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Background: Robotic surgery is a new technique and the aim of this study was to review the available literature on robotic port-site metastasis in oncological patients., Methods: The results of this study were retrieved after performing a systematic electronic search in PubMed, Scopus and Cochrane databases., Results: In total 204 patients were included in the study, of which five had robotic port-site metastasis. Their age ranged from 35-77 years. The types of cancers causing port-site metastasis were one squamous cell cervical carcinoma, two cervical adenocarcinomas, one gallbladder carcinoma and one transitional cell bladder carcinoma. The port-site metastasis occurred from 3 weeks up to 18 months postoperatively with the tumor measuring from 1.1 to 10.5 cm., Conclusions: Port-site metastasis is an extremely rare complication of robotic surgery. No safe conclusion can be drawn, but the aim of this study was to raise doctors' suspicion levels to such a rare new entity., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: To compare opinions of general and subspecialty obstetricians and gynecologists regarding teaching robotic surgery (RS) to residents., Methods: After obtaining IRB approval, 2189 gynecologic surgeons trained on the DaVinci Surgical System® (Intuitive Surgical, Sunnydale, CA) were asked to complete an online survey. Anonymous responses were obtained and compared using the chi-squared test, including opinions on training residents in RS., Results: Of these 303 respondents, 161 practiced general obstetrics and gynecology ('generalists'), and 138 were self-described 'subspecialists' (+/- fellowship training). The majority of subspecialists (82%) taught residents, and 63% allowed resident participation. Only 44% of generalists taught residents, and 36% allowed participation. Regarding ideal RS training time, generalists favored residency (39%), while subspecialists favored fellowship. (46%, P < 0.001) CONCLUSIONS: While many generalists and subspecialists incorporate training residents into their robotic cases, there is still disparity regarding the extent of participation. Standardized training curriculums should be a goal of residencies with RS., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Robot-assisted surgery is a promising technical innovation. Given the similarities between laparoscopic and robot-assisted surgery it is unlikely that randomized controlled trials would be conducted to disclose any differences between these two technical instruments. Thus, skepticism remains due to lack of any definitive conclusions in the literature., Aims: The aim of the study was to disclose any difference in outcome after robot-assisted (RNF) versus conventional laparoscopic (LNF) Nissen fundoplication for gastro-esophageal reflux disease in children., Materials and Methods: A literature review was carried out. Only studies comparing the two modalities were included. Operative time, duration of hospital stay, 30 days morbidity, mortality, conversion, recurrence and complication rates were analyzed. Review Manager 5.1.6 software, from the Cochrane library, was used for statistical analysis., Results: Three case series fulfilled the criteria for inclusion in this review. Data on 174 children were identified; 89 were operated on using the computer-assisted technology and 85 controls were operated on using the conventional laparoscopic technique. Data showed no significant difference between these two modalities., Discussion: This literature review demonstrates no significant difference between patients operated on with robot-assisted surgery and those undergoing conventional laparoscopic surgery regarding the parameters studied., Conclusion: The robot-assisted Nissen fundoplication in children is a safe alternative to conventional laparoscopic surgery. No data support the need for case selection to one of these two minimally invasive procedures., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Robotic surgery was introduced at our institution in 2003, and we used a progressive approach advancing from simple to more complex procedures., Methods: A retrospective chart review., Results: Cases included totalled 129. Set-up and operative times have improved over time and with experience. Conversion rates to standard laparoscopic or open techniques were 4.7% and 1.6%, respectively. Intraoperative complications (6.2%), blood loss and hospital stay were directly proportional to complexity. There were no mortalities and the postoperative complication rate (13.2%) was within accepted norms., Conclusion: Our findings suggest that robot technology is presently most useful in cases tailored toward its advantages, i.e. those confined to a single space, those that require performance of complex tasks, and re-do procedures., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Telesurgery delivers surgical care to a 'remote' patient by means of robotic manipulators. When accurate positioning of the surgeon's tool is required, as in microsurgery, physiological tremor causes unwanted imprecision during a surgical operation. Accurate estimation/compensation of physiological tremor in teleoperation systems has been shown to improve performance during telesurgery., Method: A new control architecture is proposed for estimation and compensation of physiological tremor in the presence of communication time delays. This control architecture guarantees stability with satisfactory transparency. In addition, the proposed method can be used for applications that require modifications in transmitted signals through communication channels. Stability of the bilateral tremor-compensated teleoperation is preserved by extending the bilateral teleoperation to the equivalent trilateral Dual-master/Single-slave teleoperation. The bandlimited multiple Fourier linear combiner (BMFLC) algorithm is employed for real-time estimation of the operator's physiological tremor., Results: Two kinds of stability analysis are employed. In the model-base controller, Llewellyn's Criterion is used to analyze the teleoperation absolute stability. In the second method, a nonmodel-based controller is proposed and the stability of the time-delayed teleoperated system is proved by employing a Lyapunov function. Experimental results are presented to validate the effectiveness of the new control architecture. The tremorous motion is measured by accelerometer to be compensated in real time. In addition, a Needle-Insertion setup is proposed as a slave robot for the application of brachytherapy, in which the needle penetrates in the desired position. The slave performs the desired task in two classes of environments (free motion of the slave and in the soft tissue)., Conclusion: Experiments show that the proposed control architecture effectively compensates the user's tremorous motion and the slave follows only the master's voluntary motion in a stable manner., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: Computerized management of medical information and 3D imaging has become the norm in everyday medical practice. Surgeons exploit these emerging technologies and bring information previously confined to the radiology rooms into the operating theatre. The paper reports the authors' experience with integrated stereoscopic 3D-rendered images in the da Vinci surgeon console., Methods: Volume-rendered images were obtained from a standard computed tomography dataset using the OsiriX DICOM workstation. A custom OsiriX plugin was created that permitted the 3D-rendered images to be displayed in the da Vinci surgeon console and to appear stereoscopic. These rendered images were displayed in the robotic console using the TilePro multi-input display. The upper part of the screen shows the real endoscopic surgical field and the bottom shows the stereoscopic 3D-rendered images. These are controlled by a 3D joystick installed on the console, and are updated in real time., Results: Five patients underwent a robotic augmented reality-enhanced procedure. The surgeon was able to switch between the classical endoscopic view and a combined virtual view during the procedure. Subjectively, the addition of the rendered images was considered to be an undeniable help during the dissection phase., Conclusion: With the rapid evolution of robotics, computer-aided surgery is receiving increasing interest. This paper details the authors' experience with 3D-rendered images projected inside the surgical console. The use of this intra-operative mixed reality technology is considered very useful by the surgeon. It has been shown that the usefulness of this technique is a step toward computer-aided surgery that will progress very quickly over the next few years., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: The use of surgical robots has slowly gained an increasing presence in the realm of hepatobiliary and pancreatic (HPB) surgery. With additional experience, anecdotal evidence has been useful in guiding patient selection for complex robotic procedures. In the following analysis, we reviewed our case series and looked for predictors of conversion in robotic HPB surgery., Methods: We retrospectively reviewed all patients who underwent robotic HPB procedures by a single surgeon at two institutions during March 2006-June 2012. Patient demographics, operative data, procedure type and conversion information were recorded. Trends were analysed for indications for conversion. A subset analysis of robotic-assisted laparoscopic distal pancreatomy was performed and compared with laparoscopic and open distal pancreatectomy during the same time period by the same surgeon., Results: During this time period, 77 patients underwent robotic hepatobiliary and pancreatic procedures. All procedures were performed by a single surgeon (J.M.) and included 38 males (49%) and 39 females (51%). Median age was 59 and the majority of patients were ASA class III. There were 24 conversions, which decreased in frequency from 2009 (7) to 2011 (3). Reasons for conversion included significant obesity and technical difficulty. Patients with conversions had more intraoperative blood loss (966 vs 176 ml), more frequently received transfusion (29% vs 2%) and were more likely to have postoperative intensive care. Overall length of stay was longer following conversion (8.3 vs 5.6 days)., Conclusions: Robotic-assisted hepatobiliary and pancreatic procedures are often extremely complex, with a significant learning curve. Recognizing factors that prohibit successful completion of a robotic-assisted surgical procedure is key for patient safety. Careful patient selection in the appropriate settings facilitates the maximal benefit of robotic-assisted complex HPB surgery., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Laparoscopic liver resection (LAPR) is safe and feasible with a better postoperative course as compared to open resections. Robot-assisted liver surgery (ROBR) is a potential alternative to LAPR. In this study we compare outcomes between ROBR and LAPR., Methods: Forty patients underwent ROBR and 223 LAPR for various indications. The surgical outcomes of two institutions, each with a specific advanced experience in laparoscopic and robotic surgery, were reviewed., Results: The major hepatectomy rate was significantly higher in LAPR (16.6% vs 0%, p = 0.011) while a parenchyma-preserving approach was favoured in ROBR (55% vs 34.1%, p = 0.019). More nodules were resected in the ROBR group (1.97 ± 1.4 vs 1.57 ± 1.1, p = 0.04). Overall conversion rate was 8/40 (20%) in the ROBR and 17/223 (7.6%) in the LAPR group (p = 0.034). Mean blood loss was 330 ± 303 ml and 174 ± 133 ml for the ROBR and LAPR groups, respectively (p = 0.001) CONCLUSIONS: Despite higher conversion rates and blood loss, robot-assisted surgery may allow the resection of more liver lesions, especially those located in the postero-superior segments, facilitating parenchyma-saving surgery with a comparable complication rate with respect to LAPR., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Strategies to spare operating room (OR) times are crucial to limiting the costs involved in robotic surgery. Among other factors, the pre-operative set-up and docking phases have been incriminated at first to be time consuming. The docking process on the standard multiport da Vinci Surgical System has not been shown to significantly prolong the overall OR time. This study aims to analyse whether the length of the docking process on the new da Vinci Si Surgical System with Single-Site™ technology remains acceptable., Methods: We prospectively analysed all of the robotic single-incision cholecystectomies performed at our institution for docking and operating times during 2011-2012. The docking task load was assessed each time in a self-administered fashion by the docking surgeon using the NASA TLX visual scale., Results: Sixty-four robotic single-incision cholecystectomies were included and analysed. The mean operative time was 78 min. Two surgeons with previous robotic surgery experience and a group of three less experienced robotic surgeons were responsible for docking the system. They performed 45, 10 and nine dockings, respectively. The overall mean docking time was 6.4 min with no significant difference between the groups. The docking process represented approximately 8% of the operating time. The surgeon with the most procedures showed significant progress in his docking times. The different task load parameters did not show a statistical difference between the three groups, with the exception of the frustration parameter, which was higher in the group of less experienced surgeons. There were significant correlations between docking times and the assessment of the various task load parameters., Conclusion: The docking process for a robotic single-incision cholecystectomy is learned rapidly and does not significantly increase the overall OR time., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men., Patients and Methods: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival., Results: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p<0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p<0.05) and potency after 12 months 39.6 % versus 66.2 % (p<0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score <7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%., Conclusions: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary.

Background: In the past 20 years, technological advancements have modified the concept of modern operating rooms (ORs) with the introduction of computer-integrated surgery (CIS) systems, which promise to enhance the outcomes, safety and standardization of surgical procedures. With CIS, different types of sensor (mainly position-sensing devices, force sensors and intra-operative imaging devices) are widely used. Recently, the need for a combined use of different sensors raised issues related to synchronization and spatial consistency of data from different sources of information., Methods: In this study, we propose a centralized, multi-sensor management software architecture for a distributed CIS system, which addresses sensor information consistency in both space and time. The software was developed as a data server module in a client-server architecture, using two open-source software libraries: Image-Guided Surgery Toolkit (IGSTK) and OpenCV. The ROBOCAST project (FP7 ICT 215190), which aims at integrating robotic and navigation devices and technologies in order to improve the outcome of the surgical intervention, was used as the benchmark. An experimental protocol was designed in order to prove the feasibility of a centralized module for data acquisition and to test the application latency when dealing with optical and electromagnetic tracking systems and ultrasound (US) imaging devices., Results: Our results show that a centralized approach is suitable for minimizing synchronization errors; latency in the client-server communication was estimated to be 2 ms (median value) for tracking systems and 40 ms (median value) for US images., Conclusion: The proposed centralized approach proved to be adequate for neurosurgery requirements. Latency introduced by the proposed architecture does not affect tracking system performance in terms of frame rate and limits US images frame rate at 25 fps, which is acceptable for providing visual feedback to the surgeon in the OR., (Copyright © 2012 John Wiley & Sons, Ltd.)

