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Takahashi Y, Hakamada K, Morohashi H, Wakasa Y, Fujita H, Ebihara Y, Oki E, Hirano S, Mori M. Effects of communication delay in the dual cockpit remote robotic surgery system. Surg Today 2024; 54:496-501. [PMID: 38071250 PMCID: PMC11026268 DOI: 10.1007/s00595-023-02784-9] [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: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 04/19/2024]
Abstract
PURPOSE To evaluate the impact of dual cockpit telesurgery on proctors and operators, and acceptable levels of processing delay for video compression and restoration. METHODS Eight medical advisors and eight trainee surgeons, one highly skilled per group, performed gastrectomy, rectal resection, cholecystectomy, and bleeding tasks on pigs. Using the Medicaroid surgical robot hinotori™, simulated delay times (0 ms, 50 ms, 100 ms, 150 ms, and 200 ms) were inserted mid-surgery to evaluate the tolerance level. Operative times and dual cockpit switching times were measured subjectively using 5-point scale questionnaires (mSUS [modified System Usability Scale], and Robot Usability Score). RESULTS No significant difference was observed in operative times between proctors and operators (proctor: p = 0.247, operator: p = 0.608) nor in switching times to the dual cockpit mode (p = 0.248). For each survey setting, proctors tended to give lower ratings to delays of ≥ 150 ms. No marked difference was observed in the operator evaluations. On the postoperative questionnaires, there were no marked differences in the mSUS or Robot Usability Score between the proctors and operators (mSUS: p = 0.779, Robot Usability Score: p = 0.261). CONCLUSION Telesurgery using a dual cockpit with hinotori™ is practical and has little impact on surgical procedures.
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Affiliation(s)
- Yoshiya Takahashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, Aomori, Tokyo, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, Aomori, Tokyo, 036-8562, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, Aomori, Tokyo, 036-8562, Japan
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
| | - Yusuke Wakasa
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, Aomori, Tokyo, 036-8562, Japan
| | - Hiroaki Fujita
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, Aomori, Tokyo, 036-8562, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Faculty of Medicine, Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Faculty of Medicine, Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, 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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Bocanegra-Becerra JE, Acha Sánchez JL, Castilla-Encinas AM, Rios-Garcia W, Mendieta CD, Quiroz-Marcelo DA, Alhwaishel K, Aguilar-Zegarra L, Lopez-Gonzalez MA. Toward a Frontierless Collaboration in Neurosurgery: A Systematic Review of Remote Augmented and Virtual Reality Technologies. World Neurosurg 2024:S1878-8750(24)00611-9. [PMID: 38636636 DOI: 10.1016/j.wneu.2024.04.048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Augmented Reality (AR) and Virtual Reality (VR) technologies have been introduced to Neurosurgery with the goal of improving the experience of human visualization. In recent years, the application of remote AR and VR has opened new horizons for neurosurgical collaboration across diverse domains of education and patient treatment. Herein, we aimed to systematically review the literature about the feasibility of this technology and discuss the technical aspects, current limitations, and future perspectives. METHODS Following the PRISMA guidelines, four databases (PubMed, Embase, Scopus, and Cochrane Library) were queried for articles discussing the use of remote AR and VR technologies in Neurosurgery. Data were collected in various fields, including surgery type, application type, subspecialty, software and hardware descriptions, haptic device utilization, visualization technology, internet connection, remote site descriptions, technical outcomes, and limitations. Data were summarized as counts and proportions and analyzed using IBM® SPSS® software. RESULTS Our search strategy generated 466 records, out of which 9 studies satisfied the inclusion criteria. The majority of AR and VR applications were used in cranial procedures (77.8%), mainly in education (63.6%), followed by telesurgical assistance (18.2%), patient monitoring (9.1%), and surgical planning (9.1%). Local collaborations were established in 55.6% of the studies, while national and international partnerships were formed in 44.4% of the studies. AR was the main visualization technology, and 3G internet connection was predominantly used (27.5%). All studies subjectively reported the utility of remote AR and VR for real-time interaction. The major technical challenges and limitations included audiovisual latency, the requirement for higher-fidelity and resolution image reconstructions, and the level of proficiency of the patient with the software. CONCLUSION The results from this systematic review suggest that AR and VR technologies are dynamically advancing to offer remote collaboration in Neurosurgery. Although still incipient in development and with an imperative need for technical improvement, remote AR and VR hold a frontierless potential for patient monitoring, neurosurgical education, and long-distance surgical assistance.
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Affiliation(s)
| | - José Luis Acha Sánchez
- Vascular Neurosurgery and Skull Base Division, Hospital Nacional Dos de Mayo, Lima, Peru
| | | | - Wagner Rios-Garcia
- Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Cristian D Mendieta
- Universidad Mayor Real y Pontificia de San Francisco Xavier de Chuquisaca, Bolivia
| | | | - Khaled Alhwaishel
- Mansoura Manchester Program, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Ota M, Oki E, Nakanoko T, Tanaka Y, Toyota S, Hu Q, Nakaji Y, Nakanishi R, Ando K, Kimura Y, Hisamatsu Y, Mimori K, Takahashi Y, Morohashi H, Kanno T, Tadano K, Kawashima K, Takano H, Ebihara Y, Shiota M, Inokuchi J, Eto M, Yoshizumi T, Hakamada K, Hirano S, Mori M. Field experiment of a telesurgery system using a surgical robot with haptic feedback. Surg Today 2024; 54:375-381. [PMID: 37653350 DOI: 10.1007/s00595-023-02732-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To verify the usefulness of haptic feedback in telesurgery and improve the safety of telerobotic surgery. METHODS The surgeon's console was installed at two sites (Fukuoka and Beppu; 140 km apart), and the patient cart was installed in Fukuoka. During the experiment, the surgeon was blinded to the haptic feedback levels and asked to grasp the intestinal tract in an animal model. The surgeon then performed the tasks at each location. RESULTS No marked differences in task accuracy or average grasping force were observed between the surgeon locations. However, the average task completion time was significantly longer, and the system usability scale (SUS) was significantly lower rating for remote operations than for local ones. No marked differences in task accuracy or task completion time were observed between the haptic feedback levels. However, with haptic feedback, the organ was grasped with a significantly weaker force than that without it. Furthermore, with haptic feedback, experienced surgeons in robotic surgery tended to perform an equivalent task with weaker grasping forces than inexperienced surgeons. CONCLUSION The haptic feedback function is a tool that allows the surgeon to perform surgery with an appropriate grasping force, both on site and remotely. Improved safety is necessary in telesurgery; haptic feedback will thus be an essential technology in robotic telesurgery going forward.
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Affiliation(s)
- Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasushi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Toyota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yu Nakaji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yoshiya Takahashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, 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
| | | | - Kotaro Tadano
- RIVERFIELD Inc., Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Shiota
- Department of Urology, Kyushu University, Fukuoka, Japan
| | | | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, 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
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, 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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Li C, Zheng J, Zhang X, Luo L, Chu G, Zhao J, Zhang Z, Wang H, Qin F, Zhou G, Jiao W, Wang Y, Yang X, Zhou Z, Yang D, Guo H, Zhang C, Li J, Niu H. Telemedicine network latency management system in 5G telesurgery: a feasibility and effectiveness study. Surg Endosc 2024; 38:1592-1599. [PMID: 38148405 DOI: 10.1007/s00464-023-10585-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Network latency is the most important factor affecting the performance of telemedicine. The aim of the study is to assess the feasibility and efficacy of a novel network latency management system in 5G telesurgery. METHODS We conducted 20 telesurgery simulation trials (hitching rings to columns) and 15 remote adrenalectomy procedures in the 5G network environment. Telemedicine Network Latency Management System and the traditional "Ping command" method (gold standard) were used to monitor network latency during preoperative simulated telesurgery and formal telesurgery. We observed the working status of the Telemedicine Network Latency Management System and calculated the difference between the network latency data and packet loss rate detected by the two methods. In addition, due to the lower latency of the 5G network, we tested the alert function of the system using the 4G network with relatively high network latency. RESULTS The Telemedicine Network Latency Management System showed no instability during telesurgery simulation trials and formal telesurgery. After 20 telesurgery simulation trials and 15 remote adrenalectomy procedures, the p-value for the difference between the network latency data monitored by the Telemedicine Network Latency Management System and the "Ping command" method was greater than 0.05 in each case. Meanwhile, the surgeons reported that the Telemedicine Network Latency Management System had a friendly interface and was easy to operate. Besides, when the network latency exceeded a set threshold, a rapid alarm sounded in the system. CONCLUSION The Telemedicine Network Latency Management System was simple and easy to operate, and it was feasible and effective to use it to monitor network latency in telesurgery. The system had an intuitive and concise interface, and its alarm function increased the safety of telesurgery. The system's own multidimensional working ability and information storage capacity will be more suitable for telemedicine work.
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Affiliation(s)
- Chengjun Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Jilu Zheng
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xin Zhang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Lei Luo
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Guangdi Chu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Jianchang Zhao
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Zhao Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Haiyun Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Fei Qin
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Guanzhi Zhou
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Wei Jiao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Yonghua Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xuecheng Yang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Zhilong Zhou
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Dejun Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Hao Guo
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Ce Zhang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China
| | - Jianmin Li
- School of Mechanical Engineering, Tianjin University, Tianjin, 300000, China.
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
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Xue J, Weng S. Navigating the legal complexities of telesurgery in China: An assessment of tort liability and the path forward. Med Sci Law 2024:258024241229831. [PMID: 38327142 DOI: 10.1177/00258024241229831] [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] [Indexed: 02/09/2024]
Abstract
This study investigates the legal challenges posed by telesurgery, an emergent healthcare modality facilitated by advancements in 5G and Artificial Intelligence. It highlights the urgent need for a comprehensive legal framework reconciling the complexities of healthcare delivery and technology integration. The paper examines the Chinese adjudication of negligence and the evidentiary hurdles in telesurgery, interrogating the application of the 'reasonable doctor' standard, the intricate causation-negligence nexus and the distribution of evidentiary burdens. The analysis contends that current statutes require revision to apportion telesurgery-induced damages fairly. Further, it proposes the formation of multidisciplinary committees to oversee medical technology, calls for systemic reforms, more reasonable liability differentiation and fortifying medical insurance frameworks.
