Focal Spot, Spring 1978

https://digitalcommons.wustl.edu/focal_spot_archives/1020/thumbnail.jp

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

BACKGROUND: Because there is limited population‐based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital‐based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER‐Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30‐day hospital readmission, and in‐hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of ≤4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN ( P < .001). Although uncommon for both groups, the adjusted probability of in‐hospital mortality was 51% higher (2.3% vs 1.5%, P = .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In‐hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long‐term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;. © 2011 American Cancer Society. Patients with kidney cancer treated with laparoscopic radical nephrectomy (LRN) were less likely to require intensive care or prolonged length of stay when compared with those treated with an open approach, supporting the convalescence benefits of laparoscopy. However, in‐hospital mortality was greater for patients treated with LRN, suggesting a potentially unanticipated consequence of this technique and highlighting the need for long‐term monitoring both during and after the widespread adoption of innovative surgical therapies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87126/1/26014_ftp.pd

Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room

Da Vinci robot at Hospital Clinic. Manoeuvrability devices and performance in robotic tech

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Tutor: Manel Puig Vidal.Robot-assisted surgical systems are becoming increasingly common in medical procedures as they embrace many of the benefits of minimally invasive surgery including less trauma, recovery time and financial costs associated to the treatment after surgery. These robotic systems allow the surgeons to navigate within confined spaces where an operator’s human hand would normally be greatly limited. This dexterity is further strengthened through motion scaling, which translates large motions by the operator into diminutive actions of the robotic end effector. An example of this is the Da Vinci System which is coupled to the EndoWrist end effector tool. Nevertheless, these systems also have some drawbacks such as the high cost of the surgery itself and the lack of tactile or haptic feedback. This means that as the surgeon is performing the procedures outside the patient’s body, he/she can not feel the resistance of the human tissue’s when cutting. Therefore, one can risk damaging healthy tissues if force is not controlled or, when sewing, one can exert an exaggerated force and break the thread. In this project, a new system is created based on the UR5 robot (Universal Robots) and an EndoWrist needle to mimic the behaviour of the Da Vinci System and implement some improvements regarding the manoeuvrability and haptic feedback performance

Surgical education: development of curricula to optimise training and evaluate competency

This PhD by Published Work (Route 2) thesis is comprised of a collection of significant papers I have published with co-authors between the years of 2010 and 2017. These published works are supported by supplemental papers, abstracts, and conference proceedings and comprise a body of work that has sought to understand how surgical education is carried out in surgical residency programs, with particular interest in learning about how surgical educators teach, how surgical trainees perceive the teaching they receive, the creation, use, and evaluation of new tools for surgical education, and the development of new surgical training curricula in an era of competency-based medical education. My research began out of a need to evaluate the problem of a lack of formal guidelines and direction to aid surgical educators in the development, delivery, and evaluation of competency-based residency education programs throughout Canada. Without formal guidelines driving curricula development, surgical trainees could potentially be graduating at different levels of proficiency, which is problematic. In addition to existing standardised testing procedures, other surgical education researchers and I believe that residents must also be evaluated via ongoing thorough assessments of their level of competency when performing in the high stakes environment of the operating room. The Royal College of Physicians and Surgeons of Canada (RCPSC) is well-known for their Canadian Medical Education Directives for Specialists (CanMEDS) physician competency framework, which has been adopted by medical and surgical training programs worldwide. In its most recent CanMEDS iteration (2015), the RCPSC has released a new initiative called Competence by Design (CBD), which will affect all Canadian residency programs. The primary goal of this initiative is to completely remove the time element of residency training and focus on residents’ progression through their respective programs solely based on the passing of pre-defined competency “milestones”. This will cause a paradigm shift whereby the traditional apprenticeship model long-used in surgical teaching may eventually cease to exist. With this thesis, I have included papers that have focused on surgical education within competency-based frameworks and means by which to optimise curricula for surgical training. My research began with the exploratory work around how surgical educators teach and how trainees perceive they are taught, and is followed by a description of simulation and the development of new tools for surgical simulation and training. I then describe the development of new curricula that are focused on competency-based initiatives and can be used to begin the development of residency curricula for CBD. This research is timely, as many accrediting bodies worldwide are currently in the process of adopting and developing competency-based curricula at different training levels. The research presented in this thesis significantly contributes to the existing body of surgical education research, and future work, some of which is described, will focus on expanding the reach of our research initiatives via collaborative efforts with other surgical residency programs within Canada and also abroad

Recent Advancements in Augmented Reality for Robotic Applications: A Survey

Robots are expanding from industrial applications to daily life, in areas such as medical robotics, rehabilitative robotics, social robotics, and mobile/aerial robotics systems. In recent years, augmented reality (AR) has been integrated into many robotic applications, including medical, industrial, human–robot interactions, and collaboration scenarios. In this work, AR for both medical and industrial robot applications is reviewed and summarized. For medical robot applications, we investigated the integration of AR in (1) preoperative and surgical task planning; (2) image-guided robotic surgery; (3) surgical training and simulation; and (4) telesurgery. AR for industrial scenarios is reviewed in (1) human–robot interactions and collaborations; (2) path planning and task allocation; (3) training and simulation; and (4) teleoperation control/assistance. In addition, the limitations and challenges are discussed. Overall, this article serves as a valuable resource for working in the field of AR and robotic research, offering insights into the recent state of the art and prospects for improvement

216 Jewish Hospital of St. Louis

https://digitalcommons.wustl.edu/bjc_216/1185/thumbnail.jp