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On the design of a macro-micro parallel manipulator for cochlear microrobot operations 关于设计用于耳蜗微型机器人操作的宏微并行机械手
IF 2.3 3区 医学 Q2 SURGERY Pub Date : 2024-06-28 DOI: 10.1002/rcs.2654
Erkin Gezgin, Alp E. Yaşar, Tuğrul Uslu, Mertcan Koçak, Didem Güzin, Seda Özbek, Gökmen A. Türkmen, Goncagül Karayaman, Rahime Alsanğur, Barış Bıdıklı, Fatih C. Can, Levent Çetin

Background

The method of stem cell transfer to narrow cochlear canals in vivo to generate hair cells is still an unclear operation. Thus, the development of any possible method that will ensure the usage of medical microrobots in small cochlear workspaces is a challenging procedure.

Methods

The current study tries to introduce a macro-micro manipulator system composed of a 6-DoF industrial serial manipulator as a macro manipulator and a proposed 5-DoF parallel manipulator with dual end effectors as a micro manipulator carrying permanent magnets for tetherless microrobot actuation inside the cochlea.

Results

Throughout the study, structural synthesis and kinematic analysis of the proposed micro manipulator were introduced. A prototype of the manipulator was manufactured and its hardware verification procedures were carried out using motion capture cameras and surgical navigation registration methodologies.

Conclusions

Following motion training, the assembled macro-micro manipulator was successfully utilised to actuate a microrobot placed inside a manufactured cochlea mockup model.

背景:将干细胞转移到体内狭窄的耳蜗管道以生成毛细胞的方法仍是一项不明确的操作。因此,开发任何可能的方法以确保在小型耳蜗工作区使用医疗微型机器人是一项具有挑战性的工作:目前的研究试图引入一种宏观-微观机械手系统,该系统由一个作为宏观机械手的 6-DoF 工业串行机械手和一个作为微观机械手的带双端效应器的拟议 5-DoF 并行机械手组成,微观机械手携带永久磁铁,用于耳蜗内的无系微观机器人驱动:在整个研究过程中,介绍了拟议微型机械手的结构合成和运动学分析。利用运动捕捉摄像机和手术导航注册方法制造了机械手原型,并对其硬件进行了验证:经过运动训练后,组装好的宏观-微观机械手被成功用于驱动放置在耳蜗模型内的微型机器人。
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引用次数: 0
Clinical efficacy and performance evaluation of a bendable remote robot system for a bone tumour surgery: A pilot animal study 用于骨肿瘤手术的可弯曲远程机器人系统的临床疗效和性能评估:试验性动物研究。
IF 2.3 3区 医学 Q2 SURGERY Pub Date : 2024-06-27 DOI: 10.1002/rcs.2653
Seungmin Kim, Donghyun Shin, Changhyeon Lee, Daehee Yu, Jongho Cho, Hyunhee Bang, Hyunjoo Lee, Donghyun Kim, Ilhyung Park, Jaesung Hong, Sanghyun Joung

Background

Traditional open surgery for bone tumours sometimes has as a consequence an excessive removal of healthy bone tissue because of the limitations of rigid surgical instruments, increasing infection risk and recovery time.

Methods

We propose a remote robot with a 4.5-mm diameter bendable end-effector, offering four degrees of freedom for accessing the inside of the bone and performing tumour debridement. The preclinical studies evaluated the effectiveness, clinical scenario, and usability across 12 total surgeries–six phantom surgeries and six bovine bone surgeries. Evaluation criteria included skin incision size, bone window size, surgical time, removal rate, and conversion to open surgery.

Results

Preclinical studies demonstrated that the robotic approach requires significantly smaller incision size and procedure times than traditional open curettage.

Conclusion

This study validated the performance of the proposed system by assessing its preclinical effectiveness and optimising surgical methods using human phantom and bovine bone tumour models.

