Beyond safety drivers: Applying air traffic control principles to support the deployment of driverless vehicles.

By adopting and extending lessons from the air traffic control system, we argue that a nationwide remote monitoring system for driverless vehicles could increase safety dramatically, speed these vehicles' deployment, and provide employment. It is becoming clear that fully driverless vehicles will not be able to handle "edge" cases in the near future, suggesting that new methods are needed to monitor remotely driverless vehicles' safe deployment. While the remote operations concept is not new, a super-human driver is needed to handle sudden, critical events. We envision that the remote operators do not directly drive the vehicles, but provide input on high level tasks such as path-planning, object detection and classification. This can be achieved via input from multiple individuals, coordinated around a task at a moment's notice. Assuming a 10% penetration rate of driverless vehicles, we show that one remote driver can replace 14,840 human drivers. A comprehensive nationwide interoperability standard and procedure should be established for the remote monitoring and operation of driverless vehicles. The resulting system has potential to be an order of magnitude safer than today's ground transportation system. We articulate a research and policy roadmap to launch this nationwide system. Additionally, this hybrid human-AI system introduces a new job category, likely a source of employment nationwide.

Of robots and humans: Creating user representations in practice.

In this study, we explore the constitution of user representations of robots in design practice. Using the results of ethnographic research in two robot laboratories, we show how user representations emerge in and are entangled with design activities. Our study speaks to the growing popularity of and investment in robotics, robots and other forms of artificial intelligence. Scholars in Science and Technology Studies (STS) have shown that it is often difficult for designers and engineers to develop accurate ideas about potential users of such technologies. However, the social context of robots and design settings themselves have received significantly less attention. Based on our laboratory ethnographies, we argue that the practices in which engineers are engaged are important as they can shape the kind of user images designers create. To capture these dynamics, we propose two new concepts: 'image-evoking activities' as well as 'user image landscape'. Our findings provide pertinent input for researchers, designers and policy-makers, as they raise questions with regards to contemporary fears of robots replacing humans, for the effectiveness of user involvement and participatory design, and for user studies in STS. If design activities co-constitute the user images that engineers develop, a greater awareness is needed specifically of the locales in which the design of robots and other types of technologies takes place.

The effectiveness of various robotic technologies in assisting older adults.

There is concern about the expanding size of the ageing population and burgeoning care costs for older adults. Robotic technology could assist older adults. In this study, the effectiveness of the robotic technologies is evaluated. A systematic literature review was undertaken of peer-reviewed literature. An initial set of 8533 studies was evaluated for relevance; these were reduced to a final subset of 58 studies finally subjected to analysis. This study categorised the problems encountered by older adults, identified robot types deployed to overcome them and derived a subjective effectiveness score. The most used and most effective robots were companion robots followed by telepresence robots. The findings imply positive effects of robotic technologies in helping elderly people's problems. Although robotic technologies could bring some innovation into aged care, more research is needed to design and develop robots to be of assistance and support elderly in having an independent lifestyle.

Improving efficiency in robotic theatres in the Royal Wolverhampton NHS Trust: a gynaecology theatres perspective.

Improving efficiency within the operating theatre is always a key concern when running a successful operating list. However, with robotic surgery, this can become paramount. Robotic procedures require a more technical set up, additional planning, and good solid communication within the multidisciplinary team. Efficiency needs to be at the forefront of everyone's mind. Forward planning requires knowledge of the procedures being carried out and adequate training with the robot. Trouble shooting will also improve efficiency in robotic surgery, as being able to expect the unexpected can be a major advantage. This article looks at the hurdles encountered by the theatre team at Royal Wolverhampton Trust at the implementation of the robotic programme, and how the theatre team made adjustments to working practice in order to minimise disruption and maximise efficiency.

Implementation of a multidisciplinary robotic centre in a high-volume university hospital.

