Review of robotic technology for keyhole transcranial stereotactic neurosurgery

The research of stereotactic apparatus to guide surgical devices began in 1908, yet a major part of today's stereotactic neurosurgeries still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information, and are, thus, obvious candidates in the guidance of instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and describe a standard stereotactic neurosurgery. Neurosurgeons' expectations and demands regarding the role of robots as assistive tools are also addressed. We list the most successful robotic systems developed specifically for or capable of executing stereotactic neurosurgery. A critical review is presented for each robotic system, emphasizing the differences between them and detailing positive features and drawbacks. An analysis of the listed robotic system features is also undertaken, in the context of robotic application in stereotactic neurosurgery. Finally, we discuss the current perspective, and future directions of a robotic technology in this field. All robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. The trend of technological progress is pointing toward the development of miniaturized cost-effective solutions with more intuitive interfaces.

Implementation of robotic laparoscopic cholecystectomy in a university hospital.

BACKGROUND: Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. METHODS: The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. RESULTS: Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. CONCLUSION: Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed.

Robotic, fluoroscopic or EMG assisted pedicle screw insertion. A CT based comparative study

Introduction: In order to improve safety of pedicle screw placement several techniques have been developed. More recently robotically assisted pedicle insertion has been introduced aiming at increasing accuracy. The aim of this study was to compare this new technique with the two main pedicle insertion techniques in our unit namely fluoroscopically assisted vs EMG aided insertion. Material and methods: A total of 382 screws (78 thoracic,304 lumbar) were introduced in 64 patients (m/f = 1.37, equally distributed between insertion technique groups) by a single experienced spinal surgeon. From those, 64 (10 thoracic, 54 lumbar) were introduced in 11 patients using a miniature robotic device based on pre operative CT images under fluoroscopic control. 142 (4 thoracic, 138 lumbar) screws were introduced using lateral fluoroscopy in 27 patients while 176 (64 thoracic, 112 lumbar) screws in 26 patients were inserted using both fluoroscopy and EMG monitoring. There was no difference in the distribution of scoliotic spines between the 3 groups (n = 13). Screw position was assessed by an independent observer on CTs in axial, sagittal and coronal planes using the Rampersaud A to D classification. Data of lumbar and thoracic screws were processed separately as well as data obtained from axial, sagittal and coronal CT planes. Results: Intra- and interobserver reliability of the Rampersaud classification was moderate, (0.35 and 0.45 respectively) being the least good on axial plane. The total number of misplaced screws (C&D grades) was generally low (12 thoracic and 12 lumbar screws). Misplacement rates were same in straight and scoliotic spines. The only difference in misplacement rates was observed on axial and coronal images in the EMG assisted thoracic screw group with a higher proportion of C or D grades (p <0.05) in that group. Recorded compound muscle action potentials (CMAP) values of the inserted screws were 30.4 mA for the robot and 24.9mA for the freehand technique with a CI of 3.8 of the mean difference of 5.5 mA. Discussion: Robotic placement did improve the placement of thoracic screws but not that of lumbar screws possibly because our misplacement rates in general near that of published navigation series. Robotically assisted spine surgery might therefore enhance the safety of screw placement in particular in training settings were different users at various stages of their learning curve are involved in pedicle instrumentation.

Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy.

Bone-mounted robotic guidance for pedicle screw placement has been recently introduced, aiming at increasing accuracy. The aim of this prospective study was to compare this novel approach with the conventional fluoroscopy assisted freehand technique (not the two- or three-dimensional fluoroscopy-based navigation). Two groups were compared: 11 patients, constituting the robotical group, were instrumented with 64 pedicle screws; 23 other patients, constituting the fluoroscopic group, were also instrumented with 64 pedicle screws. Screw position was assessed by two independent observers on postoperative CT-scans using the Rampersaud A to D classification. No neurological complications were noted. Grade A (totally within pedicle margins) accounted for 79% of the screws in the robotically assisted and for 83% of the screws in the fluoroscopic group respectively (p = 0.8). Grade C and D screws, considered as misplacements, accounted for 4.7% of all robotically inserted screws and 7.8% of the fluoroscopically inserted screws (p = 0.71). The current study did not allow to state that robotically assisted screw placement supersedes the conventional fluoroscopy assisted technique, although the literature is more optimistic about the former.

