Abstrakt Technologie Leden 2012

“Single-incision laparoscopic staging for endometrial cancer.”

Boruta Ii, D. M., W. B. Growdon, et al. (2011).

Journal of the American College of Surgeons 212(1).




“Single-incision vs straight laparoscopic segmental colectomy: A case-controlled study.”

Champagne, B. J., E. C. Lee, et al. (2011).

Diseases of the Colon and Rectum 54(2): 183-186.


PURPOSE: Single-incision laparoscopic surgery is gaining momentum in general surgery but it is essentially unstudied for laparoscopic colectomy. The aim of our study was to compare outcomes for single-incision laparoscopic colectomy with laparoscopic-assisted colectomy. METHODS: Patients undergoing laparoscopic colectomy were prospectively entered into an institutional review board-approved database. Those that underwent singleincision laparoscopic colectomy were case matched for sex, age, disease, surgery, body mass index, previous surgeries, and surgeon with patients undergoing LAC. RESULTS: Twenty-nine single-incision laparoscopic segmental colectomies were performed for polyps (4), adenocarcinoma (12), diverticulitis (6), and Crohn’s disease (7) and were case matched to laparoscopicassisted colectomy for the same indications. Mean body mass index was 28.8 ± 3 kg/m<sup>2</sup>. Operative time was longer for single-incision laparoscopic colectomy (134.4 ± 40 vs 103.8 ± 54 min; P =.0002). Four singleincision laparoscopic colectomies were converted to LAC requiring either one extra port (2) or 2 extra ports (2), and there was one conversion to laparotomy. Extraction scar length (millimeters) was similar (38 ± 6.0 vs 45 ± 6.2; P =.746). Postoperative morbidity (5/29 vs 7/29; P =.284) and length of stay (day) (3.7 ± 1.1 vs 3.9 ± 1.1; P =.445) were similar between groups. CONCLUSIONS: Single-incision laparoscopic colectomy is feasible and safe but takes more time than laparoscopicassisted colectomy. Although results approximate those for laparoscopic-assisted colectomy, an additional learning curve is involved, and extra incisions are sometimes required. Single-incision laparoscopic colectomy requires further prospective validation so that the cost of the device can be justified by an improved clinical outcome. © The ASCRS 2011.




“Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique.”

Chung, S. D., C. Y. Huang, et al. (2010).

Surgical Innovation 17(4): 361-365.


Objective: To present the initial experience of laparoendoscopic single-site (LESS) nephroureterectomy via the transperitoneal approach using the Alexis wound retractor and bladder cuff resection by endoloop. Methods: Two patients received LESS nephroureterectomies and bladder cuffs resection with homemade single ports, which were created by using an Alexis wound retractor as an access platform through a 4-cm incision. Distal ureters were resected through the same incision with endoloop. No additional ports were used and both procedures were completed successfully. Results: Both LESS procedures were completed successfully without traditional laparoscopic conversion or complication. LESS nephreoureterectomy with bladder cuff excision was performed in 165 and 325 minutes with estimated blood loss of 30 and 65 mL, respectively. Patients were discharged on postoperative days 3 and 7, respectively. Conclusions: The initial results demonstrated that LESS technique of nephroureterectomy and bladder cuff resection with endoloop is a safe and feasible procedure for urothelial carcinoma of upper urinary tract. © The Author(s) 2010.




“Minimally invasive single-site surgery for the digestive system: A technological review.”

Dhumane, P. W., M. Diana, et al. (2011).

Journal of Minimal Access Surgery 7(1): 40-51.


Minimally Invasive Single Site (MISS) surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the “Ultimate form of Minimally Invasive Surgery” will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.




“Minimal invasive single-site surgery in colorectal procedures: Current state of the art.”

Diana, M., P. Dhumane, et al. (2011).

Journal of Minimal Access Surgery 7(1): 52-60.


Background: Minimally invasive single-site (MISS) surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. Methods: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were “Single Port” or “Single-Incision” or “LaparoEndoscopic Single Site” or “SILSTM” and “Colon” or “Colorectal” and “Surgery”. Results: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%). Two “fully laparoscopic” MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. Conclusions: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.




“Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology.”

Escobar, P. F., M. Kebria, et al. (2010).

Gynecologic Oncology.


Objectives: The purpose of this protocol was to evaluate the feasibility and reproducibility of a dedicated da Vinci® single-port robotic platform in cadavers for the performance of various gynecologic oncology procedures. Methods: Three fresh frozen female cadavers were used to evaluate the feasibility, reproducibility, and to develop the correct docking of the robotic column and trocars. Procedures performed in this training protocol included (hysterectomy, bilateral salpingo-oophorectomy, modified radical hysterectomy, six pelvic lymph node dissections, and one para-aortic node dissection). A data set was collected for each procedure, operative times were compared between cases and procedures by use of Wilcoxon rank sum test, a p-value < 0.05 was considered significant. Results: All the procedures were technically successful with no need of additional ports or conversions to a standard laparoscopy. The median time of port insertion and BMI was 6 min range (4-10) and 33 min range (25-56) respectively. The median time for a left and right pelvic lymph node dissection was 22 min range (22-23) and 28 min range (26-38) respectively. There was significant difference in operating times for symmetrical procedures (pelvic lymphadenectomy), p = 0.049. Conclusion: This preliminary data demonstrates that the performance of various oncology procedures using the new da Vinci® single-site robotic platform is feasible, and more importantly, reproducible in the cadaver model. © 2010 Elsevier Inc. All rights reserved.




“Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery.”

Fader, A. N., K. L. Levinson, et al. (2011).

Journal of Minimal Access Surgery 7(1): 71-77.


Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS) surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.




“Where do we really stand with LESS and NOTES?”

Gettman, M. T., W. M. White, et al. (2011).

European Urology 59(2): 231-234.




“SPIDER Surgical System for Urologic Procedures With Laparoendoscopic Single-Site Surgery: From Initial Laboratory Experience to First Clinical Application.”

Haber, G. P., R. Autorino, et al. (2011).

European Urology.


This case study describes our initial laboratory experience using the SPIDER surgical system (TransEnterix, Morrisville, NC, USA) for laparoendoscopic single-site surgery (LESS) urologic procedures and reports its first clinical application. The SPIDER system was tested in a laboratory setting and used for a clinical case of renal cyst decortication. Three tasks were performed during the dry lab session, and different urologic procedures were conducted in a porcine model. The time to complete the tasks and penalties were registered during the dry lab session. Perioperative outcomes and subjective assessment by the surgeons were registered. The surgeons had a positive experience with the SPIDER system, with a mean overall score of 3.6 (on a scale of 1-5). The surgeons were able to gain proficiency in performing tasks regardless of their level of expertise. The highest scores recorded were for ease of device insertion, instrument insertion and exchange, and triangulation. The lowest scores were for retraction. During the clinical case, the platform provided good triangulation without instrument clashing. However, retraction was challenging because of the lack of strength and precise maneuverability with the tip of the instruments fully deployed. The SPIDER system offers intuitive instrument maneuverability and restored triangulation without external instrument clashing. Further refinements are awaited to define its role in the urologic LESS armamentarium.




“Single-incision laparoscopic myomectomy.”

Jackson, T. R. and J. I. Einarsson (2011).

Journal of Minimal Access Surgery 7(1): 83-86.


Laparoscopic myomectomy is a minimally invasive surgical option for the treatment of uterine leiomyomas. Single-incision laparoscopy is a relatively new concept that has potential in gynaecological surgery although the technical challenges of single-incision access have limited the widespread use of the technique. The use of intracorporeal suturing is a significant component of the learning curve for laparoscopic myomectomy and presents an even greater challenge with single-incision laparoscopic myomectomy. This article describes a surgeon’s approach to single-incision laparoscopic myomectomy.




“Selection of a Port for Use in Laparoendoscopic Single-siteSurgery.”

Khanna, R., M. A. White, et al. (2011).

Current Urology Reports.


Laparoendoscopic single-site surgery (LESS) is a novel technique that aims to perform abdominal surgery through a single incision. Various access techniques and ports exist. This review will attempt to describe the currently available ports as well as highlight their advantages and disadvantages.




“Transumbilical laparo-endoscopic single-site partial nephrectomy: An initial clinical experience of 2 cases.”

Liu, B., L. H. Wang, et al. (2010).

Academic Journal of Second Military Medical University 31(12): 1349-1352.


