Pub Date : 2020-03-03DOI: 10.5772/intechopen.90642
P. Diana, P. Casale, A. Saita, G. Lughezzani, N. Buffi
The standard treatment of ureteropelvic junction obstruction (UPJO) is represented by the Anderson-Hynes dismembered pyeloplasty, even if different approaches, both surgical and endoscopic, have been described. Robot-assisted pyeloplasty (RP) is a feasible and safe approach. The indications for the robotic approach remain the same as those for the laparoscopic or open pyeloplasty. Every patient with symptomatic UPJO, or with decreasing renal function in the presence of UPJO, should undergo RP. The transperitoneal, retroperitoneal, and transmesocolic approaches are described focusing on advantages and disadvan-tages of each approach. Robot-assisted pyeloplasty has excellent success rates for relief of obstruction and very low peri- and post-operative morbidity. The robotic surgical technique maintains the advantages of laparoscopic surgery providing a more precise manipulation and visualization, and a faster learning curve. Comparative studies are reported to confront the different techniques. Secondary minimally invasive pyeloplasty is obviously a more challenging procedure due to the fibrosis and the adhesions formed after the previous surgery. Newer techniques and indications such as the employment of buccal mucosal graft, the single port approach, and indocyanine green injection are described. Tips and tricks to keep in mind during this kind of procedure are listed in order to report our experience in this setting.
{"title":"Ureteropelvic Junction Obstruction: Robot-Assisted Pyeloplasty","authors":"P. Diana, P. Casale, A. Saita, G. Lughezzani, N. Buffi","doi":"10.5772/intechopen.90642","DOIUrl":"https://doi.org/10.5772/intechopen.90642","url":null,"abstract":"The standard treatment of ureteropelvic junction obstruction (UPJO) is represented by the Anderson-Hynes dismembered pyeloplasty, even if different approaches, both surgical and endoscopic, have been described. Robot-assisted pyeloplasty (RP) is a feasible and safe approach. The indications for the robotic approach remain the same as those for the laparoscopic or open pyeloplasty. Every patient with symptomatic UPJO, or with decreasing renal function in the presence of UPJO, should undergo RP. The transperitoneal, retroperitoneal, and transmesocolic approaches are described focusing on advantages and disadvan-tages of each approach. Robot-assisted pyeloplasty has excellent success rates for relief of obstruction and very low peri- and post-operative morbidity. The robotic surgical technique maintains the advantages of laparoscopic surgery providing a more precise manipulation and visualization, and a faster learning curve. Comparative studies are reported to confront the different techniques. Secondary minimally invasive pyeloplasty is obviously a more challenging procedure due to the fibrosis and the adhesions formed after the previous surgery. Newer techniques and indications such as the employment of buccal mucosal graft, the single port approach, and indocyanine green injection are described. Tips and tricks to keep in mind during this kind of procedure are listed in order to report our experience in this setting.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133753524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-06DOI: 10.5772/intechopen.90075
G. Belforte, T. Raparelli, G. Eula, S. Sirolli, S. Appendino, G. Geminiani, E. Geda, M. Zettin, Roberta Virgilio, K. Sacco
The development of innovative robotic devices allows the design of exoskeletons for robotic neurorehabilitation training. This paper presents the active exoskeleton called pneumatic interactive gait rehabilitation orthosis (P.I.G.R.O.), developed by the authors. The main innovative characteristic of this prototype is its design for fully unloaded robotic neurorehabilitation training, specific for brain-injured patients. It has six degrees of freedom (DOF) in the sagittal plane, an active ankle joint (remov-able if it is required); a wide range of anthropometric regulations, both for men and for women; a useful human machine interface (HMI); and an innovative harness system for the patient for the unloaded training. It is realized using light and strong materials, and it is electropneumatically controlled. In particular the authors also studied and defined some innovative input control curves useful for the unloaded training. In this paper, the main characteristics and innovations of P.I.G.R.O. are presented.