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Affiliation(s)
- Jiao Xue
- Zhejiang Police College, Hangzhou, Zhejiang Province, China
| | - Sunzhe Weng
- Zhejiang Police College, Hangzhou, Zhejiang Province, China
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Patel V, Saikali S, Moschovas MC, Patel E, Satava R, Dasgupta P, Dohler M, Collins JW, Albala D, Marescaux J. Technical and ethical considerations in telesurgery. J Robot Surg 2024; 18:40. [PMID: 38231309 DOI: 10.1007/s11701-023-01797-3] [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: 10/12/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
Telesurgery, a cutting-edge field at the intersection of medicine and technology, holds immense promise for enhancing surgical capabilities, extending medical care, and improving patient outcomes. In this scenario, this article explores the landscape of technical and ethical considerations that highlight the advancement and adoption of telesurgery. Network considerations are crucial for ensuring seamless and low-latency communication between remote surgeons and robotic systems, while technical challenges encompass system reliability, latency reduction, and the integration of emerging technologies like artificial intelligence and 5G networks. Therefore, this article also explores the critical role of network infrastructure, highlighting the necessity for low-latency, high-bandwidth, secure and private connections to ensure patient safety and surgical precision. Moreover, ethical considerations in telesurgery include patient consent, data security, and the potential for remote surgical interventions to distance surgeons from their patients. Legal and regulatory frameworks require refinement to accommodate the unique aspects of telesurgery, including liability, licensure, and reimbursement. Our article presents a comprehensive analysis of the current state of telesurgery technology and its potential while critically examining the challenges that must be navigated for its widespread adoption.
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Affiliation(s)
- Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Shady Saikali
- AdventHealth Global Robotics Institute, Celebration, FL, USA.
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Ela Patel
- Stanford University, Stanford, CA, 94305, USA
| | | | - Prokar Dasgupta
- MRC Centre for Transplantation, Department of Urology, King's Health Partners, King's College London, London, UK
| | - Mischa Dohler
- Advanced Technology Group, Ericsson Inc., Santa Clara, CA, 95054, USA
| | - Justin W Collins
- Division of Uro-Oncology, University College London Hospital, London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- CMR Surgical, Cambridge, UK
| | - David Albala
- Downstate Health Sciences University, Syracuse, NY, USA
- Department of Urology, Crouse Hospital, Syracuse, NY, USA
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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Ebihara Y, Hirano S, Kurashima Y, Takano H, Okamura K, Murakami S, Shichinohe T, Morohashi H, Oki E, Hakamada K, Ikeda N, Mori M. Tele-robotic distal gastrectomy with lymph node dissection on a cadaver. Asian J Endosc Surg 2024; 17:e13246. [PMID: 37727067 DOI: 10.1111/ases.13246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
The purpose of this study is to evaluate the performance of tele-robotic distal gastrectomy (tele-RDG) with lymph node dissection (LND) using a novel Japanese-made surgical robot hinotori™ (Medicaroid, Kobe, Japan) in a cadaver with a presumptive gastric cancer. The Cadaveric Anatomy and Surgical Training Laboratory (CAST-Lab.) at Hokkaido University and Kushiro City General Hospital (KCGH) are connected by a guaranteed type line (1 Gbps), and the distance between the two facilities is 250 km. A patient cart was installed at CAST-Lab, and a surgeon cockpit was installed at KCGH. Tele-RDG with D2 LND was performed on an adult human cadaver. In all surgical processes, the communication environment was stable without image degradation, and the mean round trip time was 40 milliseconds (36.5-55 milliseconds). For tele-RDG with D2 LND, the operation time was 199 minutes without any technical problems. Tele-RDG using hinotori™ was feasible and similar to local robotic RDG.
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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, Sapporo, 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, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kunishige Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Center for Education Research and Innovation of Advanced Medical Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Center for Education Research and Innovation of Advanced Medical Technology, Hokkaido University Hospital, Sapporo, 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
| | - Norihiko Ikeda
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, 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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Nakanoko T, Oki E, Ota M, Ikenaga N, Hisamatsu Y, Toshima T, Kanno T, Tadano K, Kawashima K, Ohuchida K, Morohashi H, Ebihara Y, Mimori K, Nakamura M, Yoshizumi T, Hakamada K, Hirano S, Ikeda N, Mori M. Real-time telementoring with 3D drawing annotation in robotic surgery. Surg Endosc 2023; 37:9676-9683. [PMID: 37935920 DOI: 10.1007/s00464-023-10521-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: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND In telementoring, differences in teaching methods affect local surgeons' comprehension. Because the object to be operated on is a three-dimensional (3D) structure, voice or 2D annotation may not be sufficient to convey the instructor's intention. In this study, we examined the usefulness of telementoring using 3D drawing annotations in robotic surgery. METHODS Kyushu University and Beppu Hospital are located 140 km apart, and the study was conducted using a Saroa™ surgical robot by RIVERFIELD Inc. using a commercial guarantee network on optical fiber. Twenty medical students performed vertical mattress suturing using a swine intestinal tract under surgical guidance at the Center for Advanced Medical Innovation Kyushu University. Surgical guidance was provided by Beppu Hospital using voice, 2D, and 3D drawing annotations. All robot operations were performed using 3D images, and only the annotations were independently switched between voice and 2D and 3D images. The operation time, needle movement, and performance were also evaluated. RESULTS The 3D annotation group tended to have a shorter working time than the control group (25.6 ± 63.2 vs. - 36.7 ± 65.4 min, P = 0.06). The 3D annotation group had fewer retries than the control group (1.3 ± 1.7 vs. - 1.1 ± 0.7, P = 0.006), and there was a tendency for fewer needle drops (0.4 ± 0.7 vs. - 0.5 ± 0.9, P = 0.06). The 3D annotation group scored significantly higher than the control group on the Global Evaluate Assessment of Robot Skills (16.8 ± 2.0 vs. 22.8 ± 2.4, P = 0.04). The 3D annotation group also scored higher than the voice (13.4 ± 1.2) and 2D annotation (16.2 ± 1.8) groups (3D vs. voice: P = 0.03, 3D vs. 2D: P = 0.03). CONCLUSION Telementoring using 3D drawing annotation was shown to provide good comprehension and a smooth operation for local surgeons.
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Affiliation(s)
- Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takeo Toshima
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | | | - Kotaro Tadano
- RIVERFIELD Inc, Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- RIVERFIELD Inc, Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Kyushu University, Fukuoka, 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
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, 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
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, 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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9
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Moustris G, Tzafestas C, Konstantinidis K. A long distance telesurgical demonstration on robotic surgery phantoms over 5G. Int J Comput Assist Radiol Surg 2023; 18:1577-1587. [PMID: 37095315 PMCID: PMC10124680 DOI: 10.1007/s11548-023-02913-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Using robotic technology and communications infrastructure to remotely perform surgery has been a persistent goal in medical research in the past three decades. The recent deployment of the Fifth-Generation Wireless Networks has revitalized the research efforts in the telesurgery paradigm. Offering low latency and high bandwidth communication, they are well suited for applications that require real-time data transmission and can allow smoother communication between surgeon and patient, making it possible to remotely perform complex surgeries. In this paper, we investigate the effects of the 5 G network on surgical performance during a telesurgical demonstration where the surgeon and the robot are separated by nearly 300 km. METHODS The surgeon performed surgical exercises on a robotic surgery training phantom using a novel telesurgical platform. The master controllers were connected to the local site on a 5 G network, teleoperating the robot remotely in a hospital. A video feed of the remote site was also streamed. The surgeon performed various tasks on the phantom such as cutting, dissection, pick-and-place and ring tower transfer. To assess the usefulness, usability and image quality of the system, the surgeon was subsequently interviewed using three structured questionnaires. RESULTS All tasks were completed successfully. The low latency and high bandwidth of the network resulted into a latency of 18 ms for the motion commands while the video delay was about 350 ms. This enabled the surgeon to operate smoothly with a high-definition video from about 300 km away. The surgeon viewed the system's usability in a neutral to positive way while the video image was rated as of good quality. CONCLUSION 5 G networks provide significant advancement in the field of telecommunications, offering faster speeds and lower latency than previous generations of wireless technology. They can serve as an enabling technology for telesurgery and further advance its application and adoption.
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Affiliation(s)
- George Moustris
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
| | - Costas Tzafestas
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
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10
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Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
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Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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11
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Oki E, Ota M, Nakanoko T, Tanaka Y, Toyota S, Hu Q, Nakaji Y, Nakanishi R, Ando K, Kimura Y, Hisamatsu Y, Mimori K, Takahashi Y, Morohashi H, Kanno T, Tadano K, Kawashima K, Takano H, Ebihara Y, Shiota M, Inokuchi J, Eto M, Yoshizumi T, Hakamada K, Hirano S, Mori M. Telesurgery and telesurgical support using a double-surgeon cockpit system allowing manipulation from two locations. Surg Endosc 2023; 37:6071-6078. [PMID: 37126192 PMCID: PMC10150667 DOI: 10.1007/s00464-023-10061-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/05/2022] [Accepted: 04/01/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Although several studies on telesurgery have been reported globally, a clinically applicable technique has not yet been developed. As part of a telesurgical study series conducted by the Japan Surgical Society, this study describes the first application of a double-surgeon cockpit system to telesurgery. METHODS Surgeon cockpits were installed at a local site and a remote site 140 km away. Three healthy pigs weighing between 26 and 29 kg were selected for surgery. Non-specialized surgeons performed emergency hemostasis, cholecystectomy, and renal vein ligation with remote assistance using the double-surgeon cockpits and specialized surgeons performed actual telesurgery. Additionally, the impact of adding internet protocol security (IPsec) encryption to the internet protocol-virtual private network (IP-VPN) line on communication was evaluated to address clinical security concerns. RESULTS The average time required for remote emergency hemostasis with the double-surgeon cockpit system was 10.64 s. A non-specialized surgeon could safely perform cholecystectomy or renal vein ligation with remote assistance. Global Evaluative Assessment of Robotic Skills and System Usability Scale scores were higher for telesurgical support-assisted surgery by a non-specialized surgeon using the double-surgeon cockpits than for telesurgery performed by a specialized surgeon without the double-cockpit system. Adding IPsec encryption to the IP-VPN did not have a significant impact on communication. CONCLUSION Telesurgical support through our double-surgeon cockpit system is feasible as first step toward clinical telesurgery.
