Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.
TL;DR: Future developments of computer technology and their surgical applications, particularly in the field of virtual reality three-dimensional reconstructions of patient’s specific anatomy and pathology, are the possible solutions to overcome the lack of direct patient-surgeon contact.
Abstract: Remote robot-assisted telesurgery is feasible and safe using terrestrial telecommunication lines, even through transcontinental distances. In addition to several potential benefits for the patient, remote surgery might improve surgical training and education. Future developments of computer technology and their surgical applications, particularly in the field of virtual reality three-dimensional reconstructions of patient’s specific anatomy and pathology, are the possible solutions to overcome the lack of direct patient-surgeon contact. Indeed, virtual reality systems may not only improve surgical performance by allowing preoperative simulations and rehearsal of surgical procedures ahead of time, but may also allow, thanks to real-time Internet teleconsultations, active intervention of the operating surgeon in the diagnostic process and in the evaluation of indications and contraindications to surgery.
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TL;DR: Robotic surgery is still in its infancy and its niche has not yet been well defined, so its current practical uses are mostly confined to smaller surgical procedures.
Abstract: Robotic surgery is a new and exciting emerging technology that is taking the surgical profession by storm. Up to this point, however, the race to acquire and incorporate this emerging technology has primarily been driven by the market. In addition, surgical robots have become the entry fee for centers wanting to be known for excellence in minimally invasive surgery despite the current lack of practical applications. Therefore, robotic devices seem to have more of a marketing role than a practical role. Whether or not robotic devices will grow into a more practical role remains to be seen.
Our goal in writing this review is to provide an objective evaluation of this technology and to touch on some of the subjects that manufacturers of robots do not readily disclose. In this article we discuss the development and evolution of robotic surgery, review current robotic systems, review the current data, discuss the current role of robotics in surgery, and finally we discuss the possible roles of robotic surgery in the future. It is our hope that by the end of this article the reader will be able to make a more informed decision about robotic surgery before “chasing the market.”
1,014 citations
TL;DR: Clinical data demonstrating improved outcomes are lacking for robotic surgical applications within the abdomen, and outcomes data for surgical robotics are essential given the exorbitant costs associated with the use of these tools.
Abstract: As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills However, the limitations of laparoscopy-such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field-have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm This review discusses data obtained from articles indexed in the MEDLINE database written in English and mapped to the following key words: "surgical robotics," "robotic surgery," "robotics," "computer-assisted surgery," "da Vinci," "Zeus," "fundoplication," "morbid obesity," "hepatectomy," "pancreatectomy," "small intestine," "splenectomy," "colectomy," "adrenalectomy," and "pediatric surgery" A limited subset of 387 publications was reviewed to determine article relevance to abdominal robotic surgery Particular emphasis was placed on reports that limited their discussion to human applications and surgical outcomes Included are comments about the initial 202 robotic abdominal surgery cases performed at Johns Hopkins University Hospital (Baltimore, MD) from August 2000 to January 2004 Surgical robotic systems are being used to apply laparoscopy to the surgical treatment of diseases in virtually every abdominal organ Procedures demanding superior visualization or requiring complex reconstruction necessitating extensive suturing obtain the greatest benefit from robotics over conventional laparoscopy Whereas advanced surgical robotic systems offer the promise of a unique combination of advantages over open and conventional laparoscopic approaches, clinical data demonstrating improved outcomes are lacking for robotic surgical applications within the abdomen Outcomes data for surgical robotics are essential given the exorbitant costs associated with the use of these tools
316 citations
TL;DR: This paper provides a tractable way to extend existing results on individual manipulator control using recurrent neural networks to the scenario with the coordination of multiple manipulators and proves global stability and solution optimality of the proposed neural networks.
Abstract: This paper considers cooperative kinematic control of multiple manipulators using distributed recurrent neural networks and provides a tractable way to extend existing results on individual manipulator control using recurrent neural networks to the scenario with the coordination of multiple manipulators. The problem is formulated as a constrained game, where energy consumptions for each manipulator, saturations of control input, and the topological constraints imposed by the communication graph are considered. An implicit form of the Nash equilibrium for the game is obtained by converting the problem into its dual space. Then, a distributed dynamic controller based on recurrent neural networks is devised to drive the system toward the desired Nash equilibrium to seek the optimal solution of the cooperative control. Global stability and solution optimality of the proposed neural networks are proved in the theory. Simulations demonstrate the effectiveness of the proposed method.
242 citations
TL;DR: Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload.
Abstract: Background
Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room.
208 citations
TL;DR: A rapid learning curve to a competent level using the da Vinci system is possible aided by the system’s intuitive motion, and motion analysis is a useful tool to measure performance compared to OSATS and time alone.
Abstract: Background
Robotic telemanipulation systems provide solutions to the problems of less dexterity and visual constraints of minimally invasive surgery (MIS). However, their influence over surgeons’ dexterity and learning curve needs to be assessed. We present motion analysis as an objective method to measure performance and learning progress.
170 citations
References
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01 Jan 2000
TL;DR: Boken presenterer en helhetlig strategi for hvordan myndigheter, helsepersonell, industri og forbrukere kan redusere medisinske feil.
Abstract: Boken presenterer en helhetlig strategi for hvordan myndigheter, helsepersonell, industri og forbrukere kan redusere medisinske feil.
16,469 citations
TL;DR: It is shown that robot-assisted remote telesurgery can be safely carried out across transoceanic distances and will eliminate geographical constraints and make surgical expertise available throughout the world, improving patient treatment and surgical training.
Abstract: ATM technology now enables operations to be performed over huge distances. The introduction of robotic and computer technology into surgical operations allows dexterity to be increased1,2,3 and surgical procedures to be carried out from a distance (telesurgery)4. But until now, the distance feasible for remote telesurgery was considered to be limited to a few hundred miles1 by the time lag of existing telecommunication lines. Here we show that robot-assisted remote telesurgery can be safely carried out across transoceanic distances. The ability to perform complex surgical manipulations from remote locations will eliminate geographical constraints and make surgical expertise available throughout the world, improving patient treatment and surgical training.
875 citations
TL;DR: The studies reviewed here indicate that robotics and telerobotics offer potential solutions to the inherent problems of traditional laparoscopic surgery, as well as new possibilities for telesurgery and telementoring.
Abstract: Although laparoscopic cholecystectomy rapidly became the standard of care for the surgical treatment of cholelithiasis, very few other abdominal or cardiac operations are currently performed using minimally invasive surgical techniques. The inherent limitations of traditional laparoscopic surgery make it difficult to perform these operations. We, and others, have attempted to use robotic technology to (a) provide a stable camera platform, (b) replace two-dimensional with three-dimensional (3-D) imaging, (c) simulate the fluid motions of a surgeon's wrist to overcome the motion limitations of straight laparoscopic instruments, and (d) offer the surgeon a comfortable, ergonomically optimal operating position. In this article, we review the early published clinical experience with surgical robotic and telerobotic systems and assess their current limitations. The voice-controlled AESOP robot replaces the cameraperson and facilitates the performance of solo-surgeon laparoscopic operations. AESOP provides a stable camera platform and avoids motion sickness in the operative team. The telerobotic Zeus and da Vinci surgical systems permit solo surgery by a surgeon from a remote sight. These telerobots hold the camera, replace the surgeon's two hands with robotic instruments, and serve in a master–slave relationship for the surgeon. Their robotic instruments simulate the motions of the surgeon's wrist, facilitating dissection. Both telerobots use 3-D imaging to immerse the surgeon in a three-dimensional video operating field. These robots also provide operating positions for the surgeon console that are ergonomically superior to those required by traditional laparoscopy. The technological advances of these telerobots now permit telepresence surgery from remote locations, even locations thousands of miles away. In addition, telepresence permits the telementoring of novice surgeons who are performing new procedures by expert surgeons in remote locations. The studies reviewed here indicate that robotics and telerobotics offer potential solutions to the inherent problems of traditional laparoscopic surgery, as well as new possibilities for telesurgery and telementoring. Nonetheless, these technologies are still in an early stage of development, and each device entails its own set of challenges and limitations for actual use in clinical settings.
612 citations
TL;DR: Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.
Abstract: Advances in surgery have focused on minimizing the invasiveness of surgical procedures, such that a significant paradigm shift has occurred for some procedures in which surgeons no longer directly touch or see the structures on which they operate. Advancements in video imaging, endoscope technology, and instrumentation have made it possible to convert many procedures in many surgical specialties from open surgeries to endoscopic ones. The use of computers and robotics promises to facilitate complex endoscopic procedures by virtue of voice control over the networked operating room, enhancement of dexterity to facilitate microscale operations, and development of virtual simulator trainers to enhance the ability to learn new complex operations. Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.
580 citations
TL;DR: This study has demonstrated the feasibility of several laparoscopic robotic procedures using the Da Vinci system and seems most beneficial in intra-abdominal microsurgery or for manipulations in a very small space.
Abstract: Theoretically, in laparoscopic surgery, a computer interface in command of a mechanical system (robot) allows the surgeon: (1) to recover a number a number of lost degrees of freedom, thanks to intraabdominal articulations; (2) to obtain better visual control of instrument manipulation, thanks to three-dimensional vision; (3) to modulate the amplitude of surgical motions by downscaling and stabilization; (4) to work at a distance from the patient. These advances improve the quality of surgical tasks in a perfect ergonomic position. The purpose of this paper is to evaluate the feasibility of utilizing a robot in laparoscopic surgery. The first robot-assisted procedure in humans was performed in March 1997 by our team. One hundred forty-six patients underwent robot-assisted laparoscopic surgery. Between March 1997 and February 2001 a nonconsecutive series was performed of 39 antireflux procedures, 48 cholecystectomies, 28 tubal reanastomoses, 10 gastroplasties for obesity, 3 inguinal hernias, 3 intrarectal procedures, 2 hysterectomies, 2 cardiac procedures, 2 prostactectomies, 2 arteriovenous fistulas, 1 lumbar sympathectomy, 1 appendectomy, 1 laryngeal exploration, 1 varicocele ligation, 1 endometriosis cure, 1 neosalpingostomy, 1 deferent canal. The robot (Da Vinci system, Intuitive Surgical, Mountain View, CA), consists of a console and a cart with three articulated robot arms. The surgeon sits in front of the console, manipulating joysticklike handles while observing the operative field through binoculars that provide a three-dimensional picture. This computer is capable of modulating these data by eliminating physiologic tremor and by downscaling the amplitude of motions by a factor 5 or 3 to one. This study has demonstrated the feasibility of several laparoscopic robotic procedures. There is no morbidity related to the system. Operating time and the hospital stay were within acceptable limits. The system seems most beneficial in intra-abdominal microsurgery or for manipulations in a very small space. Optimized ergonomics and increased mobility of the instrument tips are beneficial in many steps of abdominal surgical procedures.
431 citations