Intelligent Information-Guided Robotic Surgery

Laparoscopic surgery is minimally invasive, providing various benefits for patients. On the other hand, it is technically demanding for physicians due to limited dexterity of tools, limited vision. In order to cope with those limitations, recent various engineering technologies are trying to help surgeon. Robotics is one of the major technologies in this field. Until today, da Vinci has been only one such robot. But recently, many other robotic systems are under development. Those new robots are introduced in this chapter first. Other than robotics, or in conjunction with robotics, navigation technologies are getting popularity in clinical use. Navigation is a technology that provides useful information such as preoperative images or distance between tool and lesion, etc. to surgeon. Our experience in clinical use of navigation system in robotic surgery is introduced. Finally, technologies applied for the training of surgeon are introduced and described

An Experimental Feasibility Study on Robotic Endonasal Telesurgery

Novel robots have recently been developed specifically for endonasal surgery. They can deliver several thin, tentacle-like surgical instruments through a single nostril. Among the many potential advantages of such a robotic system is the prospect of telesurgery over long distances

Recent Advances in Laparoscopic Surgery

The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics

Robotic surgery, human fallibility, and the politics of care

Robotic Surgery, Human Fallibility, and the Politics of Care leverages the methods and theoretical paradigms of performance, visual, and new media studies to explore the contradictions, aspirations, and failures of modern technologized medicine. In particular, I consider the use of robots in the operating rooms of a large research hospital. University Hospital illuminates a contemporary articulation of human bodies and robotic technology that focuses and amplifies existing and emergent tensions and contradictions in modern medicine's investment in providing both care and cure. Intuitive Surgical, Inc.'s da Vinci Surgical System provides a platform for this exploration, both as a concrete, material, and particular assemblage of hardware, software and human wetware, and as a technology that offers a specific and perhaps more productive vantage point--a modest step stool--for understanding the contemporary politics of surgical pedagogy and practice. I locate the dVSS in a broader context of ambivalence that surgeons experience with regard to the manual practices of their craft, an ambivalence amplified by the increasing sophistication and automation of surgical tools and the changing ontologies of surgical practice. The surgical interface of the dVSS prosthetically enhances--as well as displaces and replaces--embodied surgical skill. At a time when all facets of medical care grapple with the problem of medical error, I outline an emergent sensibility of machinic virtuosity, articulated to both human and robotic surgical practice alike, geared toward addressing and overcoming the perceived pitfalls of human fallibility. Rather than simply enacting a technological dehumanization of medicine, robotic surgery suggests a more complicated terrain where the nature of the human and the machine bleed into each other. What I term the becoming machine of the surgeon and the becoming surgeon of the medical device occurs on the cutting edge of the robot-surgeon interface. The implications of this emergent medical sensibility are far from clear or unilateral. In closing, I reflect on the uncertain impact of the ideal of machinic virtuosity on the politics of care. This reflection considers software and machine ethics alongside medicine's aspiration to manage contingency according to the procedurality of medical and surgical protocols

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

Hand-eye calibration, constraints and source synchronisation for robotic-assisted minimally invasive surgery

In robotic-assisted minimally invasive surgery (RMIS), the robotic system allows surgeons to remotely control articulated instruments to perform surgical interventions and introduces a potential to implement computer-assisted interventions (CAI). However, the information in the camera must be correctly transformed into the robot coordinate as its movement is controlled by the robot kinematic. Therefore, determining the rigid transformation connecting the coordinates is necessary. Such process is called hand-eye calibration. One of the challenges in solving the hand-eye problem in the RMIS setup is data asynchronicity, which occurs when tracking equipments are integrated into a robotic system and create temporal misalignment. For the calibration itself, noise in the robot and camera motions can be propagated to the calibrated result and as a result of a limited motion range, the error cannot be fully suppressed. Finally, the calibration procedure must be adaptive and simple so a disruption in a surgical workflow is minimal since any change in the setup may require another calibration procedure. We propose solutions to deal with the asynchronicity, noise sensitivity, and a limited motion range. We also propose a potential to use a surgical instrument as the calibration target to reduce the complexity in the calibration procedure. The proposed algorithms are validated through extensive experiments with synthetic and real data from the da Vinci Research Kit and the KUKA robot arms. The calibration performance is compared with existing hand-eye algorithms and it shows promising results. Although the calibration using a surgical instrument as the calibration target still requires a further development, results indicate that the proposed methods increase the calibration performance, and contribute to finding an optimal solution to the hand-eye problem in robotic surgery

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents

Anatomía endoscópica de la base del cráneo: la fisura orbitaria inferior y su implicancia quirúrgica

