“Joystick interfaces are not suitable for robotized endoscope applied to NOTES.”
Allemann, P., L. Ott, et al. (2009).
Surgical Innovation 16(2): 111-116.
Background: NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer. Materials and methods: The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope. Results: Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques. Discussion: Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself. Conclusion: Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES. © 2009 Sage Publications.
“Re: Initial complete laparoendoscopic single-site surgery robotic assisted radical prostatectomy(LESS-RARP).”
Barret, E., R. Sanchez-Salas, et al. (2009).
International Braz J Urol 35(1): 92-93.
“Natural orifices transluminal endoscopic surgery (NOTES) and other allied “ultra” minimally invasive procedures: Are we loosing the plot?”
Boni, L., G. Dionigi, et al. (2009).
Surgical Endoscopy and Other Interventional Techniques 23(5): 927-929.
“New: Single-incision transumbilical laparoscopic surgery.”
Brunner, W., J. Schirnhofer, et al. (2009).
European Surgery – Acta Chirurgica Austriaca 41(3): 98-103.
Background: On the way to “no-scar” techniques novel single-incision laparoscopic methods are developed, which result in a non-visible postoperative scar. Methods: A total of 136 patients (age 10-86a; 68f/68m) underwent single-incision laparoscopic surgery at our Department for diseases of the appendix, gallbladder, colon, esophagus, liver, adrenal gland, inguinal hernia, or symptomatic adhesions. The entire operations were carried out transumbilically following the standardized procedural principles. Results: Operative time ranged from 17 to 218 min. In 16 patients (11.8%) additional trocars were inserted for procedural safety. No intraoperative adverse event or significant perioperative complication was noticed. Operative estimated blood loss yielded minimal, blood suction was needed only for liver resection and adrenalectomy. Specimen retrieval was carried out either by means of an endo-bag or directly utilizing a transumbilical protection sheet. Patients resumed oral intake at the day of surgery after cholecystectomy, hernia repair or appendectomy, or within 24 h after major surgery according to the principles of fast-track abdominal surgery. Patients’ discharge was on postoperative days 1-12 (Mean 3.8 d). At follow-up after 1-4 weeks patients presented with an optimal cosmetic result without apparent scarring. Conclusions: Single-incision transumbilical laparoscopy allows further reduction of the surgical trauma and to obviate any visible scar in various procedures. © Springer-Verlag 2009.
“Address of early stage primary colonic neoplasia by N.O.T.E.S.”
Cahill, R. A., I. Lindsey, et al. (2009).
Surgical Oncology 18(2): 163-168.
Natural Orifice Translumenal Endoscopic Surgery (N.O.T.E.S.) has the capacity to impact greatly on the practice of colorectal surgery. As much as potentially providing an alternative means of operative approach, its consideration and evolution is already also providing a wealth of instrument innovation that seems likely to greatly enhance the endoscopists’ armamentarium for advanced endoluminal intervention. Furthermore, its aspirational concept is greatly advancing the progress of single site incision laparoscopic approaches and is speeding appreciation of translumenal assistance and operation. However, if N.O.T.E.S. is to occupy a distinct role in the surgical management of colorectal disease, it needs a niche indication of its own that constitutes a therapeutic advance with considerable clinical benefit for suitable patients. Conversely, sound development of a specific stream-lined operative strategy for N.O.T.E.S-type operations may exert a reciprocal swash upon conventional specialist practice. Thus spurred by N.O.T.E.S, localized resection may become standard therapy for early stage colonic neoplasia regardless of operative access although considerable clinical study is as yet required. Therefore, as much as ensuring feasibility and accuracy in the replication of conventional surgical maneuvers, the dawn of N.O.T.E.S. should be recognized as an opportunity for the inquisition of prevailing surgical principles and prejudices in order that colorectal operations are further honed towards perfection (above all it should be realized that avoidance of abdominal scarring is not the last barrier before surgical nirvana). This may represent the main legacy of transluminal investigation whether or not pure N.O.T.E.S. operating ever becomes a clinical reality in its own right. © 2008 Elsevier Ltd. All rights reserved.
