机器人辅助颈淋巴清扫术的应用进展

机器人辅助手术因具有较传统微创技术更加可视、精确、灵活的优势而越来越广泛地应用于临床。颈淋巴清扫术作为头颈外科的经典术式之一,近年来也有单位开始在机器人辅助下对其进行尝试。本文就机器人手术的现状,机器人辅助颈淋巴清扫术的不同手术入路的应用进展、不足与前景等作一综述。     

Cost effectiveness of robot-assisted urologic oncological surgery in the United States

Urology has been on the forefront of technological advances in minimally invasive surgery, from laparoscopy to robot-assisted surgeries. As with all new technological advances in medicine, the results of new advances are compared to previously established gold standards. When it comes to robot-assisted urology, morbidity, oncological outcomes, and cost between the same surgeries performed in an open fashion vs with robot-assistance should be assessed. Because healthcare spending is increasingly under more scrutiny, there is debate on the cost effectiveness of robot-assisted surgeries given the high acquisition and maintenance cost of robotic systems. This articles aims to critically evaluate the cost effectiveness of robot-assisted surgeries for prostatectomies, cystectomies, and partial nephrectomies in the United States.     

智能机器人在抗击新冠肺炎疫情中的应用进展

〔摘 要〕 2019 年 12 月以来,新型冠状病毒肆虐全球,严重危害着人们的身体健康。智能机器人作为科学技术发 展的产物能够满足各种抗疫需求而应用于各类场景。智能机器人的应用不仅使工作人员的工作负担减轻了,而且减少 了交叉感染的风险;同时丰富了全社会的防疫知识,进而减少社会恐慌。智能机器人可顺应社会需求,因其精准、安 全、多功能的特性而很好发挥了作用,应用效果良好。     

颅颌面整形手术机器人在颏部水平截骨手术中的精确性分析

目的 探讨颅颌面整形手术机器人在颏部水平截骨手术中的应用效果和精确性.方法 回顾分析2015年1月至2020年12月接受传统颏部水平截骨手术的10例小颏畸形患者(临床组)的临床资料,并通过颅颌面整形手术机器人对该组患者1:1的3D石膏模型(机器人组)进行颏部水平截骨手术操作.以本团队前期实验研究数据标准为参考,利用数字...     

机器人辅助股骨干骨折复位的性能评价

目的通过制定并实验测定骨折复位机器人的性能指标,来评价机器人在股骨干骨折复位手术中的有效性和有用性。方法针对8例股骨模型骨,模拟股骨干骨折。采用C臂透视二维图像进行复位轨迹规划,采用股骨干骨折复位机器人进行复位操作。通过图像处理,获得复位后两段折骨之间的轴向偏移、径向(横向)偏移、折骨轴线之间的角度偏差等3个参数,来评价骨折复位效果。结果复位路径规划软件操作简单,机器人自主运行顺畅。两段折骨之间的轴向偏移量的均值为1.31mm,径向(横向)偏移量的均值为2.44mm,折骨轴线之间的角度偏差的均值为2.26°。结论机器人的复位精度满足临床要求,并能够有效维持复位状态;机器人复位过程中不需要额外的C臂成像,减少了射线辐射。     

CT-based manual segmentation and evaluation of paranasal sinuses

Manual segmentation of computed tomography (CT) datasets was performed for robot-assisted endoscope movement during functional endoscopic sinus surgery (FESS). Segmented 3D models are needed for the robots’ workspace definition. A total of 50 preselected CT datasets were each segmented in 150–200 coronal slices with 24 landmarks being set. Three different colors for segmentation represent diverse risk areas. Extension and volumetric measurements were performed. Three-dimensional reconstruction was generated after segmentation. Manual segmentation took 8–10 h for each CT dataset. The mean volumes were: right maxillary sinus 17.4 cm3, left side 17.9 cm3, right frontal sinus 4.2 cm3, left side 4.0 cm3, total frontal sinuses 7.9 cm3, sphenoid sinus right side 5.3 cm3, left side 5.5 cm3, total sphenoid sinus volume 11.2 cm3. Our manually segmented 3D-models present the patient’s individual anatomy with a special focus on structures in danger according to the diverse colored risk areas. For safe robot assistance, the high-accuracy models represent an average of the population for anatomical variations, extension and volumetric measurements. They can be used as a database for automatic model-based segmentation. None of the segmentation methods so far described provide risk segmentation. The robot’s maximum distance to the segmented border can be adjusted according to the differently colored areas.     

