The Micro Hand S vs. da Vinci Surgical Robot-Assisted Surgery on Total Mesorectal Excision: Short-Term Outcomes Using Propensity Score Matching Analysis

Objective: To compare the operation mode and clinical short-term outcomes of the Micro Hand S and the da Vinci surgical robot, we chose total mesorectal excision (TME) as the standard procedure for its good reflection of robot-assisted surgery advantages.Methods: We collected a total of 54 consecutive patients who underwent robot-assisted TME by two surgical robots from January 2016 to October 2020. We used propensity score matching (PSM) to create balanced cohorts of Micro Hand S group (n = 14) and da Vinci group (n = 14). Robotic installation and operation time, hospital and surgery costs, and intraoperative and postoperative clinical outcomes were compared.Results: In terms of robotic installation time, the Micro Hand S robot took longer than the da Vinci robot (24.2 ± 9.4 min vs. 17.1 ± 5.1 min, P < 0.05). As for the costs, the Micro Hand S group had lower total hospital costs (87,040.1 ± 24,676.9 yuan vs. 125,292.3 ± 17,706.7 yuan, P < 0.05) and surgery costs (25,772.3 ± 4,117.0 yuan vs. 46,940.9 ± 10,199.7 yuan, P < 0.05) than the da Vinci group. There were no statistically significant differences (P > 0.05) in other indicators, including total operation time, robotic operation time, blood loss, time to first liquid diet, time of getting out of bed, and hospital stay.Conclusion: The Micro Hand S enables patients with rectal cancer to enjoy lower medical costs of robotic surgery.Clinical Trial Registration:ClinicalTrials.gov [NCT02752698]

Development & Evaluation of Virtual Reality (VR) based Novel Vision System for the da Vinci Surgical Robot

Background: Robot surgery has become prevalent because of its various advantages as a progressive method based on empirical researches of conventional open surgery and minimally invasive surgery. However, the da Vinci surgical robot system, the most widely used and researched surgical robot, still requires an ergonomic improvement because of the uncomfortable posture in which it has to be operated. The stereo viewer—the current vision system of the da Vinci surgical robot—requires a user to maintain a posture wherein the user is looking down, which causes discomfort and results in musculoskeletal disorders. To overcome this limitation, a virtual reality (VR) head-mounted display (HMD) is proposed by previous researchers as an appropriate option to replace the stereo viewer, as it enables surgeons to move freely during surgery instead of having to look down on the stereo viewer. Presently, there is no direct comparison between the stereo viewer and a VR HMD by surgeons. Comparative evaluations were performed using peg transfer tasks, a questionnaire, and a NASA-Task Load Index (TLX). These were planned and performed by surgeons and novices to determine if the stereo viewer can be replaced by the VR HMD and to investigate whether the VR HMD has ergonomic.Results: Based on the results of peg transfer tasks, completion times when using VR HMD were shorter than those when using the stereo viewer. In these tasks, the participants performed more executions using the VR HMD compared to the stereo viewer. Based on the questionnaire, the participants favored the VR HMD compared to the stereo viewer, with respect to its visual and ergonomic performance. The modified NASA-TLX showed positive perceptions for the VR HMD.Conclusions: This comparative evaluation confirmed that the VR HMD can be employed as a potential alternative for the stereo viewer in a surgical robot system to achieve ergonomic improvements. The VR HMD improved the task performance of the surgical robot system, and it provided an ergonomic operation environment.

Solving the Time-Varying Inverse Kinematics Problem for the Da Vinci Surgical Robot

A dialytic-elimination and Newton-iteration based quasi-analytic inverse kinematics approach is proposed for the 6 degree of freedom (DOF) active slave manipulator in the Da Vinci surgical robot and other similar systems. First, the transformation matrix-based inverse kinematics model is derived; then, its high-dimensional nonlinear equations are transformed to a high-order nonlinear equation with only one unknown variable by using the dialytic elimination with a unitary matrix. Finally, the quasi-analytic solution is eventually obtained by the Newton iteration method. Simulations are conducted, and the result show that the proposed quasi-analytic approach has advantages in terms of accuracy (error < 0.00004 degree (or mm)), solution speed (< 20 ms) and is barely affected by the singularity during intermediate calculations, which proves that the approach meets the real-time and high-accuracy requirements of master‒slave mapping control for the Da Vinci surgical robots and other similar systems. In addition, the proposed approach can also serve as a design reference for other types of robotic arms that do not satisfy the Pieper principle.

Ontology-Based Surgical Subtask Automation, Automating Blunt Dissection

Automation of surgical processes (SPs) is an utterly complex, yet highly demanded feature by medical experts. Currently, surgical tools with advanced sensory and diagnostic capabilities are only available. A major criticism towards the newly developed instruments that they are not fitting into the existing medical workflow often creating more annoyance than benefit for the surgeon. The first step in achieving streamlined integration of computer technologies is gaining a better understanding of the SP. Surgical ontologies provide a generic platform for describing elements of the surgical procedures. Surgical Process Models (SPMs) built on top of these ontologies have the potential to accurately represent the surgical workflow. SPMs provide the opportunity to use ontological terms as the basis of automation, allowing the developed algorithm to easily integrate into the surgical workflow, and to apply the automated SPMs wherever the linked ontological term appears in the workflow. In this work, as an example to this concept, the subtask level ontological term “blunt dissection” was targeted for automation. We implemented a computer vision-driven approach to demonstrate that automation on this task level is feasible. The algorithm was tested on an experimental silicone phantom as well as in several ex vivo environments. The implementation used the da Vinci surgical robot, controlled via the Da Vinci Research Kit (DVRK), relying on a shared code-base among the DVRK institutions. It is believed that developing and linking further building blocks of lower level surgical subtasks could lead to the introduction of automated soft tissue surgery. In the future, the building blocks could be individually unit tested, leading to incremental automation of the domain. This framework could potentially standardize surgical performance, eventually improving patient outcomes.

Intraoperative presentation of Bochdalek’s hernia in an adult during robotic-assisted partial nephrectomy: An uncommon situation and literature review

Bochdalek's diaphragmatic hernia (BDH) is a congenital defect of the diaphragm that usually present during the neonatal period and rarely remain silent until adulthood. We present a 45-year-old-female case with diagnosis of double left kidney tumor prepared for robot-assisted partial nephrectomy (RPN). During the preoperative procedure she had a reduction of inspiratory volumes and increased pulmonary pressures: the robotic camera revealed the incidental presence of the left diaphragmatic defect. We report a simultaneous nephron sparing surgery (NSS) and left posterolateral BDH correction done by the da Vinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA).

Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results.