of robotics and automation technologies. To help develop a winning robotics and automation program the Air Force Logistics Command created the Robotics and Automation Center of Excellence (RACE). RACE is a command wide focal point. Race is an organic source of expertise to assist the Air Logistic Center (ALC) product directorates in improving process productivity through the judicious insertion of robotics and automation technologies. RACE is a champion for pulling emerging technologies into the aircraft logistic centers. One of those technology pulls is shared control. Small batch sizes, feature uncertainty, and varying work load conspire to make classic industrial robotic solutions impractical. One can view ALC process problems in the context of space robotics without the time delay. The ALC's will benefit greatly from the implementation of a common architecture that supports a range of control actions from fully autonomous to teleoperated. Working with national laboratories and private industry, we hope to transition shared control technology to the depot floor. This paper provides an overview of the RACE internal initiatives and customer support, with particular emphasis on production processes that will benefit from shared control technology.

RACE pulls for shared control

NASA Astrophysics Data System (ADS)

Leahy, Michael B., Jr.; Cassiday, Brian K.

1992-11-01

Maintaining and supporting an aircraft fleet, in a climate of reduced manpower and financial resources, dictates effective utilization of robotics and automation technologies. To help develop a winning robotics and automation program the Air Force Logistics Command created the Robotics and Automation Center of Excellence (RACE). RACE is a command wide focal point. An organic source of expertise to assist the Air Logistic Center (ALC) product directorates in improving process productivity through the judicious insertion of robotics and automation technologies. RACE is a champion for pulling emerging technologies into the aircraft logistic centers. One of those technology pulls is shared control. The small batch sizes, feature uncertainty, and varying work load conspire to make classic industrial robotic solutions impractical. One can view ALC process problems in the context of space robotics without the time delay. The ALCs will benefit greatly from the implementation of a common architecture that supports a range of control actions from fully autonomous to teleoperated. Working with national laboratories and private industry we hope to transition shared control technology to the depot floor. This paper provides an overview of the RACE internal initiatives and customer support, with particular emphasis on production processes that will benefit from shared control technology.

RACE pulls for shared control

NASA Technical Reports Server (NTRS)

Leahy, M. B., Jr.; Cassiday, B. K.

1993-01-01

Maintaining and supporting an aircraft fleet, in a climate of reduced manpower and financial resources, dictates effective utilization of robotics and automation technologies. To help develop a winning robotics and automation program the Air Force Logistics Command created the Robotics and Automation Center of Excellence (RACE). RACE is a command wide focal point. Race is an organic source of expertise to assist the Air Logistic Center (ALC) product directorates in improving process productivity through the judicious insertion of robotics and automation technologies. RACE is a champion for pulling emerging technologies into the aircraft logistic centers. One of those technology pulls is shared control. Small batch sizes, feature uncertainty, and varying work load conspire to make classic industrial robotic solutions impractical. One can view ALC process problems in the context of space robotics without the time delay. The ALC's will benefit greatly from the implementation of a common architecture that supports a range of control actions from fully autonomous to teleoperated. Working with national laboratories and private industry, we hope to transition shared control technology to the depot floor. This paper provides an overview of the RACE internal initiatives and customer support, with particular emphasis on production processes that will benefit from shared control technology.

Robot-assisted Heller's myotomy for achalasia in children.

PubMed

Altokhais, Tariq; Mandora, Hala; Al-Qahtani, Ayed; Al-Bassam, Abdulrahman

2016-12-01

Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

Design of Intelligent Robot as A Tool for Teaching Media Based on Computer Interactive Learning and Computer Assisted Learning to Improve the Skill of University Student

NASA Astrophysics Data System (ADS)

Zuhrie, M. S.; Basuki, I.; Asto B, I. G. P.; Anifah, L.

2018-01-01

The focus of the research is the teaching module which incorporates manufacturing, planning mechanical designing, controlling system through microprocessor technology and maneuverability of the robot. Computer interactive and computer-assisted learning is strategies that emphasize the use of computers and learning aids (computer assisted learning) in teaching and learning activity. This research applied the 4-D model research and development. The model is suggested by Thiagarajan, et.al (1974). 4-D Model consists of four stages: Define Stage, Design Stage, Develop Stage, and Disseminate Stage. This research was conducted by applying the research design development with an objective to produce a tool of learning in the form of intelligent robot modules and kit based on Computer Interactive Learning and Computer Assisted Learning. From the data of the Indonesia Robot Contest during the period of 2009-2015, it can be seen that the modules that have been developed confirm the fourth stage of the research methods of development; disseminate method. The modules which have been developed for students guide students to produce Intelligent Robot Tool for Teaching Based on Computer Interactive Learning and Computer Assisted Learning. Results of students’ responses also showed a positive feedback to relate to the module of robotics and computer-based interactive learning.

Anesthetic Challenges in Robotic-assisted Urologic Surgery

PubMed Central

Hsu, Richard L; Kaye, Alan D; Urman, Richard D

2013-01-01

Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and limited access to the patient, all present anesthetic management challenges in urologic surgery. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce surgical and anesthetic complications. PMID:24659914

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

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 have applied these methods effectively and safely. PMID:11573041

Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder).

PubMed

Bolzoni Villaret, Andrea; Doglietto, Francesco; Carobbio, Andrea; Schreiber, Alberto; Panni, Camilla; Piantoni, Enrico; Guida, Giovanni; Fontanella, Marco Maria; Nicolai, Piero; Cassinis, Riccardo

2017-09-01

Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS. Copyright © 2017 Elsevier Inc. All rights reserved.

Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse.

