No beneficial effect on survival but a decrease in postoperative complications in patients with rectal cancer undergoing robotic surgery: a retrospective cohort study

Background Robotic surgery has been taken as a new modality to surpass the technical limitations of conventional surgery. Here we aim to compare the oncologic outcomes of patients with rectal cancer receiving robotic vs. laparoscopic surgery. Methods Data from patients diagnosed with rectal cancer between March 2011 and December 2018 were obtained for outcome assessment at the First Affiliated Hospital of Nanchang University. All patients were separated into two groups: a robot group (patients receiving robotic surgery, n = 314) and a laparoscopy group (patients receiving laparoscopic surgery, n = 220). The primary endpoint was survival outcomes. The secondary endpoints were the general conditions of the operation, postoperative complications and pathological characteristics. Results The 5-year overall survival (OS) and disease-free survival (DFS) at years 1, 3 and 5 were 96.6%, 88.7%, and 87.7% vs. 96.7%, 88.1%, and 78.4%, and 98.6%, 80.2-, and 73.5% vs. 96.2-, 87.2-, and 81.1% in the robot and laparoscopy groups, respectively (P > 0.05). In the multivariable-adjusted analysis, robotic surgery was not an independent prognostic factor for OS and DFS (P = 0.925 and 0.451, respectively). With respect to the general conditions of the operation, patients in the robot group had significantly shorter operation times (163.5 ± 40.9 vs. 190.5 ± 51.9 min), shorter times to 1st gas passing [2(1) vs. 3(1)d] and shorter hospital stay days [7(2) vs. 8(3)d] compared to those in the laparoscopy group (P < 0.01, respectively). After the operation, the incidence of short- and long-term complications in the robot group was significantly lower than that in the laparoscopy group (15.9% vs. 32.3%; P < 0.001), especially for urinary retention (1.9% vs. 7.3%; 0.6% vs. 4.1%, P < 0.05, respectively). With regard to pathological characteristics, TNM stages II and III were more frequently observed in the robot group than in the laparoscopy group (94.3% vs. 83.2%, P < 0.001). No significant difference were observed in lymph nodes retrieved, lymphovascular invasion and circumferential resection margin involvement between the two groups (P > 0.05, respectively). Conclusions This monocentre retrospective comparative cohort study revealed short-term advantages of robot-assisted rectal cancer resection but similar survival compared to conventional laparoscopy.

Group interaction of robots with an arbitrary kinematic diagram of manipulators during synchronous execution of technological operations

The stabilization of the manipulated object near the position of static equilibrium under kinematic and force disturbances during cooperative transportation by two robots of arbitrary structure is considered. The dynamic balance of an object in grippers is described by the Mathieu equation. The controlled executive system of the coupled robot provides adjustment of the manipulation system with minimal potential energy in the grippers. A variant of the optimal control in terms of speed is considered when transferring the system to a position close to static equilibrium. Keywords: robot, group control, controlled generalized coordinates, continuity of connections, cooperative work. [email protected]

Efficacy of a Novel Exoskeletal Robot for Locomotor Rehabilitation in Stroke Patients: A Multi-center, Non-inferiority, Randomized Controlled Trial

Objective: To investigate the efficacy and safety of a novel lower-limb exoskeletal robot, BEAR-H1 (Shenzhen Milebot Robot Technology), in the locomotor function of subacute stroke patients.Methods: The present study was approved by the ethical committee of the First Affiliated Hospital of Nanjing Medical University (No. 2019-MD-43), and registration was recorded on the Chinese Clinical Trial Registry with a unique identifier: ChiCTR2100044475. A total of 130 patients within 6 months of stroke were randomly divided into two groups: the robot group and the control group. The control group received routine training for walking, while in the robot group, BEAR-H1 lower-limb exoskeletal robot was used for locomotor training. Both groups received two sessions daily, 5 days a week for 4 weeks consecutively. Each session lasted 30 min. Before treatment, after treatment for 2 weeks, and 4 weeks, the patients were assessed based on the 6-minute walking test (6MWT), functional ambulation scale (FAC), Fugl-Meyer assessment lower-limb subscale (FMA-LE), and Vicon gait analysis.Results: After a 4-week intervention, the results of 6MWT, FMA-LE, FAC, cadence, and gait cycle in the two groups significantly improved (P &lt; 0.05), but there was no significant difference between the two groups (P &gt; 0.05). The ratio of stance phase to that of swing phase, swing phase symmetry ratio (SPSR), and step length symmetry ratio (SLSR) was not significantly improved after 4 weeks of training in both the groups. Further analyses revealed that the robot group exhibited potential benefits, as the point estimates of 6MWT and Δ6MWT (post-pre) at 4 weeks were higher than those in the control group. Additionally, within-group comparison showed that patients in the robot group had a significant improvement in 6MWT earlier than their counterparts in the control group.Conclusions: The rehabilitation robot in this study could improve the locomotor function of stroke patients; however, its effect was no better than conventional locomotor training.