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Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasushi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Satoshi Toyota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yu Nakaji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yoshiya Takahashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, 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
| | | | - Kotaro Tadano
- Riverfield Inc., Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- Riverfield Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, 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
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, 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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12
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Symeonidis EN, Veneziano D, Borgmann H, Zapała Ł, Zachariou A, Brenneis H, Haensel SM, Haas H, Dimitriadis F. Telemedicine in Urology: Where Have We Been and Where Are We Heading? EUR UROL SUPPL 2023; 50:106-112. [PMID: 36910337 PMCID: PMC9999165 DOI: 10.1016/j.euros.2023.02.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Context Humanity is facing significant challenges, and in 2019, a new coronavirus caused an unprecedented global disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic vastly impacted health care delivery, generating devastating economic, social, and public health disruption. Although previously underutilized, it was not until recently that telemedicine emerged and amassed tremendous popularity. Objective To examine and assess telemedicine's past, present, and future roles in urology. Evidence acquisition We queried relevant literature investigating the role of telemedicine in urology using the electronic PubMed database and mainly focused on English-language studies of any design. Evidence synthesis Growing attention has been paid to the widespread adoption of novel telehealth technologies for managing various diseases. Meanwhile, solid evidence supports the meaningful use of telemedicine for most urological diagnoses. Existing literature delineates telemedicine as a viable, safe, and convenient alternative to in-person clinical visits. Conclusions The present article overviews the evolution of telemedicine in urology, and discusses its application in outpatient and physician's office settings. In addition, it highlights the technical, legal, ethical, and financial aspects of telemedicine while providing valuable insights and practical considerations for the future of telehealth in urology. Patient summary Urologists must adopt telemedicine carefully in daily practice, always adhering to predefined regulatory frameworks.
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Affiliation(s)
- Evangelos N Symeonidis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | | | - Hendrik Borgmann
- Department of Urology, University Hospital Medical School Brandenburg, Brandenburg an der Havel, Germany
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Horst Brenneis
- Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan M Haensel
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | | | - Fotios Dimitriadis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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13
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Fan S, Xu W, Diao Y, Yang K, Dong J, Qin M, Ji Z, Shen C, Zhou L, Li X. Feasibility and Safety of Dual-console Telesurgery with the KangDuo Surgical Robot-01 System Using Fifth-generation and Wired Networks: An Animal Experiment and Clinical Study. EUR UROL SUPPL 2023; 49:6-9. [PMID: 36691584 PMCID: PMC9860257 DOI: 10.1016/j.euros.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
The coronavirus disease 2019 pandemic has drawn attention to telesurgery. Important advances in fifth-generation (5G) mobile telecommunication technology have facilitated the rapid evolution of telesurgery. Previously, only a single console was used in telesurgery; thus, there was the possibility of open or laparoscopic conversion. Furthermore, the 5G network has not been available for regional hospitals in China. From October 2021 to April 2022, dual-console telesurgeries with the KangDuo Surgical Robot-01 (KD-SR-01) system were performed using 5G and wired networks in an animal experiment and clinical study. A partial nephrectomy in a porcine model was performed successfully using a wired network. The console time, warm ischemia time, and control swap time were 69 min, 27 min, and 3 s, respectively. The mean latency time was 130 (range, 60-200) ms. A 32-yr-old male patient successfully underwent a remote pyeloplasty using a series connection of 5G wireless and wired networks. The console time and control swap time were 98 min and 3 s, respectively. The mean latency time was 271 (range, 206-307) ms. In the two studies, data pocket loss was <1%. The results demonstrated that dual-console telesurgery with the KD-SR-01 system is feasible and safe using 5G and wired networks. Patient summary Advances in fifth-generation (5G) mobile telecommunication technology helped in the rapid evolution of telesurgery. Dual-console telesurgery performed with the KD-SR-01 system using 5G and wired networks was shown to be feasible and safe in an animal experiment and clinical study.
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Affiliation(s)
- Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingzhi Diao
- Department of Urology, Beijing Miyun District Hospital (Miyun Hospital, Peking University First Hospital), Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Qin
- Telemedicine Center, Peking Union Medical College Hospital, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
- Corresponding author. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, No. 8 Xishiku St., Xicheng District, Beijing 100034, China. Tel. +86 010 8357 5101; Fax: +86 010 6655 1726.
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14
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Alafaleq M. Robotics and cybersurgery in ophthalmology: a current perspective. J Robot Surg 2023:10.1007/s11701-023-01532-y. [PMID: 36637738 PMCID: PMC9838251 DOI: 10.1007/s11701-023-01532-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
Ophthalmology is one of the most enriched fields, allowing the domain of artificial intelligence to be part of its point of interest in scientific research. The requirement of specialized microscopes and visualization systems presents a challenge to adapting robotics in ocular surgery. Cyber-surgery has been used in other surgical specialties aided by Da Vinci robotic system. This study focuses on the current perspective of using robotics and cyber-surgery in ophthalmology and highlights factors limiting their progression. A review of literature was performed with the aid of Google Scholar, Pubmed, CINAHL, MEDLINE (N.H.S. Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, and Web of Science. Keywords: Cybersurgery, Telesurgery, ophthalmology robotics, Da Vinci robotic system, artificial intelligence in ophthalmology, training on robotic surgery, ethics of the use of robots in medicine, legal aspects, and economics of cybersurgery and robotics. 150 abstracts were reviewed for inclusion, and 68 articles focusing on ophthalmology were included for full-text review. Da Vinci Surgical System has been used to perform a pterygium repair in humans and was successful in ex vivo corneal, strabismus, amniotic membrane, and cataract surgery. Gamma Knife enabled effective treatment of uveal melanoma. Robotics used in ophthalmology were: Da Vinci Surgical System, Intraocular Robotic Interventional Surgical System (IRISS), Johns Hopkins Steady-Hand Eye Robot and smart instruments, and Preceyes' B.V. Cybersurgery is an alternative to overcome distance and the shortage of surgeons. However, cost, availability, legislation, and ethics are factors limiting the progression of these fields. Robotic and cybersurgery in ophthalmology are still in their niche. Cost-effective studies are needed to overcome the delay. Technologies, such as 5G and Tactile Internet, are required to help reduce resource scheduling problems in cybersurgery. In addition, prototype development and the integration of artificial intelligence applications could further enhance the safety and precision of ocular surgery.
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Affiliation(s)
- Munirah Alafaleq
- grid.411975.f0000 0004 0607 035XOphthalmology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia ,Artificial Intelligence and Business School, 18 Rue du Dôme, 92100 Boulogne Billancourt, France ,grid.412134.10000 0004 0593 9113Ophthalmology Department and Centre for Rare Ophthalmological Diseases OPHTARA, Necker Enfants-Malades University Hospital, AP-HP, University Paris Cité, Paris, France
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15
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Li J, Yang X, Chu G, Feng W, Ding X, Yin X, Zhang L, Lv W, Ma L, Sun L, Feng R, Qin J, Zhang X, Gou C, Yu Z, Wei B, Jiao W, Wang Y, Luo L, Yuan H, Chang Y, Cai Q, Wang S, Giulianotti PC, Dong Q, Niu H. Application of Improved Robot-assisted Laparoscopic Telesurgery with 5G Technology in Urology. Eur Urol 2023; 83:41-44. [PMID: 35817641 DOI: 10.1016/j.eururo.2022.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 03/31/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
The demand for telesurgery is rising rapidly, but robust evidence regarding the feasibility of its application in urology is still rare. From March to October 2021, a surgeon-controlled surgical robot in a tertiary hospital in Qingdao was used to remotely conduct robot-assisted laparoscopic radical nephrectomy (RN) in 29 patients located in eight primary hospitals. The median round-trip delay was 26 ms (interquartile range [IQR] 5) and the median distance between the primary hospital and the surgeon was 187 km (IQR 57). Both the master unit and the slave unit were guaranteed by network and mechanical engineers, and surgical assistants were well prepared on the patient side to prevent complications. The primary evaluation metric was the success rate, defined as the percentage of patients who underwent successful remote RN without conversion to other surgical procedures and no major intraoperative or postoperative complications. The results demonstrate that the combination of 5G technology and surgical robots is a novel potential telemedicine-based therapy choice for renal tumors. PATIENT SUMMARY: Our study shows that telesurgery using 5G technology is a safe and feasible treatment option for patients with kidney tumors. The total delay between the remote location and the operating rooms where surgery was being performed was just 200 ms. This approach could reduce health care costs and improve the quality of medical services accessed by patients.