PubMed

Perrenot, Cyril; Germain, Adeline; Scherrer, Marie-Lorraine; Ayav, Ahmet; Brunaud, Laurent; Bresler, Laurent

2013-07-01

Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet. The primary objective of the study was to evaluate long-term functional and anatomic results of robot-assisted laparoscopic rectopexy. The secondary objective was to evaluate the learning curve of this procedure. Monocentric study data, both preoperative and perioperative, were collected prospectively, and follow-up data were assessed by a telephone questionnaire. The study was performed in an academic center by 3 different surgeons. We evaluated all of the consecutive patients who underwent a robot-assisted laparoscopic rectopexy between June 2002 and August 2010. Rectopexy was performed with 2 anterolateral meshes or with 1 ventral mesh, and in 9 patients a sigmoidectomy was associated with rectopexy. The actuarial recurrence rate was evaluated using the Kaplan-Meier method. During the study period, 77 patients underwent a robot-assisted laparoscopic rectopexy, and the mean age was 59.9 years (range, 23-90 y). Average operating time was 223 minutes (range, 100-390 min); the learning curve was completed after 18 patients were seen. Two patients died of causes unrelated to surgery at 5 and 24 months. There were 5 conversions (6%) to open procedure. Overall morbidity was low and concerned only 8 patients (10.4%). Mean follow-up time was 52.5 months (range, 12-115 mo). Recurrences have been observed in 9 patients (12.8%). Preoperatively, 24 (34%) of the patients had constipation. Postoperatively, constipation disappeared for 12 (50%) of 24 and constipation appeared for 11 (24%) of 46 patients. Fecal incontinence decreased after surgery from Wexner score 10.5 to 5.1 of 20. There was a lack of standardization of the surgical procedure. The study was monocentric. Seven patients (9%) were lost to follow-up. Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.

Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse: A 5-Year Experience at a Tertiary Referral Center.

PubMed

van Iersel, Jan J; Formijne Jonkers, Hendrik A; Paulides, Tim J C; Verheijen, Paul M; Draaisma, Werner A; Consten, Esther C J; Broeders, Ivo A M J

2017-11-01

Laparoscopic ventral mesh rectopexy is being increasingly performed internationally to treat rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure, but literature regarding robot-assisted ventral mesh rectopexy is limited. The primary objective of this study was to assess the safety and effectiveness of robot-assisted ventral mesh rectopexy in the largest consecutive series of patients to date. This study is a retrospective cross-sectional analysis of prospectively collected data. The study was conducted in a tertiary referral center. All of the patients undergoing robot-assisted ventral mesh rectopexy for rectal prolapse syndromes between 2010 and 2015 were evaluated. Preoperative and postoperative (mesh and nonmesh) morbidity and functional outcome were analyzed. The actuarial recurrence rates were calculated using the Kaplan-Meier method. A total of 258 patients underwent robot-assisted ventral mesh rectopexy (mean ± SD follow-up = 23.5 ± 21.8 mo; range, 0.2 - 65.1 mo). There were no conversions and only 5 intraoperative complications (1.9%). Mortality (0.4%) and major (1.9%) and minor (<30 d) early morbidity (7.0%) were acceptably low. Only 1 (1.3%) mesh-related complication (asymptomatic vaginal mesh erosion) was observed. A significant improvement in obstructed defecation (78.6%) and fecal incontinence (63.7%) were achieved for patients (both p < 0.0005). At final follow-up, a new onset of fecal incontinence and obstructed defecation was induced or worsened in 3.9% and 0.4%. The actuarial 5-year external rectal prolapse and internal rectal prolapse recurrence rates were 12.9% and 10.4%. This was a retrospective study including patients with minimal follow-up. No validated scores were used to assess function. The study was monocentric, and there was no control group. Robot-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse syndromes, providing an acceptable recurrence rate and good symptomatic relief with minimal morbidity. See Video Abstract at http://links.lww.com/DCR/A427.

[Rage against the machine -- necessity of robotic assisted prostatectomy].

PubMed

Friedrich, M; Steiner, T; Popken, G

2013-03-01

During the last decade urologists have faced a dramatic increase in robotic surgery. Despite the exceptional acceptance of this technique there is a complete lack of evidence for the equi-efficacy or superiority of this technique compared to open or laparoscopic prostatectomy. There is now an increasing body of evidence for the evaluation of robotic assisted prostatectomy. Robotic assisted prostatectomy is a safe procedure. The rate of technical failure is small. The rate of surgical complications is comparable with that of open or conventional laparoscopic prostatectomy. Similar to the conventional laparoscopic prostatectomy there is a trend for a minor blood loss and a smaller transfusion rate compared to the retropubic approach. In recent meta-analyses there is no advatage regarding the oncological or functional outcome for robotic prostatectomy. Neither the rate of positive surgical margins nor the rate of biochemical recurrence favours robotic prostatectomy. Regarding functional outcome some publications describe better results for urinary and sexual function for robotic surgery. Careful evaluation of these data reveals a low level of evidence due to a strong bias in favour of robotic surgery. In contrast, recent analysis of "Medicare" data reveal a considerable poorer urinary function after robotic prostatectomy compared to open retropubic prostatectomy. The Urological Board of the Helios Hospital Group does not recommend the use of a robotic device for radical prostatectomy. © Georg Thieme Verlag KG Stuttgart · New York.

Towards Optimal Platform-Based Robot Design for Ankle Rehabilitation: The State of the Art and Future Prospects.

PubMed

Miao, Qing; Zhang, Mingming; Wang, Congzhe; Li, Hongsheng

2018-01-01

This review aims to compare existing robot-assisted ankle rehabilitation techniques in terms of robot design. Included studies mainly consist of selected papers in two published reviews involving a variety of robot-assisted ankle rehabilitation techniques. A free search was also made in Google Scholar and Scopus by using keywords "ankle ∗ ," and "robot ∗ ," and ("rehabilitat ∗ " or "treat ∗ "). The search is limited to English-language articles published between January 1980 and September 2016. Results show that existing robot-assisted ankle rehabilitation techniques can be classified into wearable exoskeleton and platform-based devices. Platform-based devices are mostly developed for the treatment of a variety of ankle musculoskeletal and neurological injuries, while wearable ones focus more on ankle-related gait training. In terms of robot design, comparative analysis indicates that an ideal ankle rehabilitation robot should have aligned rotation center as the ankle joint, appropriate workspace, and actuation torque, no matter how many degrees of freedom (DOFs) it has. Single-DOF ankle robots are mostly developed for specific applications, while multi-DOF devices are more suitable for comprehensive ankle rehabilitation exercises. Other factors including posture adjustability and sensing functions should also be considered to promote related clinical applications. An ankle rehabilitation robot with reconfigurability to maximize its functions will be a new research point towards optimal design, especially on parallel mechanisms.