Objective: To summarize our experience and operative techniques of transumbilical laparo-endoscopic single-site partial nephrectomy (TLSPN). Methods: TLSPN was performed on two patients for the right kidneys in August and September of 2009. Results: The operation was successfully done in both cases, with an additional trocar of 5 mm to retract the liver. The operation time was 255 min and 240 min; the time periods of renal artery occlusion were 48 min and 40 min; and the intraoperative blood losses were 100 ml and 50 ml. None of the patients received blood transfusion or antalgic. The drainage was removed 9 days and 5 days after operation, and the postoperative hospital stays were 13 and 12 days. Conclusion: TLSPN is a safe and effective method with less trauma. However, special instruments are needed for the procedure, and the suture and knotting are somewhat difficult. An assistant trocar is needed for the procedure for the right kidney.




“Single-incision laparoscopic surgery – Current status and controversies.”

Rao, P. P. and S. Bhagwat (2011).

Journal of Minimal Access Surgery 7(1): 6-16.


Scarless surgery is the Holy Grail of surgery and the very raison d′etre of Minimal Access Surgery was the reduction of scars and thereby pain and suffering of the patients. The work of Muhe and Mouret in the late 80s, paved the way for mainstream laparoscopic procedures and it rapidly became the method of choice for many intra-abdominal procedures. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard laparoscopy and towards scarless surgery. Natural orifice translumenal endoscopic surgery (NOTES) was developed for scarless surgery, but did not gain popularity due to a variety of reasons. NOTES stands for natural orifice translumenal endoscopic surgery, a term coined by a consortium in 2005. NOTES remains a research technique with only a few clinical cases having been reported. The lack of success of NOTES seems to have spurred on the interest in single-incision laparoscopy as an eminently doable technique in the present with minimum visible scarring, rendering a ′scarless′ effect. Laparo-endoscopic single-site surgery (LESS) is, a term coined by a multidisciplinary consortium in 2008 for single-incision laparoscopic surgery. These are complementary technologies with similar difficulties of access, lack of triangulation and inadequate instrumentation as of date. LESS seems to offer an advantage to surgeons with its familiar field of view and instruments similar to those used in conventional laparoscopy. LESS remains a evolving special technique used successfully in many a centre, but with a significant way to go before it becomes mainstream. It currently stands between standard laparoscopy and NOTES in the armamentarium of minimal access surgery. This article outlines the development of LESS giving an overview of all the techniques and devices available and likely to be available in the future.




“A Triangulating Operating Platform Enhances Bimanual Performance and Reduces Surgical Workload in Single-Incision Laparoscopy.”

Rieder, E., D. V. Martinec, et al. (2011).

Journal of the American College of Surgeons.


BACKGROUND: Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a novel, single-port, triangulating surgical platform (SPSP) might enhance performance by improving bimanual coordination and decreasing the surgeon’s mental workload. STUDY DESIGN: Fourteen participants, proficient in basic laparoscopic skills, were tested on their ability to perform a validated intracorporeal suturing task by either an SSL approach with crossed articulated instruments or a novel SPSP, providing true-right and true-left manipulation. Standard laparoscopic (SL) access served as control. Sutures were evaluated using validated scoring methods and the National Aeronautics and Space Administration Task Load Index was used to rate mental workload. RESULTS: All participants proficiently performed intracorporeal knots by SL (mean score 99.0; 95% CI 97.0 to 100.9). Performance decreased significantly (more than 50%, p < 0.001) with the SSL approach using 1 rigid and 1 articulating instrument in a cross-wise manner (mean score 39.2; 95% CI 28.3 to 50.1). The use of the SPSP significantly enhanced bimanual coordination (mean score 67.6; 95% CI 61.3 to 73.9; p < 0.001). Participants recorded lower mental workload when using true-right and true-left manipulation. CONCLUSIONS: This study objectively assessed SSL performance and current attempts for instrumentation improvement in single-site access. While SSL significantly impairs basic laparoscopic skills, surgical platforms providing true-left and true-right maneuvering of instruments appear to be more intuitive and address some of the current challenges of SSL that may otherwise limit its widespread acceptance. © 2011 American College of Surgeons.




“Early multi-institution experience with single-incision laparoscopic colectomy.”

Ross, H., S. Steele, et al. (2011).

Diseases of the Colon and Rectum 54(2): 187-192.