Introduction: The Hansen Robotic system has been utilized in ablation procedures for atrial fibrillation (AF). However, because of the lack of tactile feedback and the rigidity of the robotic sheath, this approach could result in higher risk of complications. This worldwide survey reports a multicenter experience on the methodology, efficacy, and safety of the Hansen system in AF ablations., Methods and Results: A questionnaire addressing questions on patient's demographics, procedural parameters, ablation success rate and safety information was sent to all centers where more than 50 robotic AF ablation cases have been performed. From June 2007 to December 2009, 1,728 procedures were performed at 12 centers utilizing the Hansen robotic navigation technology. The overall complication rate was 4.7% and the success rate was 67.1% after 18 ± 4 months of follow-up. In 5 low volume centers there appeared to be a learning curve of about 50 cases (complication rate 11.2% for the first 50 cases vs 3.7% for the 51-100 cases; P = 0.044) and a trend showing a decrease of complication rate with increasing case volume. However, in the remaining 7 centers no learning curve was present and the complication rate was stable over time (3.7% for the first 50 cases vs 3.6% for the 51st case thereafter; P = 0.942)., Conclusion: The Hansen robotic system can be used for AF ablation safely. In low volume centers, there appeared to be a learning curve of the first 50 cases after which the complication rate decreased. With a higher case volume, the success rate increased., (© 2012 Wiley Periodicals, Inc.)