{"title":"An Active Exoskeleton Called P.I.G.R.O. Designed for Unloaded Robotic Neurorehabilitation Training","authors":"G. Belforte, T. Raparelli, G. Eula, S. Sirolli, S. Appendino, G. Geminiani, E. Geda, M. Zettin, Roberta Virgilio, K. Sacco","doi":"10.5772/intechopen.90075","DOIUrl":"https://doi.org/10.5772/intechopen.90075","url":null,"abstract":"The development of innovative robotic devices allows the design of exoskeletons for robotic neurorehabilitation training. This paper presents the active exoskeleton called pneumatic interactive gait rehabilitation orthosis (P.I.G.R.O.), developed by the authors. The main innovative characteristic of this prototype is its design for fully unloaded robotic neurorehabilitation training, specific for brain-injured patients. It has six degrees of freedom (DOF) in the sagittal plane, an active ankle joint (remov-able if it is required); a wide range of anthropometric regulations, both for men and for women; a useful human machine interface (HMI); and an innovative harness system for the patient for the unloaded training. It is realized using light and strong materials, and it is electropneumatically controlled. In particular the authors also studied and defined some innovative input control curves useful for the unloaded training. In this paper, the main characteristics and innovations of P.I.G.R.O. are presented.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125212951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-05DOI: 10.5772/INTECHOPEN.89950
L. Aydın, O. Cakir, R. Dilek, Mucahit Ege
3D scanning technologies have promising solutions for medical needs such as anatomical models, biocompatible implants, and orthotic/prosthetic models. Although virtual presurgical planning offers more precise results, it may not be applied in every hospital because of the high costs. The aim of this study is to assess the accuracy of the suggested low-cost and effective surgical planning method by means of additive manufacturing to increase success rate of each surgery. In this study, a full spine model of a scoliosis patient was acquired and reconstructed in MIMICS software using different filters and parameters. Therefore, a comparison in terms of geometrical errors among each model was performed based on a reference model. Subsequently, patient-specific full spine model was manufactured using a three-dimensional printing method (fused deposition modeling) and utilized before the surgery. 3D surgical model reconstruction parameters such as wrap tool, binomial blur, and curvature flow filters produced high geometrical errors, while mean filter produced the lowest geometrical error. Furthermore, similarity results of the curvature flow and discrete Gaussian filters were close to mean filter. Smooth tool and mean filter produced almost the same volume of the reference model. Consequently, an ideal protocol for surgical planning of a spine surgery is defined with measurable accuracy. Thus, success rate of a spine surgery may be increased especially for the severe cases owing to the more accurate preoperative review: operability.
{"title":"Surgical Planning and Additive Manufacturing of an Anatomical Model: A Case Study of a Spine Surgery","authors":"L. Aydın, O. Cakir, R. Dilek, Mucahit Ege","doi":"10.5772/INTECHOPEN.89950","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.89950","url":null,"abstract":"3D scanning technologies have promising solutions for medical needs such as anatomical models, biocompatible implants, and orthotic/prosthetic models. Although virtual presurgical planning offers more precise results, it may not be applied in every hospital because of the high costs. The aim of this study is to assess the accuracy of the suggested low-cost and effective surgical planning method by means of additive manufacturing to increase success rate of each surgery. In this study, a full spine model of a scoliosis patient was acquired and reconstructed in MIMICS software using different filters and parameters. Therefore, a comparison in terms of geometrical errors among each model was performed based on a reference model. Subsequently, patient-specific full spine model was manufactured using a three-dimensional printing method (fused deposition modeling) and utilized before the surgery. 3D surgical model reconstruction parameters such as wrap tool, binomial blur, and curvature flow filters produced high geometrical errors, while mean filter produced the lowest geometrical error. Furthermore, similarity results of the curvature flow and discrete Gaussian filters were close to mean filter. Smooth tool and mean filter produced almost the same volume of the reference model. Consequently, an ideal protocol for surgical planning of a spine surgery is defined with measurable accuracy. Thus, success rate of a spine surgery may be increased especially for the severe cases owing to the more accurate preoperative review: operability.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126393326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-10DOI: 10.5772/intechopen.89641
K. Ko, Kyu-Sung Lee
Abdominal sacrocolpopexy for apical prolapse repair is the gold standard treatment and is more effective and durable than the transvaginal approach. The increase in minimally invasive surgery has led to attempts at laparoscopic sacrocolpopexy, but this technique has not gained popularity due to complex procedures and a steep learning curve. Robotic sacrocolpopexy overcomes these issues and has yielded good results for more than 15 years, with equivalent outcomes and safety to open and laparoscopic sacrocolpopexy (LSC). LSC is still a useful procedure for experienced surgeons, but it is expected that robot-assisted sacrocolpopexy (RSC) will have better results overall due to the advantages of the robotic instrument. The most important advantage is that surgeons who are inexperienced with minimally invasive approaches can more readily master RSC compared to overcoming the steep learning curve of LSC.