“The future of NOTES instrumentation: Flexible robotics and in vivo minirobots.”
Canes, D., A. C. Lehman, et al. (2009).
Journal of endourology / Endourological Society 23(5): 787-792.
Natural orifice translumenal endoscopic surgery (NOTES) bridges the gap between standard endoluminal and extraluminal surgery and, as such, presents unique instrumentation challenges, including lack of stable platforms, loss of spatial orientation, and limited instrument tip maneuverability. The proper instrumentation remains to be established, and the incorporation of robotic technology will be essential moving forward. Flexible robotics has been applied to ureteroscopy and holds promise for NOTES. Miniature in vivo robots will potentially play a role. The current status and future implications of these technologies are reviewed.
“Role of image-guidance systems during NOTES.”
Coughlin, G., S. Samavedi, et al. (2009).
Journal of endourology / Endourological Society 23(5): 803-812.
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments “in line.” Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
“Laparoendoscopic Single-Site Surgery: Initial Hundred Patients.”
Desai, M. M., A. K. Berger, et al. (2009).
Urology.
OBJECTIVES: To report our initial experience with laparoendoscopic single-site (LESS) surgery in 100 patients in urology. METHODS: Between October 2007 and December 2008, we performed LESS urologic procedures in 100 patients for various indications. These included nephrectomy (N = 34; simple 14, radical 3, donor 17), nephroureterectomy (N = 2), partial nephrectomy (N = 6), pyeloplasty (N = 17), transvesical simple prostatectomy (N = 32), and others (N = 9). Data were prospectively collected in a database approved by the Institutional Review Board. All procedures were performed using a novel single-port device (r-Port) and a varying combination of standard and specialized bent/articulating laparoscopic instruments. Robotic assistance was used to perform LESS pyeloplasty (N = 2) and simple prostatectomy (N = 1). In addition to standard perioperative data, we obtained data on postdischarge analgesia requirements, time to complete convalescence, and time to return to work. RESULTS: In the study period, LESS procedures accounted for 15% of all laparoscopic cases by the authors for similar indications. Conversion to standard multiport laparoscopy was necessary in 3 cases, addition of a single 5-mm port was necessary in 3 cases, and conversion to open surgery was necessary in 4 cases. On death occurred following simple prostatectomy in a Jehovah’s Witness due to patient refusal to accept transfusion following hemorrhage. Intra- and postoperative complications occurred in 5 and 9 cases, respectively. Mean operative time was 145, 230, 236, and 113 minutes and hospital stay was 2, 2.9, 2, and 3 days for simple nephrectomy, donor nephrectomy, pyeloplasty, and simple prostatectomy, respectively. CONCLUSIONS: The LESS surgery is technically feasible for a variety of ablative and reconstructive applications in urology. With proper patient selection, conversion and complications rates are low. Improvement in instrumentation and technology is likely to expand the role of LESS in minimally invasive urology.
“Robotic-Assisted Laparoendoscopic Single-Site Surgery in Gynecology: Initial Report and Technique.”Escobar, P. F., A. N. Fader, et al. (2009).
J Minim Invasive Gynecol.
Robotic surgery has greatly improved surgeon dexterity and ergonomics but has substantially increased the number and size of ports required. The typical robotic surgical procedure will use three 8-mm ports and two 12-mm ports. Single-port laparoscopy, also known as Laparo-Endoscopic Single Site (LESS) surgery, is an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery.We present our initial clinical experience and technique with robotic-assisted single-port surgery in gynecology.
“Transvesical NOTES: Current experience and potential implications for urologic applications.” Granberg, C. F., I. Frank, et al. (2009).
Journal of endourology / Endourological Society 23(5): 747-752.
Tremendous attention and energy have been put toward development of minimally invasive techniques in urology to decrease the morbidity of surgery without compromising outcomes. Urologists have remained on the cutting edge of technology, performing procedures via laparoscopic, robotic, and transurethral approaches in procedures that were formerly only performed with an open approach. As the treatment paradigm shifts toward less invasive procedures, the concept of performing surgery through natural body openings has been recognized. Natural orifice translumenal endoscopic surgery (NOTES) eliminates the need for abdominal incisions, theoretically resulting in decreased pain, faster convalescence, improved cosmesis, and absence of wound infections and hernias. While transvesical NOTES has the potential to develop into a viable technology in the clinical setting, it is still in its infancy. Initial studies have demonstrated the feasibility of transvesical NOTES; however, further work must be dedicated to this subject before its routine application in humans. The purpose of this review is to detail the experimental, cadaveric, and clinical work that has been accomplished with transvesical NOTES, in addition to discussing the advantages and disadvantages, technical obstacles, and potential risks that accompany the use of the bladder as a portal for surgery.
“Totally transumbilical laparoscopic cholecystectomy.”
Gumbs, A. A., L. Milone, et al. (2009).
Journal of Gastrointestinal Surgery 13(3): 533-534.
A recently convened Consortium at the Cleveland Clinic agreed on the term Laparo-Endoscopic Single-Site (LESS) surgery to describe minimally invasive techniques that use a single incision to accomplish laparoscopic procedures. These procedures are done by using either a single port through one fascial incision or multiple ports placed through separate fascial incisions. Because of cost containment issues and the lack of widespread availability of a single port, we currently use multiple reusable ports placed through three separate fascial incisions via a transumbilical incision. As opposed to standard laparoscopic cholecystectomy, a deflecting laparoscope and one articulating instrument are utilized to improve the safety and ease of this procedure. Presented in this video are the steps necessary to perform a LESS cholecystectomy via a transumbilical incision with commercially available instruments. © 2008 The Society for Surgery of the Alimentary Tract.
“NOTES transvaginal nephrectomy: first human experience.”
Kaouk, J. H., W. M. White, et al. (2009).
Urology 74(1): 5-8.
OBJECTIVES: To present the operative outcomes of the first natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. METHODS: A 57-year-old woman with hypertension, right-sided flank pain, and radiographic evidence of an atrophic right kidney consented for NOTES transvaginal nephrectomy. Pneumoperitoneum was achieved with a Veress needle inserted deep in the umbilicus. Under direct vision, a colpotomy was made and a transvaginal port positioned. Using standard and articulating operating instruments inserted transvaginally, the kidney was mobilized and the renal hilum was controlled with an endovascular stapler. The kidney was placed in a laparoscopic retrieval bag and extracted through the vaginal incision. Salient demographic and operative data were obtained. RESULTS: NOTES transvaginal nephrectomy was successfully completed, with all the operative steps performed transvaginally. Dense pelvic adhesions from a prior hysterectomy necessitated the use of a 5-mm umbilical port during vaginal port placement and for retraction of the ascending colon during division of the renal hilum. No intraoperative complications occurred. Operative time was 307 minutes, with 124 minutes dedicated to vaginal port placement and 183 minutes dedicated to adhesiolysis and nephrectomy. The duration of hospitalization was 23 hours. The visual analog pain scale score was 1 of 10 on postoperative day 2. CONCLUSIONS: Our experience shows that NOTES transvaginal nephrectomy is technically feasible. Access to the peritoneal cavity should be performed under visual guidance and after insufflation through the umbilicus. Additional experience is needed to better define patient selection criteria and indications for NOTES transvaginal urologic surgery.
“Laparoscopic Augmentation Enterocystoplasty Through a Single Trocar.”
Noguera, R. J. S., J. C. Astigueta, et al. (2009).
Urology 73(6): 1371-1374.