背景:传统的骨肿瘤开刀手术有时会因手术器械僵硬而切除过多健康骨组织,增加感染风险和恢复时间:由于刚性手术器械的限制,传统的骨肿瘤开放手术有时会过度切除健康的骨组织,增加感染风险和恢复时间:方法:我们提出了一种远程机器人,其末端执行器直径为 4.5 毫米,可弯曲,具有四个自由度,可进入骨内部进行肿瘤清创。临床前研究评估了 12 例手术(6 例模型手术和 6 例牛骨手术)的有效性、临床场景和可用性。评估标准包括皮肤切口大小、骨窗大小、手术时间、切除率以及是否转为开放手术:结果:临床前研究表明,与传统的开放式刮骨术相比,机器人方法所需的切口尺寸和手术时间都要小得多:本研究通过使用人体模型和牛骨肿瘤模型评估临床前效果和优化手术方法,验证了拟议系统的性能。
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引用次数: 0
Comparison of the in vivo kinematics between robotic-assisted Bi-cruciate retaining and Bi-cruciate stabilised total knee arthroplasty 机器人辅助双髋关节固定和双髋关节稳定全膝关节置换术的活体运动学比较
IF 2.3 3区 医学 Q2 SURGERY Pub Date : 2024-06-22 DOI: 10.1002/rcs.2655
Ashley Ying-Ying Wong, Michael Tim-Yun Ong, Tsz Lung Choi, Gloria Yan-Ting Lam, Xin He, Mingqian Yu, Ben Chi-Yin Choi, Daniel T. P. Fong, Patrick Shu-Hang Yung

Background

Up to 20% of patients remain unsatisfied after total knee arthroplasty (TKA), prompting the development of new implants. Bi-Cruciate Retaining (BCR) TKA preserves both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), with the ACL beneficial for its proprioceptive qualities. The Bi-Cruciate Stabilised (BCS) TKA substitutes the ACL and PCL with a unique dual cam-post mechanism. Robotics improve accuracy and facilitate technically demanding TKA.

Methods

This was a retrospective case-control study recruited from two centres. Measured outcomes included kinematic analysis, proprioception, and functional outcomes.

Results

There was a significantly larger maximum flexion angle and range of flexion to extension in sit-to-stand and stairs in BCR when compared to BCS. Further analysis revealed more similarities between BCR and normal native knees. Proprioception and functional scores did not have any statistical difference.

Conclusion

BCR TKA demonstrated better knee flexion in weight-bearing active range of motion and showed similarities with normal knee kinematics.

背景 多达 20% 的患者在接受全膝关节置换术 (TKA) 后仍不满意,这促使人们开发新的植入物。双十字韧带保留(BCR)TKA 同时保留了前十字韧带(ACL)和后十字韧带(PCL),其中前十字韧带因其本体感觉特性而受益。双十字韧带稳定型(BCS)TKA 采用独特的双凸轮支柱机制替代前十字韧带和后十字韧带。机器人技术提高了准确性,并为技术要求较高的 TKA 提供了便利。 方法 这是一项回顾性病例对照研究,研究人员来自两个中心。测量结果包括运动学分析、本体感觉和功能结果。 结果 与BCS相比,BCR在坐立和上楼梯时的最大屈曲角度和屈伸范围明显更大。进一步的分析表明,BCR与正常原生膝关节之间有更多相似之处。运动感觉和功能评分没有任何统计学差异。 结论 BCR TKA 在负重主动运动范围内显示出更好的膝关节屈曲度,并显示出与正常膝关节运动学的相似性。
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引用次数: 0
Transoral robotic surgery in the diagnosis and treatment of primary unknown head and neck squamous cell carcinoma: A preliminary single centre experience 经口机器人手术诊断和治疗原发性未知头颈部鳞状细胞癌:一个单中心的初步经验
IF 2.3 3区 医学 Q2 SURGERY Pub Date : 2024-06-21 DOI: 10.1002/rcs.2652
Yinghui Zhi, Yabing Zhang, Bin Zhang

Background

Squamous cell carcinoma of unknown primary (CUP) in the head and neck is difficult to diagnose and treat. This report outlines 11 cases of CUP treated with transoral robotic surgery (TORS), aimed at investigating the diagnostic efficiency of primary tumour and radical resection effectiveness of TORS.

Methods

11 cases of CUP among 68 oropharyngeal cancer patients treated by TORS were analysed retrospectively.

Results

All the 11 cases received TORS with cervical lymph node dissection. Primary tumours were found in 8 cases (72.7%), 4 cases in the palatine tonsil and 4 cases in the base of the tongue. The average diameter of the primary tumour was 1.65 cm. All patients resumed eating by mouth within 24 h, no tracheotomy, no pharyngeal fistula and no postoperative death. The 3-year disease-free survival rate was 91%.

Conclusions

TORS can improve the diagnostic efficiency of primary tumour of CUP and achieve good oncology and functional results.

