Telemedical technologies in urological cancer care: past,present and future applications

Since the initial development of telegraphy by Sir Charles Wheatstone in 1837 and the telephone by Alexander Graham Bell in 1875, doctors have been able to convey medical information across great distances. The exchange and sharing of medical information has evolved and adapted to suit the vast array of today’s medicine. Early adopters of telemedicine within clinical practice have gained significant health economic benefits. The arrival of wireless connections has further enhanced the possibilities for all clinical work with focus on diagnosis, treatment and management of urological cancers, as highlighted in this article.     

Experience with a new OR dedicated to robotic surgery

Summary

The use of robotic technology for minimally-invasive cardiac surgery requires a new operating room (OR) environment. Remote surgery is performed by isolating the surgeon in a central control-room, while the surgical manipulator is located in the OR. Due to the complex nature of these new procedures and the limited access that, unlike in open cardiac surgery, no longer allows direct visualisation of the heart, extensive intra-operative monitoring is essential. The OR features an angiography unit that allows multidisciplinary procedures to be carried out in close collaboration with interventional cardiologists.     

The World's First Obesity Surgery Performed by a Surgeon at a Distance

Background: In recent years, laparoscopic procedures have gained popularity. The laparoscopic technique is, however, more difficult than the conventional approach, especially in obese patients. The purpose of this article is to demonstrate a solution to these difficulties. Method: On September 16, 1998, a laparoscopic gastric banding procedure was performed by a surgeon while he was actually sitting at a distance from his patient. The surgeon's assistant was scrubbed and gowned and stood at the patient's side. The surgeon manipulated handles that were connected to a computer in command of robotic arms mounted on the operating table near the patient. The robotic arms contained surgical tools with articulated tips, well inside the abdominal cavity. The system constituted a master-slave construction called Mona (Intuitive Surgical, Mountain View, CA). The entire procedure (adjustable silicone gastric banding) was performed solely by this system without any other intervention. Results: The entire procedure lasted 90 minutes. The blood loss was 25 mL. The patient left the hospital on the second postoperative day. Conclusion: This procedure demonstrates that telesurgical procedures are feasible, can be performed safely even in obese patients, and improve the surgeon's comfort by restoring ergonomically acceptable conditions, by increasing the number of degrees of freedom, and by recreating the eye-hand connection lost in videoendoscopic procedures.     

A robotic system for telementoring and training in laparoscopic surgery

A laparoscopic surgical training system, the LapaRobot, is introduced. The system is composed of an expert station and a trainee station connected through the Internet. Embedded actuators allow the trainee station to be driven by an expert surgeon so that a trainee learns proper technique through physical feedback. The surgical‐tool trajectory and video feed can be recorded and later “played back” to a trainee to hone operative skills through guided repetition without the need for expert supervision. The system is designed to create a high‐fidelity approximation of the intracorporeal workspace, incorporate commercially available surgical instruments, and provide a wealth of high‐resolution data for quantitative analysis and feedback. Experimental evaluation demonstrated a 55% improvement in surgical performance with use of our system. In this paper, we introduce the details of the design and fabrication of the LapaRobot, illustrate the mechatronics and software‐control schemes, and evaluate the system in a study.     

辅助内镜手术机器人系统的研究与关键技术

介绍了辅助内镜手术机器人系统的研究与开发现状 ,讨论了其进一步发展趋势———遥操作手术机器人系统和远程手术系统 ,并分析了发展上述系统的关键技术。     

Robotics and telesurgery – an update on their position in laparoscopic radical prostatectomy

Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D‐vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot‐assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice‐controlled camera‐arm (AESOP) as well as six telesurgical interventions with the da Vinci‐system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25° to 45°; the angles between the instrument and the working plane that should not exceed 55°; and the bi‐planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90° to 110°. 3‐D‐systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF).To date, more than 3000 laparoscopic radical prostatectomies have been performed worldwide at 92 centres with this system. The main advantage of the system represents the translation of open surgical skills to laparoscopy. Despite recent development of basic tools (e.g. bipolar forceps) for the da Vinci robot, investment and maintenance costs still represent the major problem of the device. Additionally, the device does not provide any haptic sense (i.e. tactile feedback). Robotic surgery represents a turning point of surgical research. However, broad use of robotic systems is limited mainly because of the high investment and running costs. Interestingly, more than in the field of cardiac surgery, there seems to be a need for telemanipulators in urology, mainly to reduce the learning curve of standard laparoscopy. However, new training concepts used in combination with mono‐tasking computerized robots (AESOP) have proved their efficacy associated with a significant cost reduction.     

Going live: implementing a telesurgery program

Telesurgery is the real-time transmission of surgery to an audience in a location separate from the OR suite. Staff members at Faulkner Hospital, Jamaica Plain, Massachusetts, established an annual telesurgery event as a method of teaching health care providers about specific orthopedic and gynecology procedures. In October 2009, staff members at Faulkner Hospital successfully completed five separate live transmissions during a four-day period. Extensive planning, attention to detail, and cooperation among team members and hospital service line members are essential to conducting a safe and successful telesurgery event.