A wearable robotic orthosis with a spring-assist actuator.

PubMed

Seungmin Jung; Chankyu Kim; Jisu Park; Dongyoub Yu; Jaehwan Park; Junho Choi

2016-08-01

This paper introduces a wearable robotic orthosis with spring-assist actuators, which is designed to assist people who have difficulty in walking. The spring-assist actuator consists of an electrical motor and a spring, which are attached to a rotational axis in parallel to each other. The spring-assist actuator is developed based on the analysis on the stiffness of the knee and hip joints during walking. "COWALK-Mobile," which is a wearable robotic orthosis, is developed using the spring-assist actuators to reduce the required motor torque during walking. The COWALK-Mobile has active hip and knee joints and passive ankle joints to provide assistive torque to the wearer. The required joint torque is generated by the spring as well as the electrical motor, which results in a decrease of maximum required torque for the motor. In order to evaluate the performance of the spring-assist actuator, experiments are carried out. The experiments show that the spring-assist actuators reduced the required motor torque during walking.

Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety.

PubMed

Gagnon, Dany H; Escalona, Manuel J; Vermette, Martin; Carvalho, Lívia P; Karelis, Antony D; Duclos, Cyril; Aubertin-Leheudre, Mylène

2018-03-01

For individuals who sustain a complete motor spinal cord injury (SCI) and rely on a wheelchair as their primary mode of locomotion, overground robotic exoskeletons represent a promising solution to stand and walk again. Although overground robotic exoskeletons have gained tremendous attention over the past decade and are now being transferred from laboratories to clinical settings, their effects remain unclear given the paucity of scientific evidence and the absence of large-scale clinical trials. This study aims to examine the feasibility of a locomotor training program with an overground robotic exoskeleton in terms of recruitment, attendance, and drop-out rates as well as walking performance, learnability, and safety. Individuals with a SCI were invited to participate in a 6 to 8-week locomotor training program with a robotic exoskeleton encompassing 18 sessions. Selected participants underwent a comprehensive screening process and completed two familiarization sessions with the robotic exoskeleton. The outcome measures were the rate of recruitment of potential participants, the rate of attendance at training sessions, the rate of drop-outs, the ability to walk with the exoskeleton, and its progression over the program as well as the adverse events. Out of 49 individuals who expressed their interest in participating in the study, only 14 initiated the program (recruitment rate = 28.6%). Of these, 13 individuals completed the program (drop-out rate = 7.1%) and attended 17.6 ± 1.1 sessions (attendance rate = 97.9%). Their greatest standing time, walking time, and number of steps taken during a session were 64.5 ± 10.2 min, 47.2 ± 11.3 min, and 1843 ± 577 steps, respectively. During the training program, these last three parameters increased by 45.3%, 102.1%, and 248.7%, respectively. At the end of the program, when walking with the exoskeleton, most participants required one therapist (85.7%), needed stand-by or contact-guard assistance (57.1%), used forearm crutches (71.4%), and reached a walking speed of 0.25 ± 0.05 m/s. Five participants reported training-related pain or stiffness in the upper extremities during the program. One participant sustained bilateral calcaneal fractures and stopped the program. This study confirms that larger clinical trials investigating the effects of a locomotor training program with an overground robotic exoskeleton are feasible and relatively safe in individuals with complete motor SCI. Moreover, to optimize the recruitment rate and safety in future trials, this study now highlights the need of developing pre-training rehabilitation programs to increase passive lower extremity range of motion and standing tolerance. This study also calls for the development of clinical practice guidelines targeting fragility fracture risk assessment linked to the use of overground robotic exoskeletons.

Endocavity Ultrasound Probe Manipulators

PubMed Central

Stoianovici, Dan; Kim, Chunwoo; Schäfer, Felix; Huang, Chien-Ming; Zuo, Yihe; Petrisor, Doru; Han, Misop

2014-01-01

We developed two similar structure manipulators for medical endocavity ultrasound probes with 3 and 4 degrees of freedom (DoF). These robots allow scanning with ultrasound for 3-D imaging and enable robot-assisted image-guided procedures. Both robots use remote center of motion kinematics, characteristic of medical robots. The 4-DoF robot provides unrestricted manipulation of the endocavity probe. With the 3-DoF robot the insertion motion of the probe must be adjusted manually, but the device is simpler and may also be used to manipulate external-body probes. The robots enabled a novel surgical approach of using intraoperative image-based navigation during robot-assisted laparoscopic prostatectomy (RALP), performed with concurrent use of two robotic systems (Tandem, T-RALP). Thus far, a clinical trial for evaluation of safety and feasibility has been performed successfully on 46 patients. This paper describes the architecture and design of the robots, the two prototypes, control features related to safety, preclinical experiments, and the T-RALP procedure. PMID:24795525

Usability test of KNRC self-feeding robot.

PubMed

Song, Won-Kyung; Song, Won-Jin; Kim, Yale; Kim, Jongbae

2013-06-01

Various assistive robots for supporting the activities of daily living have been developed. However, not many of these have been introduced into the market because they were found to be impractical in actual scenarios. In this paper, we report on the usability test results of an assistive robot designed for self-feeding for people having disabilities, which includes those having spinal cord injury, cerebral palsy, and traumatic brain injury. First, we present three versions of a novel self-feeding robot (KNRC self-feeding robot), which is suitable for use with Korean food, including sticky rice. These robots have been improved based on participatory action design over a period of three years. Next, we discuss the usability tests of the KNRC self-feeding robots. People with disabilities participated in comparative tests between the KNRC self-feeding robot and the commercialized product named My Spoon. The KNRC self-feeding robot showed positive results in relation to satisfaction and performance compared to the commercialized robot when users ate Korean food, including sticky rice.

