Managerial perspectives of scaling up robotic-assisted surgery in healthcare systems:A systematic literature review

Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.

Robotic surgery in living liver donors and liver recipients

There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.

Direct 4D printing of functionally graded hydrogel networks for biodegradable,untethered,and multimorphic soft robots

Recent advances in functionally graded additive manufacturing(FGAM)technology have enabled the seamless hybridization of multiple functionalities in a single structure.Soft robotics can become one of the largest beneficiaries of these advances,through the design of a facile four-dimensional(4D)FGAM process that can grant an intelligent stimuli-responsive mechanical functionality to the printed objects.Herein,we present a simple binder jetting approach for the 4D printing of functionally graded porous multi-materials(FGMM)by introducing rationally designed graded multiphase feeder beds.Compositionally graded cross-linking agents gradually form stable porous network structures within aqueous polymer particles,enabling programmable hygroscopic deformation without complex mechanical designs.Furthermore,a systematic bed design incorporating additional functional agents enables a multi-stimuli-responsive and untethered soft robot with stark stimulus selectivity.The biodegradability of the proposed 4D-printed soft robot further ensures the sustainability of our approach,with immediate degradation rates of 96.6%within 72 h.The proposed 4D printing concept for FGMMs can create new opportunities for intelligent and sustainable additive manufacturing in soft robotics.

The evolution of robotics:research and application progress of dental implant robotic systems

The use of robots to augment human capabilities and assist in work has long been an aspiration.Robotics has been developing since the 1960s when the first industrial robot was introduced.As technology has advanced,robotic-assisted surgery has shown numerous advantages,including more precision,efficiency,minimal invasiveness,and safety than is possible with conventional techniques,which are research hotspots and cutting-edge trends.This article reviewed the history of medical robot development and seminal research papers about current research progress.Taking the autonomous dental implant robotic system as an example,the advantages and prospects of medical robotic systems would be discussed which would provide a reference for future research.

Assistive Robotics for Upper Limb Physical Rehabilitation:A Systematic Review and Future Prospects

Physical assistive robotics are oriented to support and improve functional capacities of people.In physical rehabilitation,robots are indeed useful for functional recovery of affected limb.However,there are still open questions related to technological aspects.This work presents a systematic review of upper limb rehabilitation robotics in order to analyze and establish technological challenges and future directions in this area.A bibliometric analysis was performed for the systematic literature review.Literature from the last six years,conducted between August 2020 and May 2021,was reviewed.The methodology for the literature search and a bibliometric analysis of the metadata are presented.After a preliminary search resulted in 820 articles,a total of 66 articles were included.A concurrency network and bibliographic analysis were provided.And an analysis of occurrences,taxonomy,and rehabilitation robotics reported in the literature is presented.This review aims to provide to the scientific community an overview of the state of the art in assistive robotics for upper limb physical rehabilitation.The literature analysis allows access to a gap of unexplored options to define the technological prospects applied to upper limb physical rehabilitation robotics.

Smart Gait:A Gait Optimization Framework for Hexapod Robots

The current gait planning for legged robots is mostly based on human presets,which cannot match the flexible characteristics of natural mammals.This paper proposes a gait optimization framework for hexapod robots called Smart Gait.Smart Gait contains three modules:swing leg trajectory optimization,gait period&duty optimization,and gait sequence optimization.The full dynamics of a single leg,and the centroid dynamics of the overall robot are considered in the respective modules.The Smart Gait not only helps the robot to decrease the energy consumption when in locomotion,mostly,it enables the hexapod robot to determine its gait pattern transitions based on its current state,instead of repeating the formalistic clock-set step cycles.Our Smart Gait framework allows the hexapod robot to behave nimbly as a living animal when in 3D movements for the first time.The Smart Gait framework combines offline and online optimizations without any fussy data-driven training procedures,and it can run efficiently on board in real-time after deployment.Various experiments are carried out on the hexapod robot LittleStrong.The results show that the energy consumption is reduced by 15.9%when in locomotion.Adaptive gait patterns can be generated spontaneously both in regular and challenge environments,and when facing external interferences.