Tesis (Dr. en Medicina y Cirugía)--Universidad Nacional de Córdoba. Facultad de Ciencias Médicas, 2017220 p.OBJETIVOS: Proporcionar datos y conocimiento de la anatomía endoscópica de la Fisura Orbitaria Inferior (FOI) a fin de comprender sus relaciones con las aéreas que la rodean en función de los corredores endoscópicos quirúrgicos. HIPÓTESIS: La fisura orbitaria inferior (FOI) y sus segmentos pueden ser expuestos y analizados por vía endoscópica junto con su Músculo de Müller (MM), señalando reparos anatómicos de relevancia en la cirugía endoscópica. MATERIAL Y MÉTODOS: realizamos un análisis morfométrico y descriptivo óseo de la FOI en cráneos secos, disección y estudio bajo técnica anatómica, microquirúrgica, y principalmente endoscópica, de cabezas fijadas en formol y coloreadas. Medimos distancias y ángulos a forámenes relacionados con las áreas contiguas a la FOI (fosa pterigopalatina, fosa infratemporal y ápex orbitario). El análisis estadístico lo realizamos con el programa estadístico SPSS 17. RESULTADOS: Definimos a la FOI como un estrecho espacio entre la cara lateral y el piso de la órbita. Esta fisura tiene una dirección oblicua (antero-lateral) desde su origen posteromedial a nivel del pilar maxilar (maxillary strut) hasta el hueso cigomático. Pudimos dividir a la FOI en 3 segmentos con reparos anatómicos endoscópicos precisos (posteromedial, medio y anterolateral) cada uno relacionado con diferentes áreas o regiones de la base anterolateral del cráneo. La media de longitud total de la FOI fue de 29,1mm (rango intercuartil 28-30mm). La FOI siempre estuvo tapizada por un músculo liso llamado Músculo de Müller (MM). Este binomio o unidad estructural FOI/MM fue un reparo anatómico constante y visible bajo técnica endoscópica en todo el proceso de observación, investigación y análisis. Quirúrgicamente el MM nos da una orientación anatómica de la FOI: se trata de un reparo anatómico clave que permite generar corredores específicos a cada región de la base de cráneo relacionada con la FOI. Finalmente, el estudio histológico nos confirmó las relaciones vistas y analizadas endoscópicamente. Hallamos más tejido graso del esperado. CONCLUSIONES: Las disecciones anatómicas clásicas y las endoscópicas nos permitieron tener un concepto más completo de la anatomía de la FOI y de sus regiones contiguas, aportando datos sobre una estructura hasta ahora escasamente abordada. Podemos afirmar que la unidad estructural FOI/MM es un reparo anatómico de relevancia en cirugía endoscópica y que, desde un conocimiento firme de su morfología, puede ser utilizado para definir corredores endoscópicos a la región anterolateral de la base de cráneo. Dada la profusión y continuidad de su tejido graso, queda abierta la pregunta sobre el papel de esta estructura como vía o canal de difusión de patologías.OBJECTIVES: To provide data and knowledge of the endoscopic anatomy of the IOF, to understand its relationships with the surrounding areas, upon the surgical endoscopic pathways. HYPOTHESIS: The IOF and its segments can be exposed and analyzed endoscopically together with its Müller’s muscle (MM), pointing out relevant anatomical landmarks for endoscopic surgery. MATERIALS AND METHODS: We performed a morphometric and descriptive bone analysis of the IOF in dry skulls; as well as microsurgical (mainly endoscopic) dissection and anatomic technical study of formol-fixated and colored human heads. We also measured the distances and angles to the foramina related to areas adjacent to the IOF (Pterygopalatine fossa, infratemporal fossa and orbital apex). All statistical analysis was performed using statistical software, SPSS 17. RESULTS: The IOF was defined as a narrow space between the orbit’s lateral face and the orbit’s floor. This fissure has an oblique direction (antero-lateral) from its posterior-medial origin at the maxillary strut to the zygomatic bone We were able to divide the IOF in three segments with precise anatomical landmarks (posterior-medial, medial and anterolateral) each one related with different anterolateral regions of the skull base. The mean total length of the IOF was 29.1 mm (interquartile range: 28-30 mm). The IOF was always covered by the Müller’s muscle. This binomial, or structural unit, IOF/MM, was a constant anatomical landmark, visible under endoscopic technique during the whole process of observation, investigation and analysis. Surgically, MM provided anatomical orientation within the IOF, being a key landmark allowing to generate specific pathways to each region of the skull base in relation to the IOF. Finally, histologic study confirmed the relationships which had been endoscopically seen and analyzed. We found more fat tissue than expected. CONCLUSIONS: Classical and endoscopic anatomic dissections allowed us to have a more complete concept of the IOF’s anatomy and its adjacent regions, providing information about a structure which has been scarcely approached, until now. We can state that the structural unit IOF/MM is a relevant anatomical landmark for endoscopic surgery and through its firm morphologic knowledge it can be used to open endoscopic pathways to the anterolateral region of the skull base. An open question remains in relation to the structure’s function and its fat tissue, which could provide a way for pathology spread.Fil: De Battista, Juan Carlos. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina