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Egan KG, Selber JC. Modern Innovations in Breast Surgery: Robotic Breast Surgery and Robotic Breast Reconstruction. Clin Plast Surg 2023; 50:357-366. [PMID: 36813413 DOI: 10.1016/j.cps.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Robotic surgery has a history of applications in multiple surgical areas and has been applied in plastic surgery over the past decade. Robotic surgery allows for minimal access incisions and decreased donor site morbidity in breast extirpative surgery, breast reconstruction, and lymphedema surgery. Although a learning curve exists for the use of this technology, it can be safely applied with careful preoperative planning. Robotic nipple-sparing mastectomy may be combined with either robotic alloplastic or robotic autologous reconstruction in the appropriate patient.
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Affiliation(s)
- Katie G Egan
- The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX 77030, USA
| | - Jesse C Selber
- The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX 77030, USA.
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Karsan RB, Allen R, Powell A, Beattie GW. Minimally-invasive cardiac surgery: a bibliometric analysis of impact and force to identify key and facilitating advanced training. J Cardiothorac Surg 2022; 17:236. [PMID: 36114506 PMCID: PMC9479391 DOI: 10.1186/s13019-022-01988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background The number of citations an article receives is a marker of its scientific influence within a particular specialty. This bibliometric analysis intended to recognise the top 100 cited articles in minimally-invasive cardiac surgery, to determine the fundamental subject areas that have borne considerable influence upon clinical practice and academic knowledge whilst also considering bibliometric scope. This is increasingly relevant in a continually advancing specialty and one where minimally-invasive cardiac procedures have the potential for huge benefits to patient outcomes.
Methods The Web of Science (Clarivate Analytics) data citation index database was searched with the following terms: [Minimal* AND Invasive* AND Card* AND Surg*]. Results were limited to full text English language manuscripts and ranked by citation number. Further analysis of the top 100 cited articles was carried out according to subject, author, publication year, journal, institution and country of origin. Results A total of 4716 eligible manuscripts were retrieved. Of the top 100 papers, the median (range) citation number was 101 (51–414). The most cited paper by Lichtenstein et al. (Circulation 114(6):591–596, 2006) published in Circulation with 414 citations focused on transapical transcatheter aortic valve implantation as a viable alternative to aortic valve replacement with cardiopulmonary bypass in selected patients with aortic stenosis. The Annals of Thoracic Surgery published the most papers and received the most citations (n = 35; 3036 citations). The United States of America had the most publications and citations (n = 52; 5303 citations), followed by Germany (n = 27; 2598 citations). Harvard Medical School, Boston, Massachusetts, published the most papers of all institutions. Minimally-invasive cardiac surgery pertaining to valve surgery (n = 42) and coronary artery bypass surgery (n = 30) were the two most frequent topics by a large margin. Conclusions This work establishes a comprehensive and informative analysis of the most influential publications in minimally-invasive cardiac surgery and outlines what constitutes a citable article. Undertaking a quantitative evaluation of the top 100 papers aids in recognising the contributions of key authors and institutions as well as guiding future efforts in this field to continually improve the quality of care offered to complex cardiac patients.
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Phoon PH, MacLaren G, Ti LK, Tan JS, Hwang NC. History and Current Status of Cardiac Anesthesia in Singapore. J Cardiothorac Vasc Anesth 2019; 33:3394-3401. [DOI: 10.1053/j.jvca.2018.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 11/11/2022]
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Sarfati B, Honart JF, Leymarie N, Rimareix F, Al Khashnam H, Kolb F. Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report. Breast J 2017; 24:373-376. [DOI: 10.1111/tbj.12937] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Benjamin Sarfati
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Francoise Rimareix
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Heba Al Khashnam
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Frederic Kolb
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
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Functional Outcomes and Complications of Robot-Assisted Free Flap Oropharyngeal Reconstruction. Ann Plast Surg 2017; 78:S76-S82. [PMID: 28195893 DOI: 10.1097/sap.0000000000001010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robotic surgical systems provide a clear, magnified 3-dimensional visualization as well as precise, stable instrumental movement, thereby minimizing technical difficulties that may be encountered in the surgical treatment of oropharyngeal tumors. This study assessed the outcomes of robotic-assisted free flap oropharyngeal reconstruction compared with those of conventional free flap reconstruction. MATERIALS AND METHODS A retrospective review of 47 patients who underwent reconstructive operations using a free radial forearm fasciocutaneous flap for oropharyngeal defects was conducted over a 20-month period (May 2013-December 2014). Complications were evaluated for a robot-assisted reconstruction group and a conventional reconstruction group; postoperative complication rates and revision rates were further evaluated. The Functional Intraoral Glasgow Scale (FIGS) was adopted for functional outcome assessment. RESULTS This study recruited 47 people who underwent reconstructive operations using a free radial forearm fasciocutaneous flap for oropharyngeal defects (14 robot-assisted and 33 conventional reconstructions). The mean postoperative FIGS score was 10.29 ± 2.02 in the robot-assisted group (P = 0.010) and 8.42 ± 2.29 in the conventional group at 1 month postoperatively. The mean postoperative FIGS score was 12.57 ± 1.91 in the robot-assisted group (P = 0.005) and 9.91 ± 3.09 in the conventional group at 3 months postoperatively. Complication rates between the robot-assisted and conventional groups were similar for flap failure (P = 0.531), partial necrosis, wound infection, hematoma or seroma formation (P = 0.893), wound dehiscence, and fistula formation (P = 0.515). The number of flap revision operations requiring additional surgery (P = 0.627) was comparable between the cohorts. CONCLUSIONS There is no significant difference in complications or revision rates between the robot-assisted and conventional oropharyngeal reconstructions. The functional postoperative outcomes of robot-assisted reconstructions are superior to those of conventional reconstructions. Robotic surgical systems provide a safe option with optimal postoperative oral function for the free flap reconstruction of oropharyngeal defects without lip or mandible splitting.
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Clarke NS, Price J, Boyd T, Salizzoni S, Zehr KJ, Nieponice A, Bajona P. Robotic-assisted microvascular surgery: skill acquisition in a rat model. J Robot Surg 2017; 12:331-336. [DOI: 10.1007/s11701-017-0738-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/01/2017] [Indexed: 12/16/2022]
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Abstract
In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a "no-touch" technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive approaches. Furthermore, increased robotic experience and studies, including randomized controlled trials, are needed to validate the findings of the current literature.
