Surgical Care for Women with Endometrial Cancer in Florida.

Objective: The goal of this research was to analyze if disparities in route of hysterectomy for endometrial cancer exist in Florida. Materials and Methods: In this retrospective cohort study, Florida inpatient and ambulatory surgery databases (2014-2016) were examined to find cases of patients with endometrial cancer who underwent hysterectomy in the state. Logistic regression models were used to compare patient- and hospital-level factors associated with having minimally invasive surgery (MIS) versus open surgery, and complications in patients having open hysterectomy versus MIS. Results: Overall, 6513 patients met the inclusion criteria. MIS was performed in 81.4% of cases. The odds of using a minimally invasive approach to hysterectomy (vaginal, robotic, or laparoscopic) were significantly lower for black women (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.50) as well as for other non-white patients (OR: 0.64; 95% CI: 0.49-0.84). Patients with Medicaid (OR: 0.42; 95% CI: 0.30-0.59) or Medicare managed care (OR: 0.73; 95% CI: 0.59-0.91), or who received care at a teaching hospital (OR: 0.82; 95% CI: 0.68-0.98) or government hospital (OR: 0.50; 95% CI: 0.38-0.65) were also less likely to receive MIS. Patients receiving care at a high-volume (OR: 1.69; 95% CI: 1.30-2.20) or medium-volume (OR: 3.11; 95% CI: 2.37-4.08) hospital, or patients who were located in the Central (OR: 1.71; 95% CI: 1.17-2.48) or Peninsula (OR: 1.73; 95% CI: 1.17-2.56) regions, compared to the Florida Panhandle, had greater odds of receiving MIS. Conclusions: Although Florida has a high adoption of MIS for treating endometrial cancer, disparities persist. Efforts of state-level entities should focus on improving access to minimally invasive hysterectomy for racial minorities with endometrial cancer.

Discharge Readiness after Robotic and Laparoscopic Hysterectomy.

STUDY OBJECTIVE: To evaluate which factors may be predictive of patient readiness of discharge after robotic and laparoscopic hysterectomy. DESIGN: A prospective cohort study (Canadian Task Force classification II-2). SETTING: A single tertiary care center in the United States. PATIENTS: All 230 patients undergoing robotic and laparoscopic hysterectomy between November 2015 and April 2017. INTERVENTIONS: The primary outcome measure was whether or not the patient felt ready for discharge when she was sent home, and this was assessed using a survey 4 to 6 weeks after surgery. Secondary outcomes included the number of postoperative phone calls, 30-day readmission, and also whether the patient felt knowledgeable about postoperative symptoms and restrictions (both assessed via a 4- to 6-week survey). Associations of baseline, operative, and postoperative characteristics with outcomes were evaluated using regression models appropriate for the nature of the given outcome measure. MEASUREMENTS AND MAIN RESULTS: Of the 230 patients, 207 (90%) reported they felt ready for discharge on the postoperative survey. The majority of patients strongly agreed that they felt knowledgeable about what symptoms to expect postoperatively (60%) and about postoperative restrictions (71%). The median number of postoperative phone calls was 1 (range, 0-11), with 104 patients (45%) having more than 1 postoperative call. The only factor that was significantly associated with a lack of readiness for discharge was a longer total operating room time (p = .011). Factors associated with more postoperative phone calls were a urogynecologic indication (p = .005), a cancer indication (p = .024), a longer total operative room time (p = .014), a postoperative complication (p <.001), and not seeing a patient education video (p = .018). Knowledge of postoperative restrictions was significantly worse for older patients (p = .004) and varied significantly according to surgeon (p = .038). No significant predictors of knowledge of postoperative symptoms were identified. CONCLUSIONS: Discharge readiness and knowledge of postoperative restrictions and symptoms were high in patients who underwent laparoscopic and robotic hysterectomies. The risk factors for outcomes that were identified highlight groups of patients who can be targeted for preemptive interventions both preoperatively and postoperatively.

