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Jiang W, Gao Y, Wen M, Ye Z, Liang H, Wu D, Dong W. Preliminary evaluation for ultrasound-guided targeted prostate biopsy using a portable surgical robot: Ex vivo results. Int J Med Robot 2023:e2597. [PMID: 37984069 DOI: 10.1002/rcs.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Robotic systems are increasingly used to enhance clinical outcomes in prostate intervention. To evaluate the clinical value of the proposed portable robot, the robot-assisted and robot-targeted punctures were validated experimentally. METHOD The robot registration utilising the electromagnetic tracker achieves coordinate transformation from the ultrasound (US) image to the robot. Subsequently, Transrectal ultrasound (TRUS)-guided phantom trials were conducted for robot-assisted, free-hand, and robot-targeted punctures. RESULTS The accuracy of robot registration was 0.95 mm, and the accuracy of robot-assisted, free-hand, and robot-targeted punctures was 2.38 ± 0.64 mm, 3.11 ± 0.72 mm, and 3.29 ± 0.83 mm sequentially. CONCLUSION The registration method has been successfully applied to robot-targeted puncture. Current results indicate that the accuracy of robot-targeted puncture is slightly inferior to that of manual operations. Moreover, in manual operation, robot-assisted puncture improves the accuracy of free-hand puncture. Accuracy superior to 3.5 mm demonstrates the clinical applicability of both robot-assisted and robot-targeted punctures.
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Affiliation(s)
- Wenhe Jiang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Yongzhuo Gao
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Mingwei Wen
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Zhichao Ye
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Wu
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Wei Dong
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
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Fosch-Villaronga E, Khanna P, Drukarch H, Custers B. The Role of Humans in Surgery Automation. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractInnovation in healthcare promises unparalleled potential in optimizing the production, distribution, and use of the health workforce and infrastructure, allocating system resources more efficiently, and streamline care pathways and supply chains. A recent innovation contributing to this is robot-assisted surgeries (RAS). RAS causes less damage to the patient's body, less pain and discomfort, shorter hospital stays, quicker recovery times, smaller scars, and less risk of complications. However, introducing a robot in traditional surgeries is not straightforward and brings about new risks that conventional medical instruments did not pose before. For instance, since robots are sophisticated machines capable of acting autonomously, the surgical procedure's outcome is no longer limited to the surgeon but may also extend to the robot manufacturer and the hospital. This article explores the influence of automation on stakeholder responsibility in surgery robotization. To this end, we map how the role of different stakeholders in highly autonomous robotic surgeries is transforming, explore some of the challenges that robot manufacturers and hospital management will increasingly face as surgical procedures become more and more automated, and bring forward potential solutions to ascertain clarity in the role of stakeholders before, during, and after robot-enabled surgeries (i.e. a Robot Impact Assessment (ROBIA), a Robo-Terms framework inspired by the international trade system 'Incoterms', and a standardized adverse event reporting mechanism). In particular, we argue that with progressive robot autonomy, performance, oversight, and support will increasingly be shared between the human surgeon, the support staff, and the robot (and, by extent, the robot manufacturer), blurring the lines of who is responsible if something goes wrong. Understanding the exact role of humans in highly autonomous robotic surgeries is essential to map liability and bring certainty concerning the ascription of responsibility. We conclude that the full benefits the use of robotic innovations and solutions in surgery could bring to healthcare providers and receivers cannot be realized until there is more clarity on the division of responsibilities channeling robot autonomy and human performance, support, and oversight; a transformation on the education and training of medical staff, and betterment on the complex interplay between manufacturers, healthcare providers, and patients.
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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Spine surgical robotics: review of the current application and disadvantages for future perspectives. J Robot Surg 2019; 14:11-16. [DOI: 10.1007/s11701-019-00983-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
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Dahroug B, Tamadazte B, Weber S, Tavernier L, Andreff N. Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery. IEEE Rev Biomed Eng 2018; 11:125-142. [PMID: 29994589 DOI: 10.1109/rbme.2018.2810605] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic applications.
