Telesurgery

PURPOSE: Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications. MATERIALS AND METHODS: Two paired investigators screened PubMed® , Scopus® and Web of Science® databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance...

AIM: To scrutinize the rapid development of robotic versus traditional laparoscopic technique in pelvic urologic surgery. INTRODUCTION: In the last few decades, advances in research and development have led to tremendous progress in medical diagnostics and treatment of disease. Minimally invasive surgery has moved from experimental to becoming the dominant form of surgical management across the surgical specialties. Laparoscopy is nowadays used widely in abdominal surgery, from simple diagnostic laparoscopy to complex colorectal and gynecologic cancer procedures...

PURPOSE: To evaluate the feasibility of robot-assisted simulated cataract surgery. SETTING: Institut de Recherche Contre les Cancers de l'Appareil Digestif, European Institute of Telesurgery, and Strasbourg University Hospital, Strasbourg, France. DESIGN: Experimental study. METHODS: Cataract surgeries were performed on a Kitaro cataract wet-lab training system simultaneously using the Da Vinci Xi robotic surgical system and the Whitestar Signature phacoemulsification system...

This paper presents a surgical master-slave teleoperation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. The slave robot consists of a piezoelectrically actuated 6-degree-of-freedom (DOF) robot for needle placement with an integrated fiber optic force sensor (1-DOF axial force measurement) using the Fabry-Perot interferometry (FPI) sensing principle; it is configured to operate inside the bore of the MRI scanner during imaging. By leveraging the advantages of pneumatic and piezoelectric actuation in force and position control respectively, we have designed a pneumatically actuated master robot (haptic device) with strain gauge based force sensing that is configured to operate the slave from within the scanner room during imaging...

Robotic surgery has revolutionized minimally invasive surgery. Owing to its unique features and key advantages, robotic surgery is being used for complex cases across surgical specialties. It has been introduced into reconstructive surgery, and is being applied in microsurgery. Robotic surgery combines properties of conventional microsurgery, endoscopic surgery, and telesurgery. It holds great promise in expanding the boundaries of reconstructive microsurgery. However, there are constraints that limit its widespread use...

This study aimed to evaluate the capability of performing telesurgery via radio transmission for military arenas where wired internet connections may not be practical. Most existing robotic surgery systems are too large to effectively deploy with first responders. The miniature surgical platform in this study consists of a multifunctional robot suite that can fit easily into a briefcase. METHODS: The focus of this study is to explore the implications of radio control of the robot. The hypothesis is that an in vivo robot and its control boards can be controlled using off-the-shelf wireless components...

As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future...

BACKGROUND: Few telesurgery studies assess the impact of latency on user experience, low latencies are often not studied despite evidence of negative effects, and some studies recruit inexperienced subjects instead of surgeons without evidence that latency affects both groups similarly. METHODS: Fifteen trainees and fourteen laparoscopic surgeons conducted two tasks on a laparoscopy home-trainer at six latencies below 200 milliseconds (ms). Completion time and usability (perceived awareness of latency, inefficiency, disturbance, adaptability, and impact on patient safety) were measured...

PURPOSE OF REVIEW: The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. RECENT FINDINGS: Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy...

As surgical assist robots begin to widely spread in surgery, active developments are performed all over the world. This article surveys current developments of surgical assist robots. Especially, we focus on the surgical assist robots for minimally invasive surgery, since the surgery has been promoted worldwide. Moreover, the applications of surgical assistant robots, which help performing surgery beside surgeons, are promoted. By examining currently used robots, future developments are expected, for example, making forceps diameter smaller, downsizing the system, suitable systems for long-distance telesurgery, haptic feedback to guide the surgeon, systems for single port surgery, autonomous operation of some tasks in surgery and intelligent systems integrated diagnosis and treatments...

Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring...

INTRODUCTION: Using an endoscopic telesurgical robot system (ETSRS), the authors propose a strategy for improving the safety of telesurgery by restricting the movement of an end-effector within a lesion. The strategy is validated by phantom model experiments. MATERIAL AND METHODS: The method focused on generation of force feedback and restriction of robotic end-effector movement of ETSRS based on a virtual wall. Collision detection and case classification procedures were used to determine whether the generation of force feedback or restricting the end-effector's movement was continued...

BACKGROUND: Novel robots have recently been developed specifically for endonasal surgery. They can deliver several thin, tentacle-like surgical instruments through a single nostril. Among the many potential advantages of such a robotic system is the prospect of telesurgery over long distances. OBJECTIVE: To describe a phantom pituitary tumor removal done by a surgeon in Nashville, Tennessee, controlling a robot located approximately 800 km away in Chapel Hill, North Carolina, the first remote telesurgery experiment involving tentacle-like concentric tube manipulators...

Robotic surgery was initially developed to overcome problems faced during conventional laparoscopic surgeries and to perform telesurgery at distant locations. It has now established itself as the epitome of minimally invasive surgery (MIS). It is one of the most significant advances in MIS in recent years and is considered by many as a revolutionary technology, capable of influencing the future of surgery. After its introduction to urology, robotic surgery has redefined the management of urological malignancies...

Robotic surgery is being used widely due to its various benefits that includes reduced patient trauma and increased dexterity and ergonomics for the operating surgeon. Making the whole or part of the surgical procedure autonomous increases patient safety and will enable the robotic surgery platform to be used in telesurgery. In this work, an Electrosurgery procedure that involves tissue compression and application of heat such as the coaptic vessel closure has been automated. A MIMO nonlinear model characterizing the tissue stiffness and conductance under compression was feedback linearized and tuned PID controllers were used to control the system to achieve both the displacement and temperature constraints...

Given that e-health (including telehealth) is an opportunity cost (i.e., redirecting already scarce healthcare resources away from more traditional healthcare delivery needs), performing needs assessment ensures that investment of resources in e-health is appropriate. Yet the current literature shows research is on clever, narrow, or 'one disease' telehealth applications (e.g., telediabetes; telesurgery), or creation of electronic records (e.g., EHR's; EMRs; HIS's) and accumulation of 'big data' (e.g. biosurveillance)...

BACKGROUND: Haptic feedback is of critical importance in surgical tasks. However, conventional surgical robots do not provide haptic feedback to surgeons during surgery. Thus, in this study, a combined tactile and kinesthetic feedback system was developed to provide haptic feedback to surgeons during robotic surgery. METHODS: To assess haptic feasibility, the effects of two types of haptic feedback were examined empirically - kinesthetic and tactile feedback - to measure object-pulling force with a telesurgery robotics system at two desired pulling forces (1 N and 2 N)...

BACKGROUND: The effect of telesurgical training was evaluated at two latency levels. METHODS: Eleven subjects were randomly assigned to two delay groups (400 and 600 ms). Each group trained with latency on a simple task of dV-Trainer® and performed a difficult task before (pre-test) and after (post-test) the training. The follow-up was conducted 1 week after the training. RESULTS: The difficulty decreased gradually during training for both groups, while the task completion time and the instrument motion improved only in the 600 ms group...

BACKGROUND: Advances in robotics have made teleoperated surgical procedures a feasible means of treating patients in remote locations. In this study a suite of experiments was performed to investigate the influence of time-delay on teleoperation accuracy and efficiency during a path-following task. MATERIALS AND METHODS: Subjects used a Phantom Omni 6-degrees of freedom (dof) input device (Sensable, Triangle Park, NC) to move the end-effector of a Mitsubishi (Tokyo, Japan) PA-10 7-dof robotic manipulator along a prescribed path...

We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons...