Robotic prostatectomy: where are we now? (original) (raw)
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The Experience of Robotic Camera Holder During Laparoscopic Radical Retropubic Prostatectomy
Journal of urology & nephrology studies, 2019
Laparoscopic Radical Prostatectomy (LRP) is a standard surgical approach for treating organ confined prostate cancer. The procedure has evolved significantly since it was first described by Schuessler et al. [1] in 1997 in their series of 9 cases. They used five 10-mm ports and took them an average of 9.4 hours. One of the most important aspects of laparoscopic surgery is the operator's view of the surgical field. Provision of a consistently good view is paramount, which requires a skilled assistant to hold and manipulate the camera. Excessive camera movements, loss of orientation and communication problems with the assistant are troublesome and can potentially complicate the operation and jeopardise the outcome. In addition to camera holding, the assistant is often required to use their other hand for suction or retraction. The alternative is to have 2 assistants, but this is often not possible due to staffing issues. To aid the surgeon and assistant, camera holders have been developed to keep the camera steady. However, these devices were awkward and required repositioning for different views. Robotic camera holders have been used in the past but are expensive and cumbersome. Recently, a new robotic camera holder has become available. The FreeHand® (Prosurgics Ltd, Bracknell, Berks, UK) is a light weight robotic camera holder that is controlled by the surgeon's head movement and a foot pedal (Figure 1). It is designed to facilitate surgery by improving image quality. This study describes our initial experience of the camera holder and assesses its impact on the learning curve of LRP. Figure 1: FreeHand® Camera holder with laparoscopic lens attached.
Robotic surgery and telesurgery in urology
Urology, 2005
R apid technological developments and global communication in the past two decades have revolutionized the surgical sciences. Advances in optics and instrumentation encouraged a leap from traditional open operating techniques to the minimally invasive surgeries of today. Urology has been at the forefront of these innovations, introducing endourologic techniques into everyday practice to treat a myriad of genitourinary ailments. Patients have embraced these novel approaches as they have addressed concerns of postoperative pain, cosmesis, and convalescence. However, inherent limitations with some advanced minimally invasive techniques have restricted universal mastery by urologists. For example, laparoscopic urologic surgery has been relatively slow to be incorporated into general practice. Two-dimensional visualization, restricted maneuverability, and dampened tactile feedback, present challenges to surgeons trained in traditional open approaches. Although general surgery has the cholecystectomy and gynecology has the tubal ligation, urology lacks a simple laparoscopic platform for acquiring the requisite skill. The learning curve for urologic laparoscopy is long, necessitating significant training and continued exposure. The advent of computer-assisted robotic systems has provided a potential solution to address these limitations. They also open the door for developing novel, until now impossible, procedures. Moreover, the rapid expansion of Internet resources and modern audiovisual media has allowed for realtime guidance and remote surgical assistance. This review addresses the background, advances, and continuing challenges associated with robotic surgical systems and telesurgery. ROBOTS IN UROLOGIC SURGERY ROBOTIC SYSTEMS The robots used in surgery should ideally be part of computer-integrated surgery systems. The robot is just one element of a larger system designed to assist a surgeon in performing a surgical procedure. Medical robots may be classified in many different ways: by manipulator design (eg, kinematics, actuation, degrees of freedom); by level of autonomy (eg, preprogrammed, image-guided, teleoperated, synergetic); by targeted anatomy/technique (eg, cardiac, intravascular, percutaneous, laparoscopic, microsurgical); by intended operating environment (eg, operating room, imaging scanner, hospital floor); by context of their role in computer-integrated surgery systems (surgical planner, surgical assistants). Surgical Computer-Aided Design/Computer-Aided Manufacturing Systems. Surgical computer-aided design/computer-aided manufacturing (CAD/CAM) systems transform preoperative images and other clinical information into models of individual patients. These models can be used to preplan intervention and test a variety of potential clinical scenarios. Intraoperatively, these data can be registered to the actual patient and used as an image overlay display to assist in the accurate execution of a planned intervention. The CAD/CAM systems can be incorporated with mechanical robotic devices to perform an actual intervention. Data from the model, as well as real-time patient data, are integrated and used to guide a needle, instrument, or probe into a desired target. Their purpose is to act as a trajectory-enforcement device, correctly aligning the end effectors based on ultrasonography, fluoroscopy, computed tomography, or magnetic resonance imaging. These systems can perform with great accuracy a task defined by the treating physician. By integrating preoperative planning and intraoperative decision-making, the potential exists for improved outcomes with minimal errors. Orthopedics and neurosurgery were the first fields to use these surgical CAD/CAM systems because their procedures involved well-defined, fixed anatomic landmarks that were easily imaged.
A surgical Cockpit for Minimally Invasive Surgery
2021
The Surgical Cockpit is a robotized platform for Minimally Invasive Surgery targeting the treatment of diseases affecting the digestive, urologic and gynaecologic systems. The platform is designed to assist and enhance the surgeon’s gesture without disrupting the customary surgical workflow, which is standardized according to the type of intervention. Existing surgical platforms feature a Master-Slave approach, where the surgeon remotely manipulates a master console that drives the instruments via a slave robot. On the contrary, the Surgical Cockpit does not cut off the close contact between the surgeon and their patient. The choice of lightweight, transparent robotic arms seamlessly fits into surgical frame: the robots are placed at the patient’s bedside and hold the tools and the endoscope, both conveniently fixed at the end-effector through magnetic clippers. This configuration enables a robot-surgeon co-manipulation paradigm. Introduction: In classical laparoscopic routine, surg...