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Potential Risk of Intelligent Technologies in Clinical Orthopedics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:281-288. [PMID: 30306488 DOI: 10.1007/978-981-13-1396-7_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nowadays, the intelligent technologies are getting more and more attention, and the surgical robot is one of the most typical representatives. Orthopedic robots have revolutionized orthopedic surgery, but there are also risks. The risks can be categorized into those directly related to the use of the robotic system and the general risks of the operative procedure. This paper analyzes the potential risks of intelligent technologies in clinical orthopedics from three aspects, including surgical planning and strategies, spatial registration, and robotic guidance and navigation. Through these summaries, we hope to help clinical doctors better understand intelligent orthopedic techniques and promote a wide range of clinical applications of intelligent orthopedics. Besides, we also indicate the future research direction of intelligent orthopedic techniques, such as risk analysis, safety assessment, and risk management system.
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Nouaille L, Laribi MA, Nelson CA, Zeghloul S, Poisson G. Review of Kinematics for Minimally Invasive Surgery and Tele-Echography Robots. J Med Device 2017. [DOI: 10.1115/1.4037053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper deals with the survey of kinematic structures adapted to specific medical robots: minimally invasive surgery (MIS) and tele-echography. The large diversity of kinematic architectures that can be found in medical robotics leads us to perform a statistical analysis to inform and guide design of medical robots. Safety constraints and some considerations in design evolution of medical robots are presented in this paper. First, we describe the spectrum of medical robots in minimally invasive surgery and tele-echography applications and particularly the variety of kinematic architectures used. We present the robots and their kinematic architectures and highlight differences that occur in each medical application. We perform a statistical analysis which can serve as a resource in topological synthesis for each specific medical application. Safety is an important specification in medical robotics, and for that reason we show the means used to take into account this constraint. This study demonstrates that the nature of medical robots implies specific requirements leading to different kinematic structures. The statistical analysis gives information on choice of kinematic structures for medical applications (minimally invasive surgery and echography). The safety constraint as well as the interaction between doctor and robot leads to investigate new mechanical solutions to enhance medical robot safety and compliance. We expect that this paper will serve as a significant resource and help the design of future medical robots.
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Affiliation(s)
- L. Nouaille
- PRISME Laboratory, IRAuS Department, PRES Loire Valley University, Bourges 18000, France e-mail:
| | - M. A. Laribi
- Department GMSC, PPRIME Institute, University of Poitiers, Chasseneuil 86962, France e-mail:
| | - C. A. Nelson
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588 e-mail:
| | - S. Zeghloul
- Department GMSC, PPRIME Institute, University of Poitiers, Chasseneuil 86962, France e-mail:
| | - G. Poisson
- PRISME Laboratory, IRAuS Department, PRES Loire Valley University, Bourges 18000, France e-mail:
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Zhu JH, Wang J, Wang YG, Li M, Guo YX, Liu XJ, Guo CB. Performance of Robotic Assistance for Skull Base Biopsy: A Phantom Study. J Neurol Surg B Skull Base 2017; 78:385-392. [PMID: 28875116 DOI: 10.1055/s-0037-1602791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/21/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives This study aims to evaluate the feasibility of a custom robot system guided by optical cone beam computed tomography (CBCT)-based navigation for skull base biopsy. Design An accuracy study was conducted. Setting Platform for navigation and robot-aided surgery technology. Participants Phantom skull. Main Outcome Measures The primary outcome measure was to investigate the accuracy of robot-assisted needle biopsy for skull base tumors. A 14-gauge needle was automatically inserted by the five degrees of freedom robot into the intended target, guided by optical navigation. The result was displayed on the graphical user interface after matrix transformation. Postoperative image scanning was performed, and the result was verified with image fusion. Results All 20 interventions were successfully performed. The mean deviation of the needle tip was 0.56 ± 0.22 mm (measured by the navigation system) versus 1.73 ± 0.60 mm (measured by image fusion) ( p < 0.05). The mean insertion depth was 52.3 mm (range: 49.7-55.2 mm). The mean angular deviations off the x-axis, y-axis, and z-axis were 1.51 ± 0.67, 2.33 ± 1.65, and 1.47 ± 1.16 degrees, respectively. Conclusions The experimental results show the robot system is efficient, reliable, and safe. The navigation accuracy is a significant factor in robotic procedures.