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
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Robot-assisted free flap reconstruction of oropharyngeal cancer--a preliminary report. Ann Plast Surg 2016; 74 Suppl 2:S105-8. [PMID: 25695457 DOI: 10.1097/sap.0000000000000464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The robotic surgical system provides a clear, magnified, 3-dimensional (3D) view as well as a precise and stable instrumental movement, which minimizes many technical difficulties that may be encountered in the surgical treatment of oropharyngeal tumors. A preliminary result of transoral robot-assisted free flap reconstruction of oropharyngeal cancer is presented herein. MATERIALS AND METHODS Between May and December 2013, the Da Vinci Surgical System (Da Vinci Si, Intuitive Surgical, Sunnyvale, CA) was used in 5 (4 men and 1 woman) cases of oropharyngeal reconstruction. Robot-assisted reconstruction was performed for inset of the flap and for performing a venous anastomosis of the free radial forearm fasciocutaneous flap. RESULTS All of the reconstructive surgeries were successful without flap failure or take-backs. There were no wound infections or fistulas. CONCLUSION The application of a robotic surgical system seems to be a safe option in the free flap reconstruction of oropharyngeal defects without lip or mandible splitting.
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Ganet F, Le MQ, Capsal JF, Lermusiaux P, Petit L, Millon A, Cottinet PJ. Development of a smart guide wire using an electrostrictive polymer: option for steerable orientation and force feedback. Sci Rep 2015; 5:18593. [PMID: 26673883 PMCID: PMC4682083 DOI: 10.1038/srep18593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/20/2015] [Indexed: 12/02/2022] Open
Abstract
The development of steerable guide wire or catheter designs has been strongly limited by the lack of enabling actuator technologies. This paper presents the properties of an electrostrive actuator technology for steerable actuation. By carefully tailoring material properties and the actuator design, which can be integrated in devices, this technology should realistically make it possible to obtain a steerable guide wire design with considerable latitude. Electromechanical characteristics are described, and their impact on a steerable design is discussed.
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Affiliation(s)
- F. Ganet
- Université de Lyon - INSA de Lyon – LGEF, 8 rue de la Physique, 69 621 Villeurbanne – France
- Pulsalys, 47 Boulevard du 11 Novembre 1918, CS 90170, 69625 Villeurbanne – France
| | - M. Q. Le
- Université de Lyon - INSA de Lyon – LGEF, 8 rue de la Physique, 69 621 Villeurbanne – France
| | - J. F. Capsal
- Université de Lyon - INSA de Lyon – LGEF, 8 rue de la Physique, 69 621 Villeurbanne – France
| | - P. Lermusiaux
- Groupement Hospitalier Edouard Herriot - Chirurgie Vasculaire – Pav. M – France
- Université de Lyon – Université Claude Bernard Lyon 1, 8 Avenue Rockefeller Lyon – France
| | - L. Petit
- Université de Lyon - INSA de Lyon – LGEF, 8 rue de la Physique, 69 621 Villeurbanne – France
| | - A. Millon
- Groupement Hospitalier Edouard Herriot - Chirurgie Vasculaire – Pav. M – France
- Université de Lyon – Université Claude Bernard Lyon 1, 8 Avenue Rockefeller Lyon – France
| | - P. J. Cottinet
- Université de Lyon - INSA de Lyon – LGEF, 8 rue de la Physique, 69 621 Villeurbanne – France
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Abstract
Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardiac surgery as minimally invasive cardiac surgery is reviewed.
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Abstract
Lobectomy with systematic lymph node sampling or dissection remains the mainstay of treatment of early stage non-small cell lung cancer. The use of video-assisted thoracic surgery (VATS) to perform lobectomy was first reported in 1992. Advantages of VATS include less trauma and pain, shorter chest drainage duration, decreased hospital stay, and preservation of short-term pulmonary function. However, VATS is characterized by loss of binocular vision and a limited maneuverability of thoracoscopic instruments, an unstable camera platform, and poor ergonomics for the surgeon. To overcome these limitations, robotic systems were developed during the last decades. This article reviews the technical aspects of robotic lobectomy using a VATS-based approach.
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy.
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
| | - Federico Davini
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
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Canale LS, Mick S, Mihaljevic T, Nair R, Bonatti J. Robotically assisted totally endoscopic coronary artery bypass surgery. J Thorac Dis 2014; 5 Suppl 6:S641-9. [PMID: 24251021 DOI: 10.3978/j.issn.2072-1439.2013.10.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/29/2013] [Indexed: 01/06/2023]
Abstract
Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the "best of both worlds" from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations.
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Ambrogi MC, Fanucchi O, Melfi F, Mussi A. Robotic surgery for lung cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:201-10. [PMID: 25207216 PMCID: PMC4157469 DOI: 10.5090/kjtcs.2014.47.3.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 03/31/2014] [Accepted: 03/31/2014] [Indexed: 11/16/2022]
Abstract
During the last decade the role of minimally invasive surgery has been increased, especially with the introduction of the robotic system in the surgical field. The most important advantages of robotic system are represented by the wristed instrumentation and the depth perception, which can overcome the limitation of traditional thoracoscopy. However, some data still exist in literature with regard to robotic lobectomy. The majority of papers are focused on its safety and feasibility, but further studies with long follow-ups are necessary in order to assess the oncologic outcomes. We reviewed the literature on robotic lobectomy, with the main aim to better define the role of robotic system in the clinical practice.
