Switching robotic surgical systems does not impact surgical performance

BACKGROUND: Robotic surgery is heavily dependent on the availability of, and innovation in, technology. As new robotic systems become available, it will be important to identify the impact of emerging technology on clinical outcomes in robotic surgery. MATERIALS AND METHODS: A total of 140 laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures have been performed with robotic assistance (80 with Zeus and 60 with da Vinci). Data were collected regarding the robotic operative tasks performed, the robotic setup time, the robotic operative time, and the total operative time for all cases. RESULTS: The 60 patients who had a da Vinci LRYGB had a statistically lower body mass index, when compared to patients who underwent Zeus LRYGB (n = 80; P < 0.05). The groups were otherwise statistically similar. The set-up time required for the Zeus cases decreased quickly but increased significantly once the switch was made to da Vinci. The da Vinci set-up time then decreased significantly after the first 10 cases (P < 0.05). There was no demonstrable regression in the robotic operative time when the robotic system was changed to da Vinci. Total operative time temporarily increased during the first 10 da Vinci cases but then decreased significantly (P < 0.05). There were two intraoperative gastrojejunostomy (GJ) leaks in this series (one with each system). There were no anastomotic strictures at the robotic GJ or mortalities throughout this series. CONCLUSIONS: Our data suggest that the impact of robotic platform change should be minimal in an established program. Any regression in clinical efficacy should be short-lived and only minimally impact clinical performance and outcomes.     

Variation in the utilization of robotic surgical operations

Journal of Robotic Surgery - The appropriate use of the robot in surgery continues to evolve. Robotic operations (RO) are particularly advantageous for deep pelvic and retroperitoneal procedures,...     

Laparoscopic and robotic surgical training in urology

The most important change in urology during the past decade was the development of minimally invasive surgery, particularly laparoscopy. However, the main drawback of laparoscopy is a steep learning curve, which results from the significant changes in the surgical environment. Although laparoscopy can provide important advantages for the patient, including decreased length of hospitalization, decreased analgesic requirement, and a shortened postoperative convalescence, one concern has been whether laparoscopic techniques should be learned solely in the operating room. For example, sports, music, and aviation are practiced before an actual performance is ever undertaken. In this review, the advantages and limitations of all available training modalities in minimally invasive surgery are described. Testing basic laparoscopic skills on inanimate models, becoming familiar with the principles of dissection and hemostasis on living animals, and studying surgical anatomy on cadavers should be considered as indispensable and complementary elements for laparoscopic training in the future. In addition, telementoring with the help of modern image processing and virtual reality eventually may become the basis of tomorrow’s surgical instruction.     

Gestonurse: a robotic surgical nurse for handling surgical instruments in the operating room

While surgeon–scrub nurse collaboration provides a fast, straightforward and inexpensive method of delivering surgical instruments to the surgeon, it often results in “mistakes” (e.g. missing information, ambiguity of instructions and delays). It has been shown that these errors can have a negative impact on the outcome of the surgery. These errors could potentially be reduced or eliminated by introducing robotics into the operating room. Gesture control is a natural and fundamentally sound alternative that allows interaction without disturbing the normal flow of surgery. This paper describes the development of a robotic scrub nurse Gestonurse to support surgeons by passing surgical instruments during surgery as required. The robot responds to recognized hand signals detected through sophisticated computer vision and pattern recognition techniques. Experimental results show that 95% of the gestures were recognized correctly. The gesture recognition algorithm presented is robust to changes in scale and rotation of the hand gestures. The system was compared to human task performance and was found to be only 0.83 s slower on average.     

Use of the Zeus robotic surgical system for cardiac surgery

The development of closed chest cardiopulmonary bypass systems has opened the door for totally endoscopic cardiac surgery. We used the robotic surgical system ZEUS for closure of the atrial septal defect (ASD) in three patients. Under one-lung ventilation, Port-Access cardiopulmonary bypass system of the drainage from the right internal jugular vein and the the right femoral vein and the return to the right femoral artery was started after port placement at the forth intercostal space of the right thoracic wall. ASD direct closure was achieved by using robotic surgical system ZEUS under cardiac arrest. The three patients were discharged in 7 days after the operation uneventfully. The robotic surgical system ZEUS can make cardiac surgeries less invasive than ever.     