Robotic surgery has been gaining increasing acceptance for several years now, establishing itself with success in all the surgical fields. Besides, since the introduction of single site surgery, the interest for the robotic technology is more than obvious, offering technical possibilities to overcome the natural limitations of laparoscopy. This article reviews the different devices available and the indications of robotic single site surgery. Moreover, the future developments of this new technology are discussed as well.

Background: The aim of this study was to provide pooled analysis of individually small trials comparing robotic Roux-en-Y gastric bypass (RRYGB) with standard laparoscopic RYGB (LRYGB)., Methods: A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the incidence of anastomotic leak and stricture. Secondary outcome measures were post-operative complications, operative time and length of hospital stay., Results: Seven relevant studies of 1686 patients were included in this analysis. There was a significantly reduced incidence of anastomotic stricture in the robotic group (POR = 0.43; 95% CI = 0.19 to 0.98; p = 0.04). There was no significant difference between robotic and laparoscopic groups for anastomotic leak, post-operative complications, operative time and length of hospital stay., Conclusion: The incidence of anastomotic stricture was reduced with RRYGB compared with LRYGB over a minimum follow-up period of 6 months, thus demonstrating the potential benefit of RRYGB., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: Colorectal surgery is one of the most common procedures performed by general surgeons, with an increasing number being performed laparoscopically. Robotic technology is emerging in the ongoing evolution in minimally invasive surgery. This study systematically reviews the literature regarding the safety and feasibility of robotic-assisted colorectal surgery., Methods: A comprehensive search of electronic databases was completed for the period 2000 to 2010. Two independent reviewers assessed the studies for relevance and inclusion, and extracted data., Results: After an initial screen of 347 titles, 20 studies met the inclusion criteria. A total of 854 patients were included with a mean age of 61 years and a body mass index of 25.5 kg/m(2) . Major complications included 27 anastamotic leaks (27/766 = 3.5%), 10 post-operative bleeds (1.1%) and 14 post-operative infections (1.6%). There were no mortalities reported., Conclusions: This systematic review demonstrates that robotic-assisted colorectal surgery is emerging as a safe and feasible option in colorectal surgery., (Copyright © 2011 John Wiley & Sons, Ltd.)

To examine the prevalence and content of robotic surgery information presented on websites of U.S. hospitals. We completed a systematic analysis of 400 randomly selected U.S. hospital websites in June of 2010. Data were collected on the presence and location of robotic surgery information on a hospital's website; use of images or text provided by the manufacturer; use of direct link to manufacturer website; statements of clinical superiority; statements of improved cancer outcome; mention of a comparison group for a statement; citation of supporting data and mention of specific risks. Forty-one percent of hospital websites described robotic surgery. Among these, 37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks. Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer., (© 2011 National Association for Healthcare Quality.)

The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists confirm advantages of conventional minimally invasive surgery over laparotomy for benign gynecological procedures; however, adoption remains low for the general gynecologist. A systematic search for gynecology publications was performed using Medline and Scopus. Available data on adoption rates and perioperative outcomes for hysterectomy, myomectomy, sacrocolpopexy, and endometriosis were reviewed. Robotic assistance may provide an improved rate of minimally invasive surgery adoption with equivalent perioperative outcomes to that of conventional techniques. Accessibility and cost remain controversial. Formal training programs are being created to address these issues.