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Affiliation(s)
- Marcello C Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Italy
| | - Franco Melfi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Italy
- Multidisciplinary Robotic Surgery Centre, Cisanello University Hospital, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Italy
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Melfi FMA, Fanucchi O, Davini F, Romano G, Lucchi M, Dini P, Ambrogi MC, Mussi A. Robotic lobectomy for lung cancer: evolution in technique and technology. Eur J Cardiothorac Surg 2014; 46:626-30; discussion 630-1. [PMID: 24616391 DOI: 10.1093/ejcts/ezu079] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse the results of robotic lobectomy for lung cancer. The evolution of technique and technology was evaluated. METHODS During the period 2004-12, all patients who underwent robotic lobectomy for clinical early-stage lung cancer were retrospectively reviewed. The patients were divided into two groups. Group 1 included 69 patients operated by the first generation of surgical robotic system. Group 2 included 160 patients treated with the latest generation of surgical robotic system. Age, gender, comorbidities, operative time, docking time, conversion rate, morbidity, mortality and length of postoperative stay were compared in both groups. RESULTS The two groups were homogeneous in terms of age, gender and comorbidities. Histopathological analysis showed 41 and 107 adenocarcinomas, 27 and 37 squamous cell carcinomas, 1 and 7 large cell carcinomas, in Groups 1 and 2, respectively, and 5 sarcomatoid carcinomas and 4 carcinoids in Group 2. The pathological stage for Group 1 was Stage I (48 cases), Stage II (17 cases) and Stage III (4 cases). For Group 2, Stage I was found in 115 cases, Stage II in 30 cases and Stage III in 15 cases. The mean operative time was 237 (standard deviation (SD) + 66.9) and 172 (SD ± 39.6) min for Groups 1 and 2 (P = 0.002), respectively. The conversion rates were, respectively, 10.1 and 5.6% (P = 0.21), mortality rates 1.4 and 0% (P = 0.30) and morbidity rates 22 and 15% (P = 0.12). The mean length of postoperative stay was 4.4 (SD ± 3.1) and 3.8 days (SD ± 2.2) (P = 0.26), respectively. CONCLUSIONS This study suggests a positive trend in the outcomes for patients who underwent the upgraded robotic system surgery compared with those treated by the standard system.
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Federico Davini
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Gaetano Romano
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Paolo Dini
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Marcello C Ambrogi
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy
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Vascular microanastomosis through an endoscopic approach: Feasibility study on two cadaver forearms. ACTA ACUST UNITED AC 2013; 32:136-40. [DOI: 10.1016/j.main.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022]
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Patel NP, Van Meeteren J, Pedersen J. A new dimension: robotic reconstruction in plastic surgery. J Robot Surg 2012; 6:77-80. [PMID: 27637983 DOI: 10.1007/s11701-011-0300-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Robot-assisted surgery was first approved by the Federal Drug Administration in 1994. The robotic system has the advantages of three-dimensional visualization of the operating field, 7° range of motion, tremor elimination, 360°of freedom at 10-mm distance, and a comfortable, seated operating posture. The purpose of this paper is to present a new surgical tool, the robot, for use in reconstructive surgery. METHODS A case is presented in which the robotic system was used to elevate a pedicled, myocutaneous latissimus dorsi flap for shoulder reconstruction. RESULTS The robot was used successfully to harvest a pedicled latissimus dorsi flap. Since this case, we have used the robotic system to harvest one other pedicled latissimus flap for breast reconstruction as well as to perform the microvascular anastomoses in a radial forearm and rectus abdominus free flaps to the lower extremity. CONCLUSION There is great potential for the use of robot as a surgical tool in the field of plastic surgery. The advantages are numerous, including superior visibility, greater range of motion as a more comfortable position for the operating surgeon. The limitations include the learning curve and the lack of biofeedback.
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Affiliation(s)
- Nima P Patel
- Division of Plastic and Reconstructive Surgery, Summa Health System/Northeast Ohio Universities College of Medicine, 525 E. Market Street, Akron, OH, 44304, USA
| | | | - John Pedersen
- Division of Plastic and Reconstructive Surgery, Akron General Medical Center, One Park West Boulevard, Suite 350, Akron, OH, 44320, USA
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Horiguchi A, Uyama I, Ito M, Ishihara S, Asano Y, Yamamoto T, Ishida Y, Miyakawa S. Robot-assisted laparoscopic pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:488-92. [PMID: 21491102 DOI: 10.1007/s00534-011-0383-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In the field of gastroenterological surgery, laparoscopic surgery has advanced remarkably, and now accounts for most gastrointestinal operations. This paper outlines the current status of and future perspectives on robot-assisted laparoscopic pancreatectomy. METHODS A review of the literature and authors' experience was undertaken. RESULTS The da Vinci Surgical System is a robot for assisting laparoscopy and is safer than conventional endoscopes, thanks to the 3-dimensional hi-vision images it yields, high articular function with the ability to perform 7 types of gripping, scaling function enabling 2:1, 3:1, and 5:1 adjustment of surgeon hand motion and forceps motions, a filtering function removing shaking of the surgeon's hand, and visual magnification. By virtue of these functions, this system is expected to be particularly useful for patients requiring delicate operative manipulation. CONCLUSIONS Issues of importance remaining in robot-assisted laparoscopic pancreatectomy include its time of operation, which is longer than that of open surgery, and the extra time needed for application of the da Vinci compared with ordinary laparoscopic surgery. These issues may be resolved through accumulation of experience and modifications of the procedure. Robot-assisted laparoscopic pancreatectomy appears likely to become a standard procedure in the near future.
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Affiliation(s)
- Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University, 1-98 Dengakugakubo Kutsukakecho, Toyoake, Aichi, Japan.
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Horiguchi A, Uyama I, Miyakawa S. Robot-assisted laparoscopic pancreaticoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:287-91. [PMID: 20811915 DOI: 10.1007/s00534-010-0325-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic surgery is the most advanced development in minimally invasive surgery. However, the number of reports on robot-assisted endoscopic gastrointestinal surgery is still very small. In this article, we describe total laparoscopic pancreaticoduodenectomy (PD) undertaken using the da Vinci Surgical System® (Intutive Surgical). METHODS Three patients underwent robotic PD between November 2009 and February 2010. Following resection of the pancreatic head, duodenum, and the distal stomach, intracorporeal anastomosis was accomplished by Child's method of reconstruction, which includes a two-layered end-to-side pancreaticojejunostomy, an end-to-side choledochojejunostomy, and a side-to-side gastrojejunostomy. RESULTS The time required for surgery was 703 ± 141 min, and blood loss was 118 ± 72 mL. The average hospital stay period was 26 ± 12 days. As a postoperative complication, pancreatic juice leak occurred in one case, but it was managed with conservative treatment. Of the three patients, one had cancer of the papilla of Vater, one had cancer of the pancreatic head, and one had a solid pseudopapillary neoplasm. In all cases, the surgical margin was negative for tumor. CONCLUSIONS Robot-assisted PD required a long time, but organ removal with less bleeding was able to be safely performed owing to the high degree of freedom associated with the forceps manipulation and the magnified view. Similarly, pancreatojejunostomy could certainly be conducted. No major postoperative complications were found. Accumulation of da Vinci PD experience in the future will lead to safer and faster PD.
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Affiliation(s)
- A Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Aichi, Japan.
