三站进阶模式在机器人前列腺癌根治术培训中的应用价值

目的探讨体外模型+虚拟现实+实际操作三站进阶模式在机器人辅助前列腺癌根治术培训中的应用价值。 方法第一站：体外模型训练。受训者在体外模型上进行端端吻合培训,使用Test T、Test R两种不同的评价方法对受训者进行评分。第二站：机器人虚拟现实培训。采用虚拟培训技术培训受训者,评价培训前后指标的变化。第三站：机器人体内操作。受训者与对照组医师进行机器人辅助膀胱尿道吻合,应用膀胱注水试验,评价吻合的可靠性。 结果第一站中,6名受训者总体得分显著提高（P=0.004）,由训练前的（50.0±10.5）提高至（79.2±9.7）;吻合时间明显缩短（P<0.001）,由（654.5±24.7）s降至（331.0±36.6）s。第二站中,6名受训者的总体分数显著提高（P<0.001）,由训练前的（35.3±3.1）提高至（86.0±4.2）;吻合时间显著下降（P<0.001）,由（345.5±31.2）s降至（170.0±7.4）s。第三站中,6名受训者在上级医师的指导下均顺利完成膀胱尿道吻合,相比6名对照组医师平均吻合时间由（40.7±8.6）min缩短至（27.5±8.4） min（P=0.023）。在膀胱注水试验中,受训者组未发现吻合口漏水情况,对照组有2例发生漏水情况,由上级医师进行了补救性缝合。 结论三站进阶模式能够快速缩短术者机器人前列腺癌根治术学习曲线,有利于在我国有限的机器人设备情况下推广。     

一种辅助进餐机器人的结构设计与性能分析EI北大核心CSCD

本文针对服务护理领域对专用辅助护理设备的需求,结合TRIZ理论思想设计一种可实现仿人喂食功能的辅助进餐机器人。该机器人本体采用串联关节型机械手臂模拟人体手臂运动,实现进餐时移位功能;末端采用电机驱动勺柄构件进行往复运动,模拟人体手部送喂动作实现进餐功能;整体采用眼在手上安装方式模拟人类视觉,实现基于视觉信息的机械手自动送喂功能。综合考虑辅助进餐机器人的喂食功能及其与人交互时的相对位置关系,满足最低自由度配置下具备空间上的运动灵活性,在此条件下确定辅助进餐机器人的结构,分析其受力情况,对具体应用场景适宜位置进行讨论说明。仿真结果表明所设计的辅助进餐机器人能够在低自由度配置下,满足工作空间运动灵活性的需求。     

Socially assistive robots for people with dementia: Systematic review and meta-analysis of feasibility,acceptability and the effect on cognition,neuropsychiatric symptoms and quality of life

BackgroundThere is increasing interest in using robots to support dementia care but little consensus on the evidence for their use. The aim of the study is to review evidence about feasibility, acceptability and clinical effectiveness of socially assistive robots used for people with dementia.MethodWe conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, PsychINFO, CINHAL, IEEE Xplore Digital Library, and EI Engineering Village from inception to 04 − 02–2022 - included primary studies assessing feasibility, acceptability, or effectiveness of socially assistive robots for people with dementia. Two independent reviewers screened studies for eligibility, and assessed quality. Narrative synthesis prioritized higher quality studies, and random-effect meta-analyses compared robots with usual care (UC) or active control (AC) immediately after the intervention (short-term; ST) or long-term (LT) on cognition, neuropsychiatric symptoms, and quality of life.Findings66 studies and four categories of robots were eligible: Companion robots (Pet and humanoid companion robots), telepresence communication robots, homecare assistive robots and multifunctional robots. PARO (companion robot seal) was feasible and acceptable but limited by its weight, cost, and sound. On meta-analysis, PARO had no ST or LT compared to UC or AC over 5–12 weeks on agitation (ST vs UC, 4 trials, 153 participants: pooled standardized mean difference (SMD) 0.25; − 0.57 to 0.06; LT vs UC; 2 trials, 77 participants, SMD = −0.24; − 0.94, 0.46), cognition (ST vs UC, 3 trials, 128 participants: SMD= 0.03; −0.32, 0.38), overall neuropsychiatric symptoms (ST vs UC, 3 trials, 169 participants: SMD= −0.01; −0.32, 0.29; ST vs AC, 2 trials, 145 participants: SMD =0.02, −0.71, 0.85), apathy (ST vs AC, 2 trials, 81 participants: SMD= 0.14; 0.29, 0.58), depression (ST vs UC, 4 trials, 181 participants; SMD= 0.08; −0.52, 0.69; LT vs UC: 2 trials, 77 participants: SMD =0.01; −0.75, 0.77), anxiety (ST vs UC: 2 trials, 104 participants, SMD= 0.24; −0.85, 1.33) and quality of life (ST vs UC, 2 trials, 127 participants: SMD=−0.05; −0.52, 0.42; ST vs AC: 2 trials, 159 participants, SMD =−0.36, −0.76, 0.05). Robotic animals, humanoid companion robots, telepresence robots and multifunctional robots were feasible and acceptable. However, humanoid companion robots have speech recognition problems, and telepresence robots and multifunctional robots were often difficult to use. There was mixed evidence about the feasibility of homecare robots. There was little evidence on any of these robots’ effectiveness.ConclusionAlthough robots were generally feasible and acceptable, there is no clear evidence that people with dementia derive benefit from robots for cognition, neuropsychiatric symptoms, or quality of life. We recommend that future research should use high quality designs to establish evidence of effectiveness.     

