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Chen D, Zhao Z, Zhang S, Chen S, Wu X, Shi J, Liu N, Pan C, Tang Y, Meng C, Zhao X, Tao B, Liu W, Chen D, Ding H, Zhang P, Tang Z. Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01244-x. [PMID: 38558011 DOI: 10.1007/s12975-024-01244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.
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Affiliation(s)
- Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhixian Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shenglun Zhang
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Shi
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Na Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cai Meng
- School of Astronautics, Beihang University, Beijing, China
| | - Xingwei Zhao
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Tao
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Instrument Co., Ltd., Beijing, China
| | - Diansheng Chen
- Institute of Robotics, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Han Ding
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Duan Y, Ling J, Feng Z, Ye T, Sun T, Zhu Y. A Survey of Needle Steering Approaches in Minimally Invasive Surgery. Ann Biomed Eng 2024:10.1007/s10439-024-03494-0. [PMID: 38530535 DOI: 10.1007/s10439-024-03494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
In virtue of a curved insertion path inside tissues, needle steering techniques have revealed the potential with the assistance of medical robots and images. The superiority of this technique has been preliminarily verified with several maneuvers: target realignment, obstacle circumvention, and multi-target access. However, the momentum of needle steering approaches in the past decade leads to an open question-"How to choose an applicable needle steering approach for a specific clinical application?" This survey discusses this question in terms of design choices and clinical considerations, respectively. In view of design choices, this survey proposes a hierarchical taxonomy of current needle steering approaches. Needle steering approaches of different manipulations and designs are classified to systematically review the design choices and their influences on clinical treatments. In view of clinical consideration, this survey discusses the steerability and acceptability of the current needle steering approaches. On this basis, the pros and cons of the current needle steering approaches are weighed and their suitable applications are summarized. At last, this survey concluded with an outlook of the needle steering techniques, including the potential clinical applications and future developments in mechanical design.
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Affiliation(s)
- Yuzhou Duan
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China
| | - Jie Ling
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China.
| | - Zhao Feng
- School of Power and Mechanical Engineering, Wuhan University, Wuhan, 430072, China
- Wuhan University Shenzhen Research Institute, Shenzhen, 518057, China
| | - Tingting Ye
- Industrial and Systems Engineering Department, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Tairen Sun
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Yuchuan Zhu
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China
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3
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Wang F, Sun X, Ma Z, Li J. Stereo attention-based all-in-one super-resolution for robot-assisted minimally invasive surgery. J Robot Surg 2024; 18:27. [PMID: 38231445 DOI: 10.1007/s11701-023-01769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
Robot-assisted minimally invasive surgery (MIS) faces challenges in obtaining high-quality imaging results due to the limited spatial environment. In this paper, we present an all-in-one image super-resolution (SR) algorithm designed to tackle this challenge. By utilizing the stereo information from binocular images, we effectively convert low-resolution images into high-resolution ones. Our model architecture amalgamates the prowess of Convolutional Neural Networks (CNNs) and Transformers, capitalizing on the advantages of both methodologies. To achieve super-resolution across all scale factors, we employ a trainable upsampling module within our proposed network. We substantiate the effectiveness of our method through extensive quantitative and qualitative experiments. The results of our evaluations provide strong evidence supporting the superior performance of our approach in enhancing the quality of surgical images. Our method improves the resolution and thus the overall image quality, which allows the surgeon to perform precise operations conveniently. Simultaneously, it also facilitates the scaling of the region of interest (ROI) to achieve high-quality visualization during surgical procedures. Furthermore, it has the potential to enhance the image quality during telesurgery.
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Affiliation(s)
- Feng Wang
- School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin, 300350, China
- Institute of Medical Robotics and Intelligent Systems, Tianjin University, No. 2 Huake Fifth Road, Binhai Hi-Tech Industrial Development Area, Tianjin, 300392, China
| | - Xinan Sun
- School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin, 300350, China
- Institute of Medical Robotics and Intelligent Systems, Tianjin University, No. 2 Huake Fifth Road, Binhai Hi-Tech Industrial Development Area, Tianjin, 300392, China
| | - Zhikang Ma
- School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin, 300350, China
- Institute of Medical Robotics and Intelligent Systems, Tianjin University, No. 2 Huake Fifth Road, Binhai Hi-Tech Industrial Development Area, Tianjin, 300392, China
| | - Jinhua Li
- School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin, 300350, China.