背景 头颈部原发灶不明的鳞状细胞癌(CUP)难以诊断和治疗。本报告概述了 11 例经口机器人手术(TORS)治疗的 CUP,旨在研究原发肿瘤的诊断效率和 TORS 的根治性切除效果。 方法 回顾性分析 68 例口咽癌患者中接受 TORS 治疗的 11 例 CUP 病例。 结果 所有 11 例患者均接受了 TORS 和颈淋巴结清扫术。原发肿瘤有 8 例(72.7%),其中 4 例位于腭扁桃体,4 例位于舌根部。原发肿瘤的平均直径为 1.65 厘米。所有患者均在 24 小时内恢复经口进食,无气管切开,无咽瘘,无术后死亡。3 年无病生存率为 91%。 结论 TORS 可以提高 CUP 原发肿瘤的诊断效率,并取得良好的肿瘤学和功能效果。
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引用次数: 0
3D evaluation model of facial aesthetics based on multi-input 3D convolution neural networks for orthognathic surgery 基于多输入三维卷积神经网络的面部美学三维评估模型,用于正颌外科手术。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-06-14 DOI: 10.1002/rcs.2651
Qingchuan Ma, Etsuko Kobayashi, Siao Jin, Ken Masamune, Hideyuki Suenaga

Background

Quantitative evaluation of facial aesthetics is an important but also time-consuming procedure in orthognathic surgery, while existing 2D beauty-scoring models are mainly used for entertainment with less clinical impact.

Methods

A deep-learning-based 3D evaluation model DeepBeauty3D was designed and trained using 133 patients' CT images. The customised image preprocessing module extracted the skeleton, soft tissue, and personal physical information from raw DICOM data, and the predicting network module employed 3-input-2-output convolution neural networks (CNN) to receive the aforementioned data and output aesthetic scores automatically.

Results

Experiment results showed that this model predicted the skeleton and soft tissue score with 0.231 ± 0.218 (4.62%) and 0.100 ± 0.344 (2.00%) accuracy in 11.203 ± 2.824 s from raw CT images.

Conclusion

This study provided an end-to-end solution using real clinical data based on 3D CNN to quantitatively evaluate facial aesthetics by considering three anatomical factors simultaneously, showing promising potential in reducing workload and bridging the surgeon-patient aesthetics perspective gap.

背景:定量评估面部美学是正颌外科中一项重要但耗时的工作,而现有的二维美学评分模型主要用于娱乐,对临床影响较小:对面部美学进行定量评估是正颌外科中一项重要但耗时的程序,而现有的二维美学评分模型主要用于娱乐,临床影响较小:方法:使用 133 幅患者 CT 图像设计并训练了基于深度学习的 3D 评估模型 DeepBeauty3D。定制的图像预处理模块从 DICOM 原始数据中提取骨架、软组织和个人体征信息,预测网络模块采用 3 输入 2 输出的卷积神经网络(CNN)接收上述数据并自动输出美学评分:实验结果表明,该模型能在 11.203±2.824 秒内从原始 CT 图像预测骨骼和软组织评分,准确率分别为 0.231±0.218 (4.62%)和 0.100±0.344 (2.00%):该研究基于三维 CNN,利用真实临床数据提供了一种端到端的解决方案,通过同时考虑三个解剖因素来定量评估面部美学,在减少工作量和缩小外科医生-患者美学视角差距方面显示出巨大潜力。
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引用次数: 0
Use of a fluoroscopy-based robotic-assisted total hip arthroplasty system resulted in greater improvements in hip-specific outcome measures at one-year compared to a CT-based robotic-assisted system 与基于CT的机器人辅助系统相比,使用基于透视的机器人辅助全髋关节置换术系统一年后,髋关节特异性结果指标的改善幅度更大。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-06-10 DOI: 10.1002/rcs.2650
Christian B. Ong, Graham B. J. Buchan, Christian J. Hecht II, David Liu, Joshua Petterwood, Atul F. Kamath

Background

The purpose of this study was to compare one-year patient reported outcome measures between a novel fluoroscopy-based robotic-assisted (FL-RTHA) system and an existing computerised tomography-based robotic assisted (CT-RTHA) system.

Methods

A review of 85 consecutive FL-RTHA and 125 consecutive CT-RTHA was conducted. Outcomes included one-year post-operative Veterans RAND-12 (VR-12) Physical (PCS)/Mental (MCS), Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function (PS)/Joint replacement, and University of California Los Angeles (UCLA) Activity scores.