{"title":"Robotic Sacrocolpopexy for Treatment of Prolapse of the Apical Segment of the Vagina","authors":"K. Ko, Kyu-Sung Lee","doi":"10.5772/intechopen.89641","DOIUrl":"https://doi.org/10.5772/intechopen.89641","url":null,"abstract":"Abdominal sacrocolpopexy for apical prolapse repair is the gold standard treatment and is more effective and durable than the transvaginal approach. The increase in minimally invasive surgery has led to attempts at laparoscopic sacrocolpopexy, but this technique has not gained popularity due to complex procedures and a steep learning curve. Robotic sacrocolpopexy overcomes these issues and has yielded good results for more than 15 years, with equivalent outcomes and safety to open and laparoscopic sacrocolpopexy (LSC). LSC is still a useful procedure for experienced surgeons, but it is expected that robot-assisted sacrocolpopexy (RSC) will have better results overall due to the advantages of the robotic instrument. The most important advantage is that surgeons who are inexperienced with minimally invasive approaches can more readily master RSC compared to overcoming the steep learning curve of LSC.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130114379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-03DOI: 10.5772/intechopen.89560
V. Corona-Montes, E. González-Cuenca, M. Tobias-Machado
The objective of the following chapter is to describe thoroughly the surgical technique for a robotic-assisted inguinal lymphadenectomy for penile cancer, and the surgery has been through modifications from its creation to “the Robotic Era.” Penile cancer is a rare neoplasm, with an estimated 1570 cases in the United States. The spread is predictable to the inguinal lymph nodes, where 1–2% of patients will present distant metastases. The first draining lymph area is found in the inguinal region and the secondary spread in the pelvic region, main reason for the inguinal part of the treatment of penile cancer under different indications. Radical resection of inguinal metastases of penile cancer is the standard treatment for this technique, which has been adapted to become a minimally invasive surgery compared to an open inguinal lymphadenectomy, which entails a high incidence of morbidity that stands at 50–90%. A robotic-assisted inguinal lymphadenectomy, despite its high cost, is a feasible technique when carried out in specialized centers that can reduce morbidity rates and offer good oncological results, less blood loss, and shorter hospital stay.
{"title":"Robotic-Assisted Inguinal Lymphadenectomy (RAIL)","authors":"V. Corona-Montes, E. González-Cuenca, M. Tobias-Machado","doi":"10.5772/intechopen.89560","DOIUrl":"https://doi.org/10.5772/intechopen.89560","url":null,"abstract":"The objective of the following chapter is to describe thoroughly the surgical technique for a robotic-assisted inguinal lymphadenectomy for penile cancer, and the surgery has been through modifications from its creation to “the Robotic Era.” Penile cancer is a rare neoplasm, with an estimated 1570 cases in the United States. The spread is predictable to the inguinal lymph nodes, where 1–2% of patients will present distant metastases. The first draining lymph area is found in the inguinal region and the secondary spread in the pelvic region, main reason for the inguinal part of the treatment of penile cancer under different indications. Radical resection of inguinal metastases of penile cancer is the standard treatment for this technique, which has been adapted to become a minimally invasive surgery compared to an open inguinal lymphadenectomy, which entails a high incidence of morbidity that stands at 50–90%. A robotic-assisted inguinal lymphadenectomy, despite its high cost, is a feasible technique when carried out in specialized centers that can reduce morbidity rates and offer good oncological results, less blood loss, and shorter hospital stay.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128743484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-08DOI: 10.5772/INTECHOPEN.85535
A. Aloy, Simon Hell, Andreas Nowak, M. Grasl
The superimposed high-frequency jet ventilation is a jet ventilation technique that allows the surgeon to operate in a system open to the outside endoscopic surgery in the area of the vocal cord level. Although the clinical application is uncomplicated, the possible mechanisms of the gas flow in the jet laryngoscope are largely unknown. In the performed calculations for this work, the CFD software package Fluent is used with the preprocessor GAMBIT. After creating the geometry and networking of the jet laryngoscope in the preprocessor GAMBIT, the boundary conditions and input parameters in the solver are defined. This is followed by iterative calculation using Fluent and the tabulation of results. Ventilation is provided by an electronic respirator specially developed for the endoscope. There is a bidirectional gas flow in the jet laryngoscope. The free jet characteristics of the jet beam can be confirmed. Entrainment depends on pressure and on the gas velocity. The arrangement of the nozzles enables jet ventilation in stenosis. CFD analysis enables the representation of a continuous progress of the pressure as well as the representation of the continuous profile of the velocity in the investigated endoscope. Additionally the practical application for intensive care ventilation is shown.
