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Resumen Introducción: La cirugía bariátrica se considera actualmente la opción de tratamiento más eficaz para la obesidad mórbida. El bypass gástrico laparoscópico en Y de Roux sigue siendo el estándar de oro en cirugía bariátrica. El advenimiento de la robótica quirúrgica ha llevado a una reducción de algunos de los desafíos más difíciles en la laparoscopia avanzada. Objetivo: Determinar la seguridad y eficacia del bypass gástrico en Y de Roux asistido por robot en comparación con el abordaje laparoscópico. Material y métodos: Se realizó un estudio retrospectivo que incluyo 50 pacientes con distintos grados de obesidad divididos en dos grupos de 25 cada uno. Se realizó una base de datos con las variables de acuerdo al tipo de abordaje quirúrgico (robótico y laparoscópico), registrando los días de estancia hospitalaria, sangrado, tiempo quirúrgico, complicaciones, reingresos hospitalarios, complicaciones y disminución del IMC. Resultados: En el grupo laparoscópico se observó un sangrado transoperatorio de 115.8+64 mililitros, en el grupo robótico solo fue de 59.6+45.8 mililitros (p<0.001). Un tiempo quirúrgico laparoscópico de 151.8+34.6 minutos, mientras que el grupo robótico fue de 216.4+50 minutos, los pacientes permanecieron hospitalizados 4.2+2.4 días en el grupo laparoscópico, los pacientes del grupo robótico 3.4+1 días, sin diferencia significativa (p=0.077). En ambos grupos no hubo reingresos hospitalarios. En el grupo laparoscópico la disminución de IMC fue de 8.9+2.5, mientras que para el grupo robótico fue de 13.7+2.3 con significancia estadística (p<0.001). Discusión: El bypass gástrico en Y de Roux asistido por robot es más seguro y eficaz en comparación con el abordaje laparoscópico. El abordaje robótico disminuye de forma significativa el sangrado transoperatorio, disminuye los días de estancia hospitalaria (sin diferencia significativa) y reduce de forma significativa la disminución del IMC, sin aumentar los reingresos hospitalarios a 30 días ni las complicaciones.
Abstract Introduction: Bariatric surgery is currently considered the most effective treatment option for morbid obesity. The laparoscopic Roux-en-Y gastric bypass remains the gold standard in bariatric surgery. The advent of surgical robotics has led to a reduction in some of the most difficult challenges in advanced laparoscopy. Objective: To determine the safety and efficacy of robot-assisted Roux-en-Y gastric bypass compared to the laparoscopic approach. Material and methods: A retrospective study was carried out that included 50 patients with different degrees of obesity divided into two groups of 25 patients each. A database was created with the variables according to the type of surgical approach (robotic and laparoscopic), recording the days of hospital stay, bleeding, surgical time, complications, hospital readmissions, complications, and BMI decrease. Results: In the laparoscopic group, intraoperative bleeding of 115.8+64 milliliters was observed, in the robotic group it was only 59.6+45.8 milliliters (p<0.001). A laparoscopic surgical time of 151.8+34.6 minutes, while the robotic group was of 216.4+50 minutes, the patients remained hospitalized 4.2+2.4 days in the laparoscopic group, the patients in the robotic group 3.4+1 days, with no significant difference (p=0.077). In both groups there were no hospital readmissions. In the laparoscopic group, the decrease in BMI was 8.9+2.5, while for the robotic group it was 13.7+2.3 with statistical significance (p<0.001). Discussion: Robot-assisted Roux-en-Y gastric bypass is more safe and effective compared to the laparoscopic approach. The robotic approach significantly reduces intraoperative bleeding, decreases the days of hospital stay (with no significant difference), and significantly reduces the decrease in BMI, without increasing 30-day hospital readmissions or complications.