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Robotic manipulators in cardiac surgery: the computer-assisted surgical system ZEUS. MINIM INVASIV THER 2009; 10:275-81. [PMID: 16754029 DOI: 10.1080/136457001753337555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Minimally invasive strategies continue to evolve in cardiac surgery. Robotic-assisted systems have been introduced recently, to increase the precision of endoscopic coronary surgery. This report describes the experimental and clinical use of the computer-assisted robotic system ZEUS for endoscopic coronary artery bypass anastomoses. The ZEUS system consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled-down mode. The third arm (AESOP) positions the endoscope under voice control. The present study demonstrates the feasibility of endoscopic coronary artery bypass grafting using a computer-assisted surgical robotic system on the arrested heart, as well as on the beating heart in selected patients. However, robotic-assisted cardiac surgery is still developing, and tremendous efforts are still required to establish a routine procedure.
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Beasley R, Howe R. Increasing Accuracy in Image-Guided Robotic Surgery Through Tip Tracking and Model-Based Flexion Correction. IEEE T ROBOT 2009. [DOI: 10.1109/tro.2009.2014498] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Taleb C, Nectoux E, Liverneaux P. Limb replantation with two robots: A feasibility study in a pig model. Microsurgery 2009; 29:232-5. [DOI: 10.1002/micr.20602] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tavakoli M, Aziminejad A, Patel RV, Moallem M. High-fidelity bilateral teleoperation systems and the effect of multimodal haptics. ACTA ACUST UNITED AC 2008; 37:1512-28. [PMID: 18179070 DOI: 10.1109/tsmcb.2007.903700] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In master-slave teleoperation applications that deal with a delicate and sensitive environment, it is important to provide haptic feedback of slave/environment interactions to the user's hand as it improves task performance and teleoperation transparency (fidelity), which is the extent of telepresence of the remote environment available to the user through the master-slave system. For haptic teleoperation, in addition to a haptics-capable master interface, often one or more force sensors are also used, which warrant new bilateral control architectures while increasing the cost and the complexity of the teleoperation system. In this paper, we investigate the added benefits of using force sensors that measure hand/master and slave/environment interactions and of utilizing local feedback loops on the teleoperation transparency. We compare the two-channel and the four-channel bilateral control systems in terms of stability and transparency, and study the stability and performance robustness of the four-channel method against nonidealities that arise during bilateral control implementation, which include master-slave communication latency and changes in the environment dynamics. The next issue addressed in the paper deals with the case where the master interface is not haptics capable, but the slave is equipped with a force sensor. In the context of robotics-assisted soft-tissue surgical applications, we explore through human factors experiments whether slave/environment force measurements can be of any help with regard to improving task performance. The last problem we study is whether slave/environment force information, with and without haptic capability in the master interface, can help improve outcomes under degraded visual conditions.
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Affiliation(s)
- Mahdi Tavakoli
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA.
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Westebring-van der Putten EP, Goossens RHM, Jakimowicz JJ, Dankelman J. Haptics in minimally invasive surgery--a review. MINIM INVASIV THER 2008; 17:3-16. [PMID: 18270873 DOI: 10.1080/13645700701820242] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article gives an overview of research performed in the field of haptic information feedback during minimally invasive surgery (MIS). Literature has been consulted from 1985 to present. The studies show that currently, haptic information feedback is rare, but promising, in MIS. Surgeons benefit from additional feedback about force information. When it comes to grasping forces and perceiving slip, little is known about the advantages additional haptic information can give to prevent tissue trauma during manipulation. Improvement of haptic perception through augmented haptic information feedback in MIS might be promising.
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Affiliation(s)
- E P Westebring-van der Putten
- Department of Applied Ergonomics and Design, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands.
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Lehnert M, Richter B, Beyer PA, Heller K. A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children. J Pediatr Surg 2006; 41:1392-6. [PMID: 16863843 DOI: 10.1016/j.jpedsurg.2006.04.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children. METHODS The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy. RESULTS No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 +/- 7.5 vs 34.6 +/- 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 +/- 8.7 vs 20.2 +/- 5.3 minutes, P < .05). CONCLUSION At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.
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Affiliation(s)
- Mark Lehnert
- Department of General and Vascular Surgery, Division of Pediatric Surgery, J.W. Goethe University, 60596 Frankfurt am Main, Germany
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Ishikawa N, Sun YS, Nifong LW, Watanabe G, Chitwood WR. Thoracoscopic Lobectomy with the da Vinci Surgical System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006. [DOI: 10.1177/155698450600100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Norihiko Ishikawa
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - You Su Sun
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - L. Wiley Nifong
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - Go Watanabe
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - W. Randolph Chitwood
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
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Ishikawa N, Sun YS, Nifong LW, Watanabe G, Chitwood WR. Thoracoscopic Lobectomy with the da Vinci Surgical System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006; 1:169-70. [DOI: 10.1097/01.imi.0000225788.98583.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thoracoscopic upper lobectomy has been performed with the da Vinci surgical system in human cadavers. A minithoracotomy and two additional thoraco ports provided access to the thoracic cavity. An auxiliary port was used for both retraction of the lung and suction. The pulmonary vessels were ligated by robotic instruments, and the bronchi were divided after suturing robotically or with automatic staplers. A standard lymph node dissection was performed. The current da Vinci surgical system provided superior optics and enhanced dexterity. The application of the system for minimally invasive lobectomy may add benefits for both surgeon and patients.
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Affiliation(s)
- Norihiko Ishikawa
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - You Su Sun
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - L. Wiley Nifong
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - Go Watanabe
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
| | - W. Randolph Chitwood
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina (N.I., Y.S.S., L.W.N., W.R.C.); and the Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan (N.I., G.W.)
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Katz RD, Rosson GD, Taylor JA, Singh NK. Robotics in microsurgery: use of a surgical robot to perform a free flap in a pig. Microsurgery 2006; 25:566-9. [PMID: 16178007 DOI: 10.1002/micr.20160] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present the concept that a surgical robot may be used to successfully perform a free flap. To study different microsurgical techniques, a porcine free flap model was developed in our laboratory. Dissection of the free flap model and isolation of the vessels were completed under traditional loupe magnification. The da Vinci robot was then used to perform vessel adventitiectomy and microanastomoses. The model was observed for 4 h postoperatively, noting flap color, temperature, capillary refill, and Doppler signal. At the end of this period, the flap was noted to be viable; anastomoses were evaluated and found to be grossly and microscopically patent. Advantages conferred by the da Vinci robot include elimination of tremor, scalable movements, fully articulating instruments with six degrees of spatial freedom, and a dynamic three-dimensional visualization system. Drawbacks include the cost and the absence of true microsurgical instruments.