Modular discrete event systems control based on logic inference

The paper illustrates an application of the recently developed method of dealing with controlled automata-based discrete event systems with the help of logical inference. The method based on the calculus of positively constructed formulas is extended on the case of systems built out of sets of modules. Specifications restricting system behavior are also supposed to be modular. Due to the special features of the calculus of positively constructed formulas, it may be applied at the upper level of a robot group control system. The case study of mobile robots pushing a block to a target area is considered.

Pediatric stereo-electroencephalography: effects of robot assistance and other variables on seizure outcome and complications

OBJECTIVE The safety of stereo-electroencephalography (SEEG) has been investigated; however, most studies have not differentiated pediatric and adult populations, which have different anatomy and physiology. The purpose of this study was to assess SEEG safety in the pediatric setting, focusing on surgical complications and the identification of patient and surgical risk factors, if any. The authors also aimed to determine whether robot assistance in SEEG was associated with a change in practice, surgical parameters, and clinical outcomes. METHODS The authors retrospectively studied all SEEG cases performed in their department from December 2014 to March 2020. They analyzed both demographic and surgical variables and noted the types of surgery-related complications and their management. They also studied the clinical outcomes of a subset of the patients in relation to robot-assisted and non–robot-assisted SEEG. RESULTS Sixty-three children had undergone 64 SEEG procedures. Girls were on average 3 years younger than the boys (mean age 11.1 vs 14.1 years, p < 0.01). The overall complication rate was 6.3%, and the complication rate for patients with left-sided electrodes was higher than that for patients with right-sided electrodes (11.1% vs 3.3%), although the difference between the two groups was not statistically significant. The duration of recording was positively correlated to the number of implanted electrodes (r = 0.296, p < 0.05). Robot assistance was associated with a higher number of implanted electrodes (mean 12.6 vs 7.6 electrodes, p < 0.0001). Robot-assisted implantations were more accurate, with a mean error of 1.51 mm at the target compared to 2.98 mm in nonrobot implantations (p < 0.001). Clinical outcomes were assessed in the first 32 patients treated (16 in the nonrobot group and 16 in the robot group), 23 of whom proceeded to further resective surgery. The children who had undergone robot-assisted SEEG had better eventual seizure control following subsequent epilepsy surgery. Of the children who had undergone resective epilepsy surgery, 42% (5/12) in the nonrobot group and 82% (9/11) in the robot group obtained an Engel class IA outcome at 1 year (χ2 = 3.885, p = 0.049). Based on Kaplan-Meier survival analysis, the robot group had a higher seizure-free rate than the nonrobot group at 30 months postoperation (7/11 vs 2/12, p = 0.063). Two complications, whose causes were attributed to the implantation and head-bandaging steps, required surgical intervention. All complications were either transient or reversible. CONCLUSIONS This is the largest single-center, exclusively pediatric SEEG series that includes robot assistance so far. SEEG complications are uncommon and usually transient or treatable. Robot assistance enabled implantation of more electrodes and improved epilepsy surgery outcomes, as compared to those in the non–robot-assisted cases.

Frame-based and robot-assisted insular stereo-electroencephalography via an anterior or posterior oblique approach