Author Correction: Design and Computational Modeling of a Modular, Compliant Robotic Assembly for Human Lumbar Unit and Spinal Cord Assistance.

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Design and Computational Modeling of a Modular, Compliant Robotic Assembly for Human Lumbar Unit and Spinal Cord Assistance.

Wearable soft robotic systems are enabling safer human-robot interaction and are proving to be instrumental for biomedical rehabilitation. In this manuscript, we propose a novel, modular, wearable robotic device for human (lumbar) spine assistance that is developed using vacuum driven, soft pneumatic actuators (V-SPA). The actuators can handle large, repetitive loads efficiently under compression. Computational models to capture the complex non-linear mechanical behavior of individual actuator modules and the integrated assistive device are developed using the finite element method (FEM). The models presented can predict system behavior at large values of mechanical deformations and allow for rapid design iterations. It is shown that a single actuator module can be used to obtain a variety of different motion and force profiles and yield multiple degrees of freedom (DOF) depending on the module loading conditions, resulting in high system versatility and adaptability, and efficient replication of the targeted motion range for the human spinal cord. The efficacy of the finite element model is first validated for a single module using experimental results that include free displacement and blocked-forces. These results are then extended to encompass an extensive investigation of bio-mechanical performance requirements from the module assembly for the human spine-assistive device proposed.

Soft Pneumatic Actuator Fascicles for High Force and Reliability.

Soft pneumatic actuators (SPAs) are found in mobile robots, assistive wearable devices, and rehabilitative technologies. While soft actuators have been one of the most crucial elements of technology leading the development of the soft robotics field, they fall short of force output and bandwidth requirements for many tasks. In addition, other general problems remain open, including robustness, controllability, and repeatability. The SPA-pack architecture presented here aims to satisfy these standards of reliability crucial to the field of soft robotics, while also improving the basic performance capabilities of SPAs by borrowing advantages leveraged ubiquitously in biology; namely, the structured parallel arrangement of lower power actuators to form the basis of a larger and more powerful actuator module. An SPA-pack module consisting of a number of smaller SPAs will be studied using an analytical model and physical prototype. Experimental measurements show an SPA pack to generate over 112 N linear force, while the model indicates the benefit of parallel actuator grouping over a geometrically equivalent single SPA scale as an increasing function of the number of individual actuators in the group. For a module of four actuators, a 23% increase in force production over a volumetrically equivalent single SPA is predicted and validated, while further gains appear possible up to 50%. These findings affirm the advantage of utilizing a fascicle structure for high-performance soft robotic applications over existing monolithic SPA designs. An example of high-performance soft robotic platform will be presented to demonstrate the capability of SPA-pack modules in a complete and functional system.

New soft robots really suck: Vacuum-powered systems empower diverse capabilities.

We introduce a vacuum-powered soft pneumatic actuator (V-SPA) that leverages a single, shared vacuum power supply and enables complex soft robotic systems with multiple degrees of freedom (DoFs) and diverse functions. In addition to actuation, other utilities enabled by vacuum pressure include gripping and stiffening through granular media jamming, as well as direct suction adhesion to smooth surfaces, for manipulation or vertical fixation. We investigate the performance of the new actuator through direct characterization of a 3-DoF, plug-and-play V-SPA Module built from multiple V-SPAs and demonstrate the integration of different vacuum-enabled capabilities with a continuum-style robot platform outfitted with modular peripheral mechanisms. We show that these different vacuum-powered modules can be combined to achieve a variety of tasks-including multimodal locomotion, object manipulation, and stiffness tuning-to illustrate the utility and viability of vacuum as a singular alternative power source for soft pneumatic robots and not just a peripheral feature in itself. Our results highlight the effectiveness of V-SPAs in providing core soft robot capabilities and facilitating the consolidation of previously disparate subsystems for actuation and various specialized tasks, conducive to improving the compact design efficiency of larger, more complex multifunctional soft robotic systems.