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Affiliation(s)
- Ryan D Katz
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0980, USA
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Morgan JA, Thornton BA, Peacock JC, Hollingsworth KW, Smith CR, Oz MC, Argenziano M. Does Robotic Technology Make Minimally Invasive Cardiac Surgery Too Expensive? A Hospital Cost Analysis of Robotic and Conventional Techniques. J Card Surg 2005; 20:246-51. [PMID: 15854086 DOI: 10.1111/j.1540-8191.2005.200385.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While potential benefits of robotic technology include decreased morbidity and improved recovery, some have suggested a prohibitively high cost. This study was undertaken to compare actual hospital costs of robotically assisted cardiac procedures with conventional techniques. METHODS We conducted a retrospective review of clinical and financial data of 20 patients who underwent atrial septal defect (ASD) closure and 20 patients who underwent mitral valve repair (MVr) using either robotic techniques or a conventional approach with a sternotomy. Total hospital cost (actual resource consumption) was subdivided into operative and postoperative costs. RESULTS Robotic technology did not significantly increase total hospital cost for ASD closure or MVr (p = 0.518 and p = 0.539). However, when including the initial capital investment for the robot through amortization of institutional costs, total hospital cost was increased by $3,773 for robotic ASD closure and $3,444 for robotic MVr (p = 0.021 and p = 0.004). The major driver of cost for robotic cases (operating room time) decreased over time. CONCLUSIONS Robotic technology did not significantly increase hospital cost. While the absolute cost for robotic surgery was higher than conventional techniques after taking into account the institutional cost of the robot, the major driver of cost for robotic procedures will likely continue to decrease, as the surgical team becomes increasingly familiar with robotic technology. Furthermore, other benefits, such as improvement in postoperative quality of life and more expeditious return to work may make a robotic approach cost-effective. Thus, it is possible that the benefits of robotic surgery may justify investment in this technology.
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Affiliation(s)
- Jeffrey A Morgan
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Melfi FMA, Ambrogi MC, Lucchi M, Mussi A. Video robotic lobectomy. Multimed Man Cardiothorac Surg 2005; 2005:mmcts.2004.000448. [PMID: 24414727 DOI: 10.1510/mmcts.2004.000448] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Video-assisted thoracoscopic surgery (VATS) is beneficial to the patient but challenging for the surgeon. Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. The da Vinci™ Robotic System (Intuitive Surgical, Inc, CA, USA) is one of these robots. It consists of a console and a surgical cart supporting three articulated robotic arms. The surgeon sits at the console where he manipulates the joystick handles while observing the operating field through binoculars that provide a three-dimensional image. Improved ergonomic conditions and instrument mobility at the level of distal articulation seem beneficial in thoracic procedures. After a period of technical development and training we used the robotic systems to treat patients with various thoracic diseases. We focused our efforts on the development of this technique in thoracic surgery particularly to perform video robotic lobectomy (VRL).
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery - Cardiac and Thoracic Department of Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Are you Ready to Become a Robo-Surgeon? Am Surg 2003. [DOI: 10.1177/000313480306900711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Robotic and minimally invasive surgery represents the future of modern surgical care. However, its role during the training of surgical residents has yet to be investigated. A previous study conducted by our group surveyed program directors at accredited general surgery training programs in the United States to determine the prevalence and application of robotics in their residency programs. This current study is a follow-up survey sent to residents across the United States to see whether they were being adequately trained and exposed to robotic surgery during their training. A survey was sent to 1800 general surgery residents, and their responses were tabulated and analyzed. Twenty-three per cent of the 1800 residents responded to our survey. An overwhelming 57 per cent of the responders indicated a high interest in robotic surgery. However, 80 per cent of the responders indicated not having a robotic training program. Robotic surgery has led to many promising advancements within the surgical subspecialties. With this emerging technology comes the need for a greater emphasis on the training of surgeons in robotics during their residency.
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Coronary artery bypass grafting, an on-off affair. Indian J Thorac Cardiovasc Surg 2003. [DOI: 10.1007/s12055-003-0022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Isgro F, Kiessling AH, Blome M, Lehmann A, Kumle B, Saggau W. Robotic surgery using Zeus MicroWrist technology: the next generation. J Card Surg 2003; 18:1-5; discussion 6-7. [PMID: 12696759 DOI: 10.1046/j.1540-8191.2003.01901.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of computer-animated surgical instruments for various cardiac operations has been shown to be feasible, but to date, the available information regarding the operative and technical details of these procedures is still inadequate. METHODS We used the Zeus (Computer Motion Inc., Goleta, Calif, USA) telemanipulation system to perform the internal mammary artery (IMA) takedown in 56 patients, in 12 of whom we used the newest model with MicroWristTM (Computer Motion Inc., Goleta, Calif, USA) technology. Port orientation was based on thoracic anatomy, the decisive landmarks being the mammillary line and the axillary line. The distance between ports was at least 9 cm, and the patient's arm was positioned with the left shoulder raised and angulated by not more than 90 degrees. RESULTS Mean setup time was 44 +/- 18 minutes for the first five patients and 16 +/- 7 minutes for the last five patients, with an overall average of 24 +/- 12 minutes. IMA harvest time at the beginning reached a mean of 95 +/- 23 minutes and decreased to 44 +/- 18 minutes in the last five cases. Average IMA takedown time was 58 +/- 17 minutes. The IMA was patent with a good flow in all 56 patients. CONCLUSIONS The introduction of robotic technology into clinical routine has resulted in safe procedures with a short learning curve. However, basic training in the modality is a must in order to achieve technical excellence.
