Voice activation of a surgical robotic assistant

Robotic colorectal surgery and future directions

As the adoption of robotic-assisted procedures expands across various surgical specialties, colorectal surgery stands out as a prominent beneficiary. This rise in usage can be traced back to the increased accessibility of robotic platforms and a growing institutional shift towards cutting-edge surgical methods. When compared with traditional laparoscopic methods, robotic techniques offer distinct advantages. Their true potential shines in surgeries involving complex anatomical regions, where the robot's enhanced dexterity and range of motion prove invaluable. The three-dimensional, magnified view provided by robotic systems further boosts surgical precision and clarity. These advantages render robotic assistance especially suitable for colorectal surgeries, notably in intricate areas such as the rectum and endoluminal spaces. As the medical world emphasizes minimally invasive surgical methods, there's a pressing need to evolve and optimize robotic techniques in colorectal surgery. This article traces the evolution of robotic interventions in colorectal surgeries, highlighting both its historical milestones and anticipated future trends. We'll also explore emerging robotic tools and systems set to reshape the colorectal surgical arena.

The RAVEN: Design and Validation of a Telesurgery System

The collaborative effort between fundamental science, engineering and medicine provides physicians with improved tools and techniques for delivering effective health care. Minimally invasive surgery (MIS) techniques have revolutionized the way a number of surgical procedures are performed. Recent advances in surgical robotics are once again revolutionizing MIS interventions and open surgery. In an earlier research endeavor, 30 surgeons performed 7 different MIS tasks using the Blue Dragon system to collect measurements of position, force, and torque on a porcine model. This data served as the foundation for a kinematic optimization of a spherical surgical robotic manipulator. Following the optimization, a seven-degree-of-freedom cable-actuated surgical manipulator was designed and integrated, providing all degrees of freedom present in manual MIS as well as wrist joints located at the surgical end-effector. The RAVEN surgical robot system has the ability to teleoperate utilizing a single bi-directional UDP socket via a remote master device. Preliminary telesurgery experiments were conducted using the RAVEN. The experiments illustrated the system’s ability to operate in extreme conditions using a variety of network settings.

TeleRobotic fundamentals of laparoscopic surgery (FLS): effects of time delay--pilot study

Within the area of telerobotic surgery no standardized means of surgically relevant performance evaluation has been established. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Fundamentals of Laparoscopic Surgery (FLS) program provides a set of standardized tasks that are considered the 'gold standard' in surgical skill assessment. We present a methodology for using one of the SAGES FLS tasks for surgical robotic performance evaluation. The TeleRobotic FLS methodology is extendable to two other FLS tasks. Time delay in teleoperation in general and telesurgery in particular is one of the fundamental effects that limits performance in telerobotic surgery. In this pilot study the effect of time delay on the Block Transfer task performance was investigated. The RAVEN Surgical Robot was used in a master/slave configuration in which time delays of 0, 250, 500, and 1000 ms were introduced by a network emulator between the master (Surgeon Site) and the slave (Patient Site). The study included three subjects, each of whom was presented with three of the four conditions. The results show that one subject had a lower error rate with increasing time delay, whereas the other subjects had a higher error rate with increased delay. The subject with the longest average completion time suffered the least performance decrease under time delay.

Utility of a Voice-Activated System in Minimally Invasive Surgery

BACKGROUND

Advances in computer enhancements for surgery, including a voice-activated control system for minimally invasive surgery, are being introduced into clinical practice. Few reports have objectively evaluated the utility of the voice-activated control system. The aim of this study was to evaluate the utility of a voice-activated control system for delivery of commands to specific operating room (OR) equipment.

MATERIALS AND METHODS

We evaluated a total of 30 laparoscopic procedures: 15 laparoscopic hernia repairs, 10 laparoscopic cholecystectomies, and 5 laparoscopic fundoplications performed with the HERMEStrade mark Operating Room Control Center (Computer Motion, Santa Barbara, California) voice-activated control system. When the voice command (VC) to the HERMES system was given, the circulating nurse was observed and her location was recorded. The 3 locations were A, the nurse was immediately available in the OR, not engaged in any other tasks; B, the nurse was in the OR but engaged in other tasks; or C, the nurse was outside the OR.

