Abstrakt Ostatní Září 2010

“The Electric Kool-Aid Acid Test: An allegory of surgical progress.”

Herati, A. S., M. A. Atalla, et al. (2010).

BJU International 106(6 PART B): 887-891.




“Current status and perspectives of endoscopic surgery.”

Inomata, M., S. Kitano, et al. (2010).

Nippon rinsho. Japanese journal of clinical medicine 68(7): 1232-1238.


In these twenty years, an endoscopic surgery has been widely applied to the patients as the treatment of benign and malignant diseases in the various fields, such as digestive surgery, respiratory surgery, endocrine surgery, urological surgery, and gynecological surgery. It has been generally accepted that the endoscopic surgery is less invasive and more beneficial compared with the conventional surgery in retrospective multicenter studies. In near future, with rapid advances of instruments and techniques, the establishments of EBM by prospective clinical trials, further education and training systems, and technical overcome in NOTES, SPS, and robotics, would be needed to be more widely accepted for the endoscopic surgery as extremely less invasive therapy.




“Psychological and physical stress in surgeons operating in a standard or modern operating room.”

Klein, M., L. P. H. Andersen, et al. (2010).

Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 20(4): 237-242.


Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect psychological and physiological stress in experienced laparoscopic surgeons. Methods: This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery. Results: Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two of these parameters reached statistical significance. We did not find any significant differences in the subjective parameters of surgeon satisfaction or the measured heart rate variability parameters. Conclusions: Physical strain on the surgeon was reduced when performing laparoscopic cholecystectomy in a modern OR compared with a standard room. Copyright © 2010 by Lippincott Williams & Wilkins.




“Comparison of two- and three-dimensional camera systems in laparoscopic performance: A novel 3D system with one camera.”

Kong, S. H., B. M. Oh, et al. (2010).

Surgical Endoscopy and Other Interventional Techniques 24(5): 1131-1143.


Background This study evaluated the effects of a threedimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. Methods In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. Results The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. Conclusion The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery. © Springer Science+Business Media, LLC 2009.




“Comparison of urologist reimbursement for managing patients with low-risk prostate cancer by active surveillance versus total prostatectomy.”

Manoharan, M., A. Eldefrawy, et al. (2010).

Prostate Cancer Prostatic Dis.


Active surveillance (AS) is an alternative to total prostatectomy (TP) in managing low-risk prostate cancer (PC). Our aim is to compare urologist reimbursement for managing low-risk PC by AS or TP. The urologist’s reimbursement for TP includes the fee for the procedure and follow-up visits. For AS, our protocol involves digital rectal examination (DRE) and PSA testing every 3 months for first 2 years and every 6 months thereafter. Transrectal ultrasound (TRUS)-guided biopsies are performed yearly. Some urologists recommend spacing the biopsies by 1-3 years. Medicare reimbursement values were used. The urologist reimbursements for a follow-up visit, prostate biopsy, open TP and robotic TP are $72, $595, $1905 and $2939, respectively. We also corrected for a 15% chance of having TP after being on AS. The cumulative reimbursements from open TP and following the patient up to 10 years are approximately $2121 (1 year), $2265 (2 years), $2697 (5 years) and $3057 (10 years). For robotic TP, the urologist reimbursements are $3155 (1 year), $3259 (2 years), $3731 (5 years) and $4091 (10 years). For AS, the urologist reimbursements are $883 (1 year), $1766 (2 years), $4269 (5 years) and $7964 (10 years). The urologist reimbursement from AS and TP become nearly equal between 3 and 4 years follow-up, subsequently AS attains higher reimbursement.Prostate Cancer and Prostatic Diseases advance online publication, 14 September 2010; doi:10.1038/pcan.2010.34.




“Ethics and eHealth: Reflections for a safe practice.”

Rezende, E. J. C., M. Do Carmo Barros De Melo, et al. (2010).

Ética e telessaúde: reflexões para uma prática segura 28(1): 58-65.