Robotic and telesurgery: will they change our future?
Current Opinion in Urology, 2001
In urology, at the end of the last millennium, there was an increasing use of computerized technology, extracorporeal shock wave lithotripsy, microwave therapy and high-energy focused ultrasound. However, experience with manipulating robots in urological surgery is still very limited. Laparoscopic surgery is handicapped by a reduction of the range of motion because of the fixed trocar position. The da Vinci system is the first surgical system to address all these problems adequately. The system consists of two main components: the surgeon's viewing and control console with three-dimensional imaging and the surgical arm unit that positions and manoeuvres detachable surgical instruments. The surgeon performs the procedure seated at the console holding specially designed instruments. Telerobotic laparoscopic radical prostatectomy provides advantages such as stereovision, dexterity and tremor filtering, but there is a learning curve with the device, mainly because of the magnification, the three-dimensional image and the lack of tactile feedback. However, after only a short period of time, the experienced surgeon is able to become familiar with the device. The impact of robotics in urological surgery is therefore very promising, and we are convinced that it will totally change the future of urological surgery. Curr Opin Urol 11:309±320. # 2001
Visceral Medicine
The history of laparoscopic general surgery dates back to the introduction of appendectomy by Semm in 1980 [1] and of cholecystectomy by Mühe in 1985 [2]. Subsequently, laparoscopic surgery was applied to various procedures [3-5]. Over the years, the laparoscopic instruments have been gradually evolved, which contributed to the improvement of quality and diversity of laparoscopic procedures. Among them, advances in energy devices and imaging are remarkable, and the progress made contributes to deepening anatomical knowledge and providing a safer and more stable technique. In recent years, robotic surgery represented by the da Vinci ® system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has attracted attention, and various results have been reported by a limited amount of institutions [6-8]. In contrast, considering both the advantages and high costs of robotic surgery, there are some major problems not to be ignored [9-11]. Scope holders can reduce the number of participants in surgery and provide a stable surgical field without tremors. Initially, scope holders were only invented with the intention to fix the scope [12, 13]; however, robotic scope holders have recently been developed that allow the operator to control the scope without removing the hands from the forceps [14-16]. The Soloassist ® system (AKTORmed, Barbing, Germany), a unique robotic scope holder, is a joystickguided endoscope remote control system which enables the surgeon to control the field of view [17]. In the following, we report our experiences with Soloassist for various surgical procedures, and the results of our experimental research to assess its benefits. Soloassist II ® Robotic Camera Control System Soloassist II is an endoscope holder with computer-controlled electric motors (fig. 1), which is a newly evolved as well as improved model compared to the previous version. It has six joints: three are
Journal of Urology, 2003
Purpose: For a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our knowledge we report the initial experience with robot assisted LRP of a surgeon without laparoscopic experience. Materials and Methods: Following a 1-day da Vinci (Intuitive Surgical, Mountain View, California) robotic laparoscopic training course and 2 cadaveric robotic LRPs an experienced oncologist (TEA) without laparoscopic experience performed 45 robotic LRPs. Results: All procedures were successfully completed laparoscopically with no rectal injuries or transfusions. The learning curve to 4-hour proficiency was 12 patients and mean operating time subsequently was 3.45 hours (range 2.5 to 5.1). Mean blood loss was 145 cc (range 25 to 350), the mean postoperative day 1 decrease in hemoglobin was 2.6 mg/dl (range 1.9% to 5.1) and mean hospital stay was 36 hours (range 18 to 168). Mean Gleason score was 6.8, mean prostate volume was 50.5 gm (range 12.5 to 163) and the margin positive rate was 35.5%. Four patients (8.8%) had a total of 6 complications, which were managed conservatively. Catheterization time was 7 days (range 7 to 42). Continence (0 pads) was 33% at 1 week, 63% at 1 month and 81% at 3 months. Conclusions: A laparoscopically naïve yet experienced open surgeon successfully transferred open surgical skills to a laparoscopic environment in 8 to 12 cases using a robotic interface. This outcome is comparable to the reported experience of skilled laparoscopic surgeons after more than 100 LRPs.
Initial experience with the EndoAssist camera-holding robot in laparoscopic urological surgery
Journal of Robotic Surgery, 2007
Although the advantages of laparoscopic surgery are well documented, one disadvantage is that, for optimum performance, an experienced camera driver is required who can provide the necessary views for the operating surgeon. In this paper we describe our experience with urological laparoscopic techniques using the novel EndoAssist robotic camera holder and review the current status of alternative devices. A total of 51 urological procedures (25 using the EndoAssist device and 26 using a conventional human camera driver) conducted by three experienced surgeons were studied prospectively, including nephrectomy (simple and radical), pyeloplasty, radical prostatectomy, and radical cystoprostatectomy. The surgeon noted the extent of body comfort and muscle fatigue in each case. Other aspects documented were ease of scope movement, i.e. usability, need to clean the telescope, time of set-up, surgical performance, and whether it was necessary to change the position of the arm during the surgery. All three surgeons involved in the evaluation felt comfortable throughout all procedures, with no loss of autonomy. It was, however, obvious that the large arc generated whilst doing a nephrectomy led to more episodes of lens cleaning, and the arm had to be relocated on some occasions. Clearer benefits were seen while performing pelvic surgery or pyeloplasty, perhaps because the arc of movement was smaller. The EndoAssist is an effective, easy to use device for robotic camera driving which reduces the constraint of having to have an experienced camera driver for optimum visualisation during laparoscopic urological procedures.