Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τετάρτη 27 Ιανουαρίου 2021

A study on autonomous suturing task assignment in robot‐assisted minimally invasive surgery

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Abstract

Background

Sutures are a set of standard actions which are accomplished by multi‐instruments, researchers studied the robot autonomy of suturing, which was based on movement planning completed by a single instrument, but did not consider the assignment of suturing tasks to instruments.

Method

A method was proposed for the autonomous suturing task assignment to instruments, which built a comprehensive evaluation index under some constraint conditions to determine the optimal scheme of the suturing task assignment to instruments.

Results

An experiment of duodenal ulcer repair with a suturing operation was conducted under the guidance of a surgeon, and the results showed that the optimal scheme of the suturing task assignment was obtained by using the proposed method.

Conclusions

The proposed method can be used for autonomous suturing task assignment, which is beneficial for improving the intelligence of robot operation.

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Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

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Abstract

Background

Most comparisons between robot‐assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) indicate the superiority of RAPN, but the learning curve is often not considered.

Methods

All consecutive partial nephrectomies from the very first RAPN at a single tertiary referral centre (n = 818, 500 RAPN vs. 313 OPN) were retrospectively analyzed. Complications, success rates and surgical outcomes were compared. Inequalities between cohorts and the inherent learning curve were controlled by subgroup comparisons, regression analyses, and propensity score matching.

Results

Overall, RAPN had fewer complications, less blood loss, and shorter length of stay. However, an inherent learning curve caused higher complications for the first 4 years. Thereafter, perioperative outcomes clearly favoured RAPN, even for more complex tumours.

Conclusions

In one of the largest monocentric cohorts over more than 10 years, RAPN was found to be superior to OPN. However, not all advantages of RAPN are immediate because a learning curve must be passed.

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Uptake and accessibility of surgical robotics in England

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Abstract

Background

The distribution, utilisation and accessibility of surgical robotics in England is unknown.

Methods

A nationwide Freedom of Information (FOI) request was sent to all acute National Health Service (NHS) trusts. Accessibility was assessed for 32 843 Lower Super Output Areas in England.

Results

All 149 acute NHS trusts responded to the FOI request. Sixty‐one robots are distributed between 48 trusts. The number of robots and robotic procedures has increased annually. Urological procedures comprise 84.2% of robotic procedures. Procedure volume varies between robotic centres ranging from 1 to 683 in 2018. Over 2.4 million people have a travel time of over 1 hour to their nearest robotic centre.

Discussion

National accessibility to robotic services and case volumes are variable and does not represent good value for the NHS. A national robotic surgery registry could improve the quality of robotic surgery and is needed to dynamically assess national provision of this technology.

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Indirect visual guided fracture reduction robot based on external markers

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Abstract

Background

Traditional fracture reduction surgery cannot ensure the accuracy of the reduction while consuming the physical strength of the surgeon. Although monitoring the fracture reduction process through radiography can improve the accuracy of the reduction, it will bring radiation harm to both patients and surgeons.

Methods

We proposed a novel fracture reduction solution that parallel robot is used for fracture reduction surgery. The binocular camera indirectly obtains the position and posture of the fragment wrapped by the tissue by measuring the posture of the external markers. According to the clinical experience of fracture reduction, a path is designed for fracture reduction. Then using position‐based visual serving control the robot to fracture reduction surgery. The study is approved by the ethics committee of the Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, China.

Results

Ten virtual cases of fracture were used for fracture reduction experiments. The simulation and model bone experiments are designed respectively. In model bone experiments, the fragments are reduced without collision. The angulation error after the reduction of this method is 3.3° ± 1.8°, and the axial rotation error is 0.8° ± 0.3°, the transverse stagger error and the axial direction error after reduction is 2 ± 0.5 mm and 2.5 ± 1 mm. After the reduction surgery, the external fixator is used to assist the fixing, and the deformity will be completely corrected.

Conclusions

The solution can perform fracture reduction surgery with certain accuracy and effectively reduce the number of radiographic uses during surgery, and the collision between fragments is avoided during surgery.

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Outcomes and complications of radical cystectomy with ileal conduit urinary diversion: A comparison between open, semi‐robotic and totally robotic surgery

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Abstract

Background

It was aimed to compare open versus robotic‐assisted radical cystectomy (RARC) with intracorporeal ileal conduit (ICIC), versus RARC with extracorporeal ileal conduit (ECIC) formation for bladder cancer.

Materials and Methods

Open, RARC‐ECIC and RARC‐ICIC groups were compared in terms of patient demographics, operative and postoperative parameters, pathological parameters, complications and functional outcomes.

Results

Mean operative times were lower in the RARC‐ECIC group (p = 0.004). Mean estimated blood loss was significantly lower (p < 0.01) in the robotic groups. The blood transfusion was lower in RARC‐ICIC groups (p < 0.001). Rates of stage pT3–4 disease were the highest in the RARC‐ICIC group (p = 0.004). LOS was significantly shorter in the RARC‐ICIC group (p = 0.01). Numbers of Clavien 3–5 complications were lower in the robotic groups (p = 0.012).

Conclusions

RARC and ICIC is a complex procedure involving an increased operation time but with the advantages of lower estimated blood loss, transfusion rates, complications and hospital stays compared with open surgery.

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Dynamic Model and Control for A Cable‐driven Continuum Manipulator Used for Minimally Invasive Surgery

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Abstract

Background

Due to its unique flexible and dexterity, continuum robot has been widely used in small constrained environment. However, those advantages also bring that Motion modeling and accurate control for the continuum robot is more complicated and tedious. A dynamic model and control strategy is presented for improving its control performance.

Methods

The kinematics and velocity model of the robot is derived. And the inertial force, elastic force, gravity and actuation force applied to the continuum robot are analyzed, respectively. Meanwhile, the friction in drive system is investigated and dynamic model is established by the Kane's method. Finally, a motion control strategy is proposed based on this model to verify the dynamic model.

Results

Results of the simulation and experiment of a prototype verify the proposed model and its control method.

Conclusions

The proposed model and control strategy can be used to achieve the bending deformation of the robot.

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A Body‐Mounted Device for MRI‐Guided Spinal Therapy

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Abstract

Background

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no cure and limited treatment options. Recent studies have shown that delivering cellular therapeutics to the ventral horn of the spinal cord can effectively halt neurodegeneration associated with ALS in small animal models.

Methods

We developed a robotic system that assists with MRI‐guided percutaneous injections to the spinal cord. The needle positioning robot consists of two linear axes with motorized translational sleds for two‐degree‐of‐freedom (2‐DOF) needle translation and a radial template for 2‐DOF discrete rotation.

Results

The robot's targeting capability, evaluated using phantom models and swine cadavers, showed mean targeting errors of 0.48 mm and 2.84 mm, respectively. The duration of the targeting procedure is approximately 60 minutes, with an extra 10 minutes for each additional injection.

Conclusions

The presented robot does not affect imaging quality during MRI‐guided procedures, and it enables a simplified workflow for MRI‐guided spinal therapy.

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