Robotic Gait Training Is not Superior to Conventional Treadmill Training in Parkinson Disease: A Single-Blind Randomized Controlled Trial.

BACKGROUND: The use of robots for gait training in Parkinson disease (PD) is growing, but no evidence points to an advantage over the standard treadmill. METHODS: In this randomized, single-blind controlled trial, participants aged <75 years with early-stage PD (Hoehn-Yahr <3) were randomly allocated to 2 groups: either 30 minutes of gait training on a treadmill or in the Lokomat for 3 d/wk for 4 weeks. Patients were evaluated by a physical therapist blinded to allocation before and at the end of treatment and then at the 3- and 6-month follow-up. The primary outcome measure was the 6-minute walk test. RESULTS: Of 334 screened patients, the authors randomly allocated 30 to receive gait training with treadmill or the Lokomat. At baseline, the 2 groups did not differ. At the 6-month follow-up, both groups had improved significantly in the primary outcome measure (treadmill: mean = 490.95 m, 95% confidence interval [CI] = 448.56-533.34, P = .0006; Lokomat: 458.6 m, 95% CI = 417.23-499.96, P = .01), but no significant differences were found between the 2 groups (P = .53). DISCUSSION: Robotic gait training with the Lokomat is not superior to treadmill training in improving gait performance in patients with PD. Both approaches are safe, with results maintained for up to 6 months.

Applications de la chirurgie robotique transorale dans les tumeurs de la sphère ORL [The role of transoral robotic surgery in head and neck cancer].

Since 2000 and the commercialisation of the Da Vinci robotic system, indications for robotic surgery are rapidly increasing. Recent publications proved superior functional outcomes with equal oncologic safety in comparison to conventional open surgery. Its field of application may extend to the nasopharynx and skull base surgery. The preliminary results are encouraging. This article reviews the current literature on the role of transoral robotic surgery in head and neck cancer.

Robots and robotic systems for the electronics and telecommunication industry

Tämä diplomityö tutkii elektroniikka- ja telekommunikaatioteollisuutta sekä siihen läheisesti liittyviä robotteja ja robottijärjestelmiä. Tavoitteena on määrittää E&T-teollisuuden prosesseihin soveltuvien robottien testausmenetelmä. Tavoitteena on myös selvittää kahden ABB:n robotin soveltuvuutta E&T-teollisuuden tarpeisiin. Muutamia systemaattisia valmistusjärjestelmien suunnitteluun soveltuvia menetelmiä ja apuvälineitä on myös käsitelty. Alussa työ keskittyy elektroniikka- ja telekommunikaatioteollisuuden nykytilan tutkimiseen sekä siellä vallitsevien ja ennustettujen trendien kartoitukseen. Kohdat “Collaborative manufacturing” ja E&T-teollisuuden valmistusjärjestelmille asettamat vaatimukset käydään yksityiskohtaisesti läpi. Tutkimuksen pääkohteina ovat robotit, erityisesti ABB:n IRB 140 ja IRB 340 sekä robottien testausmenetelmän määrittäminen. Työssä käydään läpi IRB 340:llä suoritetut testit, jotka tehtiin sekä konenäköjärjestelmää apuna käyttäen että ilman. Myös TTKK:lla suoritetut robottitestit on käyty läpi. Robottien testituloksia on analysoitu ja vertailtu muihin robotteihin. Testausmenetelmät perustuvat ISO 9283 standardiin. Viimeinen osa työstä esittelee robottijärjestelmien systemaattiseen suunnitteluun soveltuvia menetelmiä ja apuvälineitä. Esillä ovat mm. Modular function deployment (MFD) ja The system design method (SDM).

Robotic-Assisted Surgery Improves the Quality of Total Mesorectal Excision for Rectal Cancer Compared to Laparoscopy: Results of a Case-Controlled Analysis.

BACKGROUND: The use of a robotic surgical system is claimed to allow precise traction and counter-traction, especially in a narrow pelvis. Whether this translates to improvement of the quality of the resected specimen is not yet clear. The aim of the study was to compare the quality of the TME and the short-term oncological outcome between robotic and laparoscopic rectal cancer resections. METHODS: 20 consecutive robotic TME performed in a single institution for rectal cancer (Rob group) were matched 1:2 to 40 laparoscopic resections (Lap group) for gender, body mass index (BMI), and distance from anal verge on rigid proctoscopy. The quality of TME was assessed by 2 blinded and independent pathologists and reported according to international standardized guidelines. RESULTS: Both samples were well matched for gender, BMI (median 25.9 vs. 24.2 kg/m(2), p = 0.24), and level of the tumor (4.1 vs. 4.8 cm, p = 0.20). The quality of the TME was better in the Robotic group (complete TME: 95 vs. 55 %; p = 0.0003, nearly complete TME 5 vs. 37 %; p = 0.04, incomplete TME 0 vs. 8 %, p = 0.09). A trend for lower positive circumferential margin was observed in the Robotic group (10 vs. 25 %, p = 0.1). CONCLUSIONS: These results suggest that robotic-assisted surgery improves the quality of TME for rectal cancer. Whether this translates to better oncological outcome needs to be further investigated.

Tactile-Proprioceptive Robotic Grasping

Robotic grasping has been studied increasingly for a few decades. While progress has been made in this field, robotic hands are still nowhere near the capability of human hands. However, in the past few years, the increase in computational power and the availability of commercial tactile sensors have made it easier to develop techniques that exploit the feedback from the hand itself, the sense of touch. The focus of this thesis lies in the use of this sense. The work described in this thesis focuses on robotic grasping from two different viewpoints: robotic systems and data-driven grasping. The robotic systems viewpoint describes a complete architecture for the act of grasping and, to a lesser extent, more general manipulation. Two central claims that the architecture was designed for are hardware independence and the use of sensors during grasping. These properties enables the use of multiple different robotic platforms within the architecture. Secondly, new data-driven methods are proposed that can be incorporated into the grasping process. The first of these methods is a novel way of learning grasp stability from the tactile and haptic feedback of the hand instead of analytically solving the stability from a set of known contacts between the hand and the object. By learning from the data directly, there is no need to know the properties of the hand, such as kinematics, enabling the method to be utilized with complex hands. The second novel method, probabilistic grasping, combines the fields of tactile exploration and grasp planning. By employing well-known statistical methods and pre-existing knowledge of an object, object properties, such as pose, can be inferred with related uncertainty. This uncertainty is utilized by a grasp planning process which plans for stable grasps under the inferred uncertainty.

Four-arm single docking full robotic surgery for low rectal cancer: technique standardization

The authors present the four-arm single docking full robotic surgery to treat low rectal cancer. The eight main operative steps are: 1- patient positioning; 2- trocars set-up and robot docking; 3- sigmoid colon, left colon and splenic flexure mobilization (lateral-to-medial approach); 4-Inferior mesenteric artery and vein ligation (medial-to-lateral approach); 5- total mesorectum excision and preservation of hypogastric and pelvic autonomic nerves (sacral dissection, lateral dissection, pelvic dissection); 6- division of the rectum using an endo roticulator stapler for the laparoscopic performance of a double-stapled coloanal anastomosis (type I tumor); 7- intersphincteric resection, extraction of the specimen through the anus and lateral-to-end hand sewn coloanal anastomosis (type II tumor); 8- cylindric abdominoperineal resection, with transabdominal section of the levator muscles (type IV tumor). The techniques employed were safe and have presented low rates of complication and no mortality.