INTRODUCTION: We describe the initiation of a multidisciplinary centre for robotic surgery including the implementation of robotic-assisted procedures as standard procedure for the majority of cancer operations in urology, gynaecology and gastrointestinal surgery. METHODS: All robotic procedures performed from 2008 to 2013 were included. The information gathered included body mass index, the American Society of Anesthesiologists' physical status classification value (ASA), age, sex, time and type of surgery, duration of procedure, conversion to open surgery, length and type of anaesthesia, re-operations, length of hospital stay and 30-day mortality. RESULTS: The implementation strategy was to start with one specialty at a time, passing on experience from one specialty to the next. The surgical strategy was to begin with standard procedures for which international experience was available and subsequently perform more complex procedures, ending up with robotic-assisted procedures as the standard for most cancer surgery procedures. A total of 2,473 procedures were performed. The operative time was reduced over the period for the main procedures of all three specialties. For prostatectomies, hysterectomies and colectomies, conversion to open surgery occurred in 1.2, 3.8 and 7.7%; the risk of re-operation was 0.2, 2.3 and 7.3%; and, finally, the 30-day mortality was 0.1, 0 and 1%, respectively. CONCLUSION: The implementation was possible as a stepwise introduction across three specialties with low conversion and re-operation rates and a low mortality. A high-volume centre for robotic surgery was developed and patients with malignant diagnoses were offered robotic-assisted surgery within the framework of multidisciplinary cooperation. FUNDING: not relevant. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency R. No.: 2007-58-0015.

Stages and levels of automation in support of space teleoperations.

OBJECTIVE: This study examined the impact of stage of automation on the performance and perceived workload during simulated robotic arm control tasks in routine and off-nominal scenarios. BACKGROUND: Automation varies with respect to the stage of information processing it supports and its assigned level of automation. Making appropriate choices in terms of stages and levels of automation is critical to ensure robust joint system performance. To date, this issue has been empirically studied in domains such as aviation and medicine but not extensively in the context of space operations. METHOD: A total of 36 participants played the role of a payload specialist and controlled a simulated robotic arm. Participants performed fly-to tasks with two types of automation (camera recommendation and trajectory control automation) of varying stage. Tasks were performed during routine scenarios and in scenarios in which either the trajectory control automation or a hazard avoidance automation failed. RESULTS: Increasing the stage of automation progressively improved performance and lowered workload when the automation was reliable, but incurred severe performance costs when the system failed. CONCLUSION: The results from this study support concerns about automation-induced complacency and automation bias when later stages of automation are introduced. The benefits of such automation are offset by the risk of catastrophic outcomes when system failures go unnoticed or become difficult to recover from. APPLICATION: A medium stage of automation seems preferable as it provides sufficient support during routine operations and helps avoid potentially catastrophic outcomes in circumstances when the automation fails.

Robotic total hip arthroplasty.

Modern total hip replacement is typically effective and durable, but early failures do occur. Component position influences functional outcome, durability, and risk of complications. Surgical robotics provides the detail-oriented surgeon with a robust tool to optimize the accuracy and precision of total hip arthroplasty, with the potential to minimize risk of mechanical failure. This article describes efficient workflows for using surgical robotics to optimize surgical precision without increasing surgical complexity.

Systematic review and meta-analysis of transaxillary robotic thyroidectomy versus open thyroidectomy.

PURPOSE: It remains controversial whether the transaxillary robotic thyroidectomy (RT) is a feasible or better alternative to open thyroidectomy (OT) in thyroid surgery. We aimed to evaluate the efficacy of RT by pooling comparative studies of RT and OT in a systematic review and meta-analysis. MATERIALS AND METHODS: Original articles comparing transaxillary RT and conventional OT for thyroid diseases, published in the English language from1990 until February 3, 2013 were systematically searched in PubMed, Embase, Medline, and the Cochrane Library. The outcomes analyzed were postoperative complications, number of retrieved lymph nodes, operative time, postoperative hospital stay, and cosmetic satisfaction. RESULTS: Nine studies that fulfilled the eligibility criteria were included in the meta-analysis, of a total of 1615 patients (510 RT and 1105 OT). Compared with OT, RT showed a similar incidence of complications, number of retrieved lymph nodes, and length of postoperative hospital stay. The cosmetic effect of RT was superior to OT. But the operative time of RT was significantly longer than OT. CONCLUSIONS: The available data suggest that the efficacy of RT is similar to OT in the treatment of thyroid diseases on the whole. RT has a better cosmetic effect than OT. But longer operative time is needed by RT.