Semi-manual mastoidectomy assisted by human-robot collaborative control - A temporal bone replica study.

PubMed

Lim, Hoon; Matsumoto, Nozomu; Cho, Byunghyun; Hong, Jaesung; Yamashita, Makoto; Hashizume, Makoto; Yi, Byung-Ju

2016-04-01

To develop an otological robot that can protect important organs from being injured. We developed a five degree-of-freedom robot for otological surgery. Unlike the other robots that were reported previously, our robot does not replace surgeon's procedures, but instead utilizes human-robot collaborative control. The robot basically releases all of the actuators so that the surgeon can manipulate the drill within the robot's working area with minimal restriction. When the drill reaches a forbidden area, the surgeon feels as if the drill hits a wall. When an engineer performed mastoidectomy using the robot for assistance, the facial nerve in the segmented region was always protected with a more than 2.5mm margin, which was almost the same as the pre-set safety margin of 3mm. Semi-manual drilling using human-robot collaborative control was feasible, and may hold a realistic prospect of clinical use in the near future. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Safety of robotic-assisted treadmill therapy in children and adolescents with gait impairment: a bi-centre survey.

PubMed

Borggraefe, Ingo; Klaiber, Mirjam; Schuler, Tabea; Warken, Birgit; Schroeder, Sebastian Alexander; Heinen, Florian; Meyer-Heim, Andreas

2010-01-01

The aim of the present study was to report on adverse events encountered with robotic-assisted treadmill therapy in children and adolescents with gait disorders. Eighty-nine patients who underwent a trial of robotic assisted treadmill therapy in the two participating centres were analysed. Demographic data and safety data of the patients were analysed using descriptive statistics. In 38 (42.7%) out of 89 patients, adverse events were documented. Most commonly, mild skin erythema at the sites of the cuffs of the device and muscle pain were encountered. In five patients (5.6%), open skin lesions (n = 2), joint pain (n = 2) or tendinopathy (n = 1) limited the continuation of the therapy with the Lokomat. No severe side-effects emerged. Robotic assisted treadmill therapy is a safe method to enable longer periods of gait therapy in children and adolescents with gait disorders.

Robot-assisted excision of cervical cystic hygroma through a retroauricular hairline approach: a case report.

PubMed

Lin, Frank Cheau-Feng; Yang, Tsung-Lin; Tung, Min-Che; Tsai, Stella Chin-Shaw

2016-06-09

Cystic hygroma is a rare benign abnormality of the lymphatic system generally occurring in young children less than 2 years old. The standard transcervical surgical treatment of cystic hygroma may often leave a permanent scar in the neck region. We report a case of cystic hygroma in a 19-month-old Asian baby girl successfully treated with robot-assisted excision through a hairline neck-lift approach. We present the use of the Yang's retractor as an instrumental advancement to this surgical approach. Treatment options for cystic hygroma may be surgical or nonsurgical. We report a case of cystic hygroma in a 19-month-old child successfully treated with robot-assisted excision through a small concealed retroauricular hairline approach. This is the first report in the medical literature of treating cystic hygroma with a minimally invasive robot-assisted excision via a small, concealed, hairline incision.

Urinary tract-related quality of life after radical prostatectomy: open retropubic versus robot-assisted laparoscopic approach.

PubMed

Froehner, Michael; Koch, Rainer; Leike, Steffen; Novotny, Vladimir; Twelker, Lars; Wirth, Manfred P

2013-01-01

The best technique of radical prostatectomy--open retropubic versus robot-assisted surgery--is a subject of controversy. Between January 1st, 2007 and December 31st, 2011, 2,177 men underwent radical prostatectomy at our department. 252 (12%) cases were laparoscopic robot-assisted, the remainder open retropubic procedures. In Germany, certified prostate cancer centers are required to collect urinary tract-related outcome data after radical prostatectomy using the International Consultation of Incontinence Questionnaire Male Lower Urinary Tract Symptoms. The questionnaire data were used to compare both surgical approaches concerning the urinary tract-related outcome 1, 2 and 3 years postoperatively. Neither the voiding score nor the incontinence score or the bother scale sum differed between the two cohorts at any of the measurement times. Concerning continence recovery, in this series, there were no detectable differences between robot-assisted and open radical prostatectomy. Copyright © 2012 S. Karger AG, Basel.

Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

ERIC Educational Resources Information Center

Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela

2016-01-01

Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

24 CFR 5.363 - Housing programs: Protection of the pet.

Code of Federal Regulations, 2011 CFR

2011-04-01

... pet. 5.363 Section 5.363 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.363 Housing programs...

24 CFR 5.363 - Housing programs: Protection of the pet.

Code of Federal Regulations, 2014 CFR

2014-04-01

... pet. 5.363 Section 5.363 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.363 Housing programs...

24 CFR 5.363 - Housing programs: Protection of the pet.

Code of Federal Regulations, 2010 CFR

2010-04-01

... pet. 5.363 Section 5.363 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.363 Housing programs...

24 CFR 5.363 - Housing programs: Protection of the pet.

Code of Federal Regulations, 2013 CFR

2013-04-01

... pet. 5.363 Section 5.363 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.363 Housing programs...

24 CFR 5.363 - Housing programs: Protection of the pet.

Code of Federal Regulations, 2012 CFR

2012-04-01

... pet. 5.363 Section 5.363 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.363 Housing programs...

Trocar-site hernia at the 8-mm robotic port after robot-assisted laparoscopic prostatectomy: a case report and review of the literature.