The term eHealth (or telemedicine, telehealth) has been used to describe activities that employ information and telecommunication technologies to deliver health care. Distance is an important factor hindering the delivery of many important services, such as diagnosis, treatment, prevention, health pro-motion, and health research assessment. Although eHealth can provide interesting solutions such as a second specialist opinion in geographically isolated areas, a large number of ethical and legal issues must be considered. It is essential to discuss, among others, aspects relating to safety and confidentiality; professional accountability; technical standards relating to digital recording, storage, and transmission of clinical data; copyright; authorization from professional regulatory bodies; and licensing for the remote practice of medicine. In Brazil, the Federal Council of Medicine has already established rules for telemedicine; however, it is still necessary to further this discussion to involve the entire health care sector. Since there are many eHealth projects being developed in Brazil, there is an urgent need to design protocols and training programs for all professionals involved.



“Laparoscopic training in urology: critical analysis of current evidence.”

Autorino, R., G. P. Haber, et al. (2010).

Journal of Endourology 24(9): 1377-1390.


AIM: To provide an evidence-based analysis on the status and perspectives of laparoscopic training in urologic surgery. METHODS: A thorough review of the current literature was performed as of January 31, 2009, using the Medline database through a PubMed search. The search protocol included a free-text query using the following terms: “training,” “urologic laparoscopy,” “urology,” and “laparoscopy.” Suitable articles were selected on the basis of the study content. The following issues were addressed: prediction of laparoscopic skills and transfer of training in clinical practice; homemade and commercially available laparoscopic trainers and simulators; training models for specific laparoscopic procedures; mentored training programs; formal training programs; and the impact of robotics in laparoscopic training. RESULTS: Currently available tools predicting laparoscopic skills lack adequate validation to justify their widespread adoption. There still is not enough evidence to show definite transfer of skills from currently available simulators to the operating theater. Learning opportunities continue to evolve. Specific models have been developed for complex procedures. Various informal training programs exist, yet most urologists will not be able to complete a formal fellowship. Postgraduate urologists may possibly be more rapidly and efficiently trained using a structured mentoring program. Robotics is likely to have an increasing role in teaching urological laparoscopy. CONCLUSIONS: Despite progress in recent years and an extensive amount of data from the urological literature, the ideal training program in urological laparoscopy remains a goal to be determined objectively.




“A method for addressing research gaps in HTA, developed whilst evaluating robotic-assisted surgery: a proposal.”

Ballini, L., S. Minozzi, et al. (2010).

Health Res Policy Syst 8(1): 27.


ABSTRACT: BACKGROUND: When evaluating health technologies with insufficient scientific evidence, only innovative potentials can be assessed. A Regional policy initiative linking the governance of health innovations to the development of clinical research has been launched by the Region of Emilia Romagna Healthcare Authority. This program, aimed at enhancing the research capacity of health organizations, encourages the development of adoption plans that combine use in clinical practice along with experimental use producing better knowledge. Following the launch of this program we developed and propose a method that, by evaluating and ranking scientific uncertainty, identifies the moment (during the stages of the technology’s development ) where it would be sensible to invest in research resources and capacity to further its evaluation. The method was developed and tested during a research project evaluating robotic surgery. METHODS: A multidisciplinary panel carried out a 5-step evaluation process: 1) Definition of the technology’s evidence profile and of all relevant clinical outcomes; 2) systematic review of scientific literature and outlines of the uncertainty profile differentiating research results into steady, plausible, uncertain and unknown results; 3) definition of the acceptable level of uncertainty for investing research resources; 4) analysis of local context; 5) identification of clinical indications with promising clinical return. RESULTS: Outputs for each step of the evaluation process are: 1) evidence profile of the technology and systematic review; 2) uncertainty profile for each clinical indication; 3) exclusion of clinical indications not fulfilling the criteria of maximum acceptable risk; 4) mapping of local context; 5) recommendations for research. Outputs of the evaluation process for robotic surgery are described in the paper. CONCLUSIONS: This method attempts to rank levels of uncertainty in order to distinguish promising from hazardous clinical use and to outline a research course of action. Decision makers wishing to tie coverage policies to the development of scientific evidence could find this method a useful aid to the governance of innovations.




“New technology and health care costs – The case of robot-assisted surgery.”

Barbash, G. I. and S. A. Glied (2010).