Terapia robótica para la rehabilitación del miembro superior en patología neurológica / Upper limb robotic devices in rehabilitation for neurological disease

Objetivo. El objetivo del presente trabajo fue revisar la información publicada sobre los distintos dispositivos robóticos de miembro superior, con el fin de clasificarlos y llevar a cabo una descripción de las principales características de los mismos. Estrategia de búsqueda. Se revisan las diferentes posibilidades terapéuticas que los distintos robots de miembro superior ofrecen, valorando las articulaciones implicadas, características técnicas, sus aplicaciones en el tratamiento rehabilitador y sus fundamentos. Selección de los estudios. Se lleva a cabo una clasificación en 3 niveles, en función de si se trata de prototipos o robots con aplicabilidad clínica, según fueran exoesqueletos o de tipo efector final, o atendiendo a si abordaban la región proximal o distal del miembro. Síntesis de resultados. Existe una amplia variedad de dispositivos orientados a la rehabilitación funcional del miembro superior. En este sentido, los sistemas robóticos han demostrado ser igual de efectivos que la terapia convencional bajo los mismos parámetros de intensidad y tiempo de tratamiento. Conclusiones. La terapia robótica presenta estudios poco concluyentes en cuanto a la recuperación de la funcionalidad del miembro superior, así como en lo referente a la región distal del miembro, siendo necesarios mayores estudios con buena calidad metodológica (AU)

Objective. The aim of this study was to review the published information on the various upper limb robotic devices, in order to classify them and describe their main features. Search strategy. We reviewed the various therapeutic possibilities offered by the different robots and evaluated the joints involved, the technical characteristics, their applications in rehabilitation therapy, and the basic principles underpinning these devices. Study selection. Selected studies were classified in 3 levels, depending on whether the robots were prototypes or had clinical applicability, whether the robots were exoskeletons or end effectors, and whether they involved the proximal or distal limb. Synthesis of the results. There is a wide variety of devices aimed at functional rehabilitation of the upper limb. Robotic systems have proven to be as effective as conventional therapy under the same parameters of treatment intensity and length. Conclusions. Studies on robotic therapy have provided inconclusive results on functional recovery of the upper limb and on the distal limb. There is a need for larger studies with high-quality methodology (AU)

Development of a transoral robotic surgery program in Canada.

Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program.

A remote-controlled adaptive medchem lab: an innovative approach to enable drug discovery in the 21st Century.

This article describes our experiences in creating a fully integrated, globally accessible, automated chemical synthesis laboratory. The goal of the project was to establish a fully integrated automated synthesis solution that was initially focused on minimizing the burden of repetitive, routine, rules-based operations that characterize more established chemistry workflows. The architecture was crafted to allow for the expansion of synthetic capabilities while also providing for a flexible interface that permits the synthesis objective to be introduced and manipulated as needed under the judicious direction of a remote user in real-time. This innovative central synthesis suite is herein described along with some case studies to illustrate the impact such a system is having in expanding drug discovery capabilities.

Tratamiento del carcinoma de cuerpo uterino mediante laparoscopia asistida por robot: nuestros primeros resultados / Treatment of corpus uteri carcinoma through robot-assisted laparoscopy: Our preliminary results

Objetivo. Presentación de nuestra experiencia desde octubre del 2009 hasta diciembre del 2011 y comparación de los resultados y las complicaciones con el amplio estudio publicado en el American Journal of Obstetrics and Gynecology (AJOG) en 2011. Material y métodos. Estudio prospectivo de nuestros primeros 55 carcinomas de cuerpo uterino: 50 adenocarcinomas endometrioides, 2 adenocarcinomas seroso-papilares de endometrio y 3 tumores müllerianos mixtos (TMM), tratados mediante laparoscopia asistida por robot (da Vinci) en el Hospital Universitario de Basurto desde octubre del 2009 hasta diciembre del 2011. Las variables analizadas han sido: edad, índice de masa corporal (IMC), tipos histológicos, estadios, tipos de tratamientos, medias del tiempo quirúrgico, media del número de ganglios obtenidos y número y porcentaje de ganglios invadidos, sangrado operatorio y conversiones a laparotomía. Así mismo, se han analizado el número y el porcentaje de las complicaciones intraoperatorias, postoperatorias y totales. Resultados. Media de ganglios pélvicos: 14,44 vs. 13,16. Tiempo operatorio: 181,1/286,5 min vs. 196,33 min. Conversión a laparotomía: 5,45% vs. 2,9%. Complicaciones totales: 16,36% vs. 6,4%. Conclusiones. 1) El número de ganglios pélvicos obtenidos y el tiempo operatorio son similares a los publicados en el estudio del AJOG; 2) la conversión a laparotomía y el porcentaje de complicaciones totales son superiores a los referidos en el estudio del AJOG, quizás debido al menor número de casos y a la menor experiencia (curva de aprendizaje); 3) la laparoscopia asistida por robot es una vía adecuada y con gran futuro en el tratamiento y la estadificación de los carcinomas de cuerpo uterino(AU)