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Affiliation(s)
- Jianmin Li
- Key Laboratory for Mechanism Theory and Equipment Design of the Ministry of Education, Tianjin University, Tianjin, China; Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuecheng Yang
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangdi Chu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Feng
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuemei Ding
- Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xulong Yin
- Department of Urology, Pingyi County Hospital of Traditional Chinese Medicine, Linyi, China
| | - Liangjun Zhang
- Department of Surgery, Zhucheng Hospital of Traditional Chinese Medicine, Zhucheng, China
| | - Wei Lv
- Department of Urology, Fei County People's Hospital, Linyi, China
| | - Lufei Ma
- Department of Urology, Juxian People's Hospital, Rizhao, China
| | - Liguo Sun
- Department of Urology, Juxian People's Hospital, Rizhao, China
| | - Run Feng
- Department of Urology, Zibo Municipal Hospital, Zibo, China
| | - Jun Qin
- Department of Urology, Yinan People's Hospital, Linyi, China
| | - Xuefeng Zhang
- Department of Urology, Weihai Central Hospital, Weihai, China
| | - Chengyi Gou
- Department of Urology, Dingxi People's Hospital, Dingxi, China
| | - Zongyi Yu
- Department of Information Management, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Wei
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Jiao
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yonghua Wang
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Luo
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hang Yuan
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Chang
- Shandong Development and Reform Commission, Jinan, China
| | - Qiliang Cai
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Shuxin Wang
- Key Laboratory for Mechanism Theory and Equipment Design of the Ministry of Education, Tianjin University, Tianjin, China.
| | | | - Qian Dong
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Haitao Niu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China; Institute of Medical Robotics and Intelligent Systems, Tianjin University, Tianjin, China.
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Serafini B, Kim L, Saour BM, James R, Hannaford B, Hansen R, Kohno T, Monsky W, Seslar SP. Exploring telerobotic cardiac catheter ablation in a rural community hospital: A pilot study. Cardiovasc Digit Health J 2022; 3:313-9. [PMID: 36589313 DOI: 10.1016/j.cvdhj.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the United States and worldwide. Advancements in telecommunications, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. Objective The purpose of this study was to pilot test a system and methods to explore telerobotic cardiac catheter ablation in a rural community hospital setting. Methods We assembled a portable preclinical telerobotic catheter ablation system from commercial-grade components using third-party vendors. We then carried out 4 telerobotic surgery simulations with an urban surgeon and a rural community hospital operating room (OR) team spanning a distance of more than 2000 miles. Two challenge scenarios were incorporated into the simulations, including loss of network connection and cardiac perforation with subsequent life-threatening tamponade physiology. An ethnographic analysis was then performed. Results Interviews and observations suggested that rural OR teams readily adapt to the telesurgery context. However, participant perceptions of team trust, communication, and emergency management were significantly altered by the remote location of the surgeon. In addition, most participants believed the OR team would have been better equipped for the challenges had they received formal training or had prior experience with the procedure being simulated. Conclusion We demonstrate the utility and feasibility of a system and methods for studying specialty telerobotic surgery in a rural hospital OR setting.
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Barba P, Stramiello J, Funk EK, Richter F, Yip MC, Orosco RK. Remote telesurgery in humans: a systematic review. Surg Endosc 2022; 36:2771-7. [PMID: 35246740 DOI: 10.1007/s00464-022-09074-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the conception of robotic surgery, remote telesurgery has been a dream upon which incredible technological advances haven been built. Despite the considerable enthusiasm for, there have been few published studies of remote telesurgery on humans. METHODS We performed a systematic review of the English literature (PubMed, EMbase, Inspec & Compendex and Web of Science) to report studies of remote telesurgery in humans. Keywords included telesurgery, remote surgery, long-distance surgery, and telerobotics. Subjects had to be human (live patients or cadavers). The operating surgeon had to be remote from the patient, separated by more than one kilometer. The article had to explicitly report the use of a long-distance telerobotic technique. Articles that focused on telepresence or tele-mentoring were excluded. RESULTS The study included eight articles published from 2001 to 2020. One manuscript (1 subject) described remote surgery on a cadaver model, and the other seven were on live humans (72 subjects). Procedure types included percutaneous, endovascular, laparoscopic, and transoral. Communication methods varied, with the first report using a telephone line and the most recent studies using a 5G network. Six of the studies reported signal latency as a single value and it ranged from 28 ms to 280 ms. CONCLUSIONS Few studies have described remote telesurgery in humans, and there is considerable variability in robotic and communication methods. Future efforts should work to improve reporting of signal latency and follow careful research methodology.
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Morohashi H, Hakamada K, Kanno T, Kawashima K, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network. Surg Today 2022. [PMID: 34668052 DOI: 10.1007/s00595-00021-02384-00595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. METHODS A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. RESULTS The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. CONCLUSIONS The social implementation of telesurgery using the currently available commercial communication network is feasible.
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Affiliation(s)
- Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, 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, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | | | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, 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, Sapporo, 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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19
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Morohashi H, Hakamada K, Kanno T, Kawashima K, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network. Surg Today 2022; 52:705-714. [PMID: 34668052 PMCID: PMC8948127 DOI: 10.1007/s00595-021-02384-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. METHODS A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. RESULTS The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. CONCLUSIONS The social implementation of telesurgery using the currently available commercial communication network is feasible.
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Affiliation(s)
- Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, 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, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | | | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, 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, Sapporo, 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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Bailo P, Gibelli F, Blandino A, Piccinini A, Ricci G, Sirignano A, Zoja R. Telemedicine Applications in the Era of COVID-19: Telesurgery Issues. Int J Environ Res Public Health 2021; 19:ijerph19010323. [PMID: 35010581 PMCID: PMC8751214 DOI: 10.3390/ijerph19010323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 06/01/2023]
Abstract
Telemedicine allows for the effective delivery of health care to patients at a distance through the application of information technology to the field of medicine. This is optimal during the COVID-19 pandemic to reduce interpersonal contact to mitigate contagion. Among the possible Telemedicine applications, there is Telesurgery, which involves more and more surgical specialties thanks to the numerous benefits in quality and cost containment. In the growing field of Telesurgery, its technical and legal implications must be considered. In this study, a traditional review of the scientific literature was carried out to identify the most relevant issues of interest in Telesurgery. The problematic legal aspects identified are mainly related to the difference in legislation between different geographical areas, which is critical in the case of malpractice. In addition, there is the possibility of a malicious hacker attack on the transmitted data stream either to steal sensitive data or to harm the patient. Finally, there are inherent difficulties with the technology used, such as latency issues in data transmission. All these critical issues are currently not adequately addressed by current legislation. Therefore, one can only hope for a legislative action to allow Telesurgery to be used safely.
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Affiliation(s)
- Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Andrea Piccinini
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
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21
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Souzanchi-K M, Akbarzadeh-T MR. Brain emotional learning impedance control of uncertain nonlinear systems with time delay: Experiments on a hybrid elastic joint robot in telesurgery. Comput Biol Med 2021; 138:104786. [PMID: 34560502 DOI: 10.1016/j.compbiomed.2021.104786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/17/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023]
Abstract
Telesurgical robot control is a significant example of an uncertain nonlinear system, as it involves various complexities, including unknown master/slave dynamics, environmental uncertainties, joint elasticities, and communication time delays. This problem becomes even more complicated when desirable properties such as stability, transparency, rigidity, accuracy, and fine manipulability are considered. We consider an elastic joint telesurgical robot architecture that combines two parallel and serial manipulators to achieve the desired rigidity, accuracy, and fine manipulability. For this purpose, we propose using Brain Emotional Learning (BEL) to estimate the robot's uncertain nonlinear dynamics. In contrast to recent stability analyses of BEL-based systems, we employ Lyapunov theory to achieve the closed-loop system's general stability independent of robot dynamics and chattering. Furthermore, the proposed control architecture implements two reference impedance models for the master and slave robots' trajectory generation and makes a trade-off between transparency and stability by simultaneously considering optimal position synchronization and transparency conditions. In this regard, we extend these two conditions in absolute stability theory and Llewellyn's criterion to obtain the allowable bound of communication time delay. The proposed robot is designed and experimentally implemented at the Robotics Laboratories at FUM and SUT Universities. Along with confirming the theoretical results, simulations and laboratory experiments demonstrate that a reasonable trade-off between stability and transparency is made in four realistic case studies with and without communication time delays.
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Affiliation(s)
- M Souzanchi-K
- Center of Excellence on Soft Computing and Intelligent Information Processing (SCIIP), Department of Electrical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - M-R Akbarzadeh-T
- Center of Excellence on Soft Computing and Intelligent Information Processing (SCIIP), Department of Electrical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
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22
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Penn JW, Marcus HJ, Uff CEG. Fifth Generation Cellular Networks and Neurosurgery: A Narrative Review. World Neurosurg 2021; 156:96-102. [PMID: 34543734 DOI: 10.1016/j.wneu.2021.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/05/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
Connectivity is a driving force for productivity across a wide variety of sectors in the 21st century, with health care being no exception. Fifth generation cellular technology (5G) is frequently alluded to in the mainstream media but understanding of the technology and its potential impact is not widespread in clinical communities. It promises unprecedented improvement in speed, bandwidth, reliability, and latency, all of which have significant implications for the way we use wireless data. 5G can be subdivided into 3 parallel technological architectures: extended mobile broadband (eMBB), ultra-reliable low latency communication (URLLC), and massive machine type communication (mMTC). These domains each present different and exciting prospects for the future of health care. This narrative review aims to elucidate the nature of 5G, its context within the development of telecommunications, and describe some of the notable opportunities it presents to the neurosurgical community. In many cases the requisite hardware has already been developed, but use has been limited by the requirements of a fast, reliable, and omnipresent network connection. Examples include telesurgical robots, remote supervision of procedures, integrated smart operating rooms, and clinician telepresence. The events of 2020 and the COVID-19 pandemic have brought the world's attention to digital transformation. The mechanics of 5G connectivity creates the capacity for these changes to be applied practically. An understanding of this technology is essential to appreciate the development and opportunities which will be part of our professional future.
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Affiliation(s)
- Jack W Penn
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom.
