"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Monday, September 26, 2016

H2020 surgical robot projects - EndoVESPA

 "The EndoVESPA project (Endoscopic Versatile robotic guidancE, diagnoSis and theraPy of magnetic-driven soft-tethered endoluminAl robots) aims at developing an integrated robotic platform for the navigation of a soft-tethered colonoscope capable of performing painless diagnosis and treatment. Colorectal cancer is one of the major causes of mortality but survival rate dramatically increase in case of early diagnosis. Current screening colonoscopy is limited due to a variety of factors including invasiveness, patient discomfort, fear of pain, and the need for sedation; these factors consistently limit the pervasiveness of mass screening campaigns. Built around a novel robotic colonoscope and designed to make its use straightforward for the endoscopist and ideal for mass screening, the EndoVESPA system has the potential to introduce in the clinical practice a disruptive new paradigm for painless colonoscopy. EndoVESPA combines a “front-wheel” magnetic–driven approach for active and smooth navigation with diagnostic and therapeutic capabilities for overcoming the limitations of current colonoscopy in terms of patient discomfort, dependence on operator skills, costs and outcomes for the healthcare systems. The acceptance and consolidation of robotics in the medical domain and the ever–growing development of endoscopic–driven technologies are the fundamental building blocks for the realization of the EndoVESPA platform which can take advantage of solid and IPR protected technologies provided by the Project Partners. Aim of the EndoVESPA Project is to bring the system to the market for an extensive clinical use. The EndoVESPA Consortium is a unique blend of internationally recognized European pioneers (in all the involved disciplines), which will guarantee a dramatic leap forward in the current technology through successful implementation in terms of scientific innovation, industrial engineering, certification, market analysis, and ultimately clinical deployment."
The research leading to these results received funding from the European Community's Horizon 2020 Framework Programme Proposal for ICT 24 - 2015: Robotics Item c - Innovation Actions: Technology transfer - Robotics use cases.An international patent on the proposed capsule technology has been already granted and is owned by the project coordinator - Scuola Superiore Sant'Anna: Magnetically guided robotic device for endoscopic procedures. Reference number: WO2012080947.

Source: EndoVESPA

Sunday, September 25, 2016

I-SUR results


Frames from a simulated execution of the suturing task.
Read more about the I-SUR project on their website.

Source: Preda et al. "A Cognitive Robot Control Architecture for Autonomous Execution of Surgical Tasks

Monday, September 19, 2016

Large scale review of robotic surgical outcomes

 
Abstract
"Background  
Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. 
Methods  
MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. 
Results  
We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. 
Conclusions  
Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use."
Source: Surgical Endoscopy

Sunday, September 18, 2016

Flickstop


Prototype dexterous manipulator robot from Goldman et al. deployed through sheath into male urethra bladder model. 
Source: Herrell et al.

Friday, September 16, 2016

Preceyes goes clinical


As we reported earlier, the Preceyes system performed its first successful human trials. The official reports also arrived:
"Robot-assisted surgery have become commonplace over the last decade. However, never before has a robot been used to operate inside the eye for which even higher levels of control and precision are required. The PRECEYES Surgical System enables to execute the most delicate surgical tasks with an unprecedented level of control and precision. The technology promises to improve the safety and performance of existing ocular surgery as well as to enable new treatments, for example high-precision drug delivery.  Preceyes and the team at the University of Oxford’s Nuffield Laboratory of Ophthalmology have worked together to enable this landmark clinical trial. The trial is funded by the NIHR Oxford Biomedical Research Centre with support from Oxford University Hospitals NHS Foundation Trust, which runs the hospital. The clinical trial sponsored by the University of Oxford is assessing the robotic system to perform new gene therapy operations, which are currently under development and require ultra-precise surgery under the fovea. This has resulted in the world first robotic surgery inside the human eye."
"British surgeons have successfully performed the world’s first robotic operation inside the eye, potentially revolutionising the way such conditions are treated.
The procedure was carried out at John Radcliffe hospital in Oxford, where surgeons welcomed its success.
On completing the operation, Professor Robert MacLaren said: “There is no doubt in my mind that we have just witnessed a vision of eye surgery in the future.
“Current technology with laser scanners and microscopes allows us to monitor retinal diseases at the microscopic level, but the things we see are beyond the physiological limit of what the human hand can operate on.
“With a robotic system, we open up a whole new chapter of eye operations that currently cannot be performed.”


The procedure was necessary because the patient had a membrane growing on the surface of his retina, which had contracted and pulled it into an uneven shape. The membrane is about 100th of a millimetre thick and needed to be dissected off the retina without damaging it.
Surgeons normally attempt this by slowing their pulse and timing movements between heart beats, but the robot could make it much easier. Experts said the robot could enable new, high-precision procedures that are beyond the abilities of the human hand.
The surgeons used a joystick and touchscreen outside the eye to control the robot while monitoring its progress through the operating microscope. This gave medics a notable advantage as significant movements of the joystick resulted in tiny movements of the robot.
This is the first time a device has been available that achieves the three-dimensional precision required to operate inside the human eye.
Speaking at his follow-up visit at the Oxford eye hospital, Father Beaver said: “My sight is coming back.
“I am delighted that my surgery went so well and I feel honoured to be part of this pioneering research project.”
MacLaren said: “This will help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision.”
The robotic eye surgery trial involves 12 patients undergoing operations with increasing complexity. In the first part of the trial, the robot is used to peel membranes off the delicate retina without damaging it.
If this part is successful, as has been the case so far, the second phase of the trial will assess how the robot can place a fine needle under the retina and inject fluid through it.
Experts said this could lead to use of the robot in retinal gene therapy, a new treatment for blindness which is currently being trialled in a number of centres around the world."



Source: LinkedIn, Oxford University, Guardian, Surgical Prod Mag, BBC, RT