妇科腹腔镜治疗进展

随着理念的更新,器械的进步,经验的积累,技术的娴熟,涌现出自然腔道内镜外科、单孔腹腔镜手术、机器人手术等全新的妇科腹腔镜技术。传统的腹腔镜技术也在不断革新,无气腹腔镜手术是气腹腹腔镜的补充,腹腔镜子宫切除术和子宫肌瘤剔除术更注重适应证的选择和术者自身能力,腹腔镜输卵管保守性手术可获得较高的术后宫内妊娠率,窄带成像可提高腹腔镜下子宫内膜异位症的诊断准确率,腹腔镜治疗妇科恶性肿瘤几乎与开腹术相媲美,腹腔镜设备及器械的进步提高了腹腔镜手术的安全性。     

Neuro-rehabilitation robot-assisted assessments of synergy patterns of forearm,elbow and shoulder joints in chronic stroke patients

Background

Abnormal synergy is one of the major motor deficits in stroke patients. Abnormal muscle synergies, in conjunction with weakness and spasticity, interfere with voluntary movements and restrict the range of motion. This study aimed to quantify abnormal synergies in the affected upper limbs of chronic stroke patients by using a neuro-rehabilitation robot.

Methods

Twelve chronic stroke patients and eight age-matched control subjects were recruited to perform rectilinear tracking movements in four horizontal directions (back–forth, two oblique directions at 45°, and right–left). Kinematic, kinetic and electromyogram data were recorded and used to develop two biomechanical indices and one electromyogram assessment index based on principal component analysis.

Findings

Significant differences between upper limbs of control subjects and the affected side of stroke patients were observed in all three assessment indices. Higher correlation between the elbow joint angle and the forearm pronation/supination torque, higher variation of the forearm torque, and abnormal co-contraction of the elbow and shoulder muscles were observed in the affected limbs of stroke patients. The difference was more prominent in the right–left direction and the oblique direction contra-proximal to ipsi-distal.

Interpretation

The proposed assessment indices could be employed to quantify the abnormal synergies in stroke patients. Rectilinear tracking along the right–left direction and the oblique direction of contra-proximal to ipsi-distal is more suitable for assessing abnormal synergies.     

机器人辅助全口义齿排牙系统的初步研究

目的 研制机器人辅助制作全口义齿人工牙列的计算机系统。方法 利用CRS-450 6自由度机器人使被抓取的物体实现任意位置和姿态,研制可调式排牙器。用三维激光扫描测量系统获取无牙颌骨形态的几何参数。根据高级口腔修复专家排牙经验奸商的数学模型,用VC^ 和RAPL机器人语言编制了专家排牙、三维牙列模拟显示和机器人排牙控制程序。当排牙方案确定后,数据传给机器人,由机器人完成排牙器的定位工作,最终完成全口义齿人工牙列的制作。结果 建立了完整的机器人辅助全口义齿人工牙列制作系统。已用该系统为一例患者试作人工牙列。目前该牙列在咬合方面存在一些误差,尚需调整和完善。结论 首次实现了由机器人辅助制作人工牙列,具有科技进步意义。虽牙列在咬合方面还不十分理想,但实验结果已证明该系统的设计思想和技术路线是可行的。     

机器人辅助腹腔镜前列腺癌根治术的手术配合

目的探讨机器人辅助腹腔镜前列腺癌根治术的护理配合,提高护士的手术配合质量。方法对国内首次开展的16例机器人辅助腹腔镜前列腺癌根治手术配合进行总结分析。结果16例机器人辅助腹腔镜前列腺根治术顺利完成,无一例中转开腹。结论充分的术前准备和熟练的手术配合是机器人手术成功的重要因素。