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Christopher E G Uff
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
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23
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Huang T, Li R, Li Y, Zhang X, Liao H. Augmented reality-based autostereoscopic surgical visualization system for telesurgery. Int J Comput Assist Radiol Surg 2021; 16:1985-1997. [PMID: 34363583 DOI: 10.1007/s11548-021-02463-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/11/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The visualization of remote surgical scenes is the key to realizing the remote operation of surgical robots. However, current non-endoscopic surgical robot systems lack an effective visualization tool to offer sufficient surgical scene information and depth perception. METHODS We propose a novel autostereoscopic surgical visualization system integrating 3D intraoperative scene reconstruction, autostereoscopic 3D display, and augmented reality-based image fusion. The preoperative organ structure and the intraoperative surface point cloud are obtained from medical imaging and the RGB-D camera, respectively, and aligned by an automatic marker-free intraoperative registration algorithm. After registration, preoperative meshes with precalculated illumination and intraoperative textured point cloud are blended in real time. Finally, the fused image is shown on a 3D autostereoscopic display device to achieve depth perception. RESULTS A prototype of the autostereoscopic surgical visualization system was built. The system had a horizontal image resolution of 1.31 mm, a vertical image resolution of 0.82 mm, an average rendering rate of 33.1 FPS, an average registration rate of 20.5 FPS, and average registration errors of approximately 3 mm. A telesurgical robot prototype based on 3D autostereoscopic display was built. The quantitative evaluation experiments showed that our system achieved similar operational accuracy (1.79 ± 0.87 mm) as the conventional system (1.95 ± 0.71 mm), while having advantages in terms of completion time (with 34.11% reduction) and path length (with 35.87% reduction). Post-experimental questionnaires indicated that the system was user-friendly for novices and experts. CONCLUSION We propose a 3D surgical visualization system with augmented instruction and depth perception for telesurgery. The qualitative and quantitative evaluation results illustrate the accuracy and efficiency of the proposed system. Therefore, it shows great prospects in robotic surgery and telesurgery.
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Affiliation(s)
- Tianqi Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Ruiyang Li
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yangxi Li
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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Abstract
As an emerging field, telesurgery robotic system is changing the traditional medical mode and can delivery remote surgical treatment anywhere in the world. Advances in telesurgery robotic technology achieve the remote control beyond the current limitation of distance and special medical environment. This review introduces the development history, the current status and the potential in future of the telesurgery robotic system. In addition, it presents the construction of control platform and the application, especially in trauma treatment, as well as the challenge in clinic.
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Abstract
The emergence of the COVID-19 pandemic and subsequent public health emergency (PHE) have propelled telemedicine several years into the future. With the rapid adoption of this technology came socioeconomic inequities as minority communities disproportionately have yet to adopt telemedicine. Telemedicine offers solutions to patient access issues that have plagued urology, helping address physician shortages in rural areas and expanding the reach of urologists. The Centers for Medicare & Medicaid Services have adopted changes to expand coverage for telemedicine services. The expectation is that telemedicine will continue to be a mainstay in the health care system with gradual expansion in utilization.
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Affiliation(s)
- Eric Kirshenbaum
- Uropartners, Suite 312, 1475 E Belvidere Rd, Grayslakle, IL 60030, USA.
| | - Eugene Y Rhee
- Kaiser Permanente Urology, 4405 Vandever Ave, San Diego, CA 92120, USA; Urology, Permanente Federation
| | - Matthew Gettman
- Mayo Clinic Department of Urology, 200 First Street SW, Rochester, MN 55905, USA
| | - Aaron Spitz
- Orange County Urology, 23961 Calle De La Magdalena, Laguna Hills, CA 92653, USA
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Börner Valdez L, Datta RR, Babic B, Müller DT, Bruns CJ, Fuchs HF. 5G mobile communication applications for surgery: An overview of the latest literature. Artif Intell Gastrointest Endosc 2021; 2:1-11. [DOI: 10.37126/aige.v2.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
Fifth-generation wireless network, 5G, is expected to bring surgery to a next level. Remote surgery and telementoring could be enabled and be brought into routine medical care due to 5G characteristics, such as extreme high bandwidth, ultra-short latency, multiconnectivity, high mobility, high availability, and high reliability. This work explores the benefits, applications and demands of 5G for surgery. Therefore, the development of previous surgical procedures from using older networks to 5G is outlined. The current state of 5G in surgical research studies is discussed, as well as future aspects and requirements of 5G in surgery are presented.
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Affiliation(s)
| | - Rabi R Datta
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Benjamin Babic
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Dolores T Müller
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | | | - Hans F Fuchs
- Department of Surgery, University of Cologne, Cologne 50937, Germany
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Collins JW, Ghazi A, Stoyanov D, Hung A, Coleman M, Cecil T, Ericsson A, Anvari M, Wang Y, Beaulieu Y, Haram N, Sridhar A, Marescaux J, Diana M, Marcus HJ, Levy J, Dasgupta P, Stefanidis D, Martino M, Feins R, Patel V, Slack M, Satava RM, Kelly JD. Utilising an Accelerated Delphi Process to Develop Guidance and Protocols for Telepresence Applications in Remote Robotic Surgery Training. EUR UROL SUPPL 2020; 22:23-33. [PMID: 34337475 PMCID: PMC8317899 DOI: 10.1016/j.euros.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/15/2023] Open
Abstract
Context The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. Objective To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standardised approach to training candidates in skill acquisition via telepresence technologies. We aim to describe an approach based on the current evidence and available technologies, and define the key elements within optimised telepresence services, by seeking consensus from an expert committee comprising key opinion leaders in training. Evidence acquisition This project was carried out in phases: a systematic review of the current literature, a teleconference meeting, and then an initial survey were conducted based on the current evidence and expert opinion, and sent to the committee. Twenty-four experts in training, including clinicians, academics, and industry, contributed to the Delphi process. An accelerated Delphi process underwent three rounds and was completed within 72 h. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement. Evidence synthesis There was 100% consensus regarding an urgent need for international agreement on guidance for optimised telepresence. Consensus was reached in multiple areas, including (1) infrastructure and functionality; (2) definitions and terminology; (3) protocols for training, communication, and safety issues; and (4) accountability including ethical and legal issues. The resulting formulated guidance showed good internal consistency among experts, with a Cronbach alpha of 0.90. Conclusions Using the Delphi methodology, we achieved international consensus among experts for development and content validation of optimised telepresence services for robotic surgery training. This guidance lays the foundation for launching telepresence services in robotic surgery. This guidance will require further validation. Patient summary Owing to travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic, development of remote training and support via telemedicine is becoming increasingly important. We report a key opinion leader consensus view on a standardised approach to telepresence.
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Affiliation(s)
- Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.,Department of Uro-Oncology, University College London Hospital, London, UK.,Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Andrew Hung
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Tom Cecil
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Anders Ericsson
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mehran Anvari
- Department of Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | - Yanick Beaulieu
- Division of Cardiology and Critical Care, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nadine Haram
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.,Department of Uro-Oncology, University College London Hospital, London, UK
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Hani J Marcus
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Jeffrey Levy
- Institute for Surgical Excellence, Philadelphia, PA, USA
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Kings College London, London, UK
| | | | | | - Richard Feins
- Division of C Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | - Mark Slack
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | | | - John D Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.,Department of Uro-Oncology, University College London Hospital, London, UK
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Amalendran J, Chedid Y, Hamza Y, Sani I, Ubaide H, Abdalla M. A commentary on "Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1″. Int J Surg 2020; 82:200-1. [PMID: 32861894 DOI: 10.1016/j.ijsu.2020.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 11/21/2022]
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Zheng J, Wang Y, Zhang J, Guo W, Yang X, Luo L, Jiao W, Hu X, Yu Z, Wang C, Zhu L, Yang Z, Zhang M, Xie F, Jia Y, Li B, Li Z, Dong Q, Niu H. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc. 2020;34:5172-5180. [PMID: 32700149 DOI: 10.1007/s00464-020-07823-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND 5G communication technology has been applied to several fields in telemedicine, but its effectiveness, safety, and stability in remote laparoscopic telesurgery have not been established. Here, we conducted four ultra-remote laparoscopic surgeries on a swine model under the 5G network. The aim of the study was to investigate the effectiveness, safety, and stability of the 5G network in remote laparoscopic telesurgery. METHODS Four ultra-remote laparoscopic surgeries (network communication distance of nearly 3000 km), including left nephrectomy, partial hepatectomy, cholecystectomy, and cystectomy, were performed on a swine model with a 5G wireless network connection using a domestically produced "MicroHand" surgical robot. The average network delay, operative time, blood loss, and intraoperative complications were recorded. RESULTS Four laparoscopic telesurgeries were safely performed through a 5G network, with an average network delay of 264 ms (including a mean round-trip transporting delay of 114 ms and a 1.20% data packet loss ratio). The total operation time was 2 h. The total blood loss was 25 ml, and no complications occurred during the procedures. CONCLUSIONS Ultra-remote laparoscopic surgery can be performed safely and smoothly with 5G wireless network connection using domestically produced equipment. More importantly, our model can provide insights for promoting the future development of telesurgery, especially in areas where Internet cables are difficult to lay or cannot be laid.