New England Journal of Medicine 363(8): 701-704.




“Accuracy and speed trade-off in robot-assisted surgery.”

Chien, J. H., M. M. Tiwari, et al. (2010).

Int J Med Robot 6(3): 324-329.


BACKGROUND: Controlling surgical task speed and maintaining accuracy are vital components of robotic surgical skills. This study was designed to investigate the relationship between accuracy and speed for robot-assisted surgical skills. METHODS: Ten participants were asked to alternately touch two circular targets with various dimensions and distances between two targets, using the da Vinci Surgical System. The design of this study was based on Fitt’s law. Statistical correlations between the index of difficulty (ID) and the movement time (MT), as well as the ID and the smoothness of the movement, were analysed. RESULTS: A significant linear correlation between MT and ID was shown. Speed was reduced to maintain accuracy as the level of task difficulty increased. There was no significant correlation between the smoothness of the movement and ID. CONCLUSIONS: The trade-off between speed and accuracy plays an important role in robot-assisted surgical proficiency.




“Efficiency, risks, and advantages of using robotic support systems in interventional medicine.”

Feußner, H., S. Can, et al. (2010).

Leistungsfähigkeit, risiken und vorteile des einsatzes der robotik in medizinisch-operativen disziplinen 53(8): 831-838.


During the past decade, robotic systems were evaluated for the first time in practically all surgical disciplines. With only a few exceptions (radical prostatectomy), mechatronic systems did not achieve a breakthrough in any field of application. Second generation robotic devices with better integration of complementary technologies (preoperative therapy planning, intraoperative diagnostic work-up, navigation, etc.) and augmented functionality are now ready to be introduced into clinical practice. It is hoped that the specific advantages of robotics will result in increased use compared to previous systems. Robotics is a key technology if new surgical strategies (“scarless surgery”) are to succeed. © 2010 Springer Medizin Verlag.




“A comprehensive method to train residents in robotic hysterectomy techniques.”

Finan, M. A., S. Silver, et al. (2010).

Journal of Robotic Surgery 4(3): 183-190.


Training residents to perform robotic surgery poses several challenges. We describe a comprehensive method, beginning with a dry lab, and progressing through bedside assisting, then segmental involvement, to full participation, for residents to train and obtain credentials in robotic hysterectomy. From August 1, 2006 through July 31, 2009 a training method was developed at the University of South Alabama on the Gynecologic Oncology service. A dry lab which closely simulates specific tasks performed in a robotic hysterectomy was accompanied by resident observation of robotic surgery, and followed with progressive involvement in the robotic console. This culminated in their completion of dozens of complete robotic hysterectomies. Sixteen residents completed the dry lab and 228 robotic cases were performed, 190 of which were hysterectomy; 161/190 (84.7%) included resident participation, 103/190 (54.2%) included resident participation in the console, and in 65/190 (34.2%) residents completed the hysterectomy procedure. The mean time for resident robotic hysterectomy was 45.08 min (range = 13-92 min), and the mean time to tie a single figure-of-eight suture in the vaginal cuff was 4.41 min (range = 2.25-9.25). Complications were similar for resident and attending surgeon cases. Using a dry lab as well as graded introduction to robotic surgery which begins with observation, progresses through bedside assisting, and culminates in complete hysterectomy by residents, we have demonstrated a method to train and credential Ob/Gyn residents in robotic hysterectomy © 2010 Springer-Verlag London Ltd.




“Robotic surgery or master-slave device?”

Galatà, G. and M. Hannan (2010).

Surgical Endoscopy: 1-2.




“Indian healthcare sector needs more robots.”

Hiremath, M. B., R. B. Nerli, et al. (2010).

Current Science 98(12): 1553.




“History of robotic surgery.”

Kalan, S., S. Chauhan, et al. (2010).

Journal of Robotic Surgery 4(3): 141-147.


Robotic surgery is one of the most advanced forms of Minimally Invasive Surgery. Although the application of robotic technology to surgical robotics started some 20 years ago, the earliest work in robotics and automation can be traced back to 400 BC. Some of the early pioneers include Archytas of Arentum, Leonardo da Vinci, Gianello Toriano, and Pierre Jaquet-Droz, and we owe to these philosophers and scientists the fact that we can offer the benefit of minimal invasion in surgery. The purpose of this review is to give a brief description of the evolution of robotic surgery from its early history to present-day surgical robotics. © 2010 Springer-Verlag London Ltd.