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Affiliation(s)
- Frank Isgro
- Clinic for Cardiac Surgery, Heartcenter, Ludwigshafen, Germany
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Antona C, Scrofani R, Lemma M, Vanelli P, Mangini A, Danna P, Gelpi G. Assessment of an aortosaphenous vein graft anastomotic device in coronary surgery: clinical experience and early angiographic results. Ann Thorac Surg 2002; 74:2101-5. [PMID: 12643402 DOI: 10.1016/s0003-4975(02)04039-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Until now technologic evolution in coronary bypass surgery has focused on extracorporeal circulation, on operation without extracorporeal circulation, and on the exposure of the operative site. Recently a one-shot anastomotic device for the proximal anastomosis in coronary surgery was developed. We investigated whether the use of the aortic connector system (ACS) could facilitate the creation of aortosaphenous vein graft anastomoses in myocardial revascularization. METHODS From November 2000, 40 ACS devices were used in 36 consecutive patients (mean age 70.7 +/- 8.9 years); 12 patients (33.3%) underwent surgery on pump and 24 patients (66.6%) off pump; 50 distal anastomoses were performed. In all cases the connection with the ascending aorta was created before the distal anastomoses because of the necessity to slide the saphenous vein graft (SVG) over the vein transfer sheath. Intraoperative graft function was tested measuring blood flow by Doppler analysis. Postoperative evaluation of the anastomotic patency was carried out by early angiography in 34 patients (94.7%) but was excluded in 5 patients (5.3%) with extensive extracardiac vascular occlusive disease. RESULTS Of 38 AC (95%) evaluated, 36 (94.7%) functioned properly. The end-to-side proximal anastomosis without aortic clamping is instantaneous, the quality of anastomoses was highly rated, no additional stitches were required, and all coronary arteries could be reached. Intraoperative quantity flow was measured by Doppler analysis and all but one showed good flow. Early postoperative angiography demonstrated good patency of the grafts in all cases but 2 (5.3%). At 1-year follow-up, 1 patient died of stroke; all other patients remained free of symptoms and no reoperation was required. CONCLUSIONS The use of ACS makes end-to-side anastomosis rapid, effective, and reproducible while eliminating aortic cross clamping; it opens a new era in beating or nonbeating coronary surgery. Long-term results are mandatory to confirm our favorable preliminary results.
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Affiliation(s)
- Carlo Antona
- Division of Cardiovascular Surgery, Department of Cardiology, L. Sacco Hospital, Milan, Italy
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Affiliation(s)
- Matthew B Bloom
- Johnson & Johnson Postdoctoral Research Fellow, Center for Advanced Technology in Surgery, Stanford University School of Medicine, California, USA
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Czibik G, D'Ancona G, Donias HW, Karamanoukian HL. Robotic cardiac surgery: present and future applications. J Cardiothorac Vasc Anesth 2002; 16:495-501. [PMID: 12154434 DOI: 10.1053/jcan.2002.125129] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mabrey JD, Gillogly SD, Kasser JR, Sweeney HJ, Zarins B, Mevis H, Garrett WE, Poss R, Cannon WD. Virtual reality simulation of arthroscopy of the knee. Arthroscopy 2002; 18:E28. [PMID: 12098110 DOI: 10.1053/jars.2002.33790] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The virtual reality arthroscopic knee simulator (VR-AKS) consists of a computer platform, a video display, and two force-feedback (haptic) interfaces known as "PHANToMs" that also monitor the position of the instruments in the user's hands. The forces that the user would normally apply to the lower limb during arthroscopy are directed through an instrumented surrogate leg. Proprietary software provides the mathematical representation of the physical world and replicates the visual, mechanical, and behavioral aspects of the knee. This includes moderating the haptic interface and simultaneously executing a collision-detection algorithm that prevents the instruments from moving through "solid" surfaces. Modeling software interacts with this algorithm to send the appropriate images to the video display, including knee pathology such as meniscal tears and chondral defects as well as normal anatomy. Task-oriented programs monitor specific performance such as executing a proper examination of the knee or shaving a torn meniscus.
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Affiliation(s)
- Jay D Mabrey
- American Academy of Orthopaedic Surgeons, Council on Education Task Force on Virtual Reality, USA.
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Ott H, Bonatti J, Muller L, Chevtchik O, Riha M, Schachner T, Danzmeyr M, Laufer G. Robotically Enhanced Cardiac Surgery. Eur Surg 2002. [DOI: 10.1046/j.1563-2563.2002.02047.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Le Bret E, Papadatos S, Folliguet T, Carbognani D, Pétrie J, Aggoun Y, Batisse A, Bachet J, Laborde F. Interruption of patent ductus arteriosus in children: robotically assisted versus videothoracoscopic surgery. J Thorac Cardiovasc Surg 2002; 123:973-6. [PMID: 12019384 DOI: 10.1067/mtc.2002.121049] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES If robotic surgery is to be widely used, the risks must be equivalent to those of standard techniques. This study analyzes the feasibility, safety, and efficiency of a robotically assisted technique for patent ductus arteriosus closure and compares the results with those of the videothoracoscopic technique. METHODS During 2000, 56 children weighing 2.3 to 57 kg (mean, 12 kg) underwent surgical closure of a patent ductus arteriosus. They were distributed into 2 groups: 28 patients (group 1) underwent the videothoracoscopic technique, and 28 (group 2) underwent a robotically assisted (Zeus; Computer Motion, Inc, Goleta, Calif) approach. Operative and postoperative surgical data were studied. RESULTS Operative time was significantly higher in the robotically assisted group. One conversion in videothoracoscopy was necessary, but no thoracotomy was required. Three persistent shunts were detected at postoperative echocardiography and were treated by means of application of a new clip with videothoracoscopy (1 in group 1 and 2 in group 2). No permanent laryngeal nerve injury and no hemorrhage were noted. The mean hospital stay was 3 days in both groups. CONCLUSIONS Robotically assisted closure of a patent ductus arteriosus is comparable with closure by means of the videothoracoscopic technique. However, it requires a longer operative time because of the increment in complexity.
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Donias HW, Karamanoukian RL, Glick PL, Bergsland J, Karamanoukian HL. Survey of Resident Training in Robotic Surgery. Am Surg 2002. [DOI: 10.1177/000313480206800216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Harry W. Donias
- From the Departments of Surgery, State University of New York at Buffalo, Buffalo, New York
| | | | - Philip L. Glick
- From the Departments of Surgery, State University of New York at Buffalo, Buffalo, New York
- Department of Pediatric Surgery, Children's Hospital of Buffalo, Buffalo, New York
| | - Jacob Bergsland
- Departments of Cardiothorac Surgery, State University of New York at Buffalo, Buffalo, New York
- Division of Cardiothoracic Surgery and the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery at Kaleida Health at Buffalo General Hospital, Buffalo, New York
| | - Hratch L. Karamanoukian
- Departments of Cardiothorac Surgery, State University of New York at Buffalo, Buffalo, New York
- Division of Cardiothoracic Surgery and the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery at Kaleida Health at Buffalo General Hospital, Buffalo, New York
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41
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Abstract
Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.