Background: The robotic approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy. We aimed to report our technique and outcomes of robot-assisted adrenalectomy (RAA)., Methods: From November 2000 to February 2010, all consecutive patients who underwent a RAA by the same surgeon were prospectively entered into a dedicated database. The data were reviewed retrospectively., Results: During the study period, 21 right (50%), 20 left (47.6%) and 1 bilateral (2.4%) RAA were performed. Mean lesion size was 5.5 cm (max. 10 cm). Mean operative time was 118 ± 46 min and median blood loss was 27 ml. There were no conversions. The postoperative morbidity rate was 2.4%; mortality rate, 2.4%; median hospital stay, 4 days., Conclusions: RAA achieves good short-term outcomes and could be considered a valid option for the treatment of adrenal masses, with the potential to expand the limits of minimally invasive surgery., (Copyright © 2010 John Wiley & Sons, Ltd.)

Introduction: Recently, results describing pulmonary vein isolation (PVI) on patients using a robotic navigation system (RNS) in a high-volume center specialized in pulmonary vein isolation were published. The main purpose of this prospective study was to evaluate the learning curve of new users of RNS in a community hospital and to address the effectivity of RNS in electrophysiological settings with fewer patients. Radiation times, procedural times, feasibility, and safety with the RNS were assessed., Methods: PVI using the RNS was performed on 100 consecutive patients with symptomatic paroxysmal (n = 56, 56%) or persistent atrial fibrillation (AF). To assess the learning curve of practitioners with first-time use of RNS, patients were divided into four groups of 25 patients each (Q1-Q4). Procedural times as well as radiation times, complications, and outcome after a 6-month follow-up period were assessed for each quartile. All patients were ablated by the same physician., Results: Comparing the four patient groups, a continuous and significant reduction of procedural and radiation times was seen in the first 75 patients (Q1-Q3), whereas no further improvement was seen in the consecutive patients (Q3-Q4). One pericardial tamponade occurred in the course of 100 patients (1%). Overall success rate after a 6-month follow-up period was 74% in patients with paroxysmal and persistent AF. Comparing the four quartiles there was a higher but non-significant number of patients with freedom of atrial fibrillation after a 6-month follow-up in the subsequent groups (Q2-Q4) when compared to group 1., Conclusions: This data suggest that RNS is feasible and safe when performed in a community hospital with a significant reduction of radiation times and procedure times within the first 75 patients and with similar success and complication rates as compared to high-volume centers.

Background: Evaluation of the impact of a new robotic surgery programme on perioperative outcomes for endometrial cancer, Methods: A prospective database of all patients undergoing staging for endometrial cancer during July 2007-July 2008 was collected and analysed. Demographic data and perioperative outcomes were compared between cases performed via laparotomy, laparoscopy and robotics., Results: Sixty-five patients underwent staging during the time of data collection (LAP-26, LSC-7, ROB-32). No difference in surgical volume in the year before vs. after robotics was identified. Median operative time for robotics and laparotomy was significantly less than for laparoscopy (p = 0.023). There was no significant difference in lymph node yields between the three groups (p = 0.92). Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05). Median hospital stay was 1 day for the minimally invasive groups. Total number of perioperative inpatient days decreased from 331 to 150 in one year. Practice management of endometrial cancer transitioned from a predominantly open approach (5.6% LSC) to robotics (11% LSC, 49% ROB) within 12 months., Conclusions: Robotic surgery dramatically altered our management of endometrial cancer and was associated with a significant improvement in several perioperative outcomes when compared to laparotomy and laparoscopy., (Copyright (c) 2009 John Wiley & Sons, Ltd.)

