Overview of the Development of Spatial Positioning Accuracy Testing Technology for Surgical Robots / 中国医疗器械杂志

Characteristics of two major categories of RA equipment which defined in the standard are interpreted firstly. Few representative RA equipment in current market and their key product features are introduced. Then, classifications of different indexes of spatial positioning accuracy are declared, the difficulties of performing testing process on each indexes are further explained. Meanwhile, different kinds of three dimensional coordinate measuring equipment that are cutting edge at present stage are introduced with their main methods of use explained. According to characteristics of three dimensional coordinate measuring equipment on the market, proper measuring equipment for testing certain index of spatial positioning accuracy and corresponding experiment method are introduced.

Robotic endoscopy. A review of the literature

Abstract Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.

Cirugía robótica en artroplastia de rodilla / Robotic surgery in knee arthroplasty

La cirugía protésica de rodilla es un procedimiento ampliamente aceptado como etapa final del tratamiento de la artrosis de rodilla, con sobrevida que supera el 90% a 10­15 años. Dentro de las principales causas de fallo, se encuentran la infección (20,4%) y el aflojamiento mecánico (20,3%). El uso de ayudas tecnológicas en cirugía está en constante desarrollo, con el objetivo de mejorar la precisión del acto quirúrgico. En ese escenario, la Cirugía Asistida por Computador (CAS) en artroplastia de rodilla, crece de forma exponencial, y apunta a mejorar el posicionamiento y selección del tamaño de los componentes protésicos, aumentar la precisión de las resecciones óseas y mejorar el balance de los tejidos blandos, logrando así una mayor sobrevida del implante. En comparación a las técnicas convencionales, la cirugía robótica ha mostrado mejores resultados funcionales, al primer año de seguimiento, en términos de rango articular, menor dolor post-operatorio y menor tiempo de estadía hospitalaria. Pero todavía es necesario establecer si, a largo plazo, esas diferencias funcionales se traducirán en mejores resultados clínicos que permitan, de forma consistente, inclinar la balanza en favor de la técnica asistida por robot por sobre las técnicas tradicionales.

Prosthetic knee surgery is a widely accepted procedure as the final stage in the treatment of knee osteoarthritis, with survival rate over 90% at 10 - 15 years. Among the main causes of failure are infection (20.4%) and mechanical loosening (20.3%). The use of technological aids in surgery is in constant development, with the aim of improving the accuracy of the surgical act. In this scenario, Computer-Aided Surgery (CAS) in knee arthroplasty grows exponentially, and aims to improve the positioning and selection of the size of the prosthetic components, increase the accuracy of bone resections and improve the balance of soft tissues, thus achieving a greater survival of the implant. Compared to conventional techniques, robotic surgery has shown better functional results at the first year of follow-up, in terms of joint range, less post-operative pain and shorter hospital stay. It is still necessary to establish whether, in the long term, these functional differences will result in better clinical results that will allow - in a consistent manner - to tip the balance in favor of robot-assisted technique over traditional techniques.

Contemporary Series of Robotic-Assisted Distal Ureteral Reconstruction Utilizing Side Docking Position

Purpose: The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction. Materials and Methods: A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking. Results: A total of 14 cases were identified from 2011–2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189–364), mean estimated blood loss was 40cc (10–200), and mean length of stay was 2.3 days (1–4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1–59.3). Conclusion: Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair.

Single-port robotic cholecystectomy. Initial and pioneer experience in Brazil / Colecistectomia robótica por portal único. Experiência inicial e pioneira no Brasil

The technique of a single-port laparoscopy was developed over the last years as an attempt to lower surgical aggression and improve the aesthetic results of the minimally invasive surgery. A new robotic platform used with the da Vinci® Robotic System Single-Site System® (Intuitive Surgical, Sunnyvale, California, United States) was recently launched on the global market and is still not documented in Brazil. The authors report on the first four robotic single-port cholecystectomies performed with this da Vinci® Robotic System in Brazil.

A técnica de um único portal laparoscópico foi desenvolvida ao longo dos últimos anos, numa tentativa de diminuir a agressão cirúrgica e melhorar ainda mais os resultados estéticos da cirurgia minimamente invasiva. Uma nova plataforma robótica, usada com o Sistema Robótico da Vinci®Single-Site System® (Intuitive Surgical, Sunnyvale, Califórnia, Estados Unidos), foi recentemente lançada no mercado mundial e é ainda inédita no Brasil. Os autores relatam as primeiras quatro colecistectomias robóticas com portal único realizadas com este Sistema Robótico da Vinci® no Brasil.

Anesthetic issues for robotic cardiac surgery.

As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one‑lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.

Robotic high para-aortic lymph node dissection with high port placement using same port for pelvic surgery in gynecologic cancer patients / 부인종양

OBJECTIVE: This study reports our initial experience of robotic high para-aortic lymph node dissection (PALND) with high port placement using same port for pelvic surgery in cervical and endometrial cancer patients. METHODS: Between July 2013 and January 2014, we performed robotic high PALND up to the left renal vein during staging surgeries. With high port placement and same port usage for pelvic surgery, high PALND was successfully performed without repositioning the robotic column. All data were registered consecutively and analyzed retrospectively. RESULTS: All patients successfully underwent robotic high PALND, followed by hysterectomy and pelvic lymph node dissection. Median age was 45 years (range, 39 to 51 years) and median body mass index was 22 kg/m2 (range, 19.3 to 23.1 kg/m2). Median operative time for right PALND and left PALND was 37 minutes (range, 22 to 65 minutes) and 44 minutes (range, 36 to 50 minutes), respectively. Median number of right and left para-aortic lymph node by pathologic report was 12 (range, 8 to 15) and 13 (range, 5 to 26). CONCLUSION: With high port placement and one assistant port, robotic high PALND with the same port used in pelvic surgery is feasible to non-obese patients.

Emprego de sistemas robóticos na cirurgia cardiovascular / Robotic systems in cardiovascular surgery

O desenvolvimento de sistemas robóticos para cirurgia teve início na década de 80, por solicitação do exército norte-americano, que antevia a possibilidade de realizar operações em teatros de guerra, distantes do local onde estava o cirurgião. Entretanto, o primeiro uso em humanos só ocorreu anos mais tarde, numa ressecção transuretral de hiperplasia benigna de próstata. Cirurgiões cardíacos foram logo atraídos pela técnica robótica devido a possível aplicação com reduzido caráter invasivo; esperava-se menor trauma cirúrgico e redução da dor, morbidade, tempo de internação e custo do procedimento. Atualmente, de forma restrita e em casos selecionados, robôs são usados para revascularização do miocárdio e implante de marcapasso em cirurgias cardíacas totalmente endoscópicas; podendo também constituir apoio visual na retirada de artéria torácica interna, reconstrução valvar mitral e correção de defeitos congênitos. Utilizando o robô auxiliar AESOP® para controle do videotoracoscópio, com controle vocal por meio do sistema HERMES®, temos realizado dissecção da artéria torácica interna, implante de eletrodo ventricular esquerdo e abordagem de defeitos congênitos na cirurgia de correção. Apesar do entusiasmo científico inicial com a cirurgia robótica, ainda não existe evidência clara de superioridade desta técnica em relação à operação convencional, em termos de resultado. Isto se aplica também ao custo, pois o investimento inicial na aquisição de sistema cirúrgico completo (console, controle de vídeo, instrumental) provavelmente é compensado após muitos procedimentos e longo intervalo. Mas é certo que a cirurgia robótica terá um lugar no futuro, possibilitando aprendizagem, telepresença e realização de procedimentos pouco invasivos, embora complexos.