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Affiliation(s)
- R D Howe
- Division of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA.
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42
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Abstract
The exponential growth of OR technology during the past 10 years has placed increased demands on perioperative nurses. Proficiency is required not only in patient care but also in the understanding, operating, and troubleshooting of video systems, computers, and cutting edge medical devices. The formation of a surgical team dedicated to robotically assisted cardiac surgery requires careful selection, education, and hands-on practice. This article details the six-week training process undertaken at Sarasota Memorial Hospital, Sarasota, Fla, which enabled staff members to deliver excellent patient care with a high degree of confidence in themselves and the robotic technology.
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Affiliation(s)
- M A Connor
- Center for Advanced Surgery, Sarasota Memorial Hospital, Sarasota, Fla., USA
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43
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Abstract
Since the discovery of X-rays, medical imaging has played a major role in the guidance of surgical procedures. While medical imaging began with simple X-ray plates to indicate the presence of foreign objects within the human body, the advent of the computer has been a major factor in the recent development of this field. Imaging techniques have grown greatly in their sophistication and can now provide the surgeon with high quality three-dimensional images depicting not only the normal anatomy and pathology, but also vascularity and function. One key factor in the advances in Image-Guided Surgery (IGS) is the ability not only to register images derived from the various imaging modalities amongst themselves, but also to register them to the patient. The other crucial aspect of IGS is the ability to track instruments in real time during the procedure, and to portray them as part of a realistic model of the operative volume. Stereoscopic and virtual-reality techniques can usefully enhance the visualization process. IGS nevertheless relies heavily on the assumption that the images acquired prior to surgery, and upon which the surgical guidance is based, accurately represent the morphology of the tissue during the surgical procedure. In many instances this assumption is invalid, and intra-operative real-time imaging, using interventional MRI, Ultrasound, and electrophysiological recordings are often employed to overcome this limitation. Although now in extensive clinical use, IGS is often currently perceived as an intrusion into the operating room. It must evolve towards becoming a routine surgical tool, but this will only happen if natural and intuitive human interfaces are developed for these systems.
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Affiliation(s)
- T M Peters
- Imaging Research Laboratories, The John P. Robarts Research Institute, University of Western Ontario, London, ON, Canada, N6A-5K8
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44
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Marescaux J, Smith MK, Fölscher D, Jamali F, Malassagne B, Leroy J. Telerobotic laparoscopic cholecystectomy: initial clinical experience with 25 patients. Ann Surg 2001; 234:1-7. [PMID: 11420476 PMCID: PMC1421940 DOI: 10.1097/00000658-200107000-00001] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the safety and feasibility of performing telerobotic laparoscopic cholecystectomies. This will serve as a preliminary step toward the integration of computer-rendered three-dimensional preoperative imaging studies of anatomy and pathology onto the patient's own anatomy during surgery. SUMMARY BACKGROUND DATA Computer-assisted surgery (CAS) increases the surgeon's dexterity and precision during minimally invasive surgery, especially when using microinstruments. Clinical trials have shown the improved microsurgical precision afforded by CAS in the minimally invasive setting in cardiac and gynecologic surgery. Future applications would allow integration of preoperative data and augmented-reality simulation onto the actual procedure. METHODS Beginning in September 1999, CAS was used to perform cholecystectomies on 25 patients at a single medical center in this nonrandomized, prospective study. The operations were performed by one of two surgeons who had previous laboratory experience using the computer interface. The entire dissection was performed by the surgeon, who remained at a distance from the patient but in the same operating room. The operation was evaluated according to time of dissection, time of assembly/disassembly of robot, complications, immediate postoperative course, and short-term follow-up. RESULTS Twenty of the 25 patients had symptomatic cholelithiasis, 1 had a gallbladder polyp, and 4 had acute cholecystitis. Twenty-four of the 25 laparoscopic cholecystectomies were successfully completed by CAS. There was one conversion to conventional laparoscopic cholecystectomy. Set-up and takedown of the robotic arms took a median of 18 minutes. The median operative time for dissection and the overall operative time were 25 and 108 minutes, respectively. There were no intraoperative complications. There was one postoperative complication of a suspected pulmonary embolus, which was treated with anticoagulation. All patients were tolerating diet at discharge. CONCLUSIONS Laparoscopic cholecystectomy performed by CAS is safe and feasible, with operative times and patient recovery similar to those of conventional laparoscopy. At present, CAS cholecystectomy offers no obvious advantages to patients, but the potential advantages of CAS lie in its ability to convert the surgical act into digitized data. This digitized format can then interface with other forms of digitized data, such as pre- or intraoperative imaging studies, or be transmitted over a distance. This has the potential to revolutionize the way surgery is performed.
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Affiliation(s)
- J Marescaux
- Department of Digestive Surgery, Université Louis Pasteur, Strasbourg, France.
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45
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Tang LW, D'Ancona G, Bergsland J, Kawaguchi A, Karamanoukian HL. Robotically assisted video-enhanced-endoscopic coronary artery bypass graft surgery. Angiology 2001; 52:99-102. [PMID: 11228093 DOI: 10.1177/000331970105200202] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 1988, through fierce industry-driven competition and patients' preference for minimally invasive procedures, widely diffused through the media, laparoscopic cholecystectomy was universally adopted and rapidly became the "gold standard" for symptomatic cholelithiasis. Robotically assisted video enhanced-endoscopic coronary artery bypass surgery (RAVE-CABG) will most likely follow suit with its similar developmental processes for symptomatic coronary artery disease. Since 1998, there are currently two surgical robotic systems that have been used in a clinical setting for endoscopic coronary artery bypass (ECABG): the da Vinci and the ZEUS system. Although each has separate learning curves to overcome, as with any new technology, both offer the promise to contribute in the interests of reduced hospital days, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma such as wide exposure.