PubMed

Tsu, James Hok-Leung; Ng, Ada Tsui-Lin; Wong, Jason Ka-Wing; Wong, Edmond Ming-Ho; Ho, Kwan-Lun; Yiu, Ming-Kwong

2014-03-01

Trocar-site hernia is an uncommon but serious complication after laparoscopic surgery as it frequently requires surgical intervention. We describe a 75-year-old man with Gleason score 4 + 3, clinical stage T1c prostate adenocarcinoma who underwent an uneventful robot-assisted transperitoneal laparoscopic radical prostatectomy. On post-operative day four, he developed symptoms of small bowel obstruction due to herniation and incarceration of the small bowels in a Spigelian-type hernia at the left lower quadrant 8-mm trocar site. Surgical exploration was performed via a mini-laparotomy to reduce the bowel and repair the fascial layers. A literature search was performed to review other cases of trocar-site hernia through the 8-mm robotic port after robot-assisted surgery and the suggested methods of prevention.

3D force control for robotic-assisted beating heart surgery based on viscoelastic tissue model.

PubMed

Liu, Chao; Moreira, Pedro; Zemiti, Nabil; Poignet, Philippe

2011-01-01

Current cardiac surgery faces the challenging problem of heart beating motion even with the help of mechanical stabilizer which makes delicate operation on the heart surface difficult. Motion compensation methods for robotic-assisted beating heart surgery have been proposed recently in literature, but research on force control for such kind of surgery has hardly been reported. Moreover, the viscoelasticity property of the interaction between organ tissue and robotic instrument further complicates the force control design which is much easier in other applications by assuming the interaction model to be elastic (industry, stiff object manipulation, etc.). In this work, we present a three-dimensional force control method for robotic-assisted beating heart surgery taking into consideration of the viscoelastic interaction property. Performance studies based on our D2M2 robot and 3D heart beating motion information obtained through Da Vinci™ system are provided.

The immediate intervention effects of robotic training in patients after anterior cruciate ligament reconstruction.

PubMed

Hu, Chunying; Huang, Qiuchen; Yu, Lili; Ye, Miao

2016-07-01

[Purpose] The purpose of this study was to examine the immediate effects of robot-assisted therapy on functional activity level after anterior cruciate ligament reconstruction. [Subjects and Methods] Participants included 10 patients (8 males and 2 females) following anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy and treadmill exercise on different days. The Timed Up-and-Go test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and maximal extensor strength of isokinetic movement of the knee joint were evaluated in both groups before and after the experiment. [Results] The results for the Timed Up-and-Go Test and the 10-Meter Walk Test improved in the robot-assisted rehabilitation group. Surface electromyography of the vastus medialis muscle showed significant increases in maximum and average discharge after the intervention. [Conclusion] The results suggest that walking ability and muscle strength can be improved by robotic training.

NASA Project Constellation Systems Engineering Approach

NASA Technical Reports Server (NTRS)

Dumbacher, Daniel L.

2005-01-01

NASA's Office of Exploration Systems (OExS) is organized to empower the Vision for Space Exploration with transportation systems that result in achievable, affordable, and sustainable human and robotic journeys to the Moon, Mars, and beyond. In the process of delivering these capabilities, the systems engineering function is key to implementing policies, managing mission requirements, and ensuring technical integration and verification of hardware and support systems in a timely, cost-effective manner. The OExS Development Programs Division includes three main areas: (1) human and robotic technology, (2) Project Prometheus for nuclear propulsion development, and (3) Constellation Systems for space transportation systems development, including a Crew Exploration Vehicle (CEV). Constellation Systems include Earth-to-orbit, in-space, and surface transportation systems; maintenance and science instrumentation; and robotic investigators and assistants. In parallel with development of the CEV, robotic explorers will serve as trailblazers to reduce the risk and costs of future human operations on the Moon, as well as missions to other destinations, including Mars. Additional information is included in the original extended abstract.

Surgical energy device using steam jet for robotic assisted surgery.

PubMed

Yoshiki, Hitoshi; Tadano, Kotaro; Ban, Daisuke; Ohuchi, Katsuhiro; Tanabe, Minoru; Kawashima, Kenji

2015-01-01

In robotic assisted surgery, the carbonization and the adherence of coagulated tissues caused by surgical energy devices are problems. We propose a surgical energy device using a steam jet to solve the problems. The device applies a steam jet and performs coagulation and hemostasis. The exposed tissue is heated quickly with latent heat of the steam. The carbonization and the adherence of the tissue can be avoided. We prototyped a steam jet coagulator to prove the concept. The coagulator was mounted on the laparoscopic surgical robot. The effectiveness of the coagulation and hemostasis using steam was confirmed by the in vitro experiment on the chicken's liver and the in vivo experiments on the pig's spleen under the robotic assisted laparoscopic environment.

Human-Robot Planetary Exploration Teams

NASA Technical Reports Server (NTRS)

Tyree, Kimberly

2004-01-01

The EVA Robotic Assistant (ERA) project at NASA Johnson Space Center studies human-robot interaction and robotic assistance for future human planetary exploration. Over the past four years, the ERA project has been performing field tests with one or more four-wheeled robotic platforms and one or more space-suited humans. These tests have provided experience in how robots can assist humans, how robots and humans can communicate in remote environments, and what combination of humans and robots works best for different scenarios. The most efficient way to understand what tasks human explorers will actually perform, and how robots can best assist them, is to have human explorers and scientists go and explore in an outdoor, planetary-relevant environment, with robots to demonstrate what they are capable of, and roboticists to observe the results. It can be difficult to have a human expert itemize all the needed tasks required for exploration while sitting in a lab: humans do not always remember all the details, and experts in one arena may not even recognize that the lower level tasks they take for granted may be essential for a roboticist to know about. Field tests thus create conditions that more accurately reveal missing components and invalid assumptions, as well as allow tests and comparisons of new approaches and demonstrations of working systems. We have performed field tests in our local rock yard, in several locations in the Arizona desert, and in the Utah desert. We have tested multiple exploration scenarios, such as geological traverses, cable or solar panel deployments, and science instrument deployments. The configuration of our robot can be changed, based on what equipment is needed for a given scenario, and the sensor mast can even be placed on one of two robot bases, each with different motion capabilities. The software architecture of our robot is also designed to be as modular as possible, to allow for hardware and configuration changes. Two focus areas of our research are safety and crew time efficiency. For safety, our work involves enabling humans to reliably communicate with a robot while moving in the same workspace, and enabling robots to monitor and advise humans of potential problems. Voice, gesture, remote computer control, and enhanced robot intelligence are methods we are studying. For crew time efficiency, we are investigating the effects of assigning different roles to humans and robots in collaborative exploration scenarios.