Background: Due to improved ergonomics and dexterity, robotic surgery is promoted as being easily performed by surgeons with no special skills necessary. We tested this hypothesis by measuring IQ elements, computer gaming skills, general dexterity with chopsticks, and evaluating laparoscopic experience in correlation to performance ability with the da Vinci robot., Methods: Thirty-four individuals were tested for robotic dexterity, IQ elements, computer-gaming skills and general dexterity. Eighteen surgically inexperienced and 16 laparoscopically trained surgeons were included. Each individual performed three different tasks with the da Vinci surgical system and their times were recorded. An IQ test (elements: logical thinking, 3D imagination and technical understanding) was completed by each participant. Computer skills were tested with a simple computer game (hand-eye coordination) and general dexterity was evaluated by the ability to use chopsticks., Results: We found no correlation between logical thinking, 3D imagination and robotic skills. Both computer gaming and general dexterity showed a slight but non-significant improvement in performance with the da Vinci robot (p > 0.05). A significant correlation between robotic skills, technical understanding and laparoscopic experience was observed (p < 0.05)., Conclusions: The data support the conclusion that there are no significant correlations between robotic performance and logical thinking, 3D understanding, computer gaming skills and general dexterity. A correlation between robotic skills and technical understanding may exist. Laparoscopic experience seems to be the strongest predictor of performance with the da Vinci surgical system. Generally, it appears difficult to determine non-surgical predictors for robotic surgery.

Background: A novel imageless measurement algorithm to assess leg length (LL) and offset (OS) changes during total hip arthroplasty (THA) has been established, the purpose of this study was to describe the process and establish whether or not it is accurate., Methods: THA was performed on 17 cadaver hip specimens. LL and OS changes were determined intra-operatively, using an imageless navigation system. Pre- and postoperatively, all specimens had a computed tomography scan (CT) and the LL and OS changes were analysed by two blinded investigators., Results: With mean differences of less than 1 mm (LL, 0.74; SD, 2.4 mm; OS, 0.89; SD, 1.8 mm) supported by substantial significant correlations [r = 0.83 (LL) and r = 0.92 (OS)] imageless navigation values demonstrated a high accuracy when compared to CT measurements., Conclusions: Intra-operative LL and OS measures are reliable and accurate when using an imageless calculation algorithm which stores the position of the femoral reference frame in relation to the pelvic coordinate system before and after reconstruction.

Background: Maxillary distraction osteogenesis is a challenging procedure when it is performed with internal submerged distractors due to obligation of setting accurate distraction vectors., Methods: Five patients with severe maxillary retrognathy were planned with Mimics 10.01 CMF and Simplant 10.01 software. Distraction vectors and rods of distractors were arranged in 3D environment and on STL models. All patients were operated under general anaesthesia and complete Le Fort I downfracture was performed., Results: All distractions were performed according to orientated vectors. All patients achieved stable occlusion and satisfactory aesthetic outcome at the end of the treatment period., Conclusion: Preoperative bending of internal maxillary distractors prevents significant loss of operation time. 3D computer-aided surgical simulation and model surgery provide accurate orientation of distraction vectors for premaxillary and internal trans-sinusoidal maxillary distraction. Combination of virtual surgical simulation and stereolithographic models surgery can be validated as an effective method of preoperative planning for complicated maxillofacial surgery cases.

Background: Efficiency evaluation is important for expanding the acceptance and deployment of medical robots, but it is still an open issue. In this study, a data envelopment analysis (DEA)-based method was proposed and implemented with a novel robotic system for femoral neck surgery., Methods: Femoral neck surgeries with and without the assistance of the robotic system were modelled as decision-making units (DMUs). C(2)R model was chosen to calculate the relative efficiency., Results: Clinical simulation experiments were performed with 12 Sawbone models and 24 cadaveric femurs, and 19 clinical cases were chosen to be the control group. The minimum value of the robotically assisted surgery was 1, and the minimum value of the traditional surgery was 0.741535, demonstrating the efficiency of the robotic system., Conclusion: This research showed that DEA-based efficiency evaluation is practical for medical robotic systems.

In vivo surgical robot wheel and tissue interaction was studied using a nonlinear finite element model. A liver material model, derived from laboratory experiments, was implemented as a viscoelastic material. A finite element simulation of this laboratory test confirmed the accuracy of the liver material model. This material model was then used as the tissue model to study wheel performance. A helical wheel moving on the liver model was used to replicate laboratory experiments that included several different slip ratios and applied loads. The drawbar force produced in this model showed good agreement with the physical tests. These results have provided the baseline for studying how changes in wheel geometry, such as tread height, tread spacing and wheel diameter, affect drawbar force and ultimately wheel performance. These results will be used in future surgical robot wheel designs.