Renal cavernous hemangioma: robot-assisted partial nephrectomy with selective warm ischemia. Case report and review of the literature

Renal hemangioma is a relatively rare benign tumor with a wide range of clinical and radiological presentation, not easy to differentiate preoperatively from a renal cancer. Due to its benign nature complete surgical resection is the recommended therapy and is considered curative.A 73-year old male patient followed-up for a lung carcinoma and a chronic renal failure underwent a CT scan showing a 35-mm mass of the inferior pole of the left kidney.The patient underwent robot-assisted partial nephrectomy with left inferior pole selective warm ischemia. The outcome was favorable and no repercussions on the renal reserve were observed postoperatively.Histopathological characteristics of the surgical specimen were consistent with renal cavernous hemangioma.A robot-assisted operation allows the fine dissection required to carry out a bloodless nephron-sparing surgery without a complete warm ischemia. The use of robot could be noteworthy for nephron-sparing surgery in cases of concomitant chronic renal failure.     

机器人辅助腹腔镜手术在泌尿外科的应用

近年来机器人辅助腹腔镜手术系统开展范围较广,技术较为成熟,正逐步应用于泌尿外科手术领域,目前可施行肾切除术、肾肿瘤剜除术、肾上腺肿瘤切除术、肾盂成形术、全膀胱切除术、前列腺癌根治术等,具有出血少、恢复快、住院时间短、并发症少等优点。本文就其在泌尿外科的应用作一综述。     

机器人手术发展历史回顾

外科微创化的发展衍变逐渐开创了机器人手术的时代。机器人手术具有空前的可控制性和精细性,创伤小,疼痛轻,恢复快,住院时间短,外观美容,优势突出,目前在普通外科、心脏外科、胸外科、神经外科、泌尿外科、妇产科、骨科、眼科等多个领域,得到了日益广泛的应用。21世纪初期手术机器人引进中国后,机器人手术得到了较快发展。     

Robot-assisted laparoscopic surgery of a 12-week scar pregnancy with temporary occlusion of the uterine blood supply

A Cesarean section scar pregnancy is a serious obstetric complication. For all treatment modalities there are risks of heavy bleeding and emergency hysterectomy. Here we report the use of the da Vinci robot for removal of the pregnancy with adequate bleeding control. A 36-year-old para-3 was diagnosed having a 11 + 3 week live cesarean scar pregnancy and a complete placenta previa. S-hCG was 52 726 IU/l. One week after methotrexate treatment the pregnancy was uneventfully and completely removed by robot-assisted laparoscopy with minimal blood loss. The uterine defect was repaired. Bleeding was controlled by temporary application of metal clips to the distal internal iliac arteries and the propria ligaments. Postoperative color Doppler ultrasonography revealed normal uterine blood flow, a repaired uterine defect, and no remaining pregnancy tissue. S-hCG was normalized (<3 IU/l) 38 days after surgery. Robot-assisted laparoscopic surgery with temporary occlusion of the main uterine blood supply is a feasible and safe technique for surgery of a Cesarean scar pregnancy.     

Robot-assisted laparoscopic surgery of the infrarenal aorta

Background Recently introduced robot-assisted laparoscopic surgery (RALS) facilitates endoscopic surgical manipulation and thereby reduces the learning curve for (advanced) laparoscopic surgery. We present our learning curve with RALS for aortobifemoral bypass grafting as a treatment for aortoiliac occlusive disease. Methods Between February 2002 and May 2005, 17 patients were treated in our institution with robot-assisted laparoscopic aorto-bifemoral bypasses. Dissection was performed laparoscopically and the robot was used to make the aortic anastomosis. Operative time, clamping time, and anastomosis time, as well as blood loss and hospital stay, were used as parameters to evaluate the results and to compare the first eight (group 1) and the last nine patients (group2). Results Total median operative, clamping, and anastomosis times were 365 min (range: 225–589 min), 86 min (range: 25–205 min), and 41 min (range: 22–110 min), respectively. Total median blood loss was 1,000 ml (range: 100–5,800 ml). Median hospital stay was 4 days (range: 3–57 days). In this series 16/18 anastomoses were completed with the use of the robotic system. Three patients were converted (two in group 1, one in group 2), and one patient died postoperatively (group 1). Median clamping and anastomosis times were significantly different between groups 1 and 2 (111 min [range: 85–205 min] versus 57.5 min [range: 25–130 min], p < 0.01 and 74 min [range: 40–110 min] versus 36 min [range: 22–69 min], p < 0.01, respectively) Total operative time, blood loss, and hospital stay showed no significant difference between groups 1 and 2. Conclusions Robot-assisted aortic anastomosis was shown to have a steep learning curve with considerable reduction of clamping and anastomosis times. However, due to a longer learning curve for laparoscopic dissection of the abdominal aorta, operation times were not significantly shortened. Even with robotic assistance, laparoscopic aortoiliac surgery remains a complex procedure. Presented at SAGES 2006, April 26–29 2006, Dallas, Texas, USA An erratum to this article can be found at