Dissecting in silico: towards a taxonomy for medical simulators.

In this paper, we investigated several approaches in literature that classify different aspects of medical simulators. We have merged these definitions to form a structured taxonomy. This new taxonomy should facilitate the design of new medical simulators and allow to analyze and classify existing simulators, algorithms, toolkits and hardware.

Automation in surgery: a systematic approach.

This chapter proposes a classification of surgical assistance systems with respect to their type and level of automation. This classification is based on previous work in the field of human factors and takes two aspects into consideration, the type of information-processing function of the surgeon that is supported by the system, as well as the type of function allocation between surgeon and systems. With respect to the former, three basic functions are distinguished, referred to as information acquisition and analysis, decision making and planning, and execution of surgical action. With respect to the type of function allocation, the status of being either "passive" or "active" comes into consideration for both objects of reference (i.e. the surgeon and the machine), depending on whether a given function is mainly performed by the surgeon, by the system, or collaboratively by both. Hence, a classification results for intraoperative assistance systems in six categories, each of these representing a different degree of automation. The classification scheme is explained and illustrated on the basis of examples of surgical assistance systems from various fields.

Robotic technology in surgery: past, present, and future.

It has been nearly 20 years since the first appearance of robotics in the operating room. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation, as evidenced by the many thousands of successful robot-assisted cases. However, to build on past success and to fully leverage the potential of surgical robotics in the future, it is essential to maximize a shared understanding and communication among surgeons, engineers, entrepreneurs, and healthcare administrators. This article provides an introduction to medical robotic technologies, develops a possible taxonomy, reviews the evolution of a surgical robot, and discusses future prospects for innovation. Robotic surgery has demonstrated some clear benefits. It remains to be seen where these benefits will outweigh the associated costs over the long term. In the future, surgical robots should be smaller, less expensive, easier to operate, and should seamlessly integrate emerging technologies from a number of different fields. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care.

A prospective analysis of 211 robotic-assisted surgical procedures.

BACKGROUND: The Academic Robotics Group prospectively studied 211 robotically assisted operations to assess the safety and utility of robotically assisted surgery. METHODS: All operations took place at one of four member institutions between June 2000 and June 2001 using the recently FDA-approved daVinci robotic system. A variety of procedures were undertaken, including antireflux surgery (69), cholecystectomy (36), Heller myotomy (26), bowel resection (17), donor nephrectomy (15), left internal mammery artery mobilization (14), gastric bypass (seven), splenectomy (seven), adrenalectomy (six), exploratory laparoscopy (three), pyloroplasty (four), gastrojejunostomy (two), distal pancreatectomy (one), duodenal polypectomy (one), esophagectomy (one), gastric mass resection (one), and lysis of adhesions (one). RESULTS: Average operating room time was 188 min (range 45 to 387, SD = 83), surgical time 143 min (range 35 to 462, SD = 63), and robot time 90 min (range 12 to 235, SD = 47). Median length of stay was 1 day (range 0 to 37). There were 8 (4%) technical complications during procedures, five minor (four hook cautery dislodgement, one slipped robotic trocar) and three major (system malfunctions, two of which required conversion to standard laparoscopy). In all cases, technical problems caused only delay, without apparent altered outcome. There were medical/surgical complications in nine patients (4%). Six (3%) were considered major, including one death unrelated to the robotic procedure. CONCLUSIONS: The results of robotic-assisted surgery compare favorably with those of conventional laparoscopy with respect to mortality, complications, and length of stay. Robotic-assisted surgery is safe and effective and is a new reality for American surgery. The role of these devices in surgery will expand as the technology evolves.

[Computer-assisted surgery. The proposal of a surgical classification]. / Cirugía asistida por computadora. Propuesta de una clasificación quirúrgica.

I present a proposal for a surgical classification in computer assisted surgery (CAS), with a surgical point of view to facilitate understanding and physicians, scientists, for and engineer to be able to communicate. I considered the system's participation into the CAS definition. In this classification, I find: simulated surgery, guided surgery, assisted surgery telepresence surgery, and semi-automated surgery. I describe the systems for each.