Kelouwani, S., P. Boucher, et al. (2010).

Architecture for human-robot collaborative navigation.


Various situations of mobile platform navigation controls require a collaboration between a human agent and autonomous navigation modules. This work presents a new approach for collaborative control between such two agents, based upon a three-layer architecture. An arbitration scheme is proposed in the deliberative layer as well as a collaborative planning method for trajectory following based upon optimal control theory in the sequencer layer. The collaborative control signal in the execution layer is a weighted summation of each agent control signal. This collaborative architecture could be used for the shared control of vehicles such as motorized wheelchairs. Experimental results illustrate the efficiency of the proposed control architecture.




“Robotic Instrument Insulation Failure: Initial Report of a Potential Source of Patient Injury.”

Mues, A. C., G. N. Box, et al. (2010).



OBJECTIVES: Currently, there is no data in the literature regarding the failure rate of robotic instruments or their accessory components. We report our experience with failures in the accessory tip covers that insulate the monopolar robotic cautery scissor instruments and the patient injuries that have resulted. METHODS: All robotic surgeries performed at our institution were recorded from July 2008 to January 2009. Instrument tip cover failures were recorded at the time of failure regardless of whether a patient complication occurred. Failure was identified by the arching of the electrical current from the insulated portion of the monopolar scissors or by an intraoperative injury. RESULTS: Four-hundred fifty-four robotic procedures were recorded. A total of 12 accessory tip cover failures were discovered, demonstrating a failure rate of 2.6%, with a patient complication rate of 0.6% (25% of all failures). CONCLUSIONS: Failure in robotic accessory tip covers can lead to patient complications. The cause for failure can be attributed to a variety of electrical and mechanical causes. All centers and surgeons performing robotic surgery should be aware of the potential for this problem to occur, and the possible interventions that may reduce tip cover failure.




“Why I do not have a robot.”

Sethia, K. (2010).

Annals of the Royal College of Surgeons of England 92(1): 7-8.




“The Effect of Music on Robot-Assisted Laparoscopic Surgical Performance.”

Siu, K. C., I. H. Suh, et al. (2010).

Surgical Innovation.


Music is often played in the operating room to increase the surgeon’s concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations (P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.




“Overcoming extreme obesity with robotic surgery.”

Stone, P., A. Burnett, et al. (2010).

Int J Med Robot.


BACKGROUND: Obesity is often associated with endometrial cancer and has posed a challenge in surgical management. Complications such as wound breakdown, respiratory challenges, cardiac complications and difficult intubations are associated with obesity. For the patient with uterine cancer, surgery is necessary for staging, control of symptoms and cure. With the advent of the da Vinci() intuitive robot, alternative surgical options can now be offered to these patients. While surgery is the principal modality for the treatment and management of uterine cancer, the morbidly obese patient faces increased complications and longer postoperative recovery. As studied in the LAP2, comparable outcomes have been noted in laparotomy vs laparoscopic surgery. Recently, minimally invasive surgery has been refined with the advent of the da Vinci robotic system. Applying a minimally invasive technique further enhanced with the da Vinci robotic system, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed on a patient with a BMI of 98. METHODS: A 35 year-old G0 woman with a BMI of 98 presented with heavy vaginal bleeding and anaemia. She was diagnosed with endometrioid adenocarcinoma of the uterus, FIGO grade 1. She was treated with a robotically assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. RESULTS: Her postoperative course was uncomplicated and she was discharged home on post-operative day 1. CONCLUSIONS: Since obesity is a significant risk factor for endometrial cancer and the prevalence of obesity is increasing, developing surgical techniques to appropriately manage these patients is important. Minimally invasive surgery, specifically with robotic assistance, has increased the possibilities of performing minimally invasive surgery in morbidly obese women. It allows navigation around anatomical barriers and decreases the fatigue experienced by the surgeons. With the increasing obesity of our population and the high prevalence of uterine cancer, further advancement of equipment, anaesthesia and surgical techniques to accommodate the larger patient while decreasing complications have yet to be standardized. Copyright (c) 2010 John Wiley & Sons, Ltd.