OBJECTIVE There is an increasing interest in stereo-electroencephalography (SEEG) for invasive evaluation of insular epilepsy. The implantation of insular SEEG electrodes, however, is still challenging due to the anatomical location and complex functional segmentation in both an anteroposterior and ventrodorsal (i.e., superoinferior) direction. While the orthogonal approach (OA) is the shortest trajectory to the insula, it might insufficiently cover these networks. In contrast, the anterior approach (AOA) or posterior oblique approach (POA) has the potential for full insular coverage, with fewer electrodes bearing a risk of being more inaccurate due to the longer trajectory. Here, the authors evaluated the implantation accuracy and the detection of epilepsy-related SEEG activity with AOA and POA insular trajectories. METHODS This retrospective study evaluated the accuracy of 220 SEEG electrodes in 27 patients. Twelve patients underwent a stereotactic frame-based procedure (frame group), and 15 patients underwent a frameless robot-assisted surgery (robot group). In total, 55 insular electrodes were implanted using the AOA or POA considering the insular anteroposterior and ventrodorsal functional organization. The entry point error (EPE) and target point error (TPE) were related to the implantation technique (frame vs robot), the length of the trajectory, and the location of the target (insular vs noninsular). Finally, the spatial distribution of epilepsy-related SEEG activity within the insula is described. RESULTS There were no significant differences in EPE (mean 0.9 ± 0.6 for the nonsinsular electrodes and 1.1 ± 0.7 mm for the insular electrodes) and TPE (1.5 ± 0.8 and 1.6 ± 0.9 mm, respectively), although the length of trajectories differed significantly (34.1 ± 10.9 and 70.1 ± 9.0 mm, repsectively). There was a significantly larger EPE in the frame group than in the robot group (1.5 ± 0.6 vs 0.7 ± 0.5 mm). However, there was no group difference in the TPE (1.5 ± 0.8 vs 1.6 ± 0.8 mm). Epilepsy-related SEEG activity was detected in 42% (23/55) of the insular electrodes. Spatial distribution of this activity showed a clustering in both anteroposterior and ventrodorsal directions. In purely insular onset cases, subsequent insular lesionectomy resulted in a good seizure outcome. CONCLUSIONS The implantation of insular electrodes via the AOA or POA is safe and efficient for SEEG implantation covering both anteroposterior and ventrodorsal functional organization with few electrodes. In this series, there was no decrease in accuracy due to the longer trajectory of insular SEEG electrodes in comparison with noninsular SEEG electrodes. The results of frame-based and robot-assisted implantations were comparable.

No beneficial effect on survival but with a decreased postoperative adverse events for robotic surgery in patients with rectal cancer: A retrospective cohort study

Aim To compare the oncologic outcomes in patients with rectal cancer receiving robotic vs. laparoscopic surgery. Methods The clinical data of patients with rectal cancer receiving robotic surgery (Robot group, n = 317) or laparoscopic surgery (Laparoscopy group, n = 224) were collected for outcomes assessment. The primary endpoints were the survival outcome. The secondary outcomes were postoperative adverse events and pathologic characteristics. Results Patients in the Robot group have significantly shorter operation time (163.6 ± 41.1vs.190.6 ± 52.5min), shorter time to 1st gas passing [2(1)vs.3(1)d] and shorter hospital day [7(2)vs.8(3)d], compared to those in Laparoscopy group (P < 0.001, respectively). The incidence of urinary retention short- and long term in Robot group is significant lower than in Laparoscopy group (1.9% vs. 10.7%; 0.6% vs. 4.0%, P < 0.05, respectively). TNM stage II and III was more frequently observed in the Robot group than that in the Laparoscopy group (94.3% vs. 83.5%), whereas stage I was more common in the Laparoscopy group than in the Robot group (5.7% vs. 16.5%). No significant difference in the overall survival (OS) and disease-free survival (DFS) were observed in Robot group and Laparoscopy group at 1-, 3- and 5-year. By a multivariable-adjusted analysis, the robotic surgery was not an independent prognostic factor for OS and DFS. Conclusions A beneficial effect on survival of the robotic surgery for rectal cancer could not be demonstrated. However, the robot is a feasible surgical procedure due to the decreased postoperative adverse event.

The influence of 5-iron clubhead mass distribution on clubhead presentation and initial ball launch conditions: Part I: Golf robot tests

It is well accepted that iron clubhead properties affect shot outcomes in golf. However, the mechanisms that contribute to this relationship have not received recent scientific study. The purpose of this study was to determine how the different clubhead mass distributions in a blade 5-iron and a cavity-back 5-iron affect clubhead presentation and ball launch conditions. Nine clubhead presentation variables and four ball launch variables were measured for ten discrete impact locations and five face angles during swings using a golf robot. Group means were analysed statistically using an independent samples approach to identify differences and linear regression was used to indicate relationships between key launch variables. The cavity-back showed higher effective clubhead loft with greater total ball spin than the blade, despite having matched static lofts, whilst also providing more consistent launch outcomes across a range of impact locations. Evidence of the phenomenon known as the ‘gear effect’ was found for the cavity-back, but not the blade, suggesting that the threshold at which the clubhead’s centre of gravity (CG) is deep enough to detect the gear effect lies between the CGs of the two 5-iron types. These novel robot test findings lend support to the perceived performance benefits of perimeter-weighted irons; whether these effects translate to human golfer swings is reported in Part II of this paper.