User-centric design of a personal assistance robot (FRASIER) for active aging.

PubMed

Padir, Taşkin; Skorinko, Jeanine; Dimitrov, Velin

2015-01-01

We present our preliminary results from the design process for developing the Worcester Polytechnic Institute's personal assistance robot, FRASIER, as an intelligent service robot for enabling active aging. The robot capabilities include vision-based object detection, tracking the user and help with carrying heavy items such as grocery bags or cafeteria trays. This work-in-progress report outlines our motivation and approach to developing the next generation of service robots for the elderly. Our main contribution in this paper is the development of a set of specifications based on the adopted user-centered design process, and realization of the prototype system designed to meet these specifications.

Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis.

PubMed

van der List, Jelle P; Chawla, Harshvardhan; Joskowicz, Leo; Pearle, Andrew D

2016-11-01

Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.

Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair.

PubMed

Dangle, Pankaj P; Kearns, James; Anderson, Blake; Gundeti, Mohan S

2013-12-01

Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach. We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria. Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10). In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Effect of body weight support variation on muscle activities during robot assisted gait: a dynamic simulation study.

PubMed

Hussain, Shahid; Jamwal, Prashant K; Ghayesh, Mergen H

2017-05-01

While body weight support (BWS) intonation is vital during conventional gait training of neurologically challenged subjects, it is important to evaluate its effect during robot assisted gait training. In the present research we have studied the effect of BWS intonation on muscle activities during robotic gait training using dynamic simulations. Two dimensional (2-D) musculoskeletal model of human gait was developed conjointly with another 2-D model of a robotic orthosis capable of actuating hip, knee and ankle joints simultaneously. The musculoskeletal model consists of eight major muscle groups namely; soleus (SOL), gastrocnemius (GAS), tibialis anterior (TA), hamstrings (HAM), vasti (VAS), gluteus maximus (GLU), uniarticular hip flexors (iliopsoas, IP), and Rectus Femoris (RF). BWS was provided at levels of 0, 20, 40 and 60% during the simulations. In order to obtain a feasible set of muscle activities during subsequent gait cycles, an inverse dynamics algorithm along with a quadratic minimization algorithm was implemented. The dynamic parameters of the robot assisted human gait such as joint angle trajectories, ground contact force (GCF), human limb joint torques and robot induced torques at different levels of BWS were derived. The patterns of muscle activities at variable BWS were derived and analysed. For most part of the gait cycle (GC) the muscle activation patterns are quite similar for all levels of BWS as is apparent from the mean of muscle activities for the complete GC. Effect of BWS variation during robot assisted gait on muscle activities was studied by developing dynamic simulation. It is expected that the proposed dynamic simulation approach will provide important inferences and information about the muscle function variations consequent upon a change in BWS during robot assisted gait. This information shall be quite important while investigating the influence of BWS intonation on neuromuscular parameters of interest during robotic gait training.

Robotic-Assisted Laparoscopic Cervicovaginal Myomectomy.

PubMed

Javadian, Pouya; Juusela, Alexander; Nezhat, Farr

2018-03-28

To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy. Step-wise instruction using video and case report (Canadian Task Force classification III). A tertiary referral center. A 39-year-old woman. Robotic-assisted laparoscopy resection of leiomyoma. A 39-year-old woman, gravida 0, body mass index of 23.0 kg/m 2 , with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100 mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding. Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Robotic-assisted Laparoscopic Repair of Scrotal Inguinal Hernias.

PubMed

Yheulon, Christopher G; Maxwell, Daniel W; Balla, Fadi M; Patel, Ankit D; Lin, Edward; Stetler, Jamil L; Davis, Steven S

2018-06-01

Scrotal inguinal hernias represent a challenging surgical pathology. Although some advanced laparoscopists can repair these hernias through a minimally invasive approach, open repair is considered the technique of choice for most surgeons. The purpose of this study is to show our results of robotic-assisted laparoscopic repair of scrotal inguinal hernias. We reviewed the charts of 14 patients with inguinoscrotal hernias who underwent robotic-assisted transabdominal preperitoneal (TAPP) hernia repair. Mean follow-up was 7 months. The European Registry for Abdominal Wall Hernia Quality of Life score, a 90-point scale, was utilized to quantify patient reported outcomes. Robotic TAPP repair was successful in all 14 patients. Average case duration was 100 minutes (78 to 140 min) for unilateral hernias and 208 minutes (166 to 238 min) for bilateral hernias. Trainees were involved in 93% (13/14) of cases. There were no recurrences. Three patients developed postoperative seromas. The mean European Registry for Abdominal Wall Hernia Quality of Life score was 3.7 (0 to 10). Scrotal hernias can be safely repaired using robotic-assisted TAPP methods with low morbidity and favorable patient reported outcomes.

Overview of Robotic Devices for Nursing Care Project.

PubMed

Hirukawa, Hirohisa

2017-01-01

METI/AMED are conducting a project on the development and deployment of robotic devices for nursing care to enhance the autonomy of elderly persons and assist care givers. An evaluation protocol is presented and the devices developed in the project are introduced. The devices consist of transfer assist devices (wearable/non-wearable), walking assist devices (outdoor/indoor), safety surveillance sensors (nursing home/private home), bath lift and toilet assist.

Role of expressive behaviour for robots that learn from people.

PubMed

Breazeal, Cynthia

2009-12-12

Robotics has traditionally focused on developing intelligent machines that can manipulate and interact with objects. The promise of personal robots, however, challenges researchers to develop socially intelligent robots that can collaborate with people to do things. In the future, robots are envisioned to assist people with a wide range of activities such as domestic chores, helping elders to live independently longer, serving a therapeutic role to help children with autism, assisting people undergoing physical rehabilitation and much more. Many of these activities shall require robots to learn new tasks, skills and individual preferences while 'on the job' from people with little expertise in the underlying technology. This paper identifies four key challenges in developing social robots that can learn from natural interpersonal interaction. The author highlights the important role that expressive behaviour plays in this process, drawing on examples from the past 8 years of her research group, the Personal Robots Group at the MIT Media Lab.

