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Concept: Robotic surgery


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


The Raven-II is a platform for collaborative research on advances in surgical robotics. Seven Universities have begun research using this platform. The Raven-II system has two three DOF spherical positioning mechanisms capable of attaching interchangeable four DOF instruments. The Raven-II software is based on open standards such as Linux and ROS to maximally facilitate software development. The mechnism is robust enough for repeated experiments and animal surgery experiments, but is not engineered to sufficient safety standards for human use. Mechanisms in place for interaction among the user community and dissemination of results include an electronic forum, an online software SVN repository, and meetings and workshops at major robotics conferences.

Concepts: Medicine, Surgery, Science, Open Standards, Software engineering, Robotic surgery, Standards organization, System software


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


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


BACKGROUND: While single-port laparoscopy for abdominal surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present a case of single-incision, robotic right colectomy using this device. METHODS: A 74-year-old female with malignant polyp of caecum was operated on with a single-site approach using the Da Vinci Single-Site® robotic surgery device. Resection and anastomosis were performed extra-corporeally after undocking the robot. RESULTS: The procedure was successfully completed in 200 min. No surgical complications occurred during the intervention and the post-operative stay and no conversion to laparotomy or additional trocars were required. CONCLUSIONS: To the best of our knowledge, this is the first case of right colectomy using the Da Vinci Single-Site® robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are restoration of triangulation and reduced instrument clashes. Copyright © 2013 John Wiley & Sons, Ltd.

Concepts: Surgery, John Wiley & Sons, Laparoscopic surgery, Greatest hits, Laparotomy, Robotic surgery, The Da Vinci Code, Leonardo da Vinci


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



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


Transoral robotic surgery (TORS) has been adopted in some parts of the world as an innovative approach to the resection of oropharyngeal tumours. The development, details and outcomes of early-to-later phase evaluation of this technique and the quality of evidence to support its adoption into practice have hitherto not been summarised. The aim of this review is to identify and summarise the early and later phase studies of, and evidence for, TORS and to understand how early phase studies report intervention development, governance procedures and selection and reporting of outcomes to optimise methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence-based practice. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.

Concepts: Medicine, Evaluation, Evidence-based medicine, Systematic review, Randomized controlled trial, Surgery, Meta-analysis, Robotic surgery


Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures.

Concepts: Medicine, Surgery, Minimally invasive, Invasive, Invasiveness of surgical procedures, Open surgery, Minimally-invasive, Robotic surgery