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Orosco RK, Lurie B, Matsuzaki T, Funk EK, Divi V, Holsinger FC, Hong S, Richter F, Das N, Yip M. Compensatory motion scaling for time-delayed robotic surgery. Surg Endosc 2021; 35:2613-8. [PMID: 32514831 DOI: 10.1007/s00464-020-07681-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Round trip signal latency, or time delay, is an unavoidable constraint that currently stands as a major barrier to safe and efficient remote telesurgery. While there have been significant technological advancements aimed at reducing the time delay, studies evaluating methods of mitigating the negative effects of time delay are needed. Herein, we explored instrument motion scaling as a method to improve performance in time-delayed robotic surgery. METHODS This was a robotic surgery user study using the da Vinci Research Kit system. A ring transfer task was performed under normal circumstances (no added time delay), and with 250 ms, 500 ms, and 750 ms delay. Robotic instrument motion scaling was modulated across a range of values (- 0.15, - 0.1, 0, + 0.1, + 0.15), with negative values indicating less instrument displacement for a given amount of operator movement. The primary outcomes were task completion time and total errors. Three-dimensional instrument movement was compared against different motion scales using dynamic time warping to demonstrate the effects of scaling. RESULTS Performance declined with increasing time delay. Statistically significant increases in task time and number of errors were seen at 500 ms and 750 ms delay (p < 0.05). Total errors were positively correlated with task time on linear regression (R = 0.79, p < 0.001). Under 750 ms delay, negative instrument motion scaling improved error rates. Negative motion scaling trended toward improving task times toward those seen in non-delayed scenarios. Improvements in instrument path motion were seen with the implementation of negative motion scaling. CONCLUSIONS Under time-delayed conditions, negative robotic instrument motion scaling yielded fewer surgical errors with slight improvement in task time. Motion scaling is a promising method of improving the safety and efficiency of time-delayed robotic surgery and warrants further investigation.
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da Silva Schulz R, Santana RF, Dos Santos CTB, Faleiro TB, do Amaral Passarelles DM, Hercules ABS, do Carmo TG. Telephonic nursing intervention for laparoscopic cholecystectomy and hernia repair: A randomized controlled study. BMC Nurs 2020; 19:38. [PMID: 32425692 PMCID: PMC7212613 DOI: 10.1186/s12912-020-00432-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patient undergoing surgery may be afraid and concerned about the diagnosis, the treatment, the procedure, the postoperative care, and the surgical recovery. Good communication between staff and patients can minimize or prevent this situation. This study aimed to evaluate the effectiveness of a Telecare nursing intervention, “Telephone consultation”, in reducing the “Delayed surgical recovery” nursing diagnosis in patients undergoing laparoscopic cholecystectomy and hernia repair. Methods This study was performed in two different institutions located in Rio de Janeiro, Brazil. A total of 43 patients were enrolled. The experimental group consisted of 22 patients who had access to the telephone follow-up intervention, and the control group consisted of 21 patients who received conventional treatment without telephone follow-up. This was a randomized controlled study with patients who were 60 years or older and awaiting operative procedures of hernia repair and laparoscopic cholecystectomy who had a mobile or landline phone and were available for telephone contact. Results There was a reduction in “loss of appetite with nausea” (p = 0.013); “need help to complete self-care” (p = 0.041); “pain” (p = 0.041); and “postoperative sensation” (p = 0.023). The experimental group showed a significantly larger decrease in factors related to the “Delayed surgical recovery” diagnosis, suggesting a positive effect of the intervention compared to the effect in control group.\. Conclusion Telephone consultation identified factors that increased the risk of complications after surgery, recognized potential patients for delayed surgical recovery and helped perioperative nurses provide accurate interventions to prevent or mitigate delayed recovery. This study was registered in the platform Brazilian Registry of Clinical Trials (ReBEC) - link: http://www.ensaiosclinicos.gov.br under registration number RBR-4C249M, retrospectively registered on April 13, 2020.
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Affiliation(s)
| | - Rosimere Ferreira Santana
- 2Federal Fluminense University, CNPq researcher, Rio de Janeiro, Brazil.,Present Address: Rua Dr. Celestino, 74, 6° andar, Niterói, Rio de Janeiro, CEP: 24020-091 Brazil
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Tian W, Fan M, Zeng C, Liu Y, He D, Zhang Q. Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases. Neurospine 2020; 17:114-120. [PMID: 32252160 PMCID: PMC7136105 DOI: 10.14245/ns.1938454.227] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The purpose of this study was to determine the efficacy and feasibility of 5th generation wireless systems (5G) telerobotic spinal surgery in our first 12 cases.
Methods A total of 12 patients (5 males, 7 females; age, 23–71 years) with spinal disorders (4 thoracolumbar fractures, 6 lumbar spondylolisthesis, 2 lumbar stenosis) were treated with 5G telerobotic spinal surgery. Sixty-two pedicle screws were implanted. Results All patients had substantial relief from their symptoms. Screw placements were classified using Gertzbein-Robbins criteria. There were 59 grade A, 3 grade B. Mean operation time was 142.5 ± 46.7 minutes. Mean guiding wire insertion time was 41.3 ± 9.8 minutes. The deviation between the planned and actual positions was 0.76 ± 0.49 mm. No intraoperative adverse event was found.
Conclusion 5G remote robot-assisted spinal surgery is accurate and reliable. We conclude that 5G telerobotic spinal surgery is both efficacious and feasible for the management of spinal diseases with safety.
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Affiliation(s)
- Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Cheng Zeng
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Qi Zhang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
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Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J Gastrointest Surg 2020; 24:1692-1697. [PMID: 32385614 PMCID: PMC7206900 DOI: 10.1007/s11605-020-04623-5] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The novel coronavirus pandemic has drastically affected healthcare organizations across the globe. METHODS We sought to summarize the current telemedicine environment in order to highlight the important changes triggered by the novel coronavirus pandemic, as well as highlight how the current crisis may inform the future of telemedicine. RESULTS At many institutions, the number of telemedicine visits dramatically increased within days following the institution of novel coronavirus pandemic restrictions on in-person clinical encounters. Prior to the pandemic, telemedicine utilization was weak throughout surgical specialties due to regulatory and reimbursement barriers. As part of the pandemic response, the USA government temporarily relaxed various telemedicine restrictions and provided additional telemedicine funding. DISCUSSION The post-pandemic role of telemedicine is dependent on permanent regulatory solutions. In the coming decade, telemedicine and telesurgery are anticipated to mature due to the proliferation of interconnected consumer health devices and high-speed 5G data connectivity.
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Affiliation(s)
- Carlo M. Contreras
- grid.412332.50000 0001 1545 0811The Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Gregory A. Metzger
- grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Joal D. Beane
- grid.412332.50000 0001 1545 0811The Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Priya H. Dedhia
- grid.412332.50000 0001 1545 0811The Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Aslam Ejaz
- grid.412332.50000 0001 1545 0811The Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Timothy M. Pawlik
- grid.412332.50000 0001 1545 0811The Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811The Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
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Veneziano D, Tafuri A, Rivas JG, Dourado A, Okhunov Z, Somani BK, Marino N, Fuchs G, Cacciamani G. Is remote live urologic surgery a reality? Evidences from a systematic review of the literature. World J Urol 2019; 38:2367-2376. [PMID: 31701210 DOI: 10.1007/s00345-019-02996-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/25/2019] [Accepted: 10/20/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The possibility of performing remote-surgery has been the goal to achieve, since the early development of the first surgical robotic platforms. This systematic review aims to analyse the state of the art in the field and to provide an overview of the possible growth of this technology. METHODS All English language publications on Telementoring and Telesurgery for minimally invasive urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). RESULTS Our electronic search identified a total of 124 papers in PubMed, Scopus, and Web of Science. Of these, 81 publications were identified for detailed review, which yielded 22 included in the present systematic review. Our results showed that remote surgery has been under-utilised until today, mostly due to the lack of appropriate telecommunication technologies. CONCLUSION Remote live surgery is a growing technology that is catalyzing incremental interest. Despite not being yet reliable today on a regular basis in its most advanced applications, thanks to the advent of novel data-transmission technologies, telepresence might become a critical educational methodology, highly impacting the global healthcare system.
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Affiliation(s)
- Domenico Veneziano
- Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy. .,Department of Urology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - A Tafuri
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - J Gomez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - A Dourado
- Department of Urology, Camargo Cancer Center, Sao Paulo, Brasil
| | - Z Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | - N Marino
- University of Foggia, Foggia, Italy
| | - G Fuchs
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA
| | - G Cacciamani
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA
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36
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Miyachi S, Nagano Y, Hironaka T, Kawaguchi R, Ohshima T, Matsuo N, Maejima R, Takayasu M. Novel Operation Support Robot with Sensory-Motor Feedback System for Neuroendovascular Intervention. World Neurosurg 2019; 127:e617-e623. [PMID: 30930317 DOI: 10.1016/j.wneu.2019.03.221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Robotic technology is rapidly developing in the medical field, particularly contributing to support operative intervention using the da Vinci system during endoscopic surgery. Neuroendovascular intervention robot surgery is preferred when aiming to reduce radiation exposure among surgeons. METHODS We developed a prototype of a support robot with 2 independent slaves manipulating both the microcatheter and microguidewire connected with the remote master driver with 2 joysticks. This design simulates usual catheterization with both hands. The slave manipulator has a sufficient output force >1 N to reproduce the exact master intervention without slip and delay. This machine has a unique function that indicates the reaction force of the resistance on wire stuck using the sensor system. We investigated the master-slave response, reliability of the force gauge, and degree of slippage of the slave motion on the table and checked the controllability, safety, and reproducibility of microcatheterization and insertion maneuver into the experimental aneurysm in the in vivo silicone vessel model. RESULTS We realized the well master-slave response with a stable driving speed of the microguidewire at approximately 1 mm/s and with linear correlation between the output voltage and driving force. Also, we confirmed the well safety function to avoid the overloading to the vascular wall with the slippage of the slave roller on loading >1 N pushing force. Successful microcatheterization and insertion into the aneurysm model was performed in the wet vascular model corresponding to the 3-dimensional handling without excessive stress to the vascular or aneurysmal wall. CONCLUSIONS Neuroendovascular intervention requires delicate power adjustment with fine finger control. Our support robot for neuroendovascular interventions demonstrated the accurate reproducibility of the operator's maneuver and safe operation in the vascular model using the sensor system. This system will realize the neurointervention without human operators in the AngioSuite and may facilitate telesurgery with remote control in the near future.
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Affiliation(s)
- Shigeru Miyachi
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Yoshitaka Nagano
- Department of Electronic Control and Robot Engineering, Aichi University of Technology, Gamagori, Aichi, Japan
| | - Takahide Hironaka
- Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomotaka Ohshima
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Matsuo
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ryuya Maejima
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masakazu Takayasu
- Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan
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Abstract
Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated.
