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

Robotic Joint Replacement Surgery: Does Technology Improve Outcomes

Introduction: Osteoarthritis is a common disease that leads patients to seek Total Joint Replacement (TJR). Component misalignments leads to failure of TJR. Computer navigation enhances the precision of component alignment, but the addition of robotic guidance, can boost TJR to a higher level of accuracy. Methodology: This literature reviewed 29 English language peer reviewed articles from 2002 – 2013 and one website. A conceptual framework was adapted to explain benefits and barriers of adoption of robotic TJR. Results: A total of ten studies were reviewed with focus on more precise alignment, outcomes, length of stay, and costs. Cost to obtain robotic surgical equipment was found to be about $1 million with maintenance costs approaching$350,000. Discussion: Robotic techniques compared to conventional orthopedic surgery showed slight variances, in favor of robotic procedures. While hospitals have the potential to reduce costs and improve outcomes with robotic TJR, but the expenditure and maintenance have not been proven a clear ROI. Conclusion: As surgical robotic technology evolves in accuracy and accessibility, joint replacement surgery may benefit from improved precision and decreased healthcare costs. But, costs of equipment purchase, upkeep and surgeon training may impact its full potential in orthopedic surgery in the United States

Accuracy of magnetic resonance imaging in pretreatment lymph node assessment for gynecological malignancies

Objective: To determine the accuracy of magnetic resonance imaging (MRI) in detection of metastasis in pelvic and para-aortic lymph nodes from different gynecological malignancies.MATERIALS AND Methods: This retrospective cross sectional analytic study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital Karachi Pakistan from January 2011 to December 2012. A sample of 48 women, age range between 20-79 years, fulfilling inclusion criteria were included. All patients had histopathologically proven gynecological malignancies in the cervix, endometrium or ovary and presented for a pretreatment MRI to our radiology department.Results: MRI was 100% sensitive and had a 100% positive predictive value to detect lymph node metastasis in lymph nodes with spiculated margins and 100% sensitive with a 75% positive predictive value to detect lymph node metastasis in a lymph node with lobulated margins. The sensitivity and positive predictive value of MRI to detect heterogeneous nodal enhancement were 100% and 75% respectively.CONCLUSIONS: Our study results reinforce that MRI should be used as a modality of choice in the pretreatment assessment of lymph nodes in proven gynaecological malignancies in order to determine the line of patient management, distinguishing surgical from non-surgical cases

A Prospective Observational Study to Determine the Usefulness of Ultrasound Guided Airway Assessment Preoperatively in Predicting Difficult Airway

AIM OF THE STUDY: The primary aim of this study was to assess the usefulness of ultrasonogram as a preoperative assessment tool in identifying difficult airway. To compare and correlate the ultrasound view of the airway and clinical airway assessment with Cormack Lehane classification of the direct laryngoscopy. METHODS: 150 patients who were to undergo elective surgery and required endotracheal intubation were included in the study. Patients with no teeth and head and neck anatomical abnormality were excluded from study. On the previous day evening of surgery, Patients were shifted to the ultrasound room in the department of anaesthesiology and clinical airway assessment which included Mallampatti's classification, inter incisor gap and thyromental distance were measured. The ultrasound airway assessment was done to measure the thickness of soft tissues in the anterior neck at 3 levels namely (a) hyoid bone, (b) thyrohyoid membrane and (c) suprasternal notch. The patient's demographic details like age, sex, height and weight were also recorded. On the day of surgery, the attending anesthesiologist provided anesthesia to the patient according to the standardization measures explained to them by the anesthetists who performed the airway assessment. The Cormack-Lehane was recorded. Statistical analysis was done using the collected data. RESULTS: The statistic analysis tools that were used in this study for comparison between demographic variables, ultrasound measurements and Cormack-Lehane classification was independent t test an Chi square test. To evaluate for correlation between clinical assessment and ultrasound assessment, Spearman's Rank correlation coefficient was used. There was no statistical significance between the demographic variables like age (P=0.613), sex (P=0.670) and height (P=0.614) of the patients and the occurrence of difficult airway. Among the demographic variables, significant correlation was found between the weight (P=0.000) and difficult airway. The ultrasound measurements made at the 3 levels (a) hyoid bone, (b) thyrohyoid membrane and (c) suprasternal notch level showed significant results. The P values for each of the levels are P=0.000, P=0.000 and P=0.000 respectively. Among the 3 levels, the measurement made at thyrohyoid membrane level (skin to epiglottis thickness) was found to be highly sensitive(100%) and specific(99.3%). A cutoff point of 2.33cms was calculated using the Receiver Operating Characteristic curve (ROC curve). This cutoff point delineates difficult airway and difficult airway. No significant correlation was found between clinical assessment and ultrasound assessment. CONCLUSION : Based on this study we concluded that ultrasound can be used as a reliable tool to identify difficult airway by measuring the thickness of soft tissues in the anterior part of neck. The measurement made at thyrohyoid membrane level is more accurate than the other 2 levels