机器人手术系统在肝脏外科中的应用

机器人手术系统具有稳定、清晰及放大的3D视野,可滤过术者手部震颤,具有多个自由度的灵活稳定操作,克服了传统腹腔镜的不足。尽管机器人手术系统在泌尿外科、妇产科等外科领域得到广泛应用,但在肝脏外科中的作用仍未得到充分认识。笔者综合国内外相关文献,结合团队经验,针对机器人手术系统在肝脏外科应用中的适应证、机器人手术系统肝切除...     

机器人手术系统在子宫移植中的应用进展

子宫移植是治疗绝对子宫因素不孕症的唯一治疗方法.血管解剖困难、手术时间长、术中损伤是限制子宫移植发展的主要问题.微创技术可以缩短手术时间,减少损伤,有助于复杂血管的解剖.有研究团队实现了机器人辅助下子宫移植,并且已经有后代成功分娩的报道.本文总结了已报道的机器人辅助下子宫移植手术,通过分析现有数据,讨论机器人手术系统在子宫移植中的应用及其影响.     

机器人手术器械清洗管理研究进展

从机器人手术系统发展、手术器械清洗现状、器械管理等方面进行综述。提出应专人管理、专业培训、建立规范的清洗灭菌流程,以保障机器人手术器械的清洗质量,以期为机器人手术质量管理提供参考。     

Enhanced robotic surgical training using augmented visual feedback

The goal of this study was to enhance robotic surgical training via real-time augmented visual feedback. Thirty novices (medical students) were divided into 5 feedback groups (speed, relative phase, grip force, video, and control) and trained during 1 session in 3 inanimate surgical tasks with the da Vinci Surgical System. Task completion time, distance traveled, speed, curvature, relative phase, and grip force were measured immediately before and after training and during a retention test 2 weeks after training. All performance measures except relative phase improved after training and were retained after 2 weeks. Feedback-specific effects showed that the speed group was faster than other groups after training, and the grip force group applied less grip force. This study showed that the real-time augmented feedback during training can enhance the surgical performance and can potentially be beneficial for both training and surgery.     

Content validation of a novel robotic surgical simulator

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

? To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System.

PATIENTS AND METHODS

? Participants attending the 2010 International Robotic Urology Symposium were invited to experience RoSS. Afterwards, participants completed a survey regarding the appropriateness of the simulator as a teaching tool.

RESULTS

? Forty‐two subjects including surgeons experienced with robotics (n= 31) and novices (n= 11) participated in this study. ? Eighty per cent of the entire cohort had an average of 4 years of experience with robot‐assisted surgery. ? Eleven (26%) novices lacked independent robot‐assisted experience. The expert group comprised 17 (41%) surgeons averaging 881 (160–2200) robot‐assisted cases. Experts rated the ‘clutch control’ virtual simulation task as a good (71%) or excellent (29%) teaching tool. ? Seventy‐eight per cent rated the ‘ball place’ task as good or excellent but 22% rated it as poor. ? Twenty‐seven per cent rated the ‘needle removal’ task as an excellent teaching tool, 60% rated it good and 13% rated it poor. ? Ninety‐one per cent rated the ‘fourth arm tissue removal’ task as good or excellent. ? Ninety‐four per cent responded that RoSS would be useful for training purposes. ? Eighty‐eight per cent felt that RoSS would be an appropriate training and testing format before operating room experience for residents. ? Seventy‐nine per cent indicated that RoSS could be used for privileging or certifying in robotic surgery.

CONCLUSION

? Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity.     

Resident attitudes and compliance towards robotic surgical training

Background

Adoption of robotics in general surgery has expanded but there is no mandatory national standardized curriculum for general surgery residents (GSR).