- Institute of Medical Robotics and Intelligent Systems, Tianjin University, No. 2 Huake Fifth Road, Binhai Hi-Tech Industrial Development Area, Tianjin, 300392, China.
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Mendoza-Bautista KJ, Torres-Mendez LA, Chairez I. Adaptive controller based on barrier Lyapunov function for a composite Cartesian-delta robotic device for precise time-varying position tracking. ISA Trans 2023:S0019-0578(23)00398-1. [PMID: 37709560 DOI: 10.1016/j.isatra.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
This study presents the design of an adaptive event-driven controller for solving the trajectory tracking problem of a composite robotic device made up of a three-dimensional Cartesian and a parallel Delta robot. The proposed composite device has a mathematical model satisfying a standard Lagrangian structure affected by modeling uncertainties and external perturbations. The adaptive gain of the controller is considered to enforce the convergence of the tracking error while the state bounds are satisfied. The barrier Lyapunov function addresses the preconceived state constraints for both robotic devices by designing a time-varying gain that guarantees the ultimate boundedness of the tracking error under the effect of external perturbations. The event-driven approach considers that the Cartesian robot is moving into a predefined invariant zone near to the origin. In contrast, the delta robot can complete the tracking problem once the end-effector is inside the given zone. The suggested controller was evaluated using a virtual representation of the composite robotic device showing better tracking performance (while the restrictions are satisfied) than the performances obtained with the traditional linear state feedback controllers. Analyzing the mean square error and its integral led to confirming the benefits of using the adaptive barrier control.
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Affiliation(s)
| | | | - Isaac Chairez
- Institute of Advanced Materials for Sustainable Manufacturing, Tecnologico de Monterrey, Campus Guadalajara, Jalisco, Mexico.
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Abdurahiman N, Khorasani M, Padhan J, Baez VM, Al-Ansari A, Tsiamyrtzis P, Becker AT, Navkar NV. Scope actuation system for articulated laparoscopes. Surg Endosc 2023; 37:2404-2413. [PMID: 36750488 PMCID: PMC10017632 DOI: 10.1007/s00464-023-09904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND An articulated laparoscope comprises a rigid shaft with an articulated distal end to change the viewing direction. The articulation provides improved navigation of the operating field in confined spaces. Furthermore, incorporation of an actuation system tends to enhance the control of an articulated laparoscope. METHODS A preliminary prototype of a scope actuation system to maneuver an off-the-shelf articulated laparoscope (EndoCAMaleon by Karl Storz, Germany) was developed. A user study was conducted to evaluate this prototype for the surgical paradigm of video-assisted thoracic surgery. In the study, the subjects maneuvered an articulated scope under two modes of operation: (a) actuated mode where an operating surgeon maneuvers the scope using the developed prototype and (b) manual mode where a surgical assistant directly maneuvers the scope. The actuated mode was further assessed for multiple configurations based on the orientation of the articulated scope at the incision. RESULTS The data show the actuated mode scored better than the manual mode on all the measured performance parameters including (a) total duration to visualize a marked region, (a) duration for which scope focus shifts outside a predefined visualization region, and (c) number of times for which scope focus shifts outside a predefined visualization region. Among the different configurations tested using the actuated mode, no significant difference was observed. CONCLUSIONS The proposed articulated scope actuation system facilitates better navigation of an operative field as compared to a human assistant. Secondly, irrespective of the orientation in which an articulated scope's shaft is inserted through an incision, the proposed actuation system can navigate and visualize the operative field.
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Affiliation(s)
| | | | | | - Victor M Baez
- Department of Electrical Engineering, University of Houston, Houston, TX, USA
| | | | | | - Aaron T Becker
- Department of Electrical Engineering, University of Houston, Houston, TX, USA
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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6
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Benzakour A, Altsitzioglou P, Lemée JM, Ahmad A, Mavrogenis AF, Benzakour T. Artificial intelligence in spine surgery. Int Orthop 2023; 47:457-465. [PMID: 35902390 DOI: 10.1007/s00264-022-05517-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
The continuous progress of research and clinical trials has offered a wide variety of information concerning the spine and the treatment of the different spinal pathologies that may occur. Planning the best therapy for each patient could be a very difficult and challenging task as it often requires thorough processing of the patient's history and individual characteristics by the clinician. Clinicians and researchers also face problems when it comes to data availability due to patients' personal information protection policies. Artificial intelligence refers to the reproduction of human intelligence via special programs and computers that are trained in a way that simulates human cognitive functions. Artificial intelligence implementations to daily clinical practice such as surgical robots that facilitate spine surgery and reduce radiation dosage to medical staff, special algorithms that can predict the possible outcomes of conservative versus surgical treatment in patients with low back pain and disk herniations, and systems that create artificial populations with great resemblance and similar characteristics to real patients are considered to be a novel breakthrough in modern medicine. To enhance the body of the related literature and inform the readers on the clinical applications of artificial intelligence, we performed this review to discuss the contribution of artificial intelligence in spine surgery and pathology.