PURPOSE: Single-incision laparoscopic colectomy represents a potential advance in minimally invasive surgical approaches to colorectal disease. Although widely promoted, outcome data are virtually absent. A group of highly experienced laparoscopic attending colorectal surgeons convened to standardize technique and prospectively record operative details and outcomes. METHODS: Single-incision laparoscopic colectomy was performed by 10 experienced attending colorectal surgeons with minimal or no prior single-incision laparoscopic colectomy experience. Surgeon rating of ergonomics and 15 components of operation conduct was compared with conventional multiple-port laparoscopic colectomy. Patient demographics, operative details, and outcome data were prospectively collected. RESULTS: Thirty-nine single-incision laparoscopic colectomies were performed (25 right colectomies, 5 ileocolic resections, 8 sigmoidectomies, and 1 low anterior resection). Underlying pathology included polyps (12), cancer (15), Crohn’s disease (5), and diverticulitis (7). Patients were highly selected with a mean body mass index of 25.6 (range, 16-40). Two conversions to open resection occurred, 1 because of fistula and 1 because of adhesions, in patients with a mean body mass index of 34. An additional port was required in 3 patients. Mean incision length was 4.2 cm (range, 2.5-8) and operative time was 120 minutes (range, 68-210). Complications included 1 wound infection and 2 anastomotic bleeds requiring transfusion. Average length of stay was 4.4 days (range, 2-8). Mean lymph node harvest was 19 (range, 12-39). Exposure, instrument conflict, ergonomics, ease of instrumentation, and camera operation were rated significantly more difficult with single-incision laparoscopic colectomy than with multiple-port laparoscopic colectomy. CONCLUSIONS: Preliminary data demonstrate that single-incision laparoscopic colectomy can be performed safely in selected patients by experienced surgeons. The benefits of single-incision compared with multiple-port laparoscopic colectomy are not immediately evident. Despite the advanced skills of the faculty, a learning curve of undetermined length still exists in which specific components of single-incision laparoscopic colectomy are more difficult than multiple-port laparoscopic colectomy, and areas of focus remain that require advances to make single-incision laparoscopic colectomy equivalent to multiple-port laparoscopic colectomy. The multi-institutional registry will enable further analysis of single-incision laparoscopic colectomy. © The ASCRS 2011.




“Single-incision laparoscopic placement of an adjustable gastric band versus conventional multiport laparoscopic gastric banding: A comparative study.”

Saber, A. A., T. H. El-Ghazaly, et al. (2010).

American Surgeon 76(12): 1328-1332.


Single-incision laparoscopic surgery (SILSTM) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery nationwide. Having achieved a rapid crossover to the realm of advanced surgical procedures, SILSTM has shown remarkable versatility and adaptability, making it no longer limited to basic laparoscopic procedures. We report our experience performing laparoscopic placement of gastric bands with an emphasis on comparison of the singleincision laparoscopic approach with the conventional multiport laparoscopic approach. From December 2008 to September 2009, 27 patients underwent laparoscopic placement of an adjustable gastric band at Michigan State University/Kalamazoo Center for Medical Studies. This included 15 patients who underwent single-incision laparoscopic gastric banding and 12 patients who underwent conventional multiport laparoscopic gastric banding procedures. The overall pain score was found to be significantly less in the SILS group than that for the conventional multiport laparoscopic gastric banding group with a statistically significant P value of 0.012. The operating time was found to be significantly less in the multiport group with a P value of 0.000. Differences in immediate postoperative pain scores, analgesia, and the overall length of hospital stay were found to be statistically insignificant. Single-incision laparoscopic gastric banding is associated with significantly less overall postoperative pain than the conventional laparoscopic approach; in addition, it provides improved cosmetic outcome despite a modest increase in operative time.




“Urological applications of single-site laparoscopic surgery.”

Symes, A. and A. Rane (2011).

Journal of Minimal Access Surgery 7(1): 90-95.


Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.




“Single-Site Video Endoscopic Inguinal Lymphadenectomy: Initial Report.”

Tobias-Machado, M., W. F. Correa, et al. (2011).

Journal of Endourology.


Abstract Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization.




“Laparoendoscopic Single-Site Surgery in Gynecology: Review of Literature and Available Technology.” Uppal, S., M. Frumovitz, et al. (2011).

Journal of Minimally Invasive Gynecology 18(1): 12-23.


The objective of this article was to review the published literature on laparoendoscopic single-site surgery (LESS) in gynecology and to present current advances in instruments used in LESS surgery. Inasmuch as LESS surgery is relatively new, the current literature on use of this technique in gynecology is somewhat limited. Sixteen articles were available for the literature review: 10 case series, 2 comparative studies, 3 case reports, and 1 surgical technique demonstration. In recent years, however, improvements in traditional laparoscopic techniques and availability of more advanced instruments has made single-incision laparoscopy more feasible and safer for the patient. There is increasing interest in LESS surgery both as an alternative to traditional laparoscopy and as an adjunct to robotic surgery when performing complicated procedures through a single incision. Although LESS surgery provides another option in the arena of minimally invasive gynecologic surgery, the ultimate role of this approach remains to be determined. © 2010 AAGL.




“Renal LESS surgery: Slight modification or surgical revolution?”

Verhoest, G., J. J. Patard, et al. (2011).

La néphrectomie laparoscopique par accès ombilical unique évolution ou révolution chirurgicale ? 21(1): 29-33.


Objective: To present our initial experience of laparoendoscopic single site (LESS) renal surgery. Methods: Between May 2009 and March 2010, nine nephrectomies and one cyst decortication were performed in nine patients. Eight of the procedures were done with three 5 mm trocars inserted through a unique peri-umbilical incision. In two cases, a specific single-port device was used. All operations were achieved with a 5-mm 30° lens and conventional laparoscopic instruments. The specimens were entrapped in a 10 mm endoscopic bag and extracted through the umbilical incision. Results: Mean age was 56 years old. Mean BMI was 23.5 [19-34]. Mean operative time was 149 min [80-240], and estimated blood loss was 90 ml [20-250]. None of the patients required blood transfusion. Mean length of stay was 4.1 days [3-5]. Only one major complication occurred (functional occlusion). One conversion to conventional laparoscopy was necessary in a case of inflammatory kidney. Histologic exam showed benign lesions (cyst and non functional kidney) in seven cases, and papillary carcinoma in three cases. Conclusion: LESS surgery is feasible. Its advantages over conventional laparoscopy are not clear. LESS is a new procedure that should benefit from the improvement of technical instrumentation. © 2010 Elsevier Masson SAS.




“Design and fabrication of a novel tactile sensory system applicable in artificial palpation.”

Afshari, E., S. Najarian, et al. (2011).

Minimally Invasive Therapy and Allied Technologies 20(1): 22-29.


Force and position feedback are the two important parameters that are employed in different medical diagnoses and more specifically surgical operations. Furthermore, during different minimally invasive procedures, the ability of touch and force and position feedback are absent. In this regard, artificial palpation is a new technology that is employed to obtain tactile data in situations where physicians/surgeons cannot use their tactile sense. One of the most valuable achievements of artificial palpation are tactile sensory systems that have various applications in the detection of hard objects inside the soft tissue. Considering the present problems and limitations of kidney stone removal laparoscopy, the aim of this research is to design and fabricate a novel tactile sensory system capable of determining the exact location of stones during laparoscopy. This new tactile sensory system consists of four main parts: The sensory part, the mechanical part, the electrical part, and the display part. In this new system, due to the use of both displacement and force sensors, the usage limitations of previous tactile sensory systems are eliminated. The new tactile sensory system is well capable of finding the stone in the laboratory models through physical contact with the model’s surface. © 2011 Informa Healthcare.




“Robotic mastoidectomy.”

Danilchenko, A., R. Balachandran, et al. (2011).

Otology and Neurotology 32(1): 11-16.


Hypothesis: Using image-guided surgical techniques, we propose that an industrial robot can be programmed to safely, effectively, and efficiently perform a mastoidectomy. Background: Whereas robotics is a mature field in many surgical applications, robots have yet to be clinically used in otologic surgery despite significant advantages including reliability and precision. Methods: We designed a robotic system that incorporates custom software with an industrial robot to manipulate a surgical drill through a complex milling profile. The software controls the movements of the robot based on real-time feedback from a commercially available optical tracking system. The desired path of the drill to remove the desired volume of mastoid bone was planned using computed tomographic scans of cadaveric specimens and then implemented using the robotic system. Bone-implanted fiducial markers were used to provide accurate registration between computed tomographic and physical space. Results: A mastoid cavity was milled on 3 cadaveric specimens with a 5-mm fluted ball bit. Postmilling computed tomographic scans showed that, for the 3 specimens, 97.70%, 99.99%, and 96.05% of the target region was ablated without violation of any critical feature. Conclusion: To the best of our knowledge, this is the first time that a robot has been used to perform a mastoidectomy. Although significant hurdles remain to translate this technology to clinical use, we have shown that it is feasible. The prospect of reducing surgical time and enhancing patient safety by replacing human hand-eye coordination with machine precision motivates future work toward translating this technique to clinical use. © 2010, Otology & Neurotology, Inc.




“Simulation-guided navigation: A new approach to improve intraoperative three-dimensional reproducibility during orthognathic surgery.”

Mazzoni, S., G. Badiali, et al. (2010).

Journal of Craniofacial Surgery 21(6): 1698-1705.


Because of the recent development of three-dimensional technology, computer software is increasingly being used for diagnosis, analysis, data documentation, and surgical planning for orthognathic surgery.Currently, the typical method to reposition jaws in the correct and planned location is based on the use of surgical splints, which have a quite high level of imprecision. The most important differences between planned and achieved maxillary movements are in the vertical and rotational positioning. Several methods have been described for intraoperative maxillary control, but none of these procedures is satisfactory.We present a new method to transfer individualized three-dimensional virtual planning of the patient using a navigation system in the operating room to improve reproducibility of the simulation. We enrolled 10 patients with dentofacial deformities from November 2008 to May 2009. All patients were studied and treated according to the following steps: cone-beam computed tomography data acquisition, virtual simulation of the surgical procedure, surgery with intraoperative navigation, and validation through reproducibility evaluation.We found 86.5% mean preoperative surgical plan reproducibility with the assistance of simulation-guided navigation compared with 80% mean reproducibility obtained in our previous group, in which no intraoperative navigation was performed.According to these results, we can assume that simulation-guided navigation would be a helpful procedure during orthognathic surgery to improve reproducibility of the preoperative virtual surgical planning. Copyright © 2010 by Mutaz B. Habal, MD.




“Motion planning and coordination for robot systems based on representation space.”

Su, J. and W. Xie (2011).

IEEE Trans Syst Man Cybern B Cybern 41(1): 248-259.


This paper proposes a general motion planning and coordination strategy for robot systems. The representation space (RS) of a robot system is constructed to describe the distributions of system attributes. The reachable area in the RS, denoting the attribute set that the system can be of, indicates the system’s ability to accomplish tasks. Moreover, it also describes the influences of the internal and external constraints on the system’s capability. Task realization is transformed to finding a trajectory in the RS for the system attributes to transit along under constraints. Meanwhile, the realizable conditions of a prescribed task by the robot system of specific configurations are discussed. If the task is realizable, the optimal strategy for task execution could further be figured out. Otherwise, it could be transformed to be realizable via task reassignment or system reconfigurations so that a connected path could be found for the transition of the system attributes from the starting point to the goal in the RS. The proposed scheme contributes to designing, planning, and coordination of the robotic tasks. Experiments on path planning of a robot manipulator and formation movement of a multirobot system, as well as coordination of a mobile manipulator system, are conducted to show the validity and generalization of the proposed method.




“Automated dental implantation using image-guided robotics: registration results.”

Sun, X., F. D. McKenzie, et al. (2011).

International Journal of Computer Assisted Radiology and Surgery: 1-8.


Purpose: One of the most important factors affecting the outcome of dental implantation is the accurate insertion of the implant into the patient’s jaw bone, which requires a high degree of anatomical accuracy. With the accuracy and stability of robots, image-guided robotics is expected to provide more reliable and successful outcomes for dental implantation. Here, we proposed the use of a robot for drilling the implant site in preparation for the insertion of the implant. Methods: An image-guided robotic system for automated dental implantation is described in this paper. Patient-specific 3D models are reconstructed from preoperative Cone-beam CT images, and implantation planning is performed with these virtual models. A two-step registration procedure is applied to transform the preoperative plan of the implant insertion into intra-operative operations of the robot with the help of a Coordinate Measurement Machine (CMM). Experiments are carried out with a phantom that is generated from the patient-specific 3D model. Fiducial Registration Error (FRE) and Target Registration Error (TRE) values are calculated to evaluate the accuracy of the registration procedure. Results: FRE values are less than 0.30 mm. Final TRE values after the two-step registration are 1.42 ± 0.70 mm (N = 5). Conclusions: The registration results of an automated dental implantation system using image-guided robotics are reported in this paper. Phantom experiments show that the practice of robot in the dental implantation is feasible and the system accuracy is comparable to other similar systems for dental implantation. © 2011 CARS.




“Flexible robotics.”

Vyas, L., D. Aquino, et al. (2011).

BJU International 107(2): 187-189.