Best Practices in Robot-assisted Radical Cystectomy and Urinary Reconstruction: Recommendations of the Pasadena Consensus Panel

CONTEXT Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. OBJECTIVE A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. EVIDENCE ACQUISITION A systematic review of the literature was performed in agreement with the PRISMA statement. EVIDENCE SYNTHESIS Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. CONCLUSIONS RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. PATIENT SUMMARY Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

CONTEXT Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed. OBJECTIVE To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted. EVIDENCE SYNTHESIS The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. CONCLUSIONS Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC. PATIENT SUMMARY Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable.

An image-guided robot system for direct cochlear access

The aim of direct cochlear access (DCA) is to replace the standard mastoidectomy with a small diameter tunnel from the lateral bone surface to the cochlea for electrode array insertion. In contrast to previous attempts, the approach described in this work not only achieves an unprecedented high accuracy, but also contains several safety sub-systems. This paper provides a brief description of the system components, and summarizes accuracy results using the system in a cadaver model over the past two years.

Manual Electrode Array Insertion Through a Robot-assisted Minimal Invasive Cochleostomy: Feasibility and Comparison of Two Different Electrode Array Subtypes.

HYPOTHESIS To evaluate the feasibility and the results of insertion of two types of electrode arrays in a robotically assisted surgical approach. BACKGROUND Recent publications demonstrated that robot-assisted surgery allows the implantation of free-fitting electrode arrays through a cochleostomy drilled via a narrow bony tunnel (DCA). We investigated if electrode arrays from different manufacturers could be used with this approach. METHODS Cone-beam CT imaging was performed on fivecadaveric heads after placement of fiducial screws. Relevant anatomical structures were segmented and the DCA trajectory, including the position of the cochleostomy, was defined to target the center of the scala tympani while reducing the risk of lesions to the facial nerve. Med-El Flex 28 and Cochlear CI422 electrodes were implanted on both sides, and their position was verified by cone-beam CT. Finally, temporal bones were dissected to assess the occurrence of damage to anatomical structures during DCA drilling. RESULTS The cochleostomy site was directed in the scala tympani in 9 of 10 cases. The insertion of electrode arrays was successful in 19 of 20 attempts. No facial nerve damage was observed. The average difference between the planned and the postoperative trajectory was 0.17 ± 0.19 mm at the level of the facial nerve. The average depth of insertion was 305.5 ± 55.2 and 243 ± 32.1 degrees with Med-El and Cochlear arrays, respectively. CONCLUSIONS Robot-assisted surgery is a reliable tool to allow cochlear implantation through a cochleostomy. Technical solutions must be developed to improve the electrode array insertion using this approach.

Außerordentliches Extrablatt: Die erste goldene Frucht des Reichstages! Kein Robot! Kein Zehnt mehr! Die Stunde der Befreiung hat geschlagen, das schreckliche Wort "Unterthan" ist aus der deutschen Sprache verschwunden ...

Welsch (Projektbearbeiter): Vollendung der Bauernbefreiung, nachdem die Leibeigenschaft bereits 1781/82 unter Kaiser Joseph II. aufgehoben wurde: Bekanntgabe der Aufhebung der obrigkeitlichen Gewalt der Grundherren (ohne Entgelt) sowie der Aufhebung der Dienste und Abgaben (gegen Entschädigung). (Einstimmiger Beschluß des österreichischen Reichstages nach dem diesbezüglichen Antrag des Abgeordneten Hans Kudlich vom 26. Juli 1848)

Der Bauer ist frei: Kein Zehent, keine Robot mehr, beschlossen und mit allgemeine [sic!] Stimmenmehrheit angenommen durch die hohe Reichsversammlung, am 30. und 31. August 1848: Heute endlich gelangte der hohe Reichstag dahin, über des Abgeordneten Lasser's Antrag abzustimmen ...

Welsch (Projektbearbeiter): Der Kudlichsche Antrag auf Bauernbefreiung (26. Juli 1848) wird mit einigen Modifikationen (Abgeordneter Lasser) vom österreichischen Reichstag angenommen. Nebst Abdruck von Redebeiträgen aus den Vordebatten

Die letzte Robot: Die Bauern: "Der Wagen ist schwer, aber wir wollen hoffen ..."