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Affiliation(s)
- Ahmed Benzakour
- Centre Orléanais du Dos - Pôle Santé Oréliance, Saran, France
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jean Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Ebihara Y, Hirano S, Takano H, Kanno T, Kawashima K, Morohashi H, Oki E, Hakamada K, Urushidani S, Mori M. Technical evaluation of robotic tele-cholecystectomy: a randomized single-blind controlled pilot study. J Robot Surg 2023; 17:1105-1111. [PMID: 36602754 DOI: 10.1007/s11701-023-01522-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
Although robotic telesurgery is growing in popularity, the benefits of telesurgery compared to local surgery are unclear. This study aimed to evaluate the performance of robotic tele-cholecystectomy with a commercial line using the Saroa™ (Riverfield, Inc., Tokyo, Japan) system. The operation rooms of the Hokkaido University Hospital and Kushiro City General Hospital were connected using a best effort-type line (1 Gbps), with a distance of 250 km between the two hospitals. In this experimental single-blind randomized crossover trial, eight expert robotic surgeons performed robotic cholecystectomy in an artificial organ model using the Saroa™ system and were randomized to begin with either local surgery or telesurgery. All surgeons were assessed on task completion time, total path length of the right- and left- hand forceps and camera, Global Evaluative Assessment of Robotic Skills (GEARS), Global Operative Assessment of Laparoscopic Skills (GOALS), and System and Piper Fatigue Scale-12 (PFS-12). In all experiments, the communication environment was stable and the mean communication delay was 8 ms (3-31 ms). All tele-cholecystectomies were performed safely. There was no significant difference in completion time (P = 0.495), score of GEARS (P = 0.258), GOALS (P = 0.180), or PFS-12 (P = 0.528) between local surgery and telesurgery. The total path of the forceps tended to be longer in tele-cholecystectomy, particularly with significantly longer left-hand forceps total path length (P = 0.041). Robotic tele-cholecystectomy using a commercial line can be performed safely as same as local robotic surgery, but the total path of the left-hand forceps was prolonged in robotic tele-cholecystectomy due to overshoot. Therefore, a solution for overshooting will be required in the future.
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Affiliation(s)
- Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | | | - Kenji Kawashima
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Tokai University School of Medicine, Isehara, Japan
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Lin Y, Zhang C, Liu C, Ma X, Yang Q, Guan B, Liu Z. Imaging-Navigated Surgery. Adv Exp Med Biol 2023; 1199:87-106. [PMID: 37460728 DOI: 10.1007/978-981-32-9902-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
It is vitally important to guide or navigate therapeutic proceedings with a direct and visual approach in order to carefully undertake precision medical manipulations and efficiently evaluate the treatments. Imaging-navigated surgery is one of the common and prevailing technologies to realize this target, and more importantly it merges visualized medicine into next-generation theranostic paradigms in modern medicine. Endoscopes, surgical robots, and nanorobots are three major domains in terms of imaging-navigated surgery. The history of endoscopy has seen upgraded developments since the early 1800s. In contrast, surgical robots have been widely used and investigated in recent years, and they came into clinical uses only in the past decades. Nanorobots which closely depend on innovated and multifunctional biomaterials are still in their infancy. All these imaging-navigated technologies show similar and apparent advantages such as minimal invasiveness, minimized pain, positive prognosis, and relatively expected recovery, which have greatly improved surgery efficiency and patients' life quality. Therefore, the imaging-navigated surgery will be discussed in this chapter, and advanced clinical and preclinical medical applications will also be demonstrated for a diverse readers and comprehensive understanding.
