25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)) : Part B

In 2014 the International Endohernia Society (IEHS) published the first international "Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias". Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques-minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before

Dynamic Active Constraints for Surgical Robots using Vector Field Inequalities

Robotic assistance allows surgeons to perform dexterous and tremor-free procedures, but robotic aid is still underrepresented in procedures with constrained workspaces, such as deep brain neurosurgery and endonasal surgery. In these procedures, surgeons have restricted vision to areas near the surgical tooltips, which increases the risk of unexpected collisions between the shafts of the instruments and their surroundings. In this work, our vector-field-inequalities method is extended to provide dynamic active-constraints to any number of robots and moving objects sharing the same workspace. The method is evaluated with experiments and simulations in which robot tools have to avoid collisions autonomously and in real-time, in a constrained endonasal surgical environment. Simulations show that with our method the combined trajectory error of two robotic systems is optimal. Experiments using a real robotic system show that the method can autonomously prevent collisions between the moving robots themselves and between the robots and the environment. Moreover, the framework is also successfully verified under teleoperation with tool-tissue interactions.Comment: Accepted on T-RO 2019, 19 Page

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

An Intervening Ethical Governor for a Robot Mediator in Patient-Caregiver Relationships

© Springer International Publishing AG 2015DOI: 10.1007/978-3-319-46667-5_6Patients with Parkinson’s disease (PD) experience challenges when interacting with caregivers due to their declining control over their musculature. To remedy those challenges, a robot mediator can be used to assist in the relationship between PD patients and their caregivers. In this context, a variety of ethical issues can arise. To overcome one issue in particular, providing therapeutic robots with a robot architecture that can ensure patients’ and caregivers’ dignity is of potential value. In this paper, we describe an intervening ethical governor for a robot that enables it to ethically intervene, both to maintain effective patient–caregiver relationships and prevent the loss of dignity

Articulated Clinician Detection Using 3D Pictorial Structures on RGB-D Data

Reliable human pose estimation (HPE) is essential to many clinical applications, such as surgical workflow analysis, radiation safety monitoring and human-robot cooperation. Proposed methods for the operating room (OR) rely either on foreground estimation using a multi-camera system, which is a challenge in real ORs due to color similarities and frequent illumination changes, or on wearable sensors or markers, which are invasive and therefore difficult to introduce in the room. Instead, we propose a novel approach based on Pictorial Structures (PS) and on RGB-D data, which can be easily deployed in real ORs. We extend the PS framework in two ways. First, we build robust and discriminative part detectors using both color and depth images. We also present a novel descriptor for depth images, called histogram of depth differences (HDD). Second, we extend PS to 3D by proposing 3D pairwise constraints and a new method that makes exact inference tractable. Our approach is evaluated for pose estimation and clinician detection on a challenging RGB-D dataset recorded in a busy operating room during live surgeries. We conduct series of experiments to study the different part detectors in conjunction with the various 2D or 3D pairwise constraints. Our comparisons demonstrate that 3D PS with RGB-D part detectors significantly improves the results in a visually challenging operating environment.Comment: The supplementary video is available at https://youtu.be/iabbGSqRSg