Objectives: To report on the initial case and surgical technique of laparoendoscopic, single-site, subtotal cystectomy and augmentation enterocystoplasty performed through a single multichannel transumbilical port in a patient with neurogenic bladder. Methods: Laparoendoscopic, single-site, subtotal cystectomy and augmentation enterocystoplasty was performed in a 20-year-old woman with neurogenic bladder secondary to congenital sacral lipoma that had been operated on at 2 years of age. The patient had a long history of urinary incontinence and frequent and urgent urination. The imaging and urodynamic studies revealed a 100-mL bladder capacity with thickened walls, countless diverticula, and low compliance. The procedure was performed exclusively using a novel multichannel access port. Additional instruments included the 5-mm video laparoscope, SonoSurge, and flexible scissors. Subtotal cystectomy was initially performed by resecting 70% of the bladder. The ileal loop was exteriorized through the single port by detaching the valve, and the ileal pouch and bowel continuity were restored extracorporeally. The vesicoileal anastomosis was performed laparoscopically. Results: The operating time was 300 minutes, and the blood loss was <100 mL. No intraoperative or postoperative complications developed. The hospital stay was 6 days. The drain and Foley catheter were removed at 7 and 21 days postoperatively, respectively. Postoperative cystography confirmed a watertight anastomosis and increased bladder capacity. At last follow-up, the patient was performing intermittent self-catheterization to complete emptying. Conclusions: Our initial experience with laparoendoscopic, single-site, subtotal cystectomy and enterocystoplasty through a single port was encouraging. The use of the larger diameter port significantly facilitated extracorporeal bowel reconstruction and can be used for various minimally invasive surgical procedures. © 2009 Elsevier Inc. All rights reserved.
“Cautionary considerations regarding N.O.T.E.S. in oncology.”
O’Riordain, M. G. (2009).
Surgical Oncology 18(2): 105-109.
Over the last number of years, the emphasis in abdominal surgery has been to reduce invasiveness and to minimise trauma to the patient. This has led to the rapid development of laparoscopic techniques initially for the surgical management of benign disease and later for the successful management of malignant disease. Laparoscopy has now been shown to provide significant benefits to the cancer patient, in particular the reduction of wound infection, herniation and pain. More recently, benefits have been demonstrated in earlier discharge from hospital and return to normal activity. Laparoscopy has therefore been accepted as at least a valid alternative to open surgery for most types of abdominal cancer. With the objective of reducing invasiveness even more, the last few years has seen a rapid expansion in the development of Natural Orifice Translumenal Endoscopic Surgery (NOTES). Currently, NOTES is still in the early stages of evolution but its potential uses in the field of cancer surgery are already being proposed. To develop NOTES to the stage that it will be safe, effective and widely available for the management of cancer patients represents a huge challenge ranging from the development of equipment and techniques to the demonstration of safety and efficacy in clinical trials as well as training and competence issues. It is still not clear whether these challenges will be surmounted so that NOTES becomes mainstream therapy. A period of ‘watchful waiting’ seems appropriate therefore for the uncommitted general surgeon in order that NOTES may be given time to prove compelling and convincing before its general uptake into routine practice. © 2009 Elsevier Ltd. All rights reserved.
“Women’s positive perception of transvaginal NOTES surgery.”
Peterson, C. Y., S. Ramamoorthy, et al. (2009).
Surg Endosc 23(8): 1770-1774.
BACKGROUND: Two decades ago, minimally invasive surgery (MIS) was introduced and led to a revolution in modern surgery. Currently MIS procedures are the standard of care for many surgical interventions and patients often seek out surgeons with special training in MIS. Today, natural orifice transluminal endoscopic surgery (NOTES) appears to be on the threshold of another such revolution. We surmise that its advantages are similar to those of other MIS procedures, but there are no associated abdominal wall complications as there are no abdominal incisions. To date, there is no data evaluating women’s perceptions of such a procedure and their willingness to consent to this type of surgical approach. METHODS: We surveyed 100 women who were given a written description of MIS and NOTES surgery along with a 10-question survey exploring their concerns and opinions regarding transvaginal surgery. RESULTS: The majority of women (68%) indicated that they would want a transvaginal procedure in the future because of decreased risk of hernia and decreased operative pain (90 and 93%, respectively), while only 39% were concerned with the improved cosmesis of NOTES surgery. Of the women polled, nulliparous women and those under age 45 years were significantly more often concerned with how transvaginal surgery may affect healthy sexual life and fertility issues (p < 0.05). Of the women who would not prefer transvaginal surgery, a significant number indicated concerns over infectious issues (p < 0.05). CONCLUSIONS: Our study shows that there is considerable public interest in NOTES surgery and women would be receptive to this new surgical technique. Our study highlights a strong need for early reporting of outcomes data to enlighten ourselves, and our patients, about this exciting new technology.
