2,582 research outputs found
Optical coherence tomography-based consensus definition for lamellar macular hole.
BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research
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Semiautomated optical coherence tomography-guided robotic surgery for porcine lens removal.
PurposeTo evaluate semiautomated surgical lens extraction procedures using the optical coherence tomography (OCT)-integrated Intraocular Robotic Interventional Surgical System.SettingStein Eye Institute and Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, USA.DesignExperimental study.MethodsSemiautomated lens extraction was performed on postmortem pig eyes using a robotic platform integrated with an OCT imaging system. Lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomic modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by real-time OCT image feedback to the surgeon via a graphical user interface. Manual preparation of the pig-eye models, including the corneal incision and capsulorhexis, was performed by a trained cataract surgeon before the semiautomated lens extraction procedures. A scoring system was used to assess surgical complications in a postoperative evaluation.ResultsComplete lens extraction was achieved in 25 of 30 eyes. In the remaining 5 eyes, small lens pieces (≤1.0 mm3) were detected near the lens equator, where transpupillary OCT could not image. No posterior capsule rupture or corneal leakage occurred. The mean surgical duration was 277 seconds ± 42 (SD). Based on a 3-point scale (0 = no damage), damage to the iris was 0.33 ± 0.20, damage to the cornea was 1.47 ± 0.20 (due to tissue dehydration), and stress at the incision was 0.97 ± 0.11.ConclusionsNo posterior capsule rupture was reported. Complete lens removal was achieved in 25 trials without significant surgical complications. Refinements to the procedures are required before fully automated lens extraction can be realized
Computer- and robot-assisted Medical Intervention
Medical robotics includes assistive devices used by the physician in order to
make his/her diagnostic or therapeutic practices easier and more efficient.
This chapter focuses on such systems. It introduces the general field of
Computer-Assisted Medical Interventions, its aims, its different components and
describes the place of robots in that context. The evolutions in terms of
general design and control paradigms in the development of medical robots are
presented and issues specific to that application domain are discussed. A view
of existing systems, on-going developments and future trends is given. A
case-study is detailed. Other types of robotic help in the medical environment
(such as for assisting a handicapped person, for rehabilitation of a patient or
for replacement of some damaged/suppressed limbs or organs) are out of the
scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00
An Open-Source 7-Axis, Robotic Platform to Enable Dexterous Procedures within CT Scanners
This paper describes the design, manufacture, and performance of a highly
dexterous, low-profile, 7 Degree-of-Freedom (DOF) robotic arm for CT-guided
percutaneous needle biopsy. Direct CT guidance allows physicians to localize
tumours quickly; however, needle insertion is still performed by hand. This
system is mounted to a fully active gantry superior to the patient's head and
teleoperated by a radiologist. Unlike other similar robots, this robot's fully
serial-link approach uses a unique combination of belt and cable drives for
high-transparency and minimal-backlash, allowing for an expansive working area
and numerous approach angles to targets all while maintaining a small in-bore
cross-section of less than . Simulations verified the system's
expansive collision free work-space and ability to hit targets across the
entire chest, as required for lung cancer biopsy. Targeting error is on average
on a teleoperated accuracy task, illustrating the system's sufficient
accuracy to perform biopsy procedures. The system is designed for lung biopsies
due to the large working volume that is required for reaching peripheral lung
lesions, though, with its large working volume and small in-bore
cross-sectional area, the robotic system is effectively a general-purpose
CT-compatible manipulation device for percutaneous procedures. Finally, with
the considerable development time undertaken in designing a precise and
flexible-use system and with the desire to reduce the burden of other
researchers in developing algorithms for image-guided surgery, this system
provides open-access, and to the best of our knowledge, is the first
open-hardware image-guided biopsy robot of its kind.Comment: 8 pages, 9 figures, final submission to IROS 201
Robot Autonomy for Surgery
Autonomous surgery involves having surgical tasks performed by a robot
operating under its own will, with partial or no human involvement. There are
several important advantages of automation in surgery, which include increasing
precision of care due to sub-millimeter robot control, real-time utilization of
biosignals for interventional care, improvements to surgical efficiency and
execution, and computer-aided guidance under various medical imaging and
sensing modalities. While these methods may displace some tasks of surgical
teams and individual surgeons, they also present new capabilities in
interventions that are too difficult or go beyond the skills of a human. In
this chapter, we provide an overview of robot autonomy in commercial use and in
research, and present some of the challenges faced in developing autonomous
surgical robots
Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology
Until recently, Computer-Aided Medical Interventions (CAMI) and Medical
Robotics have focused on rigid and non deformable anatomical structures.
Nowadays, special attention is paid to soft tissues, raising complex issues due
to their mobility and deformation. Mini-invasive digestive surgery was probably
one of the first fields where soft tissues were handled through the development
of simulators, tracking of anatomical structures and specific assistance
robots. However, other clinical domains, for instance urology, are concerned.
Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU,
radiofrequency, or cryoablation), increasingly early detection of cancer, and
use of interventional and diagnostic imaging modalities, recently opened new
challenges to the urologist and scientists involved in CAMI. This resulted in
the last five years in a very significant increase of research and developments
of computer-aided urology systems. In this paper, we propose a description of
the main problems related to computer-aided diagnostic and therapy of soft
tissues and give a survey of the different types of assistance offered to the
urologist: robotization, image fusion, surgical navigation. Both research
projects and operational industrial systems are discussed
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