24 CFR 5.356 - Housing programs: Pet rule violation procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Housing programs: Pet rule... of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.356 Housing...

24 CFR 5.356 - Housing programs: Pet rule violation procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Housing programs: Pet rule... of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.356 Housing...

24 CFR 5.356 - Housing programs: Pet rule violation procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Housing programs: Pet rule... of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.356 Housing...

24 CFR 5.356 - Housing programs: Pet rule violation procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Housing programs: Pet rule... of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.356 Housing...

24 CFR 5.356 - Housing programs: Pet rule violation procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Housing programs: Pet rule... of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.356 Housing...

Bilateral simultaneous robot-assisted pyelolithotomy for large (>6 cm) kidney stones: technique and review of literature.

PubMed

Rajiv, Yadav; Kumar, Abhay; Poonam, Yadav

2015-09-01

With wide availability and demonstrable efficacy of endourological techniques, open surgery for renal stone disease has largely been replaced in contemporary urological practice. However, with increasing experience of laparoscopy and robotic surgery in urology, the principle of open renal surgery is being revisited. In certain situations, laparoscopic or robotic pyelolithomy may be an excellent minimally invasive alternative to percutaneous nephrolithomy with its unique advantages. We present a case of bilateral large kidney stones managed with bilateral simultaneous robot-assisted laparoscopic pyelolithotomy with excellent results.

Challenges in the Anesthetic Management for a Robotic Thymectomy in a Patient With Myasthenia Gravis: A Case Report.

PubMed

Martinelli, Susan M; Lateef, Bilal D; Long, Jason M; Huang, David Y; Karmarkar, Ameeta; Barrick, Brian P

2017-05-01

We describe the case of a patient with myasthenia gravis undergoing a robotic-assisted thymectomy complicated by postoperative myasthenic crisis, with a focus on the anesthetic considerations specific to this case. Because myasthenia gravis is an autoimmune disease affecting acetylcholine receptors, caution must be taken with the use of neuromuscular blockade and reversal. Utilizing a robotic-assisted surgical approach makes anesthetic management challenging given the dangers of patient movement while the robot is docked, lung isolation, extubation criteria, and postoperative disposition.

Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer.

PubMed

Carli, Franco; Brown, Russell; Kennepohl, Stephan

2012-08-01

Postoperative complications represent a major concern for elderly patients. We report a case of a medically complex and frail 88-yr-old woman with endometrial cancer who was scheduled for a robotic-assisted total abdominal hysterectomy. In addition to her cardiac morbidity she presented with several risk factors for neurocognitive decline, including prior episodes of postoperative delirium. The patient underwent functional, nutritional, and neuropsychological assessments prior to a three-week prehabilitation home-based program consisting of strength and endurance exercises as well as nutritional optimization. Remarkably, there were no episodes of postoperative confusion, and over the following eight weeks, she continued to show sustained improvement in exercise tolerance (as per the six-minute walk test), cognitive function (as per the Repeatable Battery for the Assessment of Neuropsychological Status), and overall functional capacity (Short Form-36). This report provides suggestive evidence that a prehabilitation program optimized the health of this elderly patient and may have prevented a further episode of postoperative delirium. Prehabilitation protocols should be evaluated in clinical trials to evaluate their efficacy and the target populations who may benefit and to elucidate the underlying mechanisms responsible for enhanced recovery in the perioperative setting.

Performance-based robotic assistance during rhythmic arm exercises.

PubMed

Leconte, Patricia; Ronsse, Renaud

2016-09-13

Rhythmic and discrete upper-limb movements are two fundamental motor primitives controlled by different neural pathways, at least partially. After stroke, both primitives can be impaired. Both conventional and robot-assisted therapies mainly train discrete functional movements like reaching and grasping. However, if the movements form two distinct neural and functional primitives, both should be trained to recover the complete motor repertoire. Recent studies show that rhythmic movements tend to be less impaired than discrete ones, so combining both movement types in therapy could support the execution of movements with a higher degree of impairment by movements that are performed more stably. A new performance-based assistance method was developed to train rhythmic movements with a rehabilitation robot. The algorithm uses the assist-as-needed paradigm by independently assessing and assisting movement features of smoothness, velocity, and amplitude. The method relies on different building blocks: (i) an adaptive oscillator captures the main movement harmonic in state variables, (ii) custom metrics measure the movement performance regarding the three features, and (iii) adaptive forces assist the patient. The patient is encouraged to improve performance regarding these three features with assistance forces computed in parallel to each other. The method was tested with simulated jerky signals and a pilot experiment with two stroke patients, who were instructed to make circular movements with an end-effector robot with assistance during half of the trials. Simulation data reveal sensitivity of the metrics for assessing the features while limiting interference between them. The assistance's effectiveness with stroke patients is established since it (i) adapts to the patient's real-time performance, (ii) improves patient motor performance, and (iii) does not lead the patient to slack. The smoothness assistance was by far the most used by both patients, while it provided no active mechanical work to the patient on average. Our performance-based assistance method for training rhythmic movements is a viable candidate to complement robot-assisted upper-limb therapies for training a larger motor repertoire.

The role of the assistant during robot-assisted partial nephrectomy: does experience matter?

PubMed

Potretzke, Aaron M; Knight, Brent A; Brockman, John A; Vetter, Joel; Figenshau, Robert S; Bhayani, Sam B; Benway, Brian M

2016-06-01

The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center.

Outcomes and costs associated with robotic colectomy in the minimally invasive era.