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Affiliation(s)
- Yandai Lin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chen Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chenxi Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xinyong Ma
- Division of Academic & Cultural Activities, Academic Divisions of the Chinese Academy of Sciences, Beijing, China
| | - Qiang Yang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Binggang Guan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhe Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
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Abstract
Surgical robots have been extensively researched for a wide range of surgical procedures due to the advantages of improved precision, sensing capabilities, motion scaling, and tremor reduction, to name a few. Though the underlying disease condition or pathology may be the same across patients, the intervention approach to treat the condition can vary significantly across patients. This is especially true for endovascular interventions, where each case brings forth its own challenges. Hence it is critical to develop patient-specific surgical robotic systems to maximize the benefits of robot-assisted surgery. Manufacturing patient-specific robots can be challenging for complex procedures and furthermore the time required to build them can be a challenge. To overcome this challenge, additive manufacturing, namely 3D-printing, is a promising solution. 3D-printing enables fabrication of complex parts precisely and efficiently. Although 3D-printing techniques have been researched for general medical applications, patient-specific surgical robots are currently in their infancy. After reviewing the state-of-the-art in 3D-printed surgical robots, this paper discusses 3D-printing techniques that could potentially satisfy the stringent requirements for surgical interventions. We also present the accomplishments in our group in developing 3D-printed surgical robots for neurosurgical and cardiovascular interventions. Finally, we discuss the challenges in developing 3D-printed surgical robots and provide our perspectives on future research directions.
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Affiliation(s)
- Jaydev P Desai
- J. P. Desai, J. Sheng, N. J. Deaton, and N. Rahman are with Medical Robotics and Automation (RoboMed) Laboratory in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - Jun Sheng
- J. P. Desai, J. Sheng, N. J. Deaton, and N. Rahman are with Medical Robotics and Automation (RoboMed) Laboratory in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - Shing Shin Cheng
- S. S. Cheng is with the Department of Mechanical and Automation Engineering, Chinese University of Hong Kong, Shatin, N.T. Hong Kong SAR, China
| | - Xuefeng Wang
- X. Wang is with the Department of Mechanical Engineering, University of Alabama, Tuscaloosa, AL, 35487, USA
| | - Nancy J Deaton
- J. P. Desai, J. Sheng, N. J. Deaton, and N. Rahman are with Medical Robotics and Automation (RoboMed) Laboratory in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - Nahian Rahman
- J. P. Desai, J. Sheng, N. J. Deaton, and N. Rahman are with Medical Robotics and Automation (RoboMed) Laboratory in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
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10
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Rassweiler JJ, Goezen AS, Rassweiler-Seyfried MC, Liatsikos E, Bach T, Stolzenburg JU, Klein J. [Robots in urology-an analysis of current and future devices]. Urologe A 2018; 57:1075-90. [PMID: 30030596 DOI: 10.1007/s00120-018-0733-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The monopoly of robotic surgical devices of the last 15 years will end in 2019 when key patents of Intuitive Surgical expire. Thus, we can expect an interesting competitive situation in the coming years. Based on personal experience with robot-assisted surgery since 2001, we conducted a search of the current literature together with a search of relevant patents in this field. Finally, we visited the websites of manufacturers of existing and future robotic surgical devices with possible applications in urology. Such devices have to prove that they meet the high-quality standard of the current Da Vinci series (SI, X, XI). For this purpose, we propose to classify the main features of the different devices, such as type of console (closed/open), arrangement of robotic arms (single/multiple carts/attached to operating room table), type of three-dimensional videosystem (by mirror/ocular/using polarizing glasses) or degrees of freedom (DOF) of end effectors (5 vs. 7 DOF). In the meantime, there are also robotic systems used in endourology: Avicenna Roboflex® and the AquaBeam® system for robot-assisted aquablation therapy of the prostate. While Roboflex® improves the ergonomics of flexible ureteroscopy-similar to the Da Vinci robot, AquaBeam® may for the first time eliminate the surgeon, who might only be needed to manage severe postoperative bleeding.
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11
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Barret E, Mombet A, Cathala N, Rozet F, Galiano M, Cathelineau X. Robotics in urological surgery: evolution, current status and future perspectives. Actas Urol Esp 2015; 39:435-41. [PMID: 25801676 DOI: 10.1016/j.acuro.2014.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Robotic surgery is rapidly evolving and has become an essential part of surgical practice in several parts of the world. Robotic technology will expand globally and most of the surgeons around the world will have access to surgical robots in the future. It is essential that we are updated about the outcomes of robot assisted surgeries which will allow everyone to develop an unbiased opinion on the clinical utility of this innovation. OBJECTIVE In this review we aim to present the evolution, objective evaluation of clinical outcomes and future perspectives of robot assisted urologic surgeries. ACQUISITION OF EVIDENCE A systematic literature review of clinical outcomes of robotic urological surgeries was made in the PUBMED. Randomized control trials, cohort studies and review articles were included. Moreover, a detailed search in the web based search engine was made to acquire information on evolution and evolving technologies in robotics. SYNTHESIS OF EVIDENCE The present evidence suggests that the clinical outcomes of the robot assisted urologic surgeries are comparable to the conventional open surgical and laparoscopic results and are associated with fewer complications. However, long term results are not available for all the common robotic urologic surgeries. There are plenty of novel developments in robotics to be available for clinical use in the future. CONCLUSION Robotic urologic surgery will continue to evolve in the future. We should continue to critically analyze whether the advances in technology and the higher cost eventually translates to improved overall surgical performance and outcomes.