Objective. To present our experience from October 2009 though December 2011 and to compare outcomes and complications with a large study published in the American Journal of Obstetrics and Gynecology (AJOG) in 2011. Material and methods. We performed a prospective study of our first 55 corpus uteri carcinomas: 50 endometrioid adenocarcinomas, two papillary serous carcinomas and three Müllerian adenosarcomas, treated with robot-assisted laparoscopy (da Vinci) in the Basurto University Hospital from October 2009 through December 2011. The variables analyzed were age, body mass index, histologic type, stages, treatment, mean operating time, mean of number of lymph nodes retrieved, the mean number and percentage of involved lymph nodes, surgical bleeding and conversion to laparotomy. We also analyzed the number and the percentage of operative, post-operative and total complications. Results. The mean number of pelvic nodes was 14.44 vs. 13.16. Operating time was 181.1/286.5minutes vs 196.33minutes. Conversion to laparotomy was 5.45% vs. 2.9%. The percentage of total complications was 16.36% vs. 6.4%. Conclusions. 1) The number of pelvic nodes retrieved and the operating time were similar to those reported by the AJOG study. 2) Conversion to laparotomy and the percentage of total complications were higher than those reported in the AJOG study, possibly due to the smaller number of cases and the lesser experience (learning curve). 3) Robot-assisted laparoscopy is a viable approach with an excellent future in the treatment and staging of corpus uteri carcinomas(AU)

De la nefrectomía parcial abierta a la robótica / From open to robotic partial nephrectomy

En este trabajo no realizaremos un estudio comparativo de las distintas técnicas (abierta, laparoscópica y robótica) sino más bien analizaremos el cómo, el cuándo y el porqué de cada una de ellas desde una perspectiva histórica. Este análisis histórico comenzará desde finales del siglo XIX hasta llegar a nuestros días. En él, relataremos los principios; la incertidumbre de si se puede realizar. Los fracasos; las complicaciones y las dudas del saber si se está haciendo lo correcto. Y los éxitos de un tratamiento quirúrgico que hoy en día está fuera de toda duda. Todo ello resumido, ya que supone más de cien años de historia de la medicina. La historia que han escrito hombres y mujeres inconformistas que cambiaron el rumbo del tratamiento de la patología renal neoplásica(AU)

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease(AU)

De la laparoscopia a la robótica en cáncer renal: ¿Cómo proceder? / Renal cancer from laparoscopic to robotic: how to proceed

