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

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

Towards the development of a low-cost robotic arm with residual finger movement input

Abstract Robotics has been applied to the rehabilitation of patients suffering from upper limb-related diseases such as stroke, upper spinal cord injuries and neuromuscular diseases (e. g. muscular dystrophy) alone, or combined with appropriate orthotic devices. In all cases, expensive industrial manipulators, as much as relatively low-cost commercial systems with specific modifications have been used. However, no reference has been made in the literature on the technology of such devices. This article presents the development of a joystick-computer system for the control of a step motor. Further research can lead to the development of an extremely low-cost robotic arm which uses residual finger movement input and can be used by research centers with restricted funding. Reference is made to the technology on which the circuitry is based, as well as to the design concept of it.     

Failure of a robotic arm during da Vinci prostatectomy: a case report

We report a rare case of a da Vinci robotic arm failure during a laparoscopic robot-assisted radical prostatectomy. The articulation joint of an Endowrist needle driver was broken and positioned at such an angle that made it impossible to remove through the trocar. In addition, it was later discovered that a small piece of the instrument was detached and remained inside the abdomen of the patient without even having been identified on subsequent radiological evaluation. In order to remove the broken instrument, we had to uninstall it from the robot arm and a bigger incision had to be made in the abdominal wall of the patient. The operation was completed without any other incidents. Testing the broken instrument for integrity is recommended to avoid this rare complication.     

Determination of the learning curve of the AESOP robot

Background: As the variety of procedures performed with laparoscopic technology increases, the skill levels and equipment demands also increase. Laparoscopic appendectomy, hernia repair, colon resection, and Nissen fundoplication all require someone whose only responsibility is to control the laparoscope and therefore the operative field. This is usually the most inexperienced person on the operating team. The Automated Endoscope System for Optimal Positioning (AESOP) robot provides a means to eliminate the need for the camera person, returns control of the camera and operative field to the operating surgeon, and enhances human performance. The purpose of this study was to evaluate the acquisition of skills to control the laparoscope in a satisfactory fashion. Methods: We selected medical students as our study group because they have no prior experience in laparoscopic procedures. They performed a readily reproducible task in a pelvic trainer with hand control and with the AESOP robot. Their initial times are compared, as is the improvement in their times after 10 min of practice with the AESOP robot. Results: These data show that in this study group use of the AESOP robot was not as fast as hand control but the skill to use it was learned as quickly. Additional features of the robut such as a steady view and the ability to acquire images and return to them reliably are other advantages. Conclusion: The AESOP robotic arm provides a stable support for the laparoscope during laparoscopic procedures which can be manipulated by the surgeon. We found that the time required to learn control of the laparoscope manually and with the AESOP robot is equal. Received: 22 April 1996/Accepted: 17 June 1996     

Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system

The authors attempted to clarify the feasibility and safety of thoracoscopic esophagectomy with a voice-controlled robot, the AESOP system (3000 HR), and further determine whether innovative surgical equipment could allow the performance of complex thoracoscopic esophagectomy. Thoracoscopic surgery with a voice-controlled robot system has already been used in single-surgeon lung resection. Intra-operative and postoperative outcomes were compared between patients receiving hand-assisted laparoscopic surgery (HALS) and video-assisted thoracoscopic surgery (VATS) with the AESOP system (n = 15) and patients receiving open surgery (n = 30). In the AESOP group, the volume of blood loss was significantly less, but the total operation time was longer than in the open group. There were no significant differences in postoperative outcomes or the incidences of morbidity and mortality between the two groups. The surgeon using the AESOP system could obtain a stable, close-up, and long-lasting operative view. Laparoscopic and thoracoscopic surgery with the AESOP system has the potential to enable a single surgeon to perform a complex surgical procedure like esophagectomy.     

Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm

PurposeThe purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique.Material and methodsPatients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield.ResultsA total of 25 patients (19 men, six women) with a mean age of 50.8 ± 17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n = 16) or Ga-68 PSMA (n = 8) and Ga-68 chemokine-analogue (n = 1). The biopsy samples were obtained from the liver (n = 9), bone (n = 8), lymph-nodes (n = 3), lung (n = 1), pancreas (n = 1), anterior mediastinal lesion (n = 1), peritoneal-deposit (n = 1) and thigh-lesion (n = 1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7 μSv/year for the interventionist.ConclusionPET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.     

