V-OG05 Robotic Hellers Myotomy

Background Achalasia is a rare condition affecting less than 1:100,000 patients. Treatment for this rare condition include balloon dilation, botox injection, endoscopic myotomy (POEMS) or surgical myotomy. Laparoscopic surgical myotomy is the “go to” approach for most surgeons; it is tried and tested, can be performed safely and quickly with a low complication rate, minimal pain and a short length of stay. Methods This video presents the technique adopted for robotic oesophageal myotomy in a patient with type II achalasia. A 4 arm technique was adopted with arm 4 on the patients left. The Davinci X system was used in this case. A Nathensen liver retractor was used to retract the liver; robotic instruments included the hook and cadiere forceps x2. Results The procedure was successfully performed; the operative time was 53 minutes, LOS was <24 hours. Check endoscopy revealed a wide open gastro-oesophageal junction and a long myotomy. The patient noted an improvement in symptoms with 24 hours and has had no significant reflux. Conclusion The enhanced magnified 3D view on the robotic platform allows better visualisation of the hiatal structures, vagal nerves and muscle fibres when performing the myotomy. Using the 4th arm to retract the lateral edge of the oesophageal muscle provides a very safe and stable platform to perform a long myotomy. I think the robotic system should be adopted as the standard approach for a hellers myotomy.

Robotic infant surgery with 3 mm instruments: a study in piglets of less than 10 kg body weight

No data exist concerning the appication of a new robotic system with 3 mm instruments (Senhance®, Transenterix) in infants and small children. Therefore, the aim of this study was to test the system for its feasibility, performance and safety of robotic pediatric abdominal and thoracic surgery in piglets simulating infants with a body weight lower than 10 kg. 34 procedures (from explorative laparoscopy to thoracoscopic esophageal repair) were performed in 12 piglets with a median age of 23 (interquartile range: 12–28) days and a median body weight of 6.9 (6.1–7.3) kg. The Senhance® robotic system was used with 3 mm instruments, a 10 mm 3D 0° or 30° videoscope and advanced energy devices, the setup consisted of the master console and three separate arms. The amount, size, and position of the applied ports, their distance as well as the distance between the three operator arms of the robot, external and internal collisions, and complications of the procedures were recorded and analyzed. We were able to perform all planned surgical procedures with 3 mm robotic instruments in piglets with a median body weight of less than 7 kg. We encountered two non-robot associated complications (bleeding from the inferior caval and hepatic vein) which led to termination of the live procedures. Technical limitations were the reaction time and speed of robotic camera movement with eye tracking, the excessive bending of the 3 mm instruments and intermittent need of re-calibration of the fulcrum point. Robotic newborn and infant surgery appears technically feasible with the Senhance® system. Software adjustments for camera movement and sensitivity of the fulcrum point calibration algorithm to adjust for the increased compliance of the abdominal wall of infants, therefore reducing the bending of the instruments, need to be implemented by the manufacturer as a result of our study. To further evaluate the Senhance® system, prospective trials comparing it to open, laparoscopic and other robotic systems are needed.

Locating Creativity in Differing Approaches to Musical Robotics

The field of musical robotics presents an interesting case study of the intersection between creativity and robotics. While the potential for machines to express creativity represents an important issue in the field of robotics and AI, this subject is especially relevant in the case of machines that replicate human activities that are traditionally associated with creativity, such as music making. There are several different approaches that fall under the broad category of musical robotics, and creativity is expressed differently based on the design and goals of each approach. By exploring elements of anthropomorphic form, capacity for sonic nuance, control, and musical output, this article evaluates the locus of creativity in six of the most prominent approaches to musical robots, including: 1) nonspecialized anthropomorphic robots that can play musical instruments, 2) specialized anthropomorphic robots that model the physical actions of human musicians, 3) semi-anthropomorphic robotic musicians, 4) non-anthropomorphic robotic instruments, 5) cooperative musical robots, and 6) individual actuators used for their own sound production capabilities.

Modeling biomechanical interaction between soft tissue and soft robotic instruments: importance of constitutive anisotropic hyperelastic formulations

Cardiovascular diseases are the leading cause of death in the western countries. Robotic surgery recently emerged as a confirmed strategy in the cardiovascular field, especially thanks to the improvement of soft robotics. These techniques have demonstrated their potential in terms of speed of execution and precision. In this context, a deeper knowledge of the material properties of the blood vessels is required, especially for computational soft robotics applications. A constitutive model including the contribution of the collagen fibers families is needed to take hyperelasticity and anisotropy into account. For this purpose, four different models are presented: two fiber families with dispersion (2FFD), two fiber families without dispersion (2FF), four fiber families with dispersion (4FFD), and four fiber families without dispersion (4FF). A set of experimental biaxial data obtained from ex-vivo specimens was used to assess the model performances. Two fitting procedures were imposed: a procedure with no weighting of scores and a procedure with a weight set to enhance the model performances in the contact range. A finite element simulation of a contact procedure was developed to evaluate the effect on the contact pressures and forces according to the different model implementations. In particular, a minimally invasive aortic valve positioning process through a previously designed soft robot was simulated. The results confirmed the overall fitting procedure. The adoption of the weighting process for the fitting was successful, as it permitted an accurate prediction in the region of interest through models with less parameters.

Interactively AUDIT Your Growth Curves with a Suite of R Packages

Bottlenecks often occur during data analysis when studying microbial growth in liquid culture at large scale. A researcher can collect thousands of growth curves, repeated measures of a microbial liquid culture, at once in multiple micro titer plates by purpose-built robotic instruments. However, it can be difficult and time-consuming to inspect and analyze these data. This is especially true for researchers without programming experience. To enable this researcher, we created and describe an interactive application: Automated Usher for Data Inspection and Tidying (AUDIT). It allows the user to analyze growth curve data generated from one or more runs each with one or more micro titer plates alongside their experimental design. AUDIT covers input, pre-processing, summarizing, visual exploration and output. Compared to previously available tools AUDIT handles more data, provides live previews and is built from individually re-usable pieces distributed as R packages.

ROBOTIC GASTRECTOMY: TECHNIQUE STANDARDIZATION

ABSTRACT Background: Robotic gastrectomy is gaining popularity worldwide. It allows reduced blood loss and lesser pain. However, it widespread use is limited by the extensive learning curve and costs. Aim: To describe our standard technique with reduced use of robotic instruments. Methods: We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and meticulous surgical description. Results: After standardizing the procedure, 28 patients were operated with this budget technique. For each procedure material used was: 1 (Xi model) or 2 disposable trocars (Si) and 4 robotic instruments. Stapling and clipping were performed by the assistant through an auxiliary port, limiting the use of robotic instruments and reducing the cost. Conclusion: This standardization helps implementing a robotic program for gastrectomy in the daily practice or in one`s institution.