Results

The FL-RTHA cohort had lower pre-operative VR-12 PCS, HOOS Pain, HOOS-PS, HOOS-JR, and UCLA Activity scores compared with patients in the CT-RTHA cohort. The FL-RTHA cohort reported greater improvements in HOOS-PS scores (−41.54 vs. −36.55; p = 0.028) than the CT-RTHA cohort. Both cohorts experienced similar rates of major post-operative complications, and had similar radiographic outcomes.

Conclusions

Use of the fluoroscopy-based robotic system resulted in greater improvements in HOOS-PS in one-year relative to the CT-based robotic technique.

背景:本研究的目的是比较新型透视机器人辅助(FL-RTHA)系统和现有计算机断层扫描机器人辅助(CT-RTHA)系统一年的患者报告结果:方法:对 85 例连续的 FL-RTHA 和 125 例连续的 CT-RTHA 进行了回顾。结果包括术后一年的退伍军人兰德-12(VR-12)身体(PCS)/心理(MCS)、髋关节残疾和骨关节炎结果(HOOS)疼痛/身体功能(PS)/关节置换以及加州大学洛杉矶分校(UCLA)活动评分:与 CT-RTHA 组患者相比,FL-RTHA 组患者术前的 VR-12 PCS、HOOS 疼痛、HOOS-PS、HOOS-JR 和 UCLA 活动评分较低。FL-RTHA队列的HOOS-PS评分(-41.54 vs. -36.55;p = 0.028)比CT-RTHA队列有更大的改善。两组患者的术后主要并发症发生率相似,放射学结果相似:结论:与基于CT的机器人技术相比,基于透视的机器人系统可在一年内提高HOOS-PS。
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引用次数: 0
Augmented-reality-based surgical navigation for endoscope retrograde cholangiopancreatography: A phantom study 基于增强现实技术的内镜逆行胰胆管造影手术导航:模拟研究
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-06-07 DOI: 10.1002/rcs.2649
Zhipeng Lin, Zhuoyue Yang, Ranyang Li, Shangyu Sun, Bin Yan, Yongming Yang, Hao Liu, Junjun Pan

Background

Endoscope retrograde cholangiopancreatography is a standard surgical treatment for gallbladder and pancreatic diseases. However, surgeons is at high risk and require sufficient surgical experience and skills.

Methods

(1) The simultaneous localisation and mapping technique to reconstruct the surgical environment. (2) The preoperative 3D model is transformed into the intraoperative video environment to implement the multi-modal fusion. (3) A framework for virtual-to-real projection based on hand-eye alignment. For the purpose of projecting the 3D model onto the imaging plane of the camera, it uses position data from electromagnetic sensors.

Results

Our AR-assisted navigation system can accurately guide physicians, which means a distance of registration error to be restricted to under 5 mm and a projection error of 5.76 ± 2.13, and the intubation procedure is done at 30 frames per second.

Conclusions

Coupled with clinical validation and user studies, both the quantitative and qualitative results indicate that our navigation system has the potential to be highly useful in clinical practice.

背景:内镜逆行胰胆管造影术是胆囊和胰腺疾病的标准外科治疗方法。方法:(1)采用同步定位和绘图技术重建手术环境。(2) 将术前三维模型转化为术中视频环境,实现多模态融合。(3) 基于手眼对准的虚拟到现实投影框架。为了将三维模型投影到摄像机的成像平面上,它使用了电磁传感器的位置数据:结果:我们的 AR 辅助导航系统可以为医生提供精确的指导,这意味着注册误差的距离被限制在 5 毫米以下,投影误差为 5.76 ± 2.13,插管过程以每秒 30 帧的速度完成:结论:结合临床验证和用户研究,定量和定性结果均表明,我们的导航系统在临床实践中具有非常有用的潜力。
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引用次数: 0
Force/position tracking control of fracture reduction robot based on nonlinear disturbance observer and neural network 基于非线性干扰观测器和神经网络的断裂修复机器人力/位置跟踪控制。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-06-07 DOI: 10.1002/rcs.2639
Jintao Lei, Zhuangzhuang Wang

Background

For the fracture reduction robot, the position tracking accuracy and compliance are affected by dynamic loads from muscle stretching, uncertainties in robot dynamics models, and various internal and external disturbances.

Methods

A control method that integrates a Radial Basis Function Neural Network (RBFNN) with Nonlinear Disturbance Observer is proposed to enhance position tracking accuracy. Additionally, an admittance control is employed for force tracking to enhance the robot's compliance, thereby improving the safety.