Telerobotics: Methodology for the Development of a Through-the-Internet Robotic Teleoperated System

This work presents a methodology for the development of Teleoperated Robotic Systems through the Internet. Initially, it is presented a bibliographical review of the Telerobotic systems that uses Internet as way of control. The methodology is implemented and tested through the development of two systems. The first is a manipulator with two degrees of freedom commanded remotely through the Internet denominated RobWebCam (http://www.graco.unb.br/robwebcam). The second is a system which teleoperates an ABB (Asea Brown Boveri) Industrial Robot of six degrees of freedom denominated RobWebLink (http://webrobot.graco.unb.br). RobWebCam is composed of a manipulator with two degrees of freedom, a video camera, Internet, computers and communication driver between the manipulator and the Unix system; and RobWebLink composed of the same components plus the Industrial Robot. With the use of this technology, it is possible to move far distant positioning objects minimizing transport costs, materials and people; acting in real time in the process that is wanted to be controller. This work demonstrates that the teleoperating via Internet of robotic systems and other equipments is viable, in spite of using rate transmission data with low bandwidth. Possible applications include remote surveillance, control and remote diagnosis and maintenance of machines and equipments.

Variable structure position control of an industrial robotic manipulator

The use of a robust position controller for a robotic manipulator moving in free space is presented. The aim is to implement in practice a controller that is robust to uncertainties in the model of the system, as well as being inexpensive from a computational point of view. Variable structure theory provides the technique for the design of such controller. The design steps are presented, first from a theoretical perspective and then applied to the control of a two degree-of-freedom manipulator. Simulation results that backed the implementation are presented, followed by the experiments conducted and the results that were obtained. The conclusion is that variable structure control is readily applicable to industrial robots for the robust control of positions.

Chassis frame design of a mobile platform equipped with robotic arms

The overall objective of the thesis is to design a robot chassis frame which is a bearing structure of a vehicle supporting all mechanical components and providing structure and stability. Various techniques and scientific principles were used to design a chassis frame.Design principles were applied throughout the process. By using Solid-Works software,virtual models was made for chassis frame. Chassis frame of overall dimension 1597* 800*950 mm3 was designed. Center of mass lieson 1/3 of the length from front wheel at height 338mm in the symmetry plane. Overall weight of the chassis frame is 80.12kg. Manufacturing drawing is also provided. Additionally,structural analysis was done in FEMAP which gives the busting result for chassis design by taking into consideration stress and deflection on different kind of loading resembling real life case. On the basis of simulated result, selected material was verified. Resulting design is expected to perform its intended function without failure. As a suggestion for further research, additional fatigue analysis and proper dynamic analysis can be conducted to make the study more robust.

Optimization-Based Robotic Manipulation for Safe Interaction with Human Operators

This thesis investigates a method for human-robot interaction (HRI) in order to uphold productivity of industrial robots like minimization of the shortest operation time, while ensuring human safety like collision avoidance. For solving such problems an online motion planning approach for robotic manipulators with HRI has been proposed. The approach is based on model predictive control (MPC) with embedded mixed integer programming. The planning strategies of the robotic manipulators mainly considered in the thesis are directly performed in the workspace for easy obstacle representation. The non-convex optimization problem is approximated by a mixed-integer program (MIP). It is further effectively reformulated such that the number of binary variables and the number of feasible integer solutions are drastically decreased. Safety-relevant regions, which are potentially occupied by the human operators, can be generated online by a proposed method based on hidden Markov models. In contrast to previous approaches, which derive predictions based on probability density functions in the form of single points, such as most likely or expected human positions, the proposed method computes safety-relevant subsets of the workspace as a region which is possibly occupied by the human at future instances of time. The method is further enhanced by combining reachability analysis to increase the prediction accuracy. These safety-relevant regions can subsequently serve as safety constraints when the motion is planned by optimization. This way one arrives at motion plans that are safe, i.e. plans that avoid collision with a probability not less than a predefined threshold. The developed methods have been successfully applied to a developed demonstrator, where an industrial robot works in the same space as a human operator. The task of the industrial robot is to drive its end-effector according to a nominal sequence of grippingmotion-releasing operations while no collision with a human arm occurs.