A prospective study of the safety and usefulness of a new miniature wide-angle camera: the "BirdView camera system"

A prospective study on the enhancement of surgical safety in robotic surgery: The BirdView camera system

PURPOSE

To investigate the surgical safety and benefits of using the BirdView camera system with a wide field of view in robotic surgery for rectal cancer in a prospective clinical study.

METHODS

This study included 20 consecutive patients who underwent robotic surgery at our institution between the years 2022 and 2023. The primary endpoint was perioperative safety, which was defined as the occurrence of adverse events, including other organ injuries and malfunctions, caused by the BirdView camera system.

RESULTS

There were no injuries to any other organs caused by the console surgeon or assistant forceps during surgery. Surgical adverse events occurred in five cases (atelectasis, paralytic ileus, and anastomotic leakage) during the postoperative course. There were no cases of device failure or damage to the surrounding organs, including peritoneal heat damage.

CONCLUSIONS

We believe that the BirdView system could be valuable in improving the safety of robotic surgery by enabling the observation of blind spots, thus preventing harm to other organs.

Robot-Assisted Complex Anatomical Segmentectomy Using Resection Process Map

We present a case of robot-assisted complex anatomical segmentectomy utilizing Resection Process Map (RPM) software. RPM enables the confirmation of internal structures obscured by lung parenchyma, thereby reducing the risk of injury or misidentification to essential structures. It facilitates an accurate understanding of anatomy beyond processed vessels, fostering collaboration among the surgical team and informed discussions. Preventing complications stemming from misidentification of bronchovascular structures is vital in complex segmentectomies. Robot-assisted complex segmentectomies can achieve precise anatomical resections through RPM's integration of real-time observations and virtual images. We are committed to further advancing this technology soon.

A novel training program: laparoscopic versus robotic-assisted low anterior resection for rectal cancer can be trained simultaneously

Background

Current expectations are that surgeons should be technically proficient in minimally invasive low anterior resection (LAR)-both laparoscopic and robotic-assisted surgery. However, methods to effectively train surgeons for both approaches are under-explored. We aimed to compare two different training programs for minimally invasive LAR, focusing on the learning curve and perioperative outcomes of two trainee surgeons.

Methods

We reviewed 272 consecutive patients undergoing laparoscopic or robotic LAR by surgeons A and B, who were novices in conducting minimally invasive colorectal surgery. Surgeon A was trained by first operating on 80 cases by laparoscopy and then 56 cases by robotic-assisted surgery. Surgeon B was trained by simultaneously performing 80 cases by laparoscopy and 56 by robotic-assisted surgery. The cumulative sum (CUSUM) method was used to evaluate the learning curves of operative time and surgical failure.

Results

For laparoscopic surgery, the CUSUM plots showed a longer learning process for surgeon A than surgeon B (47 vs. 32 cases) for operative time, but a similar trend in surgical failure (23 vs. 19 cases). For robotic surgery, the plots of the two surgeons showed similar trends for both operative times (23 vs. 25 cases) and surgical failure (17 vs. 19 cases). Therefore, the learning curves of surgeons A and B were respectively divided into two phases at the 47th and 32nd cases for laparoscopic surgery and at the 23rd and 25th cases for robotic surgery. The clinicopathological outcomes of the two surgeons were similar in each phase of the learning curve for each surgery.

Conclusions

For surgeons with rich experience in open colorectal resections, simultaneous training for laparoscopic and robotic-assisted LAR of rectal cancer is safe, effective, and associated with accelerated learning curves.

A dual-view multi-resolution laparoscope for safer and more efficient minimally invasive surgery

Minimally invasive surgery (MIS) is limited in safety and efficiency by the hand-held nature and narrow fields of view of traditional laparoscopes. A multi-resolution foveated laparoscope (MRFL) was invented to address these concerns. The MRFL is a stationary dual-view imaging device with optical panning and zooming capabilities. It is designed to simultaneously capture and display a zoomed view and supplemental wide view of the surgical field. Optical zooming and panning capabilities facilitate repositioning of the zoomed view without physically moving the system. Additional MRFL features designed to improve safety and efficiency include its snub-nosed endoscope, tool-tip auto tracking, programmable focus profiles, unique selectable display modalities, foot pedal controls, and independently controlled surgeon and assistant displays. An MRFL prototype was constructed to demonstrate and test these features. Testing of the prototype validates its design architecture and confirms the functionality of its features. The current MRFL prototype functions adequately as a proof of concept, but the system features and performance require further improvement to be practical for clinical use.

Surgeon Assessment of a Novel Multi-Resolution Foveated Laparoscope

BACKGROUND

We developed a multi-resolution foveated laparoscope (MRFL) to improve situational awareness in laparoscopic surgery. We assessed surgeon objective task performance and subjective attitudes with MRFL when used for box trainer tasks and porcine surgery.

METHODS

The MRFL simultaneously obtains a wide-angle view and a magnified view. The 2 images are displayed simultaneously. 6 urologists and 2 general surgeons performed box trainer and porcine surgery tasks with the MRFL and a standard laparoscope. Task time, use of display options, and subjective assessments were obtained.

RESULTS

Subjectively, surgeons rated situational awareness, depth perception, and instrument interference as comparable between the prototype MRFL and laparoscope for trainer tasks. For porcine surgery, the MRFL was rated as having less interference than the standard laparoscope. The image quality of the MRFL was rated interior to the standard laparoscope. Participants found the different viewing modes useful for different roles and reported that they would likely use the MRFL for conventional laparoscopic and robotic surgery. Objectively, box trainer task time was comparable for 2 of 3 tasks with the remaining task shorter for the standard laparoscope. Porcine nephrectomy and oophorectomy were feasible with the prototype MRFL, although nephrectomy task time was significantly longer than traditional laparoscopy.

CONCLUSIONS

The MRFL demonstrated feasibility for performing complex surgery. Surgeons had favorable attitudes toward its features and likelihood to use the device if available. Users utilized different view types for different tasks. Longer MRFL task times were attributed to poorer image quality of the prototype.

Laparoscopic surgery using 8 K ultra-high-definition technology: Outcomes of a phase II study

INTRODUCTION

Currently, laparoscopic surgery generally relies on 2 K high-definition image quality. The National Cancer Center Hospital, Olympus Corporation, and NHK Engineering System Inc. recently developed a new laparoscopic system with an 8 K ultra-high-definition (UHD) camera that provides images with a high-resolution, wide color range, high frame rate, and high dynamic range. This study aimed to investigate the effectiveness and safety of a new laparoscopic system which uses an 8 K UHD camera system (8K UHD system).

METHODS

This phase II study enrolled 23 patients with colon or rectosigmoid cancer who were indicated for radical resection with laparoscopic colectomy using the 8 K UHD system. The primary endpoint was the proportion of patients with ≥30 mL of intraoperative blood loss.

RESULTS

Of the 23 patients, 22 completed laparoscopic surgery with the 8 K UHD system. One patient was converted to the 2 K high-definition laparoscopic system due to technical difficulties with the 8 K UHD system during surgery. The median amount of intraoperative blood loss was 14 mL (range, 2-71 mL), and number of patients with intraoperative blood loss ≥30 mL was four (17.4%). None of the patients had >100 mL of intraoperative blood loss. No intraoperative complications were noted, and four (17.4%) patients developed postoperative complications. Pathological complete resection was achieved in all patients, and no conversion to open surgery was required.

CONCLUSIONS

Laparoscopic surgery using the 8 K UHD system appears to be both safe and effective. However, further refinements may be necessary to improve usability.

Improving vision for surgeons during laparoscopy: the Enhanced Laparoscopic Vision System (ELViS)

BACKGROUND

For many abdominal surgical interventions, laparotomy has gradually been replaced by laparoscopy, with numerous benefits for the patient in terms of post-operative recovery. However, during laparoscopy, the endoscope only provides a single viewpoint to the surgeon, leaving numerous blind spots and opening the way to peri-operative adverse events. Alternative camera systems have been proposed, but many lack the requisite resolution/robustness for use during surgery or cannot provide real-time images. Here, we present the added value of the Enhanced Laparoscopic Vision System (ELViS) which overcomes these limitations and provides a broad view of the surgical field in addition to the usual high-resolution endoscope.

METHODS

Experienced laparoscopy surgeons performed several typical procedure steps on a live pig model. The time-to-completion for surgical exercises performed by conventional endoscopy and ELViS-assisted surgery was measured. A debriefing interview following each operating session was conducted by an ergonomist, and a System Usability Scale (SUS) score was determined.

RESULTS

Proof of concept of ELVIS was achieved in an animal model with seven expert surgeons without peroperative adverse events related to the surgical device. No differences were found in time-to-completion. Mean SUS score was 74.7, classifying the usability of the ELViS as "good". During the debriefing interview, surgeons highlighted several situations where the ELViS provided a real advantage (such as during instrument insertion, exploration of the abdominal cavity or for orientation during close work) and also suggested avenues for improvement of the system.

CONCLUSIONS

This first test of the ELViS prototype on a live animal model demonstrated its usability and provided promising and useful feedback for further development.

Omnidirectional camera and head-mount display contribute to the safety of laparoscopic surgery

BACKGROUND

We focused on the availability of an omnidirectional camera and head-mount display (HMD). If the laparoscope is an omnidirectional camera, captured images are sent to the HMD worn by the operator in real time. The operator can thus view the image as they like without moving the camera and obtain a 360° view intuitively. However, the surgical system that can be used for actual laparoscopic operations has not yet been developed. In this study, we aimed to show that an omnidirectional camera and HMD would be useful in laparoscopic surgery.

MATERIAL AND METHODS

Eleven medical students and twelve surgical residents (Surgeons group) participated in this study. We created an experimental box with five marks randomly attached inside the box, and the inside cannot be seen from the outside. We measured the time it took to identify all marks between conventional laparoscope and substitute system in each group.

RESULTS

In the substitute system, the time required for the task was significantly shorter than with conventional laparoscopy in each group.

CONCLUSION

An omnidirectional camera and HMD may be a useful new device for laparoscopic surgery. This system may help improve the safety of laparoscopic surgery.

Large-Field-of-View Visualization Utilizing Multiple Miniaturized Cameras for Laparoscopic Surgery

The quality and the extent of intra-abdominal visualization are critical to a laparoscopic procedure. Currently, a single laparoscope is inserted into one of the laparoscopic ports to provide intra-abdominal visualization. The extent of this field of view (FoV) is rather restricted and may limit efficiency and the range of operations. Here we report a trocar-camera assembly (TCA) that promises a large FoV, and improved efficiency and range of operations. A video stitching program processes video data from multiple miniature cameras and combines these videos in real-time. This stitched video is then displayed on an operating monitor with a much larger FoV than that of a single camera. In addition, we successfully performed a standard and a modified bean drop task, without any distortion, in a simulator box by using the TCA and taking advantage of its FoV which is larger than that of the current laparoscopic cameras. We successfully demonstrated its improved efficiency and range of operations. The TCA frees up a surgical port and potentially eliminates the need of physical maneuvering of the laparoscopic camera, operated by an assistant.