SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Da Vinci Surgical System

28

A robotic system (da Vinci(®) Surgical System, Intuitive Surgical Inc., Sunnyvale, CA, USA) has technical advantages over conventional laparoscopic surgery because it increases the precision and accuracy of anatomical dissection. The present study aimed to compare the short-term outcomes between robot-assisted intersphincteric resection (ISR) and laparoscopic ISR for distal rectal cancer.

Concepts: Time, Medicine, Surgery, Al-Andalus, Accuracy and precision, Laparoscopic surgery, Laparoscopy, Da Vinci Surgical System

28

BACKGROUND: Our goal was to analyze reported instances of the da Vinci robotic surgical system instrument failures using the FDA’s MAUDE (Manufacturer and User Facility Device Experience) database. From these data we identified some root causes of failures as well as trends that may assist surgeons and users of the robotic technology. METHODS: We conducted a survey of the MAUDE database and tallied robotic instrument failures that occurred between January 2009 and December 2010. We categorized failures into five main groups (cautery, shaft, wrist or tool tip, cable, and control housing) based on technical differences in instrument design and function. RESULTS: A total of 565 instrument failures were documented through 528 reports. The majority of failures (285) were of the instrument’s wrist or tool tip. Cautery problems comprised 174 failures, 76 were shaft failures, 29 were cable failures, and 7 were control housing failures. Of the reports, 10 had no discernible failure mode and 49 exhibited multiple failures. CONCLUSIONS: The data show that a number of robotic instrument failures occurred in a short period of time. In reality, many instrument failures may go unreported, thus a true failure rate cannot be determined from these data. However, education of hospital administrators, operating room staff, surgeons, and patients should be incorporated into discussions regarding the introduction and utilization of robotic technology. We recommend institutions incorporate standard failure reporting policies so that the community of robotic surgery companies and surgeons can improve on existing technologies for optimal patient safety and outcomes.

Concepts: Hospital, Surgery, Report, Failure, Abu al-Qasim al-Zahrawi, Robotic surgery, The Da Vinci Code, Da Vinci Surgical System

28

BACKGROUND: The da Vinci robotic surgical telemanipulator has been utilized in several surgical specialties for varied procedures, and the users' experiences have been widely published. To date, no detailed system technical analyses have been performed. METHODS: A detailed review was performed of all publications and patents about the technical aspects of the da Vinci robotic system. RESULTS: Published technical literature on the da Vinci system highlight strengths and weaknesses of the robot design. While the system facilitates complex surgical operations and has a low malfunction rate, the lack of haptic (especially tactile) feedback and collisions between the robotic arms remain the major limitations of the system. Accurate, preplanned positioning of access ports is essential. CONCLUSION: Knowledge of the technical aspects of the da Vinci robot is important for optimal use. We confirmed the excellent system functionality and ease of use for surgeons without an engineering background. Research and development of the surgical robot has been predominant in the literature. Future trends address robot miniaturization and intelligent control design. Copyright © 2012 John Wiley & Sons, Ltd.

Concepts: Surgery, Physician, Academic publishing, Control theory, Robotic surgery, The Da Vinci Code, Da Vinci Surgical System, Intuitive Surgical

27

Purpose: Robotic surgical technology has been adopted by surgeons with and without previous standard laparoscopic experience. The necessity or benefit of prior training and experience in laparoscopic surgery is unknown. We hypothesized that laparoscopic training enhances performance in robotic surgery. Materials and Methods: Fourteen medical students with no surgical experience were instructed to incise a spiral using the da Vinci® surgical robot with time to completion and errors recorded. Each student was then trained for one month in standard laparoscopy but with no further robotic exposure. Training included a validated laparoscopic training program including timed and scored parameters. After completion of the month-long training, the students repeated the cutting exercise using the da Vinci® robot as well as with standard laparoscopic instruments and were scored within the same parameters. Results: The mean time to completely incise the spiral robotically prior to training was 16.72 minutes with a mean of 6.21 errors. After one month of validated laparoscopic training, the mean robotic time fell to 9:03 minutes (p=0.0002) with 3.57 errors (p=0.02). Laparoscopic performance after one month of validated laparoscopic training was 13.95 minutes with 6.14 errors, which was no better than pre-training robotic performance (p=0.20) and worse than post-training robotic performance (p=0.01). Conclusions: Formal laparoscopic training improved performance of a complex robotic task. Initial robotic performance without any robotic or laparoscopic training was equivalent to standard laparoscopic performance after extensive training. Additionally, after laparoscopic training the robot allowed significantly superior speed and precision of the task. Laparoscopic training may improve proficiency in operation of the robot. This may explain the perceived ease with which robotics is adopted by laparoscopically trained surgeons and may be important in training future robotic surgeons.

Concepts: Surgery, Laparoscopic surgery, Laparoscopy, Robotic surgery, Da Vinci Surgical System, Lindbergh Operation

27

Background Minimally invasive techniques in spine surgery have gained significant popularity due to decreased tissue dissection and destruction, postoperative pain, and hospital stay. The laparoscopic anterior lumbar interbody fusion (ALIF), an innovation in minimally invasive spine surgery, is rarely done because it has marginal benefit over the mini-open ALIF technique in rates of retrograde ejaculation and vascular complications. We propose these outcomes can be improved with enhanced robotic-assisted dissection and exposure for ALIF. Patients Two patients with single-level degenerative spine disease at L5-S1, associated with mechanical back pain, underwent anterior spinal exposure using the da Vinci S Surgical Robot during ALIF. Results In this report, we provide the first description of the use of a surgical robot in the dissection and exposure for ALIF in patients with degenerative spine disease. We demonstrate successful use of the da Vinci Surgical Robot in separating the presacral nervous plexus from retroperitoneal structures without postoperative vascular or urological complications over a 1-year follow-up period. Conclusion Use of the robotic assistance in the performance of ALIF is possible without significant operative complications. This technique may provide added benefit over conventional laparoscopic approaches to the spine.

Concepts: Hospital, Surgery, Minimally invasive, Degenerative disc disease, Orgasm, Robotic surgery, The Da Vinci Code, Da Vinci Surgical System

25

24

This paper reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic devices that provide wrists or wrist-like dexterity within the patient. Many of these devices aim to provide dexterity conceptually similar to the EndoWrist instruments of the da Vinci surgical robot, but without requiring computers and motors. The motivation is to provide high-dexterity instruments at a lower cost than current surgical robots offer. In this paper we review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two.

Concepts: Hospital, Surgery, Physician, Robotic surgery, The Da Vinci Code, Da Vinci Surgical System, Surgical robots

2

The integrity of the medical literature about robotic surgery remains unclear despite wide-spread adoption. We sought to determine if payment from Intuitive Surgical Incorporated (ISI) affected quality of the research produced by surgeons.

Concepts: Medicine, Surgery, Physician, Robotic surgery, The Da Vinci Code, Da Vinci Surgical System, Intuitive Surgical, Joseph Lister, 1st Baron Lister

1

The treatment of oropharyngeal cancer has undergone a paradigm shift in the past 2 decades, with an increase in the use of nonoperative treatment owing to poor functional outcomes associated with traditional surgical approaches. Transoral robotic surgery (TORS) allows surgical resection of oropharyngeal cancer (OPC) with less morbidity through a minimally invasive approach.

Concepts: Time, Surgery, Chemotherapy, Minimally invasive, Term, Amputation, Robotic surgery, Da Vinci Surgical System

1

Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency.

Concepts: Hospital, Surgery, Physician, Al-Andalus, Robotic surgery, Operating theater, Da Vinci Surgical System, Pit stop