Welsch (Projektbearbeiter): Satirische Kommentierung der Amendements zum Kudlichschen Antrag über die Aufhebung der bäuerlichen Untertänigkeit, die Entschädigungsfrage betreffend

Des Kaisers Gespräch in Schönbrunn mit dem Bauer Nikolaus B... aus G... : der ihm über das gewordene Geschenk der Robot- und der Zehent-Aufhebung dankend zu den Füßen fallen wollte

P. Pichler

On the allowance for support costs in Prager-Rozvany’ optimal layout theory

A recent study by Rozvany and Sokól discussed an important topic in structural design: the allowance for support costs in the optimization process. This paper examines a frequently used kind of support —that of simple foundation with horizontal reaction by friction— that appears no covered for the Authors’ approach. A simple example is examined to illustrate the case and to apply the Authors’ method and the standard design method.

A waypoint-based mission planner for a farmland coverage with an aerial robot - a precision farming tool

Remote sensing (RS) with aerial robots is becoming more usual in every day time in Precision Agriculture (PA) practices, do to their advantages over conventional methods. Usually, available commercial platforms providing off-the-shelf waypoint navigation are adopted to perform visual surveys over crop fields, with the purpose to acquire specific image samples. The way in which a waypoint list is computed and dispatched to the aerial robot when mapping non empty agricultural workspaces has not been yet discussed. In this paper we propose an offline mission planner approach that computes an efficient coverage path subject to some constraints by decomposing the environment approximately into cells. Therefore, the aim of this work is contributing with a feasible waypoints-based tool to support PA practices

Visual Servoing for the Robotenis System: a Strategy for a 3 DOF Parallel Robot to Hit a Ping-Pong Ball

This article describes a new visual servo control and strategies that are used to carry out dynamic tasks by the Robotenis platform. This platform is basically a parallel robot that is equipped with an acquisition and processing system of visual information, its main feature is that it has a completely open architecture control, and planned in order to design, implement, test and compare control strategies and algorithms (visual and actuated joint controllers). Following sections describe a new visual control strategy specially designed to track and intercept objects in 3D space. The results are compared with a controller shown in previous woks, where the end effector of the robot keeps a constant distance from the tracked object. In this work, the controller is specially designed in order to allow changes in the tracking reference. Changes in the tracking reference can be used to grip an object that is under movement, or as in this case, hitting a hanging Ping-Pong ball. Lyapunov stability is taken into account in the controller design.

A method for Kinematic Calibration of a Parallel Robot by using one camera in hand and a spherical object

The main purpose of robot calibration is the correction of the possible errors in the robot parameters. This paper presents a method for a kinematic calibration of a parallel robot that is equipped with one camera in hand. In order to preserve the mechanical configuration of the robot, the camera is utilized to acquire incremental positions of the end effector from a spherical object that is fixed in the word reference frame. The positions of the end effector are related to incremental positions of resolvers of the motors of the robot, and a kinematic model of the robot is used to find a new group of parameters which minimizes errors in the kinematic equations. Additionally, properties of the spherical object and intrinsic camera parameters are utilized to model the projection of the object in the image and improving spatial measurements. Finally, the robotic system is designed to carry out tracking tasks and the calibration of the robot is validated by means of integrating the errors of the visual controller.

Analysis and 2D Simulation of a Hexapod Robot Leg for Remote Exploration

A walking machine is a wheeled rover alternative, well suited for work in an unstructured environment and specially in abrupt terrain. They have some drawback like speed and power consumption, but they can achieve complex movements and protrude very little the environment they are working on. The locomotion system is determined by the terrain conditions and, in our case, this legged design has been chosen based in a working area like Rio Tinto in the South of Spain, which is a river area with abrupt terrain. A walking robot with so many degrees of freedom can be a challenge when dealing with the analysis and simulations of the legs. This paper shows how to deal with the kinematical analysis of the equations of a hexapod robot based on a design developed by the Center of Astrobiology INTA-CSIC following the classical formulation of equations

Using the Own Flexibility of a Climbing Robot as a Double Force Sensor

Force sensors are used when interaction tasks are carried out by robots in general, and by climbing robots in particular. If the mechanics and electronics systems are contained inside the own robot, the robot becomes portable without external control. Commercial force sensors cannot be used due to limited space and weight. By selecting the links material with appropriate stiffness and placing strain gauges on the structure, the own robot flexibility can be used such as force sensor. Thus, forces applied on the robot tip can be measured without additional external devices. Only gauges and small internal electronic converters are necessary. This paper illustrates the proposed algorithm to achieve these measurements. Additionally, experimental results are presented.