“Assessing feasibility and safety of laparoendoscopic single-site surgery adrenalectomy: Initial experience.”
Cindolo, L., S. Gidaro, et al. (2010).
Journal of Endourology 24(6): 977-980.
Background and Purpose: Laparoendoscopic single-site surgery (LESS) is one of the most interesting surgical advances. We performed LESS adrenalectomy in three patients to assess feasibility, safety, and perioperative outcomes. Patients and Methods: Three patients with nonfunctional adrenal masses underwent TriPort<sup>TM</sup> adrenalectomy. Demographics, perioperative, and pathological records were collected together with postoperative data. TriPort was used through a 3cm subcostal incision with 10mm 30° optic and two 5mm instruments. The specimens were extracted via a 10mm bag instead of the optic. Results: TriPort adrenalectomy was completed in all cases. The mean operative time was 200 minutes (mean blood loss, 40mL). No perioperative complications were recorded. Pathology examination confirmed one adenoma, one lung cancer metastasis, and one myelolipoma. Conclusions: LESS adrenalectomy is feasible and safe, with favorable perioperative and short-term outcomes. It is technically more challenging than standard laparoscopy and requires advanced surgical skills. Prospective studies are needed for further conclusions. © Mary Ann Liebert, Inc. 2010.
“Single incision laparoscopic colectomy: Technical aspects, feasibility, and expected benefits.”
Delaney, C. P., F. Leblanc, et al. (2010).
Diagnostic and Therapeutic Endoscopy.
Background. This paper studied technical aspects and feasibility of single incision laparoscopic colectomy (SILC). Methods. Bibliographic search was carried out up to October 2009 including original articles, case reports, and technical notes. Assessed criteria were techniques, operative time, scar length, conversion, complications, and hospitalization duration. Results. The review analyzed seventeen SILCs by seven surgical teams. A single port system was used by four teams. No team used the same laparoscope. Two teams used two laparoscopes. All teams used curved instruments. SILC time was 116 ± 34 minutes. Final scar was longer than port incision (31 ± 7 versus 24 ± 8mm; P=.036). No conversion was reported. The only complication was a bacteremia. Hospitalization was 5 ± 2 days. Conclusion. SILC is feasible. A single incision around the umbilical scar represents cosmetic progress. Comparative studies are needed to assess potential abdominal wall and recovery benefits to justify the increased cost of SILC. © 2010 F. Leblanc et al.
“Single-Incision Laparoscopic Myomectomy.”
Einarsson, J. I. (2010).
Journal of Minimally Invasive Gynecology 17(3): 371-373.
Single-incision laparoscopic myomectomy is a feasible operation even in the presence of a transmural uterine myoma. The most challenging step of the operation is greatly facilitated by using bidirectional barbed sutures because no knots are required and excellent tension is maintained throughout the hysterotomy closure site. Prospective studies are urgently needed to fully evaluate potential benefits of single-incision laparoscopic surgery. © 2010 AAGL.
“Laparoendoscopic Single-site Radical Cystectomy and Pelvic Lymph Node Dissection: Initial Experience and 2-Year Follow-up.”
Kaouk, J. H., R. K. Goel, et al. (2010).
Urology.
Objective: To report the first series of laparoendoscopic single-site surgery for radical cystectomy and bilateral pelvic lymph node dissection. The development of laparoendoscopic single-site surgery and its application to urothelial malignancy has not been previously evaluated. Methods: A novel, single multichannel port and flexible laparoscopic instruments and laparoscope were used for all procedures. The eligible patients had transitional cell carcinoma that was muscle invasive or refractory to intravesical therapy. Locally advanced disease, previous abdominal or pelvic surgery or radiotherapy, or those desiring orthotopic reconstruction were excluded. No additional ports were needed, and lymphadenectomy was performed using an extended template up to the aortic bifurcation. Results: A total of 3 patients (2 men and 1 woman) underwent radical cystectomy with bilateral pelvic lymph node dissection. All the procedures were completed successfully. All patients underwent extracorporeal urinary diversion by way of extension of the umbilical port site. The operative time was 315 ± 40 minutes, and the blood loss was minimal (217 ± 29 mL). The pathologic evaluation revealed negative margins and negative lymph node involvement (mean number of nodes 16 ± 3). All patients were discharged within 1 week (6 ± 1 days) with minimal postoperative pain according to the visual analog pain scale (0-1 of 10). At a minimum of 2 years of follow-up (range 24-26 months), no evidence of recurrent or metastatic disease was detected. Conclusions: Laparoendoscopic single-site surgery for radical cystectomy and bilateral pelvic lymph node dissection is feasible and safe for select patients. Adequate lymph node dissection was possible through a single multichannel port. The long-term oncologic evaluation of these patients awaits; however, the preliminary outcomes have been promising. © 2010 Elsevier Inc. All rights reserved.
“Single-incision laparoscopic surgery: feasibility for pediatric appendectomies.”
Oltmann, S. C., N. M. Garcia, et al. (2010).
Journal of Pediatric Surgery 45(6): 1208-1212.
Introduction: Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery using a single incision. The end result is a lone incision at the umbilicus for a perceived scarless abdomen. We report our early experience using the SILS technique for appendectomies in the pediatric population. Methods: A retrospective chart review was performed on our first patients to undergo SILS appendectomy (SILS-A) or laparoscopic appendectomy (LAP-A) during the same period at a freestanding children’s hospital. Results: Thirty-nine patients were reviewed. Nineteen patients underwent SILS-A (8.7 ± 0.76 [SEM] years old), and 20 patients underwent LAP-A (10.5 ± 0.87 years old, 2-17). Ages were 19 months to 14 years in the SILS-A group, with 21% (4 patients) not older than 6 years. Median weight for SILS-A was 32 kg (14.5-80.3). Twelve patients had acute nonperforated appendicitis (62%). Mean duration of operation was 58 ± 5.6 (30-135) minutes vs 43 ± 3.6 (30-85) minutes for standard LAP-A. Two patients were converted to a transumbilical appendectomy, one for inability to maintain a pneumoperitoneum and one for extensive adhesions. Postoperative complications consisted of one wound seroma. No wound infections, hernias, readmissions, or difference in length of stay were noted. Conclusion: The SILS approach for acute appendicitis is feasible in the pediatric population even in patients as young as 19 months. Operating room times are somewhat longer than with LAP-A, but should decrease with improved instrumentation and experience. Larger studies and further technical refinements are needed before its widespread implementation. © 2010 Elsevier Inc. All rights reserved.
“Single-incision transumbilical laparoscopic splenic cyst unroofing: First reported case.”
Saber, A. A. and T. H. El-Ghazaly (2010).
American Surgeon 76(5): 509-511.
Single-incision laparoscopic surgery is an emerging minimally invasive approach. When using the single-incision laparoscopic surgery approach, the surgeon operates almost exclusively through a single point of entry, usually the patient’s umbilicus. This approach is steadily gaining popularity among minimally invasive surgeons, as it combines the cosmetic advantage of Natural Orifice Translumenal Surgery with the technical familiarity of conventional laparoscopic surgery. In this report, we describe our implementation of the single-incision laparoscopic approach to perform an unroofing of a posttraumatic splenic cyst; in this case, the entire procedure is performed through a 2-cm intraumbilical incision.
“Force sensing in natural orifice transluminal endoscopic surgery.”
Trejos, A. L., S. Jayaraman, et al. (2010).
Surgical Endoscopy: 1-7.
Background: Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation. Methods: Sensorized instruments were used to measure the forces acting at the tip of the instruments during transgastric and transperineal NOTES procedures performed in two female pigs. The maximum and average forces when handling tissue were determined and compared. Results: The results show that, for the transgastric approach, the average forces required are significantly less than in the transperineal approach (43% less), and that the maximum forces required are almost 8 and 16 N in the transgastric and transperineal approaches, respectively. The forces were higher than 5 N in 1.6% of the measurements in the transgastric approach and 2.9% in the transperineal approach. Conclusions: This study presents an experimental measurement of tissue manipulation forces in a NOTES procedure. This information may be valuable for research groups interested in developing NOTES instruments and devices. It is recommended that NOTES instruments be designed to easily handle forces as high as 16 N. © 2010 Springer Science+Business Media, LLC.
“Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology.”
Yong, W. J., W. K. Sang, et al. (2009).
Journal of Gynecologic Oncology 20(3): 137-144.
Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.
“Open core control software for surgical robots.”
Arata, J., H. Kozuka, et al. (2010).
International Journal of Computer Assisted Radiology and Surgery 5(3): 211-220.
In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days.Acutting-edge “intelligent surgical robot” will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are “home-made” in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. Materials and methods In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a “force guide” for supporting operators to perform precise manipulation by using amaster- slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. Results The Open Core Control software was implemented on a surgical master-slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a “force guide” on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. Conclusion In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement “General Principles of Software Validation” or IEC62304. For following these regulations, it is important to dev lop a self-test environment. Therefore, a test environment is nowunder development to test various interference in operation room such as a noise of electric knife by considering safety and test environment regulations such as ISO13849 and IEC60508. The Open Core Control software is currently being developed software in open-source manner and available on the Internet. A communization of software interface is becoming a major trend in this field. Based on this perspective, the Open Core Control software can be expected to bring contributions in this field. © CARS 2009.
“Force sensing in natural orifice transluminal endoscopic surgery.”
Trejos, A. L., S. Jayaraman, et al. (2010).
Surgical Endoscopy: 1-7.
Background: Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation. Methods: Sensorized instruments were used to measure the forces acting at the tip of the instruments during transgastric and transperineal NOTES procedures performed in two female pigs. The maximum and average forces when handling tissue were determined and compared. Results: The results show that, for the transgastric approach, the average forces required are significantly less than in the transperineal approach (43% less), and that the maximum forces required are almost 8 and 16 N in the transgastric and transperineal approaches, respectively. The forces were higher than 5 N in 1.6% of the measurements in the transgastric approach and 2.9% in the transperineal approach. Conclusions: This study presents an experimental measurement of tissue manipulation forces in a NOTES procedure. This information may be valuable for research groups interested in developing NOTES instruments and devices. It is recommended that NOTES instruments be designed to easily handle forces as high as 16 N. © 2010 Springer Science+Business Media, LLC.
“Somatosensory Comparison during Haptic Tracing.”
Weiss, E. J. and M. Flanders (2010).
Cerebral Cortex.
Active sensing involves memory retrieval and updating as well as mechanisms that trigger corrections to the ongoing exploratory movement. The present study examined this process in a task where human subjects moved the index fingertip clockwise around the circumference of a virtual sphere created by a robotic device. The fingertip pressed into the sphere during the movement, and the subjects were to report slight differences in sphere size (or surface curvature), which occurred from trial to trial. During each 2- to 3-s trial, subjects gradually adjusted their speed and pressure according to the current surface curvature, achieving a consistent level of contact force in the last half of the exploration. The results demonstrate that subjects were gradually accumulating haptic information about curvature and, at the same time, gradually changing the motor commands for the movement. When subjects encountered an unexpected transition in curvature (from circular to flat), they reacted by abruptly decreasing contact force at a latency of about 50 ms. This short latency indicates that spinally mediated corrections are engaged during this task. The results support the hypothesis that during haptic exploration, the neural comparison between expected and actual somatosensory feedback takes places at multiple levels, including the spinal cord.