Review of Fluorescence Guided Surgery Visualization and Overlay Techniques

In fluorescence guided surgery, data visualization represents a critical step between signal capture and display needed for clinical decisions informed by that signal. The diversity of methods for displaying surgical images are reviewed, and a particular focus is placed on electronically detected and visualized signals, as required for near-infrared or low concentration tracers. Factors driving the choices such as human perception, the need for rapid decision making in a surgical environment, and biases induced by display choices are outlined. Five practical suggestions are outlined for optimal display orientation, color map, transparency/alpha function, dynamic range compression, and color perception check

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10~ml ICG with a concentration of 0.25~mg/ml, a continuous intra-arterial perfusion was established at a rate of 2~ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54~min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies

Realtime elastosonography of the penis in patients with Peyronie's disease

Objective: To evaluate the performance of real time elastosonography (RTE) in the iden- tification of different types of penile lesions in patients with Peyronie’s disease. Materials and methods: Seventy four consecutive patients with complaints of Peyronie’s disease underwent B-Mode ultrasonography (US) and RTE of the penis in the same sit- ting. In each patient all sequences of elastosonography and B-Mode US were recorded and compared to evaluate the diagnostic performance of the new imaging technique. Results: B-Mode US detected penile plaques in 64 patients (86.41%) and elastosonography con- firmed these data. In the remaining 10 patients elastosonography documented, in five of them, areas of reducing elasticity suggesting the presence of initial fibrosis. Cohen’s K was used to eval- uate the discordances between B-Mode US and Elastosonography scan. A p value 30°, and the penile plaque evalua- tions were completely concordant. Conclusions: RTE is a simple, non invasive, rapid complementary imaging technique that may improve the accuracy of B-Mode US in detecting penile lesions in patients with Peyronie’s disease

Ultrasonic Transducer And Method For Using Same

An improved ultrasonic transducer fabricated on a silicon base has a piezoelectric layer of polyvinylidene fluoride-trfluroethylene copolymer. The piezoelectric layer is sandwiched between two conductive electrodes, all of which are supported on a dielectric layer on top of the silicon base. At least one of the electrodes forms a Fresnel zone plate to focus the ultrasonic signals from the transducers. To improve the performance of the transducer, the silicon base behind the active area is removed, leaving the dielectric layer as a membrane to support the electrodes and the piezoelectric layer. The resulting void in the silicon base is filled with an acoustically matched backing, such as an epoxy, to enhance the wideband performance of the transducer. The transducer is especially suited for characterizing anatomical structures or features requiring very high resolution.Georgia Tech Research Corp.Medical College Of Georgia Research Institut

Comparison of Four Different Embolic Materials For Uterine Artery Embolization In Post-Procedure MRI Enhancement

The aim of this study was to assess embolic agent equivalency in uterine artery embolization (UAE) using post-procedure MRI enhancement of uterine fibroids in patients embolized using Embosphere Microspheres, (EM) Contour SE spheres (CSE), Poly-Vinyl Alcohol particles (PVA) and Bead Block spheres (BB). A total of 84 women with 6-month MRI follow-up constituted this retrospective study. Within this group, 25 women were treated with PVA, 23 were treated with CSE, 19 were treated with EM and 17 were treated with BB. Pre- and post-procedure MRI exams were analyzed for the total number of fibroids present in the uterus of each patient and the percentage individual fibroid enhancement of each fibroid was scored in quartile intervals. The overall percentage change in enhancement was then calculated for each patient. Bivariate analysis using Generalized Linear Modeling and one-way ANOVA was used to assess differences in infarction by different embolic materials. Of patients treated with PVA and EM, there was a mean reduction in enhancement by 76.60% and 83.07%, respectively, compared to a mean reduction of 52.53% and 49.78% in patients treated with CSE and BB, respectively. There was a statistically significant difference between CSE or BB and EM or PVA. Patients treated with BB and CSE demonstrate a reduced degree of infarction on follow-up MRI than those patients treated with PVA or EM