Los beneficios de la cirugía laparoscópica están bien establecidos en la literatura. Sin embargo, en nuestro entorno, todavía la mayor parte de los procedimientos reconstructivos/oncológicos se realiza como cirugía abierta. Esto se puede explicar por los múltiples desafíos que esta técnica conlleva, así como una curva de aprendizaje exigente. La tecnología ha proporcionado los medios para mejorar la precisión y utilidad de la laparoscopia, así como para ampliar su uso entre la comunidad médica, acortando su curva de aprendizaje. Los tumores renales han sido manejados por laparoscopia durante los últimos 20 años. En este tiempo, muchos estudios han aparecido en la literatura comparando este procedimiento con la cirugía abierta. En la gran mayoría, la cirugía laparoscópica es superior en lo que respecta a los eventos peri-operatorios. Varias series están disponibles con respecto a la viabilidad de la nefrectomía radical robótica, sin embargo no hay literatura disponible que demuestre un mejor resultado de la nefrectomía radical robótica en comparación con la laparoscopia estándar. La nefrectomía parcial laparoscópica es una técnica difícil, lo que ha impedido su difusión masiva en la comunidad urológica, incluso entre laparoscopistas entrenados. Los reportes actuales comienzan a favorecer a la nefrectomía parcial robótica por sobre la laparoscopia estándar en lo que respecta a los resultados peri-operatorios, con similares resultados oncológicos. Se necesitan más estudios con el fin de identificar la importancia de NOTES/LESS en el tratamiento del cáncer renal localizado, sin embargo el uso del robot disminuirá su curva de aprendizaje y probablemente las hará atractivas en el corto plazo. A pesar de que esta tecnología ha acercado la laparoscopia a un mayor número de cirujanos, los médicos deben estar familiarizados con procedimientos laparoscópicos convencionales, antes de embarcarse en la cirugía robótica(AU)

The benefits laparoscopic surgery brings to the table are well established in the literature. In our environment however, still most of the reconstructive/oncologic procedures are performed as open surgery. This can be explained by the multiple challenges this technique involves, as well as a demanding learning curve. Technology has provided means to improve precision and usefulness of laparoscopy, as well as broaden its use amongst the medical community by shortening its learning curve. Renal tumors have been managed by laparoscopic approach for the past 20 years. During this time, many studies appeared in the literature comparing this procedure with open surgery. In the vast majority, laparoscopic surgery has the upper hand in regards of perioperative events. A number of series are available regarding the feasibility of robotic radical nephrectomy, however there is no literature available that demonstrates better outcome of robotic radical nephrectomy compared to standard laparoscopy. Laparoscopic partial nephrectomy is technically difficult, which has prevented its massive spread through the urologist community, even amongst trained laparoscopists. Current reports are starting to favor robotic partial nephrectomy over standard laparoscopy regarding perioperative outcomes, with similar oncologic results. More studies have to be performed in order to elucidate the importance of NOTES and LESS in the treatment on localized renal cancer, but the use of the robot will lower their learning curve and probably make them attractive in the short term. Even though this technology has brought laparoscopy closer to a greater number of surgeons, physicians should become familiar and proficient in conventional laparoscopic procedures before embarking into robotics(AU)

How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures.

BACKGROUND: Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit. METHODS: We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department's internal organization, the organization within the hospital complex, and cost were evaluated. RESULTS: A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7-18 years) and average weight of 26 kg (range, 6-77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70-550 min), and average hospital stay was 6.4 days (range, 2-24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5-43 months). Robotic surgical procedure had an extra cost of 1934 compared to conventional open surgery. CONCLUSIONS: Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.

Point-of-Care Programming for Neuromodulation: A Feasibility Study Using Remote Presence.

BACKGROUND: The expansion of neuromodulation and its indications has resulted in hundreds of thousands of patients with implanted devices worldwide. Because all patients require programming, this growth has created a heavy burden on neuromodulation centers and patients. Remote point-of-care programming may provide patients with real-time access to neuromodulation expertise in their communities. OBJECTIVE: To test the feasibility of remotely programming a neuromodulation device using a remote-presence robot and to determine the ability of an expert programmer to telementor a nonexpert in programming the device. METHODS: A remote-presence robot (RP-7) was used for remote programming. Twenty patients were randomly assigned to either conventional programming or a robotic session. The expert remotely mentored 10 nurses with no previous experience to program the devices of patients assigned to the remote-presence sessions. Accuracy of programming, adverse events, and satisfaction scores for all participants were assessed. RESULTS: There was no difference in the accuracy or clinical outcomes of programming between the standard and remote-presence sessions. No adverse events occurred in any session. The patients, nurses, and the expert programmer expressed high satisfaction scores with the remote-presence sessions. CONCLUSION: This study establishes the proof-of-principle that remote programming of neuromodulation devices using telepresence and expert telementoring of an individual with no previous experience to accurately program a device is feasible. We envision a time in the future when patients with implanted devices will have real-time access to neuromodulation expertise from the comfort of their own home.