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

Change of practice patterns in urology with the introduction of the da Vinci surgical system: results from a Greek national hospital

Σκοπός: Nα καθοριστεί η αλλαγή της χειρουργικής νοοτροπίας στην Ουρολογία μετά την εισαγωγή του ρομποτικού συστήματος da Vinci (DVS). Περιγράφουμε τις σύγχρονες τάσεις σε επίπεδο δημοσίου νοσοκομείου, ενώ η χώρα βρίσκεται σε οικονομική κρίση. Υλικό και Μέθοδοι: Μελετήσαμε αναδρομικά, τα δεδομένα καταγραφής ουρολογικών χειρουργικών επεμβάσεων από το Γενικό Νοσοκομείο Αθηνών (ΓΝΑ) ‘Λαϊκό’ από το 2008 έως και το 2013. Εκτιμήσαμε τις τάσεις σχετικά με τις ρομποτικά- υποβοηθούμενες επεμβάσεις (ΡΥΕ) και την σχέση τους με την αλλαγή στο συνολικό αριθμό επεμβάσεων που πραγματοποιήθηκαν. Αποτελέσματα: Μελετήθηκαν 1578 από τις ουρολογικές επεμβάσεις που πραγματοποιήθηκαν στο ΓΝΑ ‘Λαϊκό’, από έξι χειρουργούς κατά την 6-χρονη περίοδο μελέτης, 1342 (85%) από τις οποίες έγιναν ανοικτά και 96 (15%) έγιναν ΡΥΕ. Παρατηρήσαμε αύξηση κατά έξι φορές στον αριθμό των ΡΥΕ που πραγματοποιήθηκαν, από 7 % επί του συνολικού αριθμού επεμβάσεων (14/212) το 2008 σε 30 % (96/328) το 2013, κατά κύριο λόγο από δύο χειρουργούς αφοσιωμένους στις ΡΥΕ. Όσον αφορά την ριζική προστατεκτομή, το 2008 το 2% έγινε ρομποτικά-υποβοηθούμενα και το 98% ανοικτά, ενώ το 2013 το 46% και το 54% αντιστοίχως.Οι αφοσιωμένοι χειρουργοί στις ΡΥΕ αύξησαν τον αριθμό των ΡΥΕ αλλά και το συνολικό αριθμό επεμβάσεων που πραγματοποίησαν. Από 86 επεμβάσεις το 2008 σε 145 το 2013, με το 57% από αυτές να είναι ΡΥΕ το 2013 σε σύγκριση με ποσοστό 13% το 2008. Συμπεράσματα: Η ρομποτικά-υποβοηθούμενη χειρουργική έχει ενσωματωθεί στο οπλοστάσιο του Έλληνα ουρολόγου χειρουργού σε επίπεδο δημοσίου νοσοκομείου. Η εξομοίωση με το DVS σχετίζεται επίσης με αύξηση του συνολικού αριθμού επεμβάσεων που πραγματοποιούνται, κυρίως την ριζική προστατεκτομή, παρόλη την έντονη διαμάχη περί της χρησιμότητας και της σχέσης κόστους- αποτελεσματικότητας.Purpose: To determine the attitudinal change for urologic surgery in Greece since the introduction of the da Vinci Surgical System (DVS). We describe contemporary trends at public hospital level, while at the same time Greece is in economic crisis. Materials and Methods: We retrospectively analyzed annualized case log data on urologic procedures, between 2008 (installation of the DVS) and 2013, from “Laiko’’ Hospital in Athens. We evaluated, using summary statistics, trends regarding robot- assisted surgery (RAS). Results: 1578 of the urological procedures that were performed at “Laiko’’ Hospital by six surgeons during this 6 -year period, 1342(85%) open and 236 RAS (15 %), were pooled and studied. We observed a 6-fold increase in the number of RAS performed, from 7% of the total procedural volume (14/212) in 2008 to 30% (96/331) in 2013, particularly from the two RAS –dedicated surgeons. For radical prostatectomy, in 2008 2% were robot-assisted and 98% open while in 2013, 46% and 54% respectively.RAS-dedicated surgeons increased both RAS and the total number of procedures they performed. From 86 in 2008 to 145 in 2013, with 57 % of them being RAS in 2013 as compared to 13 % in 2008. Conclusions: Robot-assisted surgery has integrated into the armamentarium for urologic surgery in Greece at national hospital level. Surgical robot acquisition is also associated with increased volume of procedures, especially prostatectomy, despite the ongoing debate over the usefulness and cost-effectiveness