Theoretically, robotic surgery is likely to overcome the intrinsic limitations of laparoscopic surgery, such as a view not under the direct surgeon's control, two-dimensional imaging, and limited motion of instruments. In this chapter, the preliminary experience with a robotic laparoscopic surgery system in the Surgical Department of the Alessandria Hospital, Italy, is reported. From November 2005 to August 2007, a total of 162 laparoscopic robotic operations were performed, in which robotic surgery was found to be feasible and safe. It takes a longer time than standard laparoscopy but seems able to reduce the need of a steep learning curve.

Objective: To evaluate the feasibility of robotic microsurgical tubal anastomosis and compare the results and cost effectiveness with the same procedure performed by laparotomy., Design: Prospective cohort study., Setting: University hospital., Patient(s): Patients with a history of bilateral tubal ligation who desired reversal for future fertility., Intervention(s): Tubal anastomoses through either a robotic approach or through a laparotomy., Main Outcome Measure(s): Operative times, hospitalization, complications, postoperative patency, clinical outcomes, and the cost per live birth., Result(s): The mean operative time for robotic anastomoses was statistically significantly greater than open anastomoses (ROBOT 201 minutes; OPEN 155.3 minutes), although hospitalization times were statistically significantly shorter (ROBOT 4 hours; OPEN 34.7 hours). The return to instrumental activities of daily living was accelerated in the patients who had undergone a robotic anastomosis (ROBOT 11.1 days; OPEN 28.1 days). Although this was a small series, the pregnancy rates were comparable between groups (ROBOT 62.5%; OPEN 50%), yet the rate of abnormal pregnancy was higher in the robotic group (ectopic: ROBOT 4, OPEN 1; spontaneous pregnancy loss: ROBOT 2, OPEN 1). The cost per delivery was similar between the groups (ROBOT $92,488.00, OPEN $92,205.90)., Conclusion(s): Robotically assisted laparoscopic microsurgical tubal anastomosis is feasible and cost effective with results that are comparable with the traditional open approach.

The interaction between surgical tools and soft tissue has nonlinear mechanical properties. In robot-assisted surgery, a pre-specified trajectory of tool positions (or applied forces) is desired for achieving a surgical treatment. Due to the computational complexity involved in solving the nonlinear optimal trajectory following problem, a tractable path is to find lower bounds on the optimal cost. The lower bound serves as a reference to evaluate the goodness of any specific controller. A mathematical derivation of a lower bound on the optimal cost of the dynamic optimization problem, using a linear matrix inequality (LMI) approach, is developed. Semi-definite programming is used to solve the LMIs. This approach is demonstrated for a previously studied soft tissue grasping control problem.

Background: Laparoscopic pyeolplasty has become a minimally invasive alternative to open pyeloplasty. Due to technical concerns with intracorporeal suturing, robotic pyeloplasty has become an emerging alternative., Methods: The literature was reviewed for reports and outcomes on robotic pyeloplasty., Results: Reports of robotic pyeloplasty are increasing, and outcomes appear excellent., Conclusions: Robotic pyeloplasty is feasible with excellent outcomes. Challenges remain in making the procedure cost effective., (Copyright 2006 John Wiley & Sons, Ltd.)

Computer-enhanced surgical systems are becoming common worldwide. Currently, 331 da Vinci surgical systems have been installed. Robotic surgery was successfully performed on more than 20,000 patients in 2004. Intuitive Surgical has received FDA clearance for laparoscopic and thoracoscopic procedures, including hysterectomy or prostatectomy, as well as cardiac revascularization. The Japanese "Future Project" team has developed a prototype of a smaller surgical robotic system and successfully performed telesurgery on animals between Tokyo and Fujinomiya on August 8, 2002, and between Fukuoka and Seoul on March 2, 2005. Robotic surgery will lead to dramatic progress in medicine with the development of surgical navigation systems, simulation systems, and telementoring systems.

Aim: The aim of this study was to assess the clinical benefit and rate of complications of robot-assisted primary total hip replacement., Methods: Electronic bibliographic databases, the reference lists of relevant articles and various health services research-related resources were analysed and selected studies were assessed using defined quality criteria., Results: 57 publications and three HTA-reports were assessed. Only two prospective randomised controlled studies could be identified. There was no proof of clinical benefit but rather an increased incidence of complications., Conclusion: Patients must be informed on the risks, complications, benefits and especially alternatives to a robot-assisted operation. The importance of HTA reports to evaluate new or established procedures will even increase in Germany especially in the recent medico-legal context.