“Single-port laparoscopic surgery: Is a single incision the next frontier in minimally invasive gynecologic surgery?”
Ramirez, P. T. (2009).
Gynecologic Oncology 114(2): 143-144.
“Evaluation of a manually driven, multitasking platform for complex endoluminal and natural orifice transluminal endoscopic surgery applications (with video).”
Thompson, C. C., M. Ryou, et al. (2009).
Gastrointestinal Endoscopy 70(1): 121-125.
Background: The Direct Drive Endoscopic System (DDES) is a multitasking platform developed to overcome the limitations of the currently available rigid and flexible endoscopic systems in application to natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopy, and advanced endoluminal procedures. The system consists of a 3-channel, steerable guide sheath accepting a 6-mm endoscope and two 4-mm articulating instruments. The system’s overall design enables the interventionalist to operate instruments bimanually from a stable platform, conveying a laparoscopic paradigm to the functional working space at the distal end of the flexible guide sheath. Objective: To assess the basic functionality of the DDES device in a series of defined exercises by using ex vivo porcine stomachs and 1 in vivo animal model. Design: Ex vivo calibration and training exercises, including EMR, full-thickness suturing, and knot tying. Setting: Animal laboratory. Interventions: EMR, full-thickness suturing, and knot tying. Main Outcome Measurements: Successful completion of specified tasks. Results: Independent instrument movement with a wide range of motion allowed the interventionalist to perform several complex tasks efficiently. The DDES was able to (1) grasp tissue and hold it under tension, (2) cut through layers of porcine stomach in a controlled fashion, (3) suture, and (4) tie knots. Limitation: Ex vivo study. Conclusions: This novel multitasking platform demonstrated surgical functionality including triangulation, cutting, grasping, suturing, and knot tying. Preliminary results suggest that the DDES can perform complex endosurgical tasks that have traditionally been challenging or impossible with the standard endoscopic paradigm, and may enable NOTES, single-port laparoscopy, and complex endoluminal procedures. © 2009 American Society for Gastrointestinal Endoscopy.
“Single-port Urological Surgery: Single-center Experience With the First 100 Cases.”
White, W. M., G. P. Haber, et al. (2009).
Urology.
OBJECTIVES: To present perioperative outcomes in an observational cohort of patients who underwent LaparoEndoscopic Single Site (LESS) surgery at a single academic center. METHODS: A prospective study was performed to evaluate patient outcomes after LESS urologic surgery. Demographic data including age, body mass index, operative time, estimated blood loss, operative indications, complications, and postoperative Visual Analog Pain Scale scores were accrued. Patients were followed postoperatively for evidence of adverse events. RESULTS: Between September 2007 and February 2009, 100 patients underwent LESS urologic surgery. Specifically, 74 patients underwent LESS renal surgery (cryoablation, 8; partial nephrectomy, 15; metastectomy, 1; renal biopsy, 1; simple nephrectomy, 7; radical nephrectomy, 6; cyst decortication, 2; nephroureterectomy, 7; donor nephrectomy, 19; and dismembered pyeloplasty, 8) and 26 patients underwent LESS pelvic surgery (varicocelectomy, 3; radical prostatectomy, 6; radical cystectomy, 3; sacral colpopexy, 13; and ureteral reimplant, 1). Mean patient age was 54 years. Mean body mass index was 26.2 kg/m(2). Mean operative time was 199 minutes. Mean estimated blood loss was 136 mL. No intraoperative complications occurred. Six patients required conversion to standard laparoscopy. Mean length of hospitalization was 3 days. Mean Visual Analog Pain Scale score at discharge was 1.5/10. At a mean follow-up of 11 months, 9 Clavien Grade II (transfusion, 7; urinary tract infection, 1; deep vein thrombosis, 1) and 2 Clavien Grade IIIb (recto-urethral fistula, 1; angioembolization, 1) surgical complications occurred. CONCLUSIONS: In our experience, LESS urologic surgery is feasible, offers improved cosmesis, and may offer decreased pain. Complications are consistent with the published data. Whether LESS urologic surgery is superior in comparison with standard laparoscopy is currently speculative.
