Design and Motion Planning for a Reconfigurable Robotic Base

A robotic platform for mobile manipulation needs to satisfy two contradicting requirements for many real-world applications: A compact base is required to navigate through cluttered indoor environments, while the support needs to be large enough to prevent tumbling or tip over, especially during fast manipulation operations with heavy payloads or forceful interaction with the environment. This paper proposes a novel robot design that fulfills both requirements through a versatile footprint. It can reconfigure its footprint to a narrow configuration when navigating through tight spaces and to a wide stance when manipulating heavy objects. Furthermore, its triangular configuration allows for high-precision tasks on uneven ground by preventing support switches. A model predictive control strategy is presented that unifies planning and control for simultaneous navigation, reconfiguration, and manipulation. It converts task-space goals into whole-body motion plans for the new robot. The proposed design has been tested extensively with a hardware prototype. The footprint reconfiguration allows to almost completely remove manipulation-induced vibrations. The control strategy proves effective in both lab experiment and during a real-world construction task.Comment: 8 pages, accepted for RA-L and IROS 202

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach.

OBJECTIVE First rib resection is a well-recognized treatment option for thoracic outlet syndrome (TOS). In case of a vascular insufficiency that can be provoked and/or progressive neurologic symptoms without response to conservative treatment, surgical decompression of the space between the clavicle and the first rib is indicated. The aim of this paper is to present our experience with a new minimally invasive robotic approach using the da Vinci Surgical System®. METHODS Between January 2015 and October 2017, eight consecutive first rib resections in seven patients were performed at our institution. Four patients presented with neurologic (one bilateral), and three patients with vascular (venous) impairment. In all cases, a transthoracic robotic-assisted approach was used. The first rib was removed using a 3-port robotic approach with an additional 2-cm axillary incision in the first six patients. The latest resection was performed through only three thoracic ports. RESULTS Median operative time was 108 min, and the median hospital stay was 2 days. Postoperative courses were uneventful in all patients. Clinical follow-up examinations showed relief of symptoms in all nonspecific TOS patients, and duplex ultrasonography confirmed complete vein patency in the remaining patients 3 months after surgery. CONCLUSIONS While there are limitations in conventional transaxillary, subclavicular and supraclavicular approaches in the first rib resection, the robotic method is not only less invasive but also allows better exposure and visualization of the first rib. Furthermore, the technique takes advantage of the benefits of the da Vinci Surgical System® in terms of 3D visualization and improved instrument maneuverability. Our early experience clearly demonstrates these advantages, which are also supported by the very good outcomes

Completely Thoracoscopic 3-Port Robotic First Rib Resection for Thoracic Outlet Syndrome.

BACKGROUND In thoracic outlet syndrome, the constriction between bony and muscular structures leads to compression of the neurovascular bundle to the upper extremity. Traditional surgical techniques using supraclavicular, infraclavicular, or transaxillary approaches to remove the first rib do not usually allow good exposure of the entire rib and neurovascular bundle. We have therefore developed a robotic approach to overcome these limitations. METHODS Between January 2015 and November 2020, 38 consecutive first rib resections for neurogenic, venous, or arterial thoracic outlet syndrome were performed in 34 patients at our institutions. For our completely portal approach, we used two 8-mm working ports and one 12-mm camera port. RESULTS The surgery time was between 71 and 270 minutes (median ± SD: 133 ± 44.7 minutes) without any complications. Chest tube was removed on postoperative day 1 in all patients and the hospital stay after surgery ranged from 1-7 days (2 ± 2.1 days). No relevant intraoperative or postoperative complications were observed and complete or subtotal resolution of symptoms was seen in all patients. CONCLUSIONS The robotic technique described here for first rib resection has proven to be a safe and effective approach. The unsurpassed exposure of the entire first rib and possibility for a robotic-assisted meticulous surgical dissection has prevented both intraoperative and postoperative complications. This makes this technique unique as the safest and most minimally invasive approach to date. It helps improve patient outcomes by reducing perioperative morbidity with an easily adoptable procedure

Uncertainty based assessment of dynamic freshwater scarcity in semi-arid watersheds of Alberta, Canada

Study region: Alberta, Canada. Study focus: The security of freshwater supplies is a growing concern worldwide. Understanding dynamics of water supply and demand is the key for sustainable planning and management of watersheds. Here we analyzed the uncertainties in water supply of Alberta by building an agro-hydrological model, which accounts for major hydrological features, geo-spatial heterogeneity, and conflicts over water-food-energy resources. We examined the cumulative effects of natural features (e.g., potholes, glaciers, climate, soil, vegetation), anthropogenic factors (e.g., dams, irrigation, industrial development), environmental flow requirements (EFR), and calibration schemes on water scarcity in the dynamics of blue and green water resources, and groundwater recharge. New hydrological insights for the region: Natural hydrologic features of the region create a unique hydrological system, which must be accurately represented in the model for reliable estimates of water supply at high spatial and temporal resolution. Accounting for EFR, increases the number of months of water scarcity and the population exposed. Severe blue water scarcity in spring and summer months was found to be due to irrigated agriculture, while in winter months it was mostly due to the demands of petroleum or other industries. We found over exploitation of the groundwater in southern subbasins and concluded that more detailed analysis on groundwater flow and connectivity is required. Our study provides a general and unified approach for similar analyses in other jurisdictions around the world

Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment?

In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS were performed in 23 patients at our institutions. For our completely portal approach we used two 8mm working ports and one 12/8 mm camera port. Preoperatively, pressurized catheter-based thrombolysis (AngioJet®) was successfully performed in 13 patients with vTOS. Operative time ranged from 71-270 min (median 128.5 min, SD +/- 43.2 min) with no related complications. The chest tube was removed on Day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD +/- 2.1 days). Stent grafting was performed 5-35 days (mean 14.8 days, SD +/- 11.1) postoperatively in 6 patients. The robotic approach to first rib resection described here allows perfect exposure of the entire rib as well as the neurovascular bundle and is one of the least invasive surgical approaches to date. It helps improve patient outcomes by reducing perioperative morbidity and is a procedure that can be easily adopted by trained robotic thoracic surgeons. In particular, patients with a/vTOS may benefit from careful and meticulous preparation and removal of scar tissue around the vessels