RESULTS

The 30 cases were performed by the same surgeon and completed laparoscopically. For 170 VCs for gas insufflation, the location of the circulating nurse was: A=50, B=98, and C=22. For 135 light source adjustments, the locations were A=34, B=82, and C=19. In 76 white balance VCs: A=16, B=51, and C=9. In 128 VCs for camera adjustment: A=27, B=77, and C=24. Eight video capture VCs: A=1, B=3, and C=4. For 69 image capture VCs: A=5, B=41, and C=23. The total number of VCs was 586: A=133 (22.7%), B=352 (60%), and C=101(17.3%). All VCs were accurately interpreted by the HERMES system.

CONCLUSION

Voice-activated control systems improve communication with and efficiency of OR staff. The surgeon is afforded the most timely equipment adjustment possible. Circulating nurses are allowed to concentrate on patient care instead of equipment adjustment during the course of the surgery.

Controlled trial of the introduction of a robotic camera assistant (EndoAssist) for laparoscopic cholecystectomy

BACKGROUND

The role of the human camera holder during laparoscopic surgery keeps valuable personnel from other duties. EndoAssist is a robotic camera-holding device controlled by the operator's head movements. This study assesses its introduction into clinical practice.

METHOD

Ninety-three patients undergoing laparoscopic cholecystectomy were randomized to have either the robotic (40) or a human (46) assistant. Seven patients converted to open operation were excluded. Six surgeons were evaluated. Operating time and subjective assessments were recorded. Learning curves were constructed.

RESULTS

The mean operating time was less using the robotic assistant (66 min) than with human assistance (74 min) (p < 0.05, two-tailed t-test). The learning curves for operating time showed that within three operations surgeons were trained in using the robot. The device was safe in use.

CONCLUSION

The EndoAssist operating device is a significant asset in laparoscopic surgery and a suitable substitute for a human assistant. Surgeons became competent in the use of the robot within three operations. The robot offers stability and good control of the television image in laparoscopic surgery.

Survey of Resident Training in Robotic Surgery

Robotics has been recognized as a major driving force in the advancement of minimally invasive surgery. However, the extent to which General Surgery residents are being trained to use robotic technology has never been assessed. A survey was sent to program directors of accredited General Surgery training programs to determine the prevalence and application of robotics in surgical training programs. Responses were tabulated and analyzed. Thirty-three per cent indicated interest in minimally invasive surgery. Twelve per cent of responders have used robotics in their practice, and 65 per cent felt robotics will play an important role in the future of General Surgery. Currently residents from 14 per cent of the responding training programs have exposure to robotic technology, and residents from an additional 4 per cent of these programs have limited didactic exposure. Program directors from 23 per cent of responding programs identified plans to incorporate robotics into their program. Robotics have been shown to make standard endoscopic surgical procedures more efficient and cost-effective as well as allowing a variety of procedures that were only possible with conventional methods to be completed with minimally invasive techniques. This new technology promises to be a large part of the future of surgery and as such deserves more attention in the training of General Surgery residents.

Robotically assisted laparoscopic microsurgical uterine horn anastomosis

OBJECTIVE

To evaluate the feasibility, safety, and sterility issues with regard to the use of a robotic device to perform uterine horn anastomosis in a live porcine model.

DESIGN

Prospective animal study.

SETTING

Landrace-Yorkshire pigs in a conventional laboratory setting.

INTERVENTION(S)

Six female pigs underwent laparoscopic bipolar electrocoagulation of the distal uterine horns. Two weeks later, the uterine horns were reanastomosed laparoscopically with use of a robotic system for microsuturing. Necropsy was performed 4 weeks later to assess postoperative adhesions and anastomosis patency.

MAIN OUTCOME MEASURE(S)

Tubal patency; secondary measures were operative time, complications, and surgeon fatigue.

RESULT(S)

The mean (+/-SD) total operative time per animal was 170+/-34 minutes including setting up and dismantling the robotic arms. The robot functioned well with only minor technical problems. All pigs survived both surgeries with no perioperative complications related to the use of the robot. Patency was confirmed after completing each anastomosis (12 anastomoses; 100% patency). Four weeks later, necropsy showed that eight anastomoses were still patent (67%). Only one pig had bilateral occlusion. Surgeon's fatigue was mild for each animal study.

CONCLUSION(S)

Robotic technology can be used safely in creating laparoscopic microsurgical anastomoses. The robot functioned properly in a sterile operating room environment. Adequate patency rates were achieved during the acute phase and at 4-week follow-up. Robotic technology has the potential to make laparoscopic microsuturing easier.