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Affiliation(s)
- L W Tang
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, and Kaleida Health-Buffalo General Hospital, USA
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46
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Virtual Fixtures for Robotic Cardiac Surgery. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2001 2001. [DOI: 10.1007/3-540-45468-3_252] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Falk V, Fann JI, Grünenfelder J, Daunt D, Burdon TA. Endoscopic computer-enhanced beating heart coronary artery bypass grafting. Ann Thorac Surg 2000; 70:2029-33. [PMID: 11156115 DOI: 10.1016/s0003-4975(00)02003-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Telemanipulation systems have enabled coronary revascularization on the arrested heart. The purpose of this study was to develop a technique for computer-enhanced endoscopic coronary artery bypass grafting on the beating heart. METHODS The operation was performed using the daVinci telemanipulation system. Through three ports, the left internal thoracic artery was harvested in 10 mongrel dogs (30 to 35 kg) using single right-lung ventilation and CO2 insufflation. Through a fourth port an articulating stabilizer, manipulated from a second surgical console, was inserted to stabilize the heart. The left anterior descending artery was snared using silicone elastomer slings anchored in the stabilizer cleats and the graft to coronary artery anastomosis was performed. RESULTS In 7 of 10 dogs, total endoscopic beating heart bypass grafting, cardiac stabilization, arteriotomy, and arterial anastomosis were performed using computer-enhanced technology. Endoscopic stabilization and temporary left anterior descending artery occlusion were well tolerated. All grafts were patent although minor strictures were found in 2. In 3 dogs, the procedure could not be completed (1 ventricular arrhythmia, 1 left atrial laceration, and 1 right ventricular outflow tract compression). CONCLUSIONS Endoscopic beating heart coronary artery bypass grafting is possible in a canine model using a computer-enhanced instrumentation system and articulating stabilization.
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Affiliation(s)
- V Falk
- Department of Cardiothoracic Surgery, Stanford University Medical Center, California 94305, USA.
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LaPietra A, Grossi EA, Derivaux CC, Applebaum RM, Hanjis CD, Ribakove GH, Galloway AC, Buttenheim PM, Steinberg BM, Culliford AT, Colvin SB. Robotic-assisted instruments enhance minimally invasive mitral valve surgery. Ann Thorac Surg 2000; 70:835-8. [PMID: 11016319 DOI: 10.1016/s0003-4975(00)01610-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The potential for totally endoscopic mitral valve surgery has been advanced by the development of minimally invasive techniques. Recently surgical robots have offered instrument access through small ports, obviating the need for a significant thoracotomy. This study tested the hypothesis that a microsurgical robot with 5 degrees of freedom is capable of performing an endoscopic mitral valve replacement (MVR). METHODS Dogs (n = 6) were placed on peripheral cardiopulmonary bypass; aortic occlusion was achieved with endoaortic clamping and transesophageal echocardiographic control. A small left seventh interspace "service entrance" incision was used to insert sutures, retractor blade, and valve prosthesis. Robotically controlled instruments included a thoracoscope and 5-mm needle holders. MVR was performed using an interrupted suture technique. RESULTS Excellent visualization was achieved with the thoracoscope. Instrument setup required 25.8 minutes (range 12 to 37); valve replacement required 69.3+/-5.39 minutes (range 48 to 78). MVR was accomplished with normal prosthetic valve function and without misplaced sutures or inadvertent injuries. CONCLUSIONS This study demonstrates the feasibility of adjunctive use of robotic instrumentation for minimally invasive MVR. Clinical trials are indicated.
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Affiliation(s)
- A LaPietra
- Department of Surgery, New York University School of Medicine, New York, USA
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Miyaji K, Hannan RL, Ojito J, Dygert JM, White JA, Burke RP. Video-assisted cardioscopy for intraventricular repair in congenital heart disease. Ann Thorac Surg 2000; 70:730-7. [PMID: 11016302 DOI: 10.1016/s0003-4975(00)01497-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgical techniques have been widely adopted as a means to reduce surgical trauma. By adapting pediatric thoracoscopic instrumentation, we have developed a technique for video-assisted cardioscopy (VAC). We report our experience and describe the technical feasibility of VAC. METHODS Since June 1995, 409 consecutive patients underwent 431 intracardiac procedures (ventricular septal defect, 150; tetralogy of Fallot or double outlet right ventricle, 101; atrioventricular canal, 52; subaortic stenosis, 43; valve repair, 50; Rastelli procedure, 12; Konno or Ross Konno operation, 11; and miscellaneous, 12) using VAC at Miami Children's Hospital. Using a prospective database, we tracked outcomes and operative events to delineate the usefulness and efficacy of this technique. RESULTS VAC provided clear and precise imaging of small or remote intracardiac structures during repair of congenital heart defects without technical complications. Procedure times and aortic cross-clamp times using VAC were not prolonged. Intraoperative images were collected for every operation, documenting each patient's cardiac anatomy before and after repair. Surgery through small incisions was facilitated. Operative mortality was 1.2% (5 of 409), and no patient required reoperation before discharge. At a mean follow-up interval of 22 months, the incidence of reoperation for residual or recurrent lesions was 1.2% (5 of 404). CONCLUSIONS Our experience demonstrates the technical feasibility and clinical utility of routine endoscopic imaging during open heart surgery for congenital heart repair.
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Affiliation(s)
- K Miyaji
- Department of Cardiovascular Surgery, Miami Children's Hospital, Florida 33155-4069, USA
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50
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Damiano RJ, Ducko CT, Stephenson ER, Lawton JS, Kuenzler RO, Chambers CE. Robotically assisted coronary artery bypass grafting: a prospective single center clinical trial. J Card Surg 2000; 15:256-65. [PMID: 11758061 DOI: 10.1111/j.1540-8191.2000.tb01287.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This prospective study was performed as a Phase 1 Food and Drug Administration clinical trial to assess the safety and feasibility of robotically assisted coronary artery bypass grafting (CABG). METHODS Eighteen patients undergoing elective CABG were enrolled in this study. Full sternotomy was performed in 17 of 18 patients, while cardiopulmonary bypass and cardioplegic arrest was used in all cases. Robotically assisted CABG of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD) was performed through three ports using a robotically assisted microsurgical system. Conventional techniques were used to perform all other grafts. Blood flow in the LITA graft was measured in the operating room, and when necessary, angiography was performed. Six weeks after the operation, all patients underwent selective coronary angiography of the LITA graft. RESULTS Robotically assisted coronary artery anastomoses were successfully completed in all patients. Blood flow through the LITA graft was adequate in 16 of 18 patients (89%). The two inadequate grafts were revised successfully by hand. Six weeks after the operation, angiography demonstrated a graft patency of 100% (13 of 13). Mean follow-up has been over 190 days. All patients remain New York Heart Association Angina Class I. CONCLUSION Robotic assistance represents an enabling technology that may allow the surgeon to perform endoscopic coronary artery anastomoses. Further clinical trials are needed to explore the clinical potential and value of robotically assisted CABG.
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Affiliation(s)
- R J Damiano
- Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Penn State University, Hershey 17033, USA.
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