The international journal of medical robotics + computer assisted surgery : MRCAS最新文献

Background: The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients.

Materials and methods: Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients).

Results: Intra-operative bleeding was similar in the two groups (90 vs 100 mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1 min for Group A and B, respectively, P-value = 0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275 min vs 250 min, respectively).

Conclusion: Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety.

Introduction: In the field of pancreatic surgery, robotic surgery has yet to be evaluated against open and laparoscopic approaches. The outcomes of robotic surgery for distal pancreatectomy were analysed and the results compared with those of laparoscopic and open procedures.

Methods: Retrospective reviews were made of 47 patients who underwent distal pancreatectomy at our institution between 2008 and 2013 with three different approaches: 16 robotic, 18 laparoscopic and 13 open surgeries.

Results: A significant difference was observed in blood loss in the open group (mean 3.44 units) compared with the robotic (mean 0.5 units) and laparoscopic (0 units) technique (P  = 0.046). A shorter hospital stay was observed for the robotic group (8.87 days) compared with the laparoscopic (19.16 days) and open groups (20.44 days) (P = 0.035). Morbidity was lower in the robotic group (0%) compared with the Laparoscopic (44%) and Open groups (46%) (P = 0.014).

Conclusions: These findings support the proposition that robotic distal pancreatectomy is as safe as the laparoscopic approach.

Background: Intra-operative imaging is widely used to provide visual feedback to a clinician when he/she performs a procedure. In visual servoing, surgical instruments and parts of tissue/body are tracked by processing the acquired images. This information is then used within a control loop to manoeuvre a robotic manipulator during a procedure.

Methods: A comprehensive search of electronic databases was completed for the period 2000-2013 to provide a survey of the visual servoing applications in medical robotics. The focus is on medical applications where image-based tracking is used for closed-loop control of a robotic system.

Results: Detailed classification and comparative study of various contributions in visual servoing using endoscopic or direct visual images are presented and summarized in tables and diagrams.

Conclusion: The main challenges in using visual servoing for medical robotic applications are identified and potential future directions are suggested. 'Supervised automation of medical robotics' is found to be a major trend in this field.

Background: The objective was to evaluate the learning curve for performing a robotic hysterectomy to treat benign gynaecological disease.

Methods: Thirty-six patients underwent robotic hysterectomy for benign indications. A systematic chart review of consecutive cases was conducted. The collected data included age, BMI, operating time, set-up time, docking time, uterine weight, blood loss, intraoperative complications, postoperative complications, conversions to laparotomy and length of hospital stay.

Results: The mean operating, set-up and docking times were 169 ± 54.5, 52.9 ± 12.4 and 7.8 ± 7.6 min, respectively. The learning curve analysis revealed a decrease in both docking and operating times, with both curves plateauing after case 9.

Conclusions: The learning curve analysis revealed a decrease in docking time and operating time after case 9, suggesting that there might be a fast, learning curve for experienced laparoscopic surgeons to master robotic hysterectomy, and that the docking process does not have a significant negative influence on the overall operating time.