PubMed

Tyler, Joshua A; Fox, Justin P; Desai, Mayur M; Perry, W Brian; Glasgow, Sean C

2013-04-01

Robotic-assisted surgery has become increasingly common; however, it is unclear if its use for colectomy improves in-hospital outcomes compared with the laparoscopic approach. The aim of the study is to compare in-hospital outcomes and costs between patients undergoing robotic or laparoscopic colectomy. This study is a retrospective review of the 2008 to 2009 Nationwide Inpatient Sample. SETTINGS, PATIENTS, INTERVENTIONS: All adult patients who underwent an elective robotic or laparoscopic colectomy in hospitals performing both procedures (N = 2583 representing an estimated 12,732 procedures) were included. Outcomes included intraoperative and postoperative complications, length of stay, and direct costs of care. Regression models were used to compare these outcomes between procedural approaches while controlling for baseline differences in patient characteristics. Overall, 6.1% of patients underwent a robotic procedure. Factors associated with robotic-assisted colectomy included younger age, benign diagnoses, and treatment at a lower-volume center. Patients undergoing robotic and laparoscopic procedures experienced similar rates of intraoperative (3.0% vs 3.3%; adjusted OR = 0.88 (0.35-2.22)) and postoperative (21.7% vs 21.6%; adjusted OR = 0.84 (0.54-1.30)) complications, as well as risk-adjusted average lengths of stay (5.4 vs 5.5 days, p = 0.66). However, robotic-assisted colectomy resulted in significantly higher costs of care ($19,231 vs $15,807, p < 0.001). Although the overall postoperative morbidity rate was similar between groups, the individual complications experienced by each group were different. A limitation of this study is the potential miscoding of robotic cases in administrative data. Robotic-assisted colectomy significantly increases the costs of care without providing clear reductions in overall morbidity or length of stay. As the use of robotic technology in colon surgery continues to evolve, critical appraisal of the benefits offered in comparison with the resources consumed is required.

A novel technique for robot assisted latissimus dorsi flap harvest.

PubMed

Chung, Jae-Hyun; You, Hi-Jin; Kim, Hyon-Surk; Lee, Byung-Il; Park, Seung-Ha; Yoon, Eul-Sik

2015-07-01

A robotic surgery technique of harvesting the latissimus dorsi muscle flap has technical advantages over endoscopic harvest and cosmetic advantages over the open technique. The authors introduce a new transaxillary gasless technique using an articulated long retractor for robot assisted latissimus dorsi flap harvest. Twelve robot assisted latissimus dorsi muscle flaps were harvested: 3 cases of delayed reconstruction following tissue expander insertion or breast conserving surgery; 4 cases of immediate reconstruction following nipple-sparing mastectomy; and 5 cases of chest wall deformity correction in patients with Poland syndrome. A specially designed articulated long retractor was used to maintain adequate working space and enable latissimus dorsi muscle dissection without gas insufflation. Twelve muscle flaps were successfully harvested in 12 patients without converting to an open technique. The mean docking time was 54.6 min, and the mean operative time and robotic time were 400.4 min and 85.8 min, respectively. There were no donor site complications or flap problems. Average follow-up was 15.7 months. All patients were satisfied with their esthetic results, especially the absence of visible scars. The novel robot assisted latissimus dorsi harvest technique is a safe alternative to the conventional method. Copyright © 2015. Published by Elsevier Ltd.

Put Your Robot In, Put Your Robot Out: Sequencing through Programming Robots in Early Childhood

ERIC Educational Resources Information Center

Kazakoff, Elizabeth R.; Bers, Marina Umaschi

2014-01-01

This article examines the impact of programming robots on sequencing ability in early childhood. Thirty-four children (ages 4.5-6.5 years) participated in computer programming activities with a developmentally appropriate tool, CHERP, specifically designed to program a robot's behaviors. The children learned to build and program robots over three…

Robotic surgery in children: adopt now, await, or dismiss?

PubMed

Cundy, Thomas P; Marcus, Hani J; Hughes-Hallett, Archie; Khurana, Sanjeev; Darzi, Ara

2015-12-01

The role of robot-assisted surgery in children remains controversial. This article aims to distil this debate into an evidence informed decision-making taxonomy; to adopt this technology (1) now, (2) later, or (3) not at all. Robot-assistance is safe, feasible and effective in selected cases as an adjunctive tool to enhance capabilities of minimally invasive surgery, as it is known today. At present, expectations of rigid multi-arm robotic systems to deliver higher quality care are over-estimated and poorly substantiated by evidence. Such systems are associated with high costs. Further comparative effectiveness evidence is needed to define the case-mix for which robot-assistance might be indicated. It seems unlikely that we should expect compelling patient benefits when it is only the mode of minimally invasive surgery that differs. Only large higher-volume institutions that share the robot amongst multiple specialty groups are likely to be able to sustain higher associated costs with today's technology. Nevertheless, there is great potential for next-generation surgical robotics to enable better ways to treat childhood surgical diseases through less invasive techniques that are not possible today. This will demand customized technology for selected patient populations or procedures. Several prototype robots exclusively designed for pediatric use are already under development. Financial affordability must be a high priority to ensure clinical accessibility.

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.

Electroencephalography (EEG) Based Control in Assistive Mobile Robots: A Review

NASA Astrophysics Data System (ADS)

Krishnan, N. Murali; Mariappan, Muralindran; Muthukaruppan, Karthigayan; Hijazi, Mohd Hanafi Ahmad; Kitt, Wong Wei

2016-03-01

Recently, EEG based control in assistive robot usage has been gradually increasing in the area of biomedical field for giving quality and stress free life for disabled and elderly people. This study reviews the deployment of EGG based control in assistive robots, especially for those who in need and neurologically disabled. The main objective of this paper is to describe the methods used for (i) EEG data acquisition and signal preprocessing, (ii) feature extraction and (iii) signal classification methods. Besides that, this study presents the specific research challenges in the designing of these control systems and future research directions.

Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy.

PubMed

Cornejo-Dávila, V; Nazmy, M; Kella, N; Palmeros-Rodríguez, M A; Morales-Montor, J G; Pacheco-Gahbler, C

2016-04-01

Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. To demonstrate the implementation of fluorescence in nephron-sparing surgery. This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.