“Comparative Analysis of Global Practice Patterns in Urologic Robot-Assisted Surgery.”

Yuh, B. E., A. Hussain, et al. (2010).

Journal of Endourology.


Abstract Objectives: To determine and compare the status of urologic laparoscopic and robot-assisted surgery (RAS) across the world. Methods: Two hundred ninety-one surveys were completed by urologists at various national and international conferences in 2008. The 58-item questionnaire assessed the individual and institutional practice patterns of minimally invasive surgery with a focus on RAS. Surveys from Europe and North American continents (ENA) were compared with surveys from the Middle East and Asian continents (MEA). Results: One hundred sixty-six (57%) surveys were completed by urologists from MEA and 125 (43%) from ENA. Eighty percent of respondents performed minimally invasive surgery, with 64% having prior formal training. Respondents in ENA were more likely to have had formal training in RAS and performed more RAS cases (p < 0.01). Sixty percent of those surveyed from ENA had used robotic consoles in training courses compared with only 20% in MEA (p < 0.01). Dedicated RAS support teams were less common in MEA (p < 0.01). Lack of a robotic system was the most common deterrent for RAS in MEA (56%). Respondents in ENA performed more robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy. In the more established robotic environment of ENA, robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy represented the gold standard in 34%, 14%, and 26% of surveys, respectively. Comparatively, MEA respondents were more likely to believe RAS represented the gold standard. Conclusions: Usage of RAS in urology continues to grow across the globe, though to most it represents a surgical alternative rather than benchmark. Even with reduced exposure, training, and access, more urologists in the MEA considered RAS to be the surgical standard for prostatectomy, cystectomy, and nephrectomy. The evolution of attitudinal change should be the focus of further study.



“Clinical applications of robotic technology in vascular and endovascular surgery.”

Antoniou, G. A., C. V. Riga, et al. (2010).

Journal of Vascular Surgery.


Background: Emerging robotic technologies are increasingly being used by surgical disciplines to facilitate and improve performance of minimally invasive surgery. Robot-assisted intervention has recently been introduced into the field of vascular surgery to potentially enhance laparoscopic vascular and endovascular capabilities. The objective of this study was to review the current status of clinical robotic applications in vascular surgery. Methods: A systematic literature search was performed in order to identify all published clinical studies related to robotic implementation in vascular intervention. Web-based search engines were searched using the keywords “surgical robotics,” “robotic surgery,” “robotics,” “computer assisted surgery,” and “vascular surgery” or “endovascular” for articles published between January 1990 and November 2009. An evaluation and critical overview of these studies is reported. In addition, an analysis and discussion of supporting evidence for robotic computer-enhanced telemanipulation systems in relation to their applications in laparoscopic vascular and endovascular surgery was undertaken. Results: Seventeen articles reporting on clinical applications of robotics in laparoscopic vascular and endovascular surgery were detected. They were either case reports or retrospective patient series and prospective studies reporting laparoscopic vascular and endovascular treatments for patients using robotic technology. Minimal comparative clinical evidence to evaluate the advantages of robot-assisted vascular procedures was identified. Robot-assisted laparoscopic aortic procedures have been reported by several studies with satisfactory results. Furthermore, the use of robotic technology as a sole modality for abdominal aortic aneurysm repair and expansion of its applications to splenic and renal artery aneurysm reconstruction have been described. Robotically steerable endovascular catheter systems have potential advantages over conventional catheterization systems. Promising results from applications in cardiac interventions and preclinical studies have urged their use in vascular surgery. Although successful applications in endovascular repair of abdominal aortic aneurysm and lower extremity arterial disease have been reported, published clinical experience with the endovascular robot is limited. Conclusions: Robotic technology may enhance vascular surgical techniques given preclinical evidence and early clinical reports. Further clinical studies are required to quantify its advantages over conventional treatments and define its role in vascular and endovascular surgery. Crown Copyright © 2010.