Adenopathy and Extensive Skin Patch Overlying a Plasmacytoma (AESOP) Syndrome

Adenopathy and extensive skin patch overlying a plasmacytoma is a very rare syndrome featuring a red-to-brown, violaceous skin patch along with a plasmacytoma. Only 11 case reports exist in the literature. Skin biopsies from the cutaneous patch overlying the plasmacytoma exhibit a dermal vascular hyperplasia with increased surrounding dermal mucin. Radiation therapy is used to treat and cure the plasmacytoma.Adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome is a very rare constellation of findings seen in patients with a yet-to-be diagnosed solitary plasmacytoma.1,2 There are only 11 cases reported in the literature; the first report dates back to Sheinker in 1938 (3

TABLE 1

Summary of patients with AESOP syndrome ranked by ascending age

The Voice-Controlled Robotic Assist Scope Holder AESOP for the Endoscopic Approach to the Sella

OBJECTIVE: To evaluate the feasibility of using a voice-controlled robot Automated Endoscopic System for Optimal Positioning (AESOP) for holding and maneuvering the endoscope in the trans-sphenoidal approach to the pituitary. DESIGN: To compare the manual approach to the voice-activated robotic scope holder in maneuvering the endoscope and resecting pituitary lesions using a two-handed technique. SETTING: Robotic laboratory at Louisiana State University Health Sciences Center, Shreveport. Cadavers: Ten fresh cadaver heads. MAIN OUTCOME MEASURES: To determine the feasibility, advantages, and disadvantages of a single neurosurgeon maneuvering the endoscope, visualizing key anatomical features in the sphenoid, and resecting skull base lesions after the approach by an otolaryngologist. RESULTS: The learning curve for utilization of the voice-controlled robotic arm was short. The compact cart with the AESOP took up little space and allowed the standard setup for this procedure. The elimination of the need for manual stabilization of the endoscope permitted the use of both hands for the actual procedure. The elimination of the tremor inherent with holding the endoscope manually allowed the scope to be placed closer to the target organ with fewer collisions. The most significant advantage was the ability of AESOP to save three anatomical positions, which could be returned to with a single voice command. CONCLUSIONS: Recently, the endoscopic-endonasal approach to the sella has gained popularity. The voice-activated robotic scope holder is safe and has several advantages over current scope holders. Its utility may reduce operating time and eliminate the need for a second surgeon to hold the endoscope.     

Thirty robotic adrenalectomies

Background Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports and small series of robotic adrenalectomies have been reported. This study presents a single institution’s series of 30 robotic adrenalectomies, and evaluates the procedure’s safety, efficacy, and cost. Methods Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented. Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional laparoscopic and open adrenalectomies performed during the same time period. Results Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital charges for robotic adrenalectomy ($12,977) were not significantly different than charges for traditional laparoscopic ($11,599) or open adrenalectomy ($14,600). Conclusions Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy.     

Upper arm fractures and upper arm shaft pseudarthroses

An assessment of treatment results achieved during two periods of observation (1953-1976 and 1976-1981) shows that chances of osseous healing are good in fractures and non-unions of the shaft of the humerus, provided the method of treatment had been correctly indicated. Preference should be given to conservative treatment in case of fresh fractures of the shaft. However, if this is not possible, surgery is indicated, as is the case if healing does not take place. Laminar osteosynthesis performed from the dorsal side should be the method of choice, since it combines the advantages of easy surveyability while performing the operation with those of biomechanical stability.     

Computer-enhanced robotic telesurgery

BACKGROUND: A new type of computer-enhanced telemanipulator device for "robotic" laparoscopic surgery was recently approved. We prospectively evaluated the initial patients undergoing procedures with this new device at our institution. METHODS: Patient demographics, operative indications, port placement, operative time, robot time, complications, and hospital stay were recorded. Follow-up evaluation was appropriate for the individual procedure. RESULTS: Initially, 35 cases were managed. There were 22 anti-reflux procedures, 9 Heller myotomies, 1 pyloroplasty, 1 distal pancreatectomy with splenectomy, 1 esophagectomy with intrathoracic anastomosis, and 1 diagnostic laparoscopy. The operative times ranged from 88 to 458 min. The robot use times were between 16 and 185 min. There were no device-related complications. CONCLUSIONS: Computer-enhanced robotic telesurgery is a safe and effective treatment method for a variety of diseases of the proximal gastrointestinal tract. Further study is needed to determine the benefits of this approach as compared with current technology.