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Affiliation(s)
- Robert Saadi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA
| | - Dana Goldenberg
- Tulane University, 6823 Street, Charles Avenue, New Orleans, LA 70118, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA.
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Bao X, Guo S, Xiao N, Li Y, Yang C, Jiang Y. A cooperation of catheters and guidewires-based novel remote-controlled vascular interventional robot. Biomed Microdevices 2018; 20:20. [PMID: 29460178 DOI: 10.1007/s10544-018-0261-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the overall accuracy of surgical operations and reduce the occupational risks of intervening physicians, such as radiation exposure and chronic neck/back pain. Several RVIRs have been used to operate catheters or guidewires accurately. However, a lack of cooperation between the catheters and guidewires results in the surgeon being unable to complete complex surgery by propelling the catheter/guidewire to the target position. Furthermore, it is a significant challenge to operate the catheter/guidewire accurately and detect their proximal force without damaging their surfaces. In this study, we introduce a novel method that allows catheters and guidewires to be operated simultaneously in complex surgery. Our method accurately captures force measurements and enables precisely controlled catheter and guidewire operation. A prototype is validated through various experiments. The results demonstrate the feasibility of the proposed RVIR to operate a catheter and guidewire accurately, detect the resistance forces, and complete complex surgical operations in a cooperative manner.
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Hamacher A, Kim SJ, Cho ST, Pardeshi S, Lee SH, Eun SJ, Whangbo TK. Application of Virtual, Augmented, and Mixed Reality to Urology. Int Neurourol J 2016; 20:172-81. [PMID: 27706017 DOI: 10.5213/inj.1632714.357] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 09/26/2016] [Indexed: 12/04/2022] Open
Abstract
Recent developments in virtual, augmented, and mixed reality have introduced a considerable number of new devices into the consumer market. This momentum is also affecting the medical and health care sector. Although many of the theoretical and practical foundations of virtual reality (VR) were already researched and experienced in the 1980s, the vastly improved features of displays, sensors, interactivity, and computing power currently available in devices offer a new field of applications to the medical sector and also to urology in particular. The purpose of this review article is to review the extent to which VR technology has already influenced certain aspects of medicine, the applications that are currently in use in urology, and the future development trends that could be expected.
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40
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Glenn IC, Bruns NE, Hayek D, Hughes T, Ponsky TA. Rural surgeons would embrace surgical telementoring for help with difficult cases and acquisition of new skills. Surg Endosc 2016; 31:1264-1268. [PMID: 27444835 DOI: 10.1007/s00464-016-5104-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 02/13/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical telementoring, consisting of an expert surgeon guiding a less experienced surgeon through advanced or novel cases from a remote location, is an evolving technology which has potential to become an integral part of surgical practice. This study sought to apprise the attitudes of rural general surgeons toward the possible benefits and applications of surgical telementoring in their practices. METHODS A survey assessing demographics and attitudes toward telementoring was e-mailed to members of the American College of Surgeons (ACS) Advisory Council for Rural Surgery and posted to the ACS website in areas targeting rural surgeons. A link to a webpage with a description of surgical telementoring and brief demonstrative video were included with the survey. RESULTS There were 159 respondents, with 82.3 % of them practicing in communities smaller than 50,000 people. Overall, 78.6 % felt that telementoring would be useful to their practice, and 69.8 % thought it would benefit their hospitals. There was no correlation between years of practice and perceived usefulness of surgical telementoring. When asked the single most useful, or primary, application of surgical telementoring there was a split between learning new techniques (46.5 %) and intraoperative assistance with unexpected findings (39.0 %). When asked to select all applications in which they would be interested in using telementoring from a list of possible uses, surgeons most frequently selected: intraoperative consultation for unexpected findings (67.7 %), trauma consultation (32.9 %), and laparoscopic colectomy (32.9 %). CONCLUSIONS Surgical telementoring is on the verge of widespread use but industry and surgical societies remain ambivalent about supporting its implementation due to concerns over lack of interest. This study demonstrates interest among rural surgeons. While there are differing opinions regarding compensation of the telementoring, the most common, single interest in the use of surgical telementoring was for learning new techniques or skill sets.
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Affiliation(s)
- Ian C Glenn
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Nicholas E Bruns
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Danial Hayek
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | | | - Todd A Ponsky
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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Abstract
A new European telesurgical system, the Telelap Alf-x, is introduced. Its main features are individual arms, which enable free access to the patient throughout surgery, a large range of reusable surgical instruments, an open console with eye-tracking system, where the camera follows the eye and head movements of the surgeon, and the existing force feedback enables for the first time to feel the consistency of the tissues and avoid tearing of the stitches while suturing. The system combines the benefits of open surgery and endoscopy. The first clinical application, which involved 146 operations at the gynecological department of the Gemelli University Hospital in Rome, proved the safety and the surgical team's quick adaptation to the system.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA) , Berlin , Germany
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42
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Perez M, Xu S, Chauhan S, Tanaka A, Simpson K, Abdul-Muhsin H, Smith R. Impact of delay on telesurgical performance: study on the robotic simulator dV-Trainer. Int J Comput Assist Radiol Surg 2015; 11:581-7. [PMID: 26450105 DOI: 10.1007/s11548-015-1306-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 05/19/2015] [Accepted: 09/21/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the impact of communication latency on telesurgical performance using the robotic simulator dV-Trainer®. METHODS Surgeons were enrolled during three robotic congresses. They were randomly assigned to a delay group (ranging from 100 to 1000 ms). Each group performed three times a set of four exercises on the simulator: the first attempt without delay (Base) and the last two attempts with delay (Warm-up and Test). The impact of different levels of latency was evaluated. RESULTS Thirty-seven surgeons were involved. The different latency groups achieved similar baseline performance with a mean task completion time of 207.2 s (p > 0.05). In the Test stage, the task duration increased gradually from 156.4 to 310.7 s as latency increased from 100 to 500 ms. In separate groups, the task duration deteriorated from Base for latency stages at delays ≥300 ms, and the errors increased at 500 ms and above (p < 0.05). The subjects' performance tended to improve from the Warm-up to the Test period. Few subjects completed the tasks with a delay higher than 700 ms. CONCLUSION Gradually increasing latency has a growing impact on performances. Measurable deterioration of performance begins at 300 ms. Delays higher than 700 ms are difficult to manage especially in more complex tasks. Surgeons showed the potential to adapt to delay and may be trained to improve their telesurgical performance at lower-latency levels.
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Affiliation(s)
- Manuela Perez
- IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France.
- General and Emergency Surgery Department, University Hospital of Nancy, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
- Hôpital Central Service de Chirurgie Générale et Urgences, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.
| | - Song Xu
- IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France
- Urology Department, University Hospital of Nancy, Allée du Morvan, 54511, Vandoeuvre-les-Nancy, France
| | - Sanket Chauhan
- Center for Evidence Based Simulation, Baylor University Medical Center, Dallas, TX, USA
- Associate Professor Texas A&M Health Science Center, College Station, TX, USA
| | - Alyssa Tanaka
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Khara Simpson
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Haidar Abdul-Muhsin
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Roger Smith
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
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Zhao D, Ma L, Ma C, Tang J, Liao H. Floating autostereoscopic 3D display with multidimensional images for telesurgical visualization. Int J Comput Assist Radiol Surg 2016; 11:207-15. [PMID: 26410839 DOI: 10.1007/s11548-015-1289-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/31/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE We propose a combined floating autostereoscopic three-dimensional (3D) display approach for telesurgical visualization, which could reproduce live surgical scene in a realistic and intuitive manner. METHODS A polyhedron-shaped 3D display device is developed for spatially floating autostereoscopic 3D image. Integral videography (IV) technique is adopted to generate real-time 3D images. Combined two-dimensional (2D) and 3D displays are presented floatingly around the center of the display device through reflection of semitransparent mirrors. Intra-operative surgery information is fused and updated in the 3D display, so that telesurgical visualization could be enhanced remotely. RESULTS The experimental results showed that our approach can achieve a combined floating autostereoscopic display that presents 2D and 3D fusion images. The glasses-free IV 3D display has full parallax and can be observed by multiple persons from surrounding areas at the same time. Furthermore, real-time surgical scene could be presented and updated in a realistic and intuitive visualization platform. It is shown that the proposed method is feasible for facilitating telesurgical visualization. CONCLUSION The proposed floating autostereoscopic display device presents surgical information in an efficient form, so as to enhance operative cooperation and efficiency during operation. Combined presentation of imaging information is promising for medical applications.
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Abstract
INTRODUCTION Using an endoscopic telesurgical robot system (ETSRS), the authors propose a strategy for improving the safety of telesurgery by restricting the movement of an end-effector within a lesion. The strategy is validated by phantom model experiments. MATERIAL AND METHODS The method focused on generation of force feedback and restriction of robotic end-effector movement of ETSRS based on a virtual wall. Collision detection and case classification procedures were used to determine whether the generation of force feedback or restricting the end-effector's movement was continued. The method was implemented in ETSRS and tested using a brain and tofu phantom. RESULTS Force feedback was well generated proportional to a linear combination of the insertion depth and the velocity of the end-effector of the ETSRS from the surface of the predefined virtual wall. The movement of the end-effector was well limited inside the virtual wall by the method. The virtual wall update was sufficiently fast to check the current surgical situation. The control rate of the entire system was >30 fps so that the method showed acceptable performance in phantom experiments. CONCLUSION The results show that the strategy allows for well controlled robotic end-effectors inside a predefined virtual wall by the robot itself and an operator through the signal and force feedback.