{"title":"CFD Analysis of Flow Characteristics in a Jet Laryngoscope and the Different Application Forms of Superimposed Jet Ventilation","authors":"A. Aloy, Simon Hell, Andreas Nowak, M. Grasl","doi":"10.5772/INTECHOPEN.85535","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85535","url":null,"abstract":"The superimposed high-frequency jet ventilation is a jet ventilation technique that allows the surgeon to operate in a system open to the outside endoscopic surgery in the area of the vocal cord level. Although the clinical application is uncomplicated, the possible mechanisms of the gas flow in the jet laryngoscope are largely unknown. In the performed calculations for this work, the CFD software package Fluent is used with the preprocessor GAMBIT. After creating the geometry and networking of the jet laryngoscope in the preprocessor GAMBIT, the boundary conditions and input parameters in the solver are defined. This is followed by iterative calculation using Fluent and the tabulation of results. Ventilation is provided by an electronic respirator specially developed for the endoscope. There is a bidirectional gas flow in the jet laryngoscope. The free jet characteristics of the jet beam can be confirmed. Entrainment depends on pressure and on the gas velocity. The arrangement of the nozzles enables jet ventilation in stenosis. CFD analysis enables the representation of a continuous progress of the pressure as well as the representation of the continuous profile of the velocity in the investigated endoscope. Additionally the practical application for intensive care ventilation is shown.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133420684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-08DOI: 10.5772/INTECHOPEN.82189
H. Tanabe, Munehiro Ikuta, Toshimasa Mikawa, A. Kondo, Y. Morita
We have developed a rehabilitation training system (UR-System-PARKO: Useful and Ultimate Rehabilitation System-PARKO) for patients after a stroke to promote recovery of motor function of the severe plegic hand with hemiplegia. A clinical test with six patients for the therapeutic effect of the UR-System-PARKO for severe plegic hand was performed. For all patients, the active ranges of motion (total active motion) of finger extension improved after training with the UR-System-PARKO. Moreover, the modified Ashworth scale (MAS) scores of finger extension increased. Thus, the training reduced the spastic paralysis. These results suggest the effectiveness of training with the UR-System-PARKO for recovery of motor function as defined by finger extension in the severe plegic hand.
我们为中风患者开发了一套康复训练系统(UR-System-PARKO: Useful and Ultimate rehabilitation system - parko)，以促进严重偏瘫手的运动功能恢复。对6例患者进行了UR-System-PARKO治疗严重手麻痹的临床试验。所有患者在UR-System-PARKO训练后，手指伸展的活动范围(总活动范围)均有改善。此外，改良Ashworth量表(MAS)的手指延伸得分也有所提高。因此，训练减少了痉挛性麻痹。这些结果表明，UR-System-PARKO训练对于恢复严重瘫痪手的手指伸展运动功能是有效的。
{"title":"Application of a Robotic Rehabilitation Training System for Recovery of Severe Plegie Hand Motor Function after a Stroke","authors":"H. Tanabe, Munehiro Ikuta, Toshimasa Mikawa, A. Kondo, Y. Morita","doi":"10.5772/INTECHOPEN.82189","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82189","url":null,"abstract":"We have developed a rehabilitation training system (UR-System-PARKO: Useful and Ultimate Rehabilitation System-PARKO) for patients after a stroke to promote recovery of motor function of the severe plegic hand with hemiplegia. A clinical test with six patients for the therapeutic effect of the UR-System-PARKO for severe plegic hand was performed. For all patients, the active ranges of motion (total active motion) of finger extension improved after training with the UR-System-PARKO. Moreover, the modified Ashworth scale (MAS) scores of finger extension increased. Thus, the training reduced the spastic paralysis. These results suggest the effectiveness of training with the UR-System-PARKO for recovery of motor function as defined by finger extension in the severe plegic hand.","PeriodicalId":329470,"journal":{"name":"Medical Robotics - New Achievements","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128729522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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