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Affiliation(s)
- Jian-Hua Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Jing Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Yong-Gui Wang
- Intelligent Robotics Institute, Beijing Institute of Technology, Haidian District, Beijing, People's Republic of China
| | - Meng Li
- Intelligent Robotics Institute, Beijing Institute of Technology, Haidian District, Beijing, People's Republic of China
| | - Yu-Xing Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Xiao-Jing Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
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Kettenbach J, Kronreif G. Robotic systems for percutaneous needle-guided interventions. MINIM INVASIV THER 2014; 24:45-53. [DOI: 10.3109/13645706.2014.977299] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kettenbach J, Kara L, Toporek G, Fuerst M, Kronreif G. A robotic needle-positioning and guidance system for CT-guided puncture: Ex vivo results. MINIM INVASIV THER 2014; 23:271-8. [PMID: 24953817 DOI: 10.3109/13645706.2014.928641] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To test the feasibility of a robotic needle-guidance platform during CT-guided puncture ex vivo. MATERIAL AND METHODS Thin copper wires inserted into a torso phantom served as targets. The phantom was placed on a carbon plate and the robot-positioning unit (RPU) of the guidance platform (iSYS Medizintechnik GmbH, Kitzbuehel, Austria) was attached. Following CT imaging and automatic registration a double oblique trajectory was planned and the RPU was remotely moved into appropriate position and angulation. A 17G-puncture needle was then manually inserted until the preplanned depth, permanently guided by the RPU. The CT scan was repeated and the distance between the actual needle tip and the target was evaluated. RESULTS Automatic registration was successful in ten experiments and the median duration of an experiment was 9.6 (6.4-46.0) minutes. The angulation of the needle path in x-y and z-axis was within 15.6° to 32.6°, and -32.8° to 3.2°, respectively and the needle insertion depth was 92.8 ± 14.4 mm. The Euclidean distance between the actual needle tip and the target was 2.3 ± 0.8 (range, 0.9-3.7) mm. CONCLUSION Automatic registration and accurate needle placement close to small targets was demonstrated. Study settings and torso phantom were very close to the clinical reality.
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Affiliation(s)
- Joachim Kettenbach
- ARTORG Center for Biomedical Engineering, University of Bern , Switzerland
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Abstract
SUMMARYSurgical robotics is a growing discipline, continuously expanding with an influx of new ideas and research. However, it is important that the development of new devices take account of past mistakes and successes. A structured approach is necessary, as with proliferation of such research, there is a danger that these lessons will be obscured, resulting in the repetition of mistakes and wasted effort and energy. There are several research paths for surgical robotics, each with different risks and opportunities and different methodologies to reach a profitable outcome. The main emphasis of this paper is on a methodology for ‘applied research’ in surgical robotics. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers, the most important first two tiers, and thus gain some acceptability. However, the lack of conformity to the criteria in the top tier, and the inability to conclusively prove increased clinical benefit, is shown to be hampering their potential in gaining wide establishment.
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Albers J, Schmidt T, Hassfeld S, Heid F, Vahl CF. Sternotomie und Kraniotomie mithilfe autonomer Roboter. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2007. [DOI: 10.1007/s00398-007-0599-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cleary K, Melzer A, Watson V, Kronreif G, Stoianovici D. Interventional robotic systems: applications and technology state-of-the-art. MINIM INVASIV THER 2006; 15:101-13. [PMID: 16754193 PMCID: PMC3107540 DOI: 10.1080/13645700600674179] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many different robotic systems have been developed for invasive medical procedures. In this article we will focus on robotic systems for image-guided interventions such as biopsy of suspicious lesions, interstitial tumor treatment, or needle placement for spinal blocks and neurolysis. Medical robotics is a young and evolving field and the ultimate role of these systems has yet to be determined. This paper presents four interventional robotics systems designed to work with MRI, CT, fluoroscopy, and ultrasound imaging devices. The details of each system are given along with any phantom, animal, or human trials. The systems include the AcuBot for active needle insertion under CT or fluoroscopy, the B-Rob systems for needle placement using CT or ultrasound, the INNOMOTION for MRI and CT interventions, and the MRBot for MRI procedures. Following these descriptions, the technology issues of image compatibility, registration, patient movement and respiration, force feedback, and control mode are briefly discussed. It is our belief that robotic systems will be an important part of future interventions, but more research and clinical trials are needed. The possibility of performing new clinical procedures that the human cannot achieve remains an ultimate goal for medical robotics. Engineers and physicians should work together to create and validate these systems for the benefits of patients everywhere.
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Affiliation(s)
- Kevin Cleary
- Department of Radiology, Imaging Science and Information Systems Center, Georgetown University Medical Center, Washington, DC 20007, USA.
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Kronreif G, Kettenbach J, Fürst M, Kornfeld M, Ptacek W, Vogele M. IntraROB—a programmable targeting device for interventional radiology. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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