Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Abstract Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of Computed tomography and Magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical target through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

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Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

10.21203/rs.3.rs-43531/v1 ◽

2020 ◽

Author(s):

Ning Fan ◽

Shuo Yuan ◽

Peng Du ◽

Wenyi Zhu ◽

Liang Li ◽

...

Keyword(s):

Learning Curve ◽

Navigation System ◽

High Speed ◽

Preoperative Planning ◽

3D Visualization ◽

Lumbar Disc ◽

Planning System ◽

Robot Arm ◽

Robot Assisted ◽

And Performance

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Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02003-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ning Fan ◽

Shuo Yuan ◽

Peng Du ◽

Wenyi Zhu ◽

Liang Li ◽

...

Keyword(s):

Learning Curve ◽

Navigation System ◽

High Speed ◽

Preoperative Planning ◽

3D Visualization ◽

Lumbar Disc ◽

Planning System ◽

Robot Arm ◽

Robot Assisted ◽

And Performance

Abstract Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of computed tomography and magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical levels through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

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Precise microwave ablation in hepatic neoplasms adjacent to high-risk structures: a prospective pilot study

10.21203/rs.3.rs-69363/v1 ◽

2020 ◽

Author(s):

Liping Yang ◽

Qinying Li ◽

Gang Dong ◽

Lulu Sun ◽

Yan Xia ◽

...

Keyword(s):

High Risk ◽

Pleural Effusion ◽

Preoperative Planning ◽

3D Visualization ◽

Serum Levels ◽

Complete Separation ◽

Planning System ◽

Hepatic Neoplasms ◽

Local Progression ◽

Artificial Pleural Effusion

Abstract Objective To evaluate the safety and efficiency of ultrasound (US)-guided precise MWA assisted by artificial pleural effusion and/or ascites in hepatic neoplasms adjacent to high-risk structures based on a 3D preoperative planning system. Methods Twenty-five patients with hepatic neoplasms adjacent to high-risk structures were enrolled. CT images of all patients were reconstructed with 3D visualization software for preoperative planning. The puncture path and needle layout were estimated. US-guided precise MWA assisted by artificial pleural effusion and/or ascites was performed. Patients were followed by clinical and imaging examinations at 3, 6, and 12 months after the MWA. Study outcomes including complications, liver function, AFP level, and ablation lesion volumes were evaluated. Results Thirty-two tumors in 25 patients underwent precise MWA. Except for 4 patients with tumors near the macrovascular, 21 patients received artificial pleural effusion and/or ascites, achieving a complete separation. Based on preoperative 3D planning, patients with tumors near the diaphragmatic dome underwent administration of artificial pleural effusion and ascites, while patients with tumors near the gastrointestinal tract or gallbladder received artificial ascites. Of the 32 tumors, 30 achieved complete ablation in the first MWA session, and 29 achieved conformal ablation with a safe boundary of 0.5-1 cm. No severe complications were observed. Only one tumor exhibited local progression. Moreover, serum levels of ALT, AST and AFP were significantly decreased during the follow-up period. Conclusion Based on the 3D preoperative planning system, US-guided precise MWA assisted by artificial pleural effusion and ascites, is a safe and effective tool to treat hepatic neoplasms adjacent to high-risk structures.

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How should we evaluate robotics in the operating theatre?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b4.bjj-2019-1210.r1 ◽

2020 ◽

Vol 102-B (4) ◽

pp. 407-413 ◽

Cited By ~ 3

Author(s):

Hannes Vermue ◽

Jasper Lambrechts ◽

Thomas Tampere ◽

Nele Arnout ◽

Edouard Auvinet ◽

...

Keyword(s):

Learning Curve ◽

Knee Arthroplasty ◽

Preoperative Planning ◽

Operating Time ◽

Operating Theatre ◽

Current Evidence ◽

Cochrane Library ◽

Surgical Team ◽

Robot Assisted ◽

Stress Levels

The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking. This systematic review aims to evaluate the current evidence on the learning curve of robot-assisted knee arthroplasty. An extensive literature search of PubMed, Medline, Embase, Web of Science, and Cochrane Library was conducted. Randomized controlled trials, comparative studies, and cohort studies were included. Outcomes assessed included: time required for surgery, stress levels of the surgical team, complications in regard to surgical experience level or time needed for surgery, size prediction of preoperative templating, and alignment according to the number of knee arthroplasties performed. A total of 11 studies met the inclusion criteria. Most were of medium to low quality. The operating time of robot-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is associated with a learning curve of between six to 20 cases and six to 36 cases respectively. Surgical team stress levels show a learning curve of seven cases in TKA and six cases for UKA. Experience with the robotic systems did not influence implant positioning, preoperative planning, and postoperative complications. Robot-assisted TKA and UKA is associated with a learning curve regarding operating time and surgical team stress levels. Future evaluation of robotics in the operating theatre should include detailed measurement of the various aspects of the total operating time, including total robotic time and time needed for preoperative planning. The prior experience of the surgical team should also be evaluated and reported. Cite this article: Bone Joint J 2020;102-B(4):407–413.

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High Speed Fluorescence Endomicroscopy with Structured Illumination for Robot Assisted Minimally Invasive Surgery

10.31256/hsmr2018.19 ◽

2018 ◽

Author(s):

Haojie Zhang ◽

◽

Guang-Zhong Yang

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

High Speed ◽

Structured Illumination ◽

Robot Assisted

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Spatially Resolved Experimental Modal Analysis on High-Speed Composite Rotors Using a Non-Contact, Non-Rotating Sensor

Sensors ◽

10.3390/s21144705 ◽

2021 ◽

Vol 21 (14) ◽

pp. 4705

Author(s):

Julian Lich ◽

Tino Wollmann ◽

Angelos Filippatos ◽

Maik Gude ◽

Juergen Czarske ◽

...

Keyword(s):

High Speed ◽

Natural Frequencies ◽

Mode Shapes ◽

Fiber Reinforced ◽

Structural Dynamic ◽

Spatially Resolved ◽

Glass Fiber Reinforced ◽

Vibration Responses ◽

And Performance

Due to their lightweight properties, fiber-reinforced composites are well suited for large and fast rotating structures, such as fan blades in turbomachines. To investigate rotor safety and performance, in situ measurements of the structural dynamic behaviour must be performed during rotating conditions. An approach to measuring spatially resolved vibration responses of a rotating structure with a non-contact, non-rotating sensor is investigated here. The resulting spectra can be assigned to specific locations on the structure and have similar properties to the spectra measured with co-rotating sensors, such as strain gauges. The sampling frequency is increased by performing consecutive measurements with a constant excitation function and varying time delays. The method allows for a paradigm shift to unambiguous identification of natural frequencies and mode shapes with arbitrary rotor shapes and excitation functions without the need for co-rotating sensors. Deflection measurements on a glass fiber-reinforced polymer disk were performed with a diffraction grating-based sensor system at 40 measurement points with an uncertainty below 15 μrad and a commercial triangulation sensor at 200 measurement points at surface speeds up to 300 m/s. A rotation-induced increase of two natural frequencies was measured, and their mode shapes were derived at the corresponding rotational speeds. A strain gauge was used for validation.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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