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Affiliation(s)
- A Sivaraman
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Department of Urology, Institute Mutualiste Montsouris, París, Francia.
| | - D Prapotnich
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - E Barret
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - A Mombet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - N Cathala
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - F Rozet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - M Galiano
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
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Wachs JP, Frenkel B, Dori D. Operation room tool handling and miscommunication scenarios: an object-process methodology conceptual model. Artif Intell Med 2014; 62:153-63. [PMID: 25466935 DOI: 10.1016/j.artmed.2014.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Errors in the delivery of medical care are the principal cause of inpatient mortality and morbidity, accounting for around 98,000 deaths in the United States of America (USA) annually. Ineffective team communication, especially in the operation room (OR), is a major root of these errors. This miscommunication can be reduced by analyzing and constructing a conceptual model of communication and miscommunication in the OR. We introduce the principles underlying Object-Process Methodology (OPM)-based modeling of the intricate interactions between the surgeon and the surgical technician while handling surgical instruments in the OR. This model is a software- and hardware-independent description of the agents engaged in communication events, their physical activities, and their interactions. The model enables assessing whether the task-related objectives of the surgical procedure were achieved and completed successfully and what errors can occur during the communication. METHODS AND MATERIAL The facts used to construct the model were gathered from observations of various types of operations miscommunications in the operating room and its outcomes. The model takes advantage of the compact ontology of OPM, which is comprised of stateful objects - things that exist physically or informatically, and processes - things that transform objects by creating them, consuming them or changing their state. The modeled communication modalities are verbal and non-verbal, and errors are modeled as processes that deviate from the "sunny day" scenario. Using OPM refinement mechanism of in-zooming, key processes are drilled into and elaborated, along with the objects that are required as agents or instruments, or objects that these processes transform. The model was developed through an iterative process of observation, modeling, group discussions, and simplification. RESULTS The model faithfully represents the processes related to tool handling that take place in an OR during an operation. The specification is at various levels of detail, each level is depicted in a separate diagram, and all the diagrams are "aware" of each other as part of the whole model. Providing ontology of verbal and non-verbal modalities of communication in the OR, the resulting conceptual model is a solid basis for analyzing and understanding the source of the large variety of errors occurring in the course of an operation, providing an opportunity to decrease the quantity and severity of mistakes related to the use and misuse of surgical instrumentations. Since the model is event driven, rather than person driven, the focus is on the factors causing the errors, rather than the specific person. This approach advocates searching for technological solutions to alleviate tool-related errors rather than finger-pointing. Concretely, the model was validated through a structured questionnaire and it was found that surgeons agreed that the conceptual model was flexible (3.8 of 5, std=0.69), accurate, and it generalizable (3.7 of 5, std=0.37 and 3.7 of 5, std=0.85, respectively). CONCLUSION The detailed conceptual model of the tools handling subsystem of the operation performed in an OR focuses on the details of the communication and the interactions taking place between the surgeon and the surgical technician during an operation, with the objective of pinpointing the exact circumstances in which errors can happen. Exact and concise specification of the communication events in general and the surgical instrument requests in particular is a prerequisite for a methodical analysis of the various modes of errors and the circumstances under which they occur. This has significant potential value in both reduction in tool-handling-related errors during an operation and providing a solid formal basis for designing a cybernetic agent which can replace a surgical technician in routine tool handling activities during an operation, freeing the technician to focus on quality assurance, monitoring and control of the cybernetic agent activities. This is a critical step in designing the next generation of cybernetic OR assistants.
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Affiliation(s)
- Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette 47906, IN, USA.
| | | | - Dov Dori
- Massachusetts Institute of Technology, Cambridge, MA, USA; Technion, Israel Institute of Technology, Haifa, Israel
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