Robotic Surgery – A Personal View of the Past, Present and Future

Research into robotic surgery has been undertaken for over 25 years. In that period a small number of companies have been formed to exploit this research and have undertaken clinical trials on patients. However, far fewer clinical applications have been undertaken than would have been expected from the level of research activity. This paper puts forward a number of reasons for this, many of which are not to do with the technology but are a consequence of the clinical and business environments. Recommendations are provided that will hopefully increase the number of clinical systems being applied. Some predictions are made for the future which should increase the number of commercial systems and thus achieve patient benefits

Proctocolectomia totale ibrida laparoscopica hand-assisted/robotica con ileo pouch-ano anastomosi: tecnica chirurgica ed esperienza preliminare

Introduzione: esistono pochi studi descriventi interventi chirurgici di proctocolecotomia totale effettuata con tecnica mini-invasiva e con confezionamento di anastomosi ileo pouch-anale (AIPA) per retto-colite ulcerosa (RCU) e poliposi adenomatosa familiare (FAP). Materiali e metodi: tra il Febbraio 2010 ed il Luglio 2013, quattro pazienti sono stati sottoposti a proctocolecotomia totale effettuata con tecnica mini-invasiva e con confezionamento di AIPA. In tutti gli interventi la colectomia è stata eseguita con tecnica laparoscopica hand-assisted attraverso incisione trasversa sovrapubica, che è stata utilizzata anche per confezionare il pouch ileale; la proctectomia è stata eseguita con il Sistema Robotico da Vinci ®; l’AIPA è stata effettuata con approccio transanale ed è stata confezionata una ileostomia di protezione. Risultati: il tempo operatorio medio è stato di 473 minuti (range 360–565 min). In tutti i casi è stata eseguita una proctectomia nerve-sparing e nessun intervento è stato convertito a laparotomia tradizionale. La durata media della degenza post-operatoria è stata 17 giorni (range 11–24). Non sono state osservate deiscenze anastomotiche. Ad oggi, non sono stati osservati disturbi autonomici, con una media di 3,8 evacuazioni quotidiane. Conclusioni: l’approccio ibrido laparoscopico hand-assisted – robotico per la proctocolectomia totale con AIPA non è mai stato descritto in letteratura. La nostra esperienza mostra la fattibilità di questa tecnica, che supera molte delle limitazioni delle tecniche puramente laparoscopiche o robotiche. È comunque necessaria una maggiore esperienza per raffinare la tecnica e dimostrare i suoi potenziali vantaggi. Background: Few studies have reported minimally invasive total proctocolectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic–robotic technique for patients with FAP and UC. Methods: Between February 2010 and July 2013, four patients underwent hand-assisted hybrid laparoscopic–robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse supra-pubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was handsewn through a transanal approach. The procedure was complemented by a temporary diverting loop ileostomy. Results: The mean operative time was 473 min (range, 360–565 min). In all cases, a nerve-sparing proctectomy was performed and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 17 days (range, 11–24 days). No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with an average of 3.8 bowel movements per day. Conclusions: The hand-assisted hybrid laparoscopic–robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages

Current status of robot-assisted surgery

The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.published_or_final_versio

Implementation of a Surgical Robot Dynamical Simulation and Motion Planning Framework

The daVinci Research Kit (dVRK) is a research platform that consists of the clinical daVinci surgical robot, provided by Intuitive Surgical to Academic Institutions. It provides an open source software and hardware platform for researchers to study and analyze the current architecture and expand the capabilities of the existing technology. The line between general purpose robotics and medical robotics has segregated the two fields. A significant part of the segregation lies at the software end, where new tools and methods developed in general purpose robotics cannot make it to medical robotics in a short amount of time. This research focuses on the integration of a widely used software architecture for general purpose robotics with the dVRK with the hope of utilizing the research and development from one field to the other. As a first step towards this bridging, a motion planning framework and a dynamic simulator has been developed for the dVRK using ROS. The motion planning framework is aimed to assist the surgeon in performing task with additional safety and machine intelligence. A few use cases have been proposed as well. Lastly, a Matlab Interface has been developed that is standalone in terms of usage and provides capabilities to interact with dVRK

Телехирургия: новые возможности лапароскопических технологий

В работе проведен анализ возможностей нового направления современноймедицины, объединяющей возможности миниинвазивных хирургических и информационнотелекоммуникационных технологий — телехирургии. Приведен сравнительный анализ результатов телехирургических вмешательств с традиционными лапароскопическими хирургическими технологиями.The analysis of a new direction of contemporary medicine, which is based on both miniinvasive laparoscopic surgery and informational-telecommunicative technologies and titled as telesurgery is delivered. The comparative evaluation of telesurgical interventions with traditional surgery was performed