Results

Experiments are conducted on a long bone fracture model with simulated muscle forces and the results demonstrate that the position tracking error is less than ±0.2 mm, the angular displacement error is less than ±0.3°, and the maximum force tracking error is 26.28 N. This result can meet surgery requirements.

Conclusions

The control method shows promising outcomes in enhancing the safety and accuracy of long bone fracture reduction with robotic assistance.

背景:对于骨折复位机器人来说,肌肉拉伸产生的动态载荷、机器人动力学模型的不确定性以及各种内部和外部干扰都会影响其位置跟踪精度和顺应性:对于骨折复位机器人来说,位置跟踪精度和顺应性受到肌肉拉伸产生的动态负载、机器人动力学模型的不确定性以及各种内部和外部干扰的影响:方法:提出了一种将径向基函数神经网络(RBFNN)与非线性干扰观测器相结合的控制方法,以提高位置跟踪精度。此外,还在力跟踪中采用了导纳控制,以增强机器人的顺应性,从而提高安全性:在模拟肌肉力量的长骨骨折模型上进行了实验,结果表明位置跟踪误差小于±0.2 mm,角位移误差小于±0.3°,最大力跟踪误差为 26.28 N,这一结果可以满足手术要求:该控制方法在提高机器人辅助长骨骨折复位的安全性和准确性方面显示出良好的效果。
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引用次数: 0
Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain 使用日之鸟机器人辅助手术系统进行根治性前列腺切除术:无对接设计有助于减轻术后疼痛。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-06-02 DOI: 10.1002/rcs.2648
Yutaro Sasaki, Yoshito Kusuhara, Takuro Oyama, Mitsuki Nishiyama, Saki Kobayashi, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Hiroomi Kanayama, Junya Furukawa

Background

The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction.

Methods

This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group.

Results

Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062).

Conclusions

The docking-free design may contribute to reducing postoperative pain.

背景:日本Hinotori手术机器人系统的无对接设计可使机器人手臂避免抓取套管,从而最大限度地减少过度的腹壁应力。本研究旨在评估使用日之鸟系统进行机器人辅助根治性前列腺切除术(RARP)的安全性和有效性,并探讨其无对接设计对减轻术后疼痛的潜在贡献:这项研究回顾了94名接受前列腺癌根治术的患者的临床记录:Hinotori组48人,达芬奇Xi组46人:结果:Hinotori组的手术时间和控制时间明显更长(分别为p = 0.030和p = 0.029)。两组围手术期并发症和肿瘤结果无差异。在术后第4天,Hinotori组的最大视觉模拟评分下降率略微显著(p = 0.062):结论:无对接设计可能有助于减轻术后疼痛。
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引用次数: 0
A haptic guidance system for simulated catheter navigation with different kinaesthetic feedback profiles 用于模拟导管导航的触觉引导系统,具有不同的动觉反馈曲线。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2024-05-31 DOI: 10.1002/rcs.2638
Taha Abbasi-Hashemi, Farrokh Janabi-Sharifi, Asim N. Cheema, Kourosh Zareinia

Background

This paper proposes a haptic guidance system to improve catheter navigation within a simulated environment.

Methods

Three force profiles were constructed to evaluate the system: collision prevention; centreline navigation; and a novel force profile of reinforcement learning (RL). All force profiles were evaluated from the left common iliac to the right atrium.

Results

Our findings show that providing haptic feedback improved surgical safety compared to visual-only feedback. If staying inside the vasculature is the priority, RL provides the safest option. It is also shown that the performance of each force profile varies in different anatomical regions.

Conclusion

The implications of these findings are significant, as they hold the potential to improve how and when haptic feedback is applied for cardiovascular intervention.

背景:本文提出了一种在模拟环境中改善导管导航的触觉引导系统:方法:构建了三种力曲线来评估该系统:碰撞预防、中心线导航和强化学习(RL)的新型力曲线。我们对从左髂总动脉到右心房的所有力曲线进行了评估:结果:我们的研究结果表明,与纯视觉反馈相比,触觉反馈提高了手术安全性。如果在血管内进行手术是首要任务,那么 RL 就是最安全的选择。研究还表明,在不同的解剖区域,每种力谱的性能都有所不同:这些发现意义重大,因为它们有可能改善触觉反馈在心血管介入中的应用方式和时间。
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引用次数: 0
期刊
International Journal of Medical Robotics and Computer Assisted Surgery
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