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Affiliation(s)
- Jongseong Jang
- a 1 Institute of Innovative Surgical Technology, Hanyang University , Seoul, Republic of Korea
| | - Hyung Wook Kim
- a 1 Institute of Innovative Surgical Technology, Hanyang University , Seoul, Republic of Korea
| | - Byung-Rok So
- c 3 Robotics R/BD Group, Korea Institute of Industrial Technology , Republic of Korea
| | - Young Soo Kim
- b 2 Department of Neurosurgery and Department of Biomedical Engineering, College of Medicine, Hanyang University , Seoul, Republic of Korea
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Saglam R, Muslumanoglu AY, Tokatlı Z, Caşkurlu T, Sarica K, Taşçi Aİ, Erkurt B, Süer E, Kabakci AS, Preminger G, Traxer O, Rassweiler JJ. A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b). Eur Urol 2014; 66:1092-100. [PMID: 25059998 DOI: 10.1016/j.eururo.2014.06.047] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [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: 04/07/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. OBJECTIVE To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. DESIGN, SETTING, AND PARTICIPANTS Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2). SURGICAL PROCEDURE Robotic FURS was performed with the Roboflex Avicenna robotic device. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. RESULTS AND LIMITATIONS Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. CONCLUSIONS Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. PATIENT SUMMARY Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics.
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Affiliation(s)
- Remzi Saglam
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | | | - Zafer Tokatlı
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | - Turhan Caşkurlu
- Department of Urology, Medeniyet University Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Kartal Training Hospital, Istanbul, Turkey
| | - Ali İhsan Taşçi
- Department of Urology, Bakırköy Training Hospital, Istanbul, Turkey
| | - Bülent Erkurt
- Department of Urology, Medipol University Medical School Hospital, Istanbul, Turkey
| | - Evren Süer
- Department of Urology, Ankara University Medical School Hospital, Ankara, Turkey
| | | | - Glenn Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Olivier Traxer
- Department of Urology, Université Pierre et Marie Curie, Hôpital Tenon, Paris, France
| | - Jens J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany; Department of Urology, University of Heidelberg, Heidelberg, Germany.
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Cazac C, Radu G. Telesurgery--an efficient interdisciplinary approach used to improve the health care system. J Med Life 2014; 7 Spec No. 3:137-41. [PMID: 25870712 PMCID: PMC4391408] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
At the time of the writing of this article, there are three operational telemedicine control centers in Bucharest, Targul-Mures, and Iasi; however, the current telemedicine infrastructure has limited geographic coverage and is exclusively used in the field of emergency medicine with only few promising beginnings in the domain of family medicine. Nevertheless, many areas of Romania are still lacking qualified medical personnel that can perform vital surgeries thus requiring patients to travel long distances to obtain the health care services they require. In order to improve the current healthcare infrastructure and eliminate the difficulties associated with a lack of qualified medical personnel in rural areas of the country, this article suggests the implementation of telesurgery as a practical solution. This article will hope to analyze the applicability of telesurgery by looking at the benefits and costs of creating a national telesurgery infrastructure, by predicting possible obstacles in creating such a system and by suggesting ways in which these obstacles can be avoided. The writing of this article was possible thanks to interviews, articles, and data obtained from surgeons and medical personnel that practice in Romania, the Republic of Moldova, Canada, and the United States of America. A vast majority of technical details has been furnished by the producers of robotic surgery platforms such as Intuitive Surgical®.
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Affiliation(s)
- C Cazac
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Radu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Bhatia PD, Bottoni DA, Malthaner RA. Telesurgical evaluation of stable thoracic trauma patients: a feasibility study. Eur J Trauma Emerg Surg 2011; 37:297. [PMID: 26815111 DOI: 10.1007/s00068-011-0094-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND We evaluated a robotic telesurgical platform in managing thoracic trauma in an animal model. STUDY DESIGN The da Vinci(®) robot was used to evaluate and treat a random number of blinded injuries in ten porcine thoraces. RESULTS Ninety-five percent of injuries were correctly identified. The median survey time was 20.5 min (range 16-63 min). The mean time to repair lung lacerations was 19.8 min (range 14-27.5 min) and to evacuate the hemothoraces, it was 5.3 min (range 4.5-6.5 min). Diaphragmatic lacerations required repositioning of the ports and the robot. Only two out of five lacerations were successfully repaired (mean time 38.8 min, range 32.5-45 min). All aortic injuries were correctly identified. One subject died of a pre-existing pneumonia. CONCLUSIONS A robotic telesurgical approach to the evaluation of stable thoracic trauma patients is safe and feasible in a porcine model. Diaphragmatic injuries can be repaired but require repositioning of the robot.
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Affiliation(s)
- P D Bhatia
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada
| | - D A Bottoni
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada
| | - R A Malthaner
- Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd. East, Suite E2-124, London, ON, N6A 5W9, Canada.
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Garcia JC, Mantovani G, Gouzou S, Liveneaux P. Telerobotic anterior translocation of the ulnar nerve. J Robot Surg 2011; 5:153-6. [PMID: 27637545 DOI: 10.1007/s11701-010-0226-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 02/19/2010] [Accepted: 11/03/2010] [Indexed: 11/24/2022]
Abstract
The application of telerobotics in the biomedical field has grown rapidly and is showing very promising results. Robotically assisted microsurgery and nerve manipulation are some of its latest innovations. The purpose of this article is to update the community of shoulder and elbow surgeons on that field. Simple anterior subcutaneous translocation of the ulnar nerve was first experimented in two cadavers, and then performed in one live patient who presented with cubital tunnel syndrome. This procedure is the first reported case using the robot in elbow surgery. In this paper we attempt to analyze various aspects related to human versus robotically assisted surgery.
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Affiliation(s)
- Jose Carlos Garcia
- Sports Medicine Division/Shoulder and Elbow Surgery Division, Pontifical Catholic University of Campinas Sao Paulo-Brazil, Rua Indiana 670, Brooklin, Sao Paulo, SP, 04562-001, Brazil.
| | - Gustavo Mantovani
- Sports Medicine Division/Elbow Surgery division, Pontifical Catholic University of Campinas, Rua Indiana 670, Brooklin, Sao Paulo, SP, 04562-001, Brazil
| | - Stephanie Gouzou
- Strasbourg University, Hôpitaux Universitaires 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Philippe Liveneaux
- Strasbourg University, Hôpitaux Universitaires 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
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Nguan C, Girvan A, Luke PP. Robotic surgery versus laparoscopy; a comparison between two robotic systems and laparoscopy. J Robot Surg 2008; 1:263-8. [PMID: 25484975 DOI: 10.1007/s11701-007-0050-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 12/05/2007] [Indexed: 12/31/2022]
Abstract
Laparoscopy has found a role in standard urologic practice, and with training programs continuing to increase emphasis on its use, the division between skill sets of established non-laparoscopic urologic practitioners and urology trainees continues to widen. At the other end of the spectrum, as technology progresses apace, advanced laparoscopists continue to question the role of surgical robotics in urologic practice, citing a lack of significant advantage to this modality over conventional laparoscopy. We seek to compare two robotic systems (Zeus and DaVinci) versus conventional laparoscopy in surgical training modules in the drylab environment in the context of varying levels of surgical expertise. A total of 12 volunteers were recruited to the study: four staff, four postgraduate trainees, and four medical student interns. Each volunteer performed repeated time trials of standardized tasks consisting of suturing and knot tying using each of the three platforms: DaVinci, Zeus and conventional laparoscopy. Task times and numbers of errors were recorded for each task. Following each platform trial, a standardized subjective ten-point Likert score questionnaire was distributed to the volunteer regarding various operating parameters experienced including: visualization, fluidity, efficacy, precision, dexterity, tremor, tactile feedback, and coordination. Task translation from laparoscopy to Zeus robotics appeared to be difficult as both suture times and knot-tying times increased in pairwise comparisons across skill levels.
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Munver R, Volfson IA, Kesler SS, Nazmy M, Sawczuk IS. Transition from open to robotic-assisted radical prostatectomy: 7 years experience at Hackensack University Medical Center. J Robot Surg 2007; 1:155-9. [PMID: 25484953 DOI: 10.1007/s11701-007-0023-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 03/21/2007] [Indexed: 11/13/2022]
Abstract
Background and objective Open radical prostatectomy (ORP) is the standard approach for the surgical management of localized prostate cancer. The steep learning curve for laparoscopic prostatectomy poses a challenge for surgeons with minimal laparoscopic experience. As robotic-assisted surgery becomes more prevalent in the urologic community, there appears to be an increasing interest in robotic-assisted radical prostatectomy (RARP) among urologists throughout the United States. We report on the impact of robotics on practice patterns in the treatment of localized prostate cancer at a single institution. Methods A retrospective review was conducted of radical prostatectomies performed between January 2000 and December 2006 at Hackensack University Medical Center (Hackensack, N.J.). Over this time period, our medical center acquired four da Vinci™ Surgical Systems. The trends for open and robotic-assisted prostatectomies were analyzed. Results Over a 7-year period (2000–2006), a total of 1252 radical prostatectomies were performed by 17 urologists: 469 (37%) ORPs and 783 (63%) RARPs. The total number of prostatectomies increased annually during this time period. The robotic-assisted procedure was predominantly performed by three (18%) urologists from 2001–2003, seven (41%) in 2004, nine (53%) in 2005, and 11 (65%) in 2006. As more urologists became trained in robotic-assisted surgery, the trend gradually shifted towards robotic-assisted prostatectomy. In 2001, only 9.6% of all radical prostatectomies at our institution were performed with robotic assistance; in 2006, this had risen to 92.8%. Conclusion The acquisition of the da Vinci™ Surgical System has allowed robotic-assisted surgery to be an available alternative to open surgery at a single institution. The implementation of robotic technology has led to the gradual adoption of robotic-assisted radical prostatectomy by many of the urologists that surgically treat prostate cancer. As a result, the percentage of open prostatectomies has steadily decreased over time, while trends in robotic-assisted prostatectomies have increased. The impact of robotics also appears to have had an influential effect on the total number of prostatectomies performed annually.
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