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Objective To compare and analyze the accuracy and safety of robot-assisted and conventional freehand open approach in pedicle screw fixation using meta-analysis.Methods PubMed,Embase,Cochrane,China Biology Medicine,Wanfang and CNKI databases were searched by computer retrieval to identify the relevant literatures published before December1,2016.The qualified literatures were selected according to the preestablished the inclusion criteria and exclusion criteria,and processed for data extraction and quality evaluation.The RevMan 5.3 software was used for the meta-analysis.The relative risk (RR) and 95％ confidence interval (CI) were adopted to represent the effect differences in the dichotomous variable data.The effect difference of continuous variable data was represented by mean difference (MD) or standardized mean difference (SMD).When P＜0.05 and 95％ CI does not contain the value of 1,the difference was considered statistically significant.Results A total of 266 patients were enrolled,including 138 cases of robot-assisted group and 128 cases of conventional freehand open group,in which 1 200 screws were implanted,including 608 screws by robot-assisted system and 592 screws by conventional freehand open approach.The Gertzbein-Robbins grading criteria (grade A to C) were used.The results showed that there was no significant difference in the accuracy of pedicle screw fixation between the robotic-assisted and conventional freehand open approach according to the grading criteria,i.e.grades A (RR =1.07,95％CI:0.82,1.39,I2=46％,P=0.62),grades B (RR=l.56,95％CI:0.86,2.82,I2=0％,P=0.14) and grades C (RR=0.91,95％CI:0.32,2.55,I2=0％,P=0.85).For the two groups,the difference was no statistically significance in the complication rate (RR=0.33,95％CI:0.05,2.17,I2=0％,P=0.25),and in the revision rate (RR=0.53,95％CI:0.10,2.90,I2=0％,P=0.47).The difference was statistically significance in the overall surgical time (MD=20.90,95％CI:5.54,36.26,I2=15％,P=0.008),and in the exposure time (MD=-1.19,95％CI:-1.63,-0.75,I2=15％,P＜0.000 01).The difference was no statistically significance in the distance between screws and facet joint surfaces (SMD=-1.15,95％CI:0.79,1.51,I2=16％,P＜0.000 01).Conclusions Compared with the conventional freehand open approach,the current evidence cannot confirm that the robot-assisted system has significant advantages in the surgical accuracy of pedicle screw fixation and complication rate.The spinal surgical robot-assisted system,as a new technology,has considerable potential for further development and application in spinal surgery.
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Objective To compare and analyze the accuracy and safety of robot-assisted and conventional freehand open approach in pedicle screw fixation using meta-analysis.Methods PubMed,Embase,Cochrane,China Biology Medicine,Wanfang and CNKI databases were searched by computer retrieval to identify the relevant literatures published before December1,2016.The qualified literatures were selected according to the preestablished the inclusion criteria and exclusion criteria,and processed for data extraction and quality evaluation.The RevMan 5.3 software was used for the meta-analysis.The relative risk (RR) and 95％ confidence interval (CI) were adopted to represent the effect differences in the dichotomous variable data.The effect difference of continuous variable data was represented by mean difference (MD) or standardized mean difference (SMD).When P＜0.05 and 95％ CI does not contain the value of 1,the difference was considered statistically significant.Results A total of 266 patients were enrolled,including 138 cases of robot-assisted group and 128 cases of conventional freehand open group,in which 1 200 screws were implanted,including 608 screws by robot-assisted system and 592 screws by conventional freehand open approach.The Gertzbein-Robbins grading criteria (grade A to C) were used.The results showed that there was no significant difference in the accuracy of pedicle screw fixation between the robotic-assisted and conventional freehand open approach according to the grading criteria,i.e.grades A (RR =1.07,95％CI:0.82,1.39,I2=46％,P=0.62),grades B (RR=l.56,95％CI:0.86,2.82,I2=0％,P=0.14) and grades C (RR=0.91,95％CI:0.32,2.55,I2=0％,P=0.85).For the two groups,the difference was no statistically significance in the complication rate (RR=0.33,95％CI:0.05,2.17,I2=0％,P=0.25),and in the revision rate (RR=0.53,95％CI:0.10,2.90,I2=0％,P=0.47).The difference was statistically significance in the overall surgical time (MD=20.90,95％CI:5.54,36.26,I2=15％,P=0.008),and in the exposure time (MD=-1.19,95％CI:-1.63,-0.75,I2=15％,P＜0.000 01).The difference was no statistically significance in the distance between screws and facet joint surfaces (SMD=-1.15,95％CI:0.79,1.51,I2=16％,P＜0.000 01).Conclusions Compared with the conventional freehand open approach,the current evidence cannot confirm that the robot-assisted system has significant advantages in the surgical accuracy of pedicle screw fixation and complication rate.The spinal surgical robot-assisted system,as a new technology,has considerable potential for further development and application in spinal surgery.
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Resumen En este trabajo se presenta la implementación de un simulador virtual de cirugía gobernado por interfaz natural a través de Leap Motion para determinar la viabilidad de la utilización de esta clase de interfaces. El simulador consta de tres robots, uno de los cuales maneja el endoscopio en el abdomen del paciente, y los otros son robots quirúrgicos, también se implementó una colecistectomía laparoscópica (extirpación de la vesícula biliar), que se dirige a través del movimiento libre de las manos. La aplicación permite algunas acciones como apertura o cierre de pinzas quirúrgicas, localizar grapas, hacer cortes, guiar instrumentos y fue probada por estudiantes de cirugía, obteniéndose un mejor grado de satisfacción con el uso de la interfaz natural.
Abstract This paper presents the implementation of a virtual surgical simulator governed by natural interface through Leap Motion to determine the feasibility of using this interface in this area. The simulator comprises three robots one of which handles the endoscope into the patient's abdomen, and the others are surgical robots. A method of laparoscopic cholecystectomy (removal of the gallbladder) was developed, which targets through joystick or natural interface. The application allows some actions such as opening or closing crow bill, locate clips, make cuts and guide the instruments. Additionally this tool was tested by surgery students, obtaining a better degree of satisfaction with the use of natural interface.
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El presente artículo muestra el diseño y operación de un primer prototipo de robot para la guía en la inserción de tornillos en cirugía de fijación de columna. Este tipo de cirugía, realizada normalmente de forma manual, puede producir muchas lesiones debido a errores humanos al momento de introducir los tornillos en las vértebras del paciente. Para evitar dichos errores se puede utilizar la tomografía computarizada, pero los resultados son mucho mejores si un robot asistente proporciona al cirujano el camino para la inserción del tornillo, según la imagen del tomógrafo. Este artículo muestra como utilizando un robot comercial de bajo costo se puede implementar un sistema que provee una solución funcional a este problema. Se implementó un software que permite definir la posición inicial y final del tornillo a ser introducido, sobre la imagen Dicom del paciente. Con esta información el sistema mueve el robot el cual posee un anillo que guiará al cirujano en la inserción final. Los resultados muestran un sistema bastante preciso ofreciendo al cirujano un camino seguro de inserción.
This article presents the design and operation of the first prototype of a robot, designed to guide the insertion of screws in spinal fixation surgery. This type of surgery, usually done manually, could cause many injuries due to human error at the moment of inserting the screws into the patient’s vertebrae. Computed tomography can be used to avoid such errors, but the results are much better if a robot assists and indicates the surgeon the path for the insertion of the screw, according to the image scanner. This article shows how using a commercial low-cost robot can be implemented in a system that provides a practical solution to this problem. A software that allows you to define the start and the end positions of the screw to be introduced on the Dicom image of the patient, was implemented. With this information the system moves the robot which has a ring that will guide the surgeon in the final insertion. The results show a fairly accurate system, giving the surgeon a safe path of insertion.
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This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS), trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs) were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.
Este artículo discute los desafíos e innovaciones relacionadas al uso de sistemas de tutoría en telecirugía (telementoring). La mayoría de los sistemas presentados se basan en tres tipos de canales de interacción: auditivo, visual y físico. El canal auditivo permite al instructor instruir verbalmente al alumno, y a este último hacer preguntas. El canal visual es usado para transmitir al alumno anotaciones, alertas y otro tipo de mensajes gráficos durante la cirugía. Estas representaciones visuales aparecen en un marcador de vídeo (telestrator). El canal físico ha sido usado en cirugías laparoscópicas por medio de retroalimentador de fuerza (forcefeedback). Mientras que en la instrucción cara a cara, el instructor hace gestos para transmitir ciertos aspectos de la instrucción quirúrgica, esta forma de interacción no tiene un equivalente en la interacción entre instructor y alumno en sistemas de telementoring. Si bien la tendencia es conducir procedimientos mínimamente invasivos (MIS) con estos sistemas, se deben tener en cuenta cirugías de trauma, todavía necesarias, especialmente donde la resucitación inicial y estabilización del paciente es un tema crítico y urgente. Este artículo presenta un estudio preliminar conducido en la Escuela de Medicina de Indiana (EE.UU.) y en la Universidad Purdue, donde el vocabulario de gestos (lexicons) usados en instrucción quirúrgica (SIGs) se determinaron por medio de observaciones sistemáticas mientras el instructor y el alumno operaban juntos. Se concluye discutiendo maneras alternativas de presentar esta información de gestos por medio de robots quirúrgicos.
Subject(s)
Humans , Education, Distance/methods , Education, Medical, Continuing/methods , Operating Rooms , Robotics/methods , Surgery, Computer-Assisted/education , Telemedicine/methods , Audiovisual Aids , Gestures , Inventions , Man-Machine Systems , Mentors , Robotics/education , Teaching Materials , Telemedicine/instrumentationABSTRACT
Este artículo presenta el diseño de un nuevo robot para cirugía endoscópica transluminal. Este tipo de cirugía, evolución tecnológica de la cirugía laparoscópica, pretende ingresar al abdomen del paciente por los orificios naturales (boca, uretra, ano o vagina), y desde allí acceder al sitio donde se hace necesaria la intervención, procedimiento que conlleva muchas más ventajas respecto a la cirugía laparoscópica. El robot diseñado consta de diecinueve grados de libertad y es movido por un joystick utilizando un controlador por par calculado. La simulación muestra bajos errores cartesianos y movimientos muy precisos del órgano terminal.
This article presents the design of a new robot for translumenal endoscopic surgery. This type of surgery, evolved from laparoscopic surgery, allows the access into the abdominal cavity of the patient through natural orifices such as the mouth, urethra, anus or vagina, and from there reaches the area of the surgical intervention. This procedure has many advantages over laparoscopic surgery. The designed robot has nineteen degrees of freedom and is moved with a joystick device and controlled by a computer torque control. Simulation shows low cartesian errors as well as accurate movements at the end effector.