“Joystick interfaces are not suitable for robotized endoscope applied to NOTES.”
Allemann, P., L. Ott, et al. (2009).
Surgical Innovation 16(2): 111-116.
Background: NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer. Materials and methods: The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope. Results: Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques. Discussion: Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself. Conclusion: Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES. © 2009 Sage Publications.
“Role of image-guidance systems during NOTES.”
Coughlin, G., S. Samavedi, et al. (2009).
Journal of endourology / Endourological Society 23(5): 803-812.
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments “in line.” Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
“Robo-school. New college dedicated to robotic surgery focuses training on technique, teamwork as demand for the procedures increases.”
DerGurahian, J. (2009).
Mod Healthc 39(27): 26-28.
“Usability of robotic platforms for remote surgical teleproctoring.”
Ereso, A. Q., P. Garcia, et al. (2009).
Telemedicine and e-Health 15(5): 445-453.
Military field hospitals and rural medical centers may lack surgical subspecialists. Robotic technology can enable proctoring of remotely located general surgeons by subspecialists. Our objective compared three proctoring platforms: (1) 6-degree-of-freedom (DOF) computer input devices controlling a camera and laser pointer mounted on robotic arms, (2) a computer mouse controlling a pan-tilt-zoom (PTZ) camera and robotic laser scanner, and (3) a computer pen/tablet controlling a PTZ-camera and robotic laser scanner. Our hypothesis was that a pen/tablet or mouse platform would be superior to the 6-DOF-input device platform. Five surgeons used each platform by simulating the creation of operative incisions. Qualitative (instrument handling, time, motion, spatial awareness) and quantitative performance (accuracy, speed) was assessed on a five-point scale. Each surgeon completed a satisfaction survey. Both mouse and pen/tablet had higher mean performance scores than the 6-DOF-input device in all quantitative (6-DOF = 1.7 ± 0.8, mouse = 4.3 ± 0.2, pen = 4.1 ± 0.6; p < 0.001) and qualitative measures (6-DOF = 1.7 ± 0.2, mouse = 4.8 ± 0.0, pen = 4.6 ± 0.1; p < 0.001). Handling, motion, and instrument awareness were superior with the mouse and pen/tablet versus 6-DOF-input devices (p < 0.0001). Speed and accuracy were also superior using the mouse or pen/tablet versus 6-DOF-input devices (p < 0.0001). Surgeons completed tasks faster using the mouse versus pen/tablet (p = 0.02). Satisfaction surveys revealed a preference for the mouse. This study demonstrates the superiority of a mouse or pen/tablet controlling a PTZ-camera and robotic laser scanner for remote surgical teleproctoring versus 6-DOF-input devices controlling a camera and laser pointer. Either a mouse or pen/tablet platform allows subspecialists to proctor remotely located surgeons. © Mary Ann Liebert, Inc. 2009.
“Technological advances in the operating room.”
Schmock, B. A. (2009).
The Pennsylvania nurse 64(1).
“Training Requirements and Credentialing for Laparoscopic and Robotic Surgery-What are Our Responsibilities?”
Schwartz, B. F. (2009).
J Urol.