Robotic complete mesocolic excision for right colon cancer:Learning curve,training,techniques,approach,platforms,and future perspectives

Colon cancer has the fifth highest incidence worldwide and has the sixth highest mortality.Compared with rectal cancer,colon cancer currently has the worst 5-year overall survival for patients with stage Ⅱ and Ⅲ disease.Complete mesocolic excision has been developed as a standardized and optimized surgical technique for the excision of colon cancers.This technique has traditionally been performed through an open approach since laparoscopy is generally considered technically challenging.The robotic approach has been slowly implemented for colon cancer,but the newest robotic platforms allow for a safer and optimized approach for right colon cancer.Several robotic approaches have been developed and explored.The expansion of the current robotic platform ecosystem is gradually providing new outputs in the application of the robotic approach to complete mesocolic excision.This review gains an oversight of existing literature on robotic complete mesocolic excision for right colon cancer(learning curve,training,techniques,approach,platforms,and future perspectives).

Advancements in Humanoid Robots: A Comprehensive Review and Future Prospects

This paper provides a comprehensive review of the current status, advancements, and future prospects of humanoid robots, highlighting their significance in driving the evolution of next-generation industries. By analyzing various research endeavors and key technologies, encompassing ontology structure,control and decision-making, and perception and interaction, a holistic overview of the current state of humanoid robot research is presented. Furthermore, emerging challenges in the field are identified, emphasizing the necessity for a deeper understanding of biological motion mechanisms, improved structural design,enhanced material applications, advanced drive and control methods, and efficient energy utilization. The integration of bionics, brain-inspired intelligence, mechanics, and control is underscored as a promising direction for the development of advanced humanoid robotic systems. This paper serves as an invaluable resource, offering insightful guidance to researchers in the field,while contributing to the ongoing evolution and potential of humanoid robots across diverse domains.

A versatile humanoid robot platform for dexterous manipulation and human-robot collaboration

Humanoid robots have attracted much attention by virtue of their compatibility with human environments.However,biped humanoids with immense promise still cannot function steadily and reliably in real-world settings in the current state.Hence,rationally combining a humanoid robot with different stable mobile platforms is a favoured solution for diverse scenarios.Here,a new versatile humanoid robot platform,aiming to provide a generic solution that can be flexibly deployed in diverse scenarios,for example,indoors and fields is presented.Versatile humanoid robot platform incorporates multimodal perception,and extensible interfaces on hardware and software,allowing it to be rapidly integrated with different mobile platforms and end-effectors,only through easyto-assemble interfaces.Additionally,the platform has achieved impressive integration,lightness,dexterity,and strength in its class,with human-like size and rich perception,targeted to have human-intelligent manipulation skills for human-engineered environments.Overall,this article elaborates on the reasoning behind the design choices,and outlines each subsystem.Lastly,the essential performance of the platform is successfully demonstrated in a set of experiments with precise and dexterous manipulation,and human–robot collaboration requirements.

Effectiveness of the A3 robot on lower extremity motor function in stroke patients:A prospective,randomized controlled trial

BACKGROUND The results of existing lower extremity robotics studies are conflicting,and few relevant clinical trials have examined short-term efficacy.In addition,most of the outcome indicators in existing studies are scales,which are not objective enough.We used the combination of objective instrument measurement and scale to explore the short-term efficacy of the lower limb A3 robot,to provide a clinical reference.AIM To investigate the improvement of lower limb walking ability and balance in stroke treated by A3 lower limb robot.METHODS Sixty stroke patients were recruited prospectively in a hospital and randomized into the A3 group and the control group.They received 30 min of A3 robotics training and 30 min of floor walking training in addition to 30 min of regular rehabilitation training.The training was performed five times a week,once a day,for 2 wk.The t-test or non-parametric test was used to compare the threedimensional gait parameters and balance between the two groups before and after treatment.RESULTS The scores of basic activities of daily living,Stroke-Specific Quality of Life Scale,FM balance meter,Fugl-Meyer Assessment scores,Rivermead Mobility Index,Stride speed,Stride length,and Time Up and Go test in the two groups were significantly better than before treatment(19.29±12.15 vs 3.52±4.34;22.57±17.99 vs 4.07±2.51;1.21±0.83 vs 0.18±0.40;3.50±3.80 vs 0.96±2.08;2.07±1.21 vs 0.41±0.57;0.89±0.63 vs 0.11±0.32;12.38±9.00 vs 2.80±3.43;18.84±11.24 vs 3.80±10.83;45.12±69.41 vs 8.41±10.20;29.45±16.62 vs 8.68±10.74;P<0.05).All outcome indicators were significantly better in the A3 group than in the control group,except the area of the balance parameter.CONCLUSION For the short-term treatment of patients with subacute stroke,the addition of A3 robotic walking training to conventional physiotherapy appears to be more effective than the addition of ground-based walking training.

Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors

Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.

基于Robotstudio的工业机器人课程教学设计与实践

阐述工业机器人实训课程教学实践,将Robotstudio软件融入课程教学中,探讨以实例项目驱动的教学内容设计,以虚实结合手段提升课堂教学效果的教学模式,从而实现教学与实践的统一。

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.

Adaptive Trajectory Tracking Control for Nonholonomic Wheeled Mobile Robots:A Barrier Function Sliding Mode Approach

The trajectory tracking control performance of nonholonomic wheeled mobile robots(NWMRs)is subject to nonholonomic constraints,system uncertainties,and external disturbances.This paper proposes a barrier function-based adaptive sliding mode control(BFASMC)method to provide high-precision,fast-response performance and robustness for NWMRs.Compared with the conventional adaptive sliding mode control,the proposed control strategy can guarantee that the sliding mode variables converge to a predefined neighborhood of origin with a predefined reaching time independent of the prior knowledge of the uncertainties and disturbances bounds.Another advantage of the proposed algorithm is that the control gains can be adaptively adjusted to follow the disturbances amplitudes thanks to the barrier function.The benefit is that the overestimation of control gain can be eliminated,resulting in chattering reduction.Moreover,a modified barrier function-like control gain is employed to prevent the input saturation problem due to the physical limit of the actuator.The stability analysis and comparative experiments demonstrate that the proposed BFASMC can ensure the prespecified convergence performance of the NWMR system output variables and strong robustness against uncertainties/disturbances.

Treatment of hemolymphangioma by robotic surgery: A case report

BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.

基于Robot Studio的分类码垛仿真设计

针对工业机器人轨迹规划和自动化生产协调难度大的问题,提出一种基于Robot Studio的分类码垛仿真设计方案。使用Robot Studio软件,创建工业机器人仿真工作站。通过Smart组件的设计、I/O信号的设定、工作站逻辑的建立和程序编写等工作,最终实现工业机器人智能分类码垛操作。经过模拟仿真,结果表明:分类码垛的速度和准确率均可达到预期要求。说明该分类码垛设计方案可行,可以为实际码垛工作站的搭建和生产提供一定的现实指导。

天玑骨科机器人TiRobot Recon导航系统使用风险关键控制点确定及运维管理体系应用效果分析

目的:构建天玑骨科机器人TiRobot Recon导航系统风险控制点确定及运维管理体系(以下简称风险控制运维管理体系)并分析应用效果,为提高天玑骨科机器人临床服务效果和质量提供理论指导与参考。方法:通过查阅文献、总结临床实践经验等方式明确天玑骨科机器人TiRobot Recon导航系统风险关键控制点,据此构建风险控制运维管理体系,比较该体系实施前(2022年1月~2022年12月)与实施后(2023年1月~2023年12月)对天玑骨科机器人TiRobot Recon导航系统的管理效果。结果:实施风险控制运维管理体系后,天玑骨科机器人TiRobot Recon导航系统日均使用时间、预期目标达标率、系统风险事件上报准确性、风险预警及时性和风险事件数据规范性均高于实施前,系统故障待机时间和故障率低于实施前,差异有统计学意义(t=6.956、9.656、5.415、4.678、3.711、3.354、5.229,P<0.05);实施分线控制运维管理体系后,天玑骨科机器人TiRobot Recon导航系统的人员日常养护、使用前检查、使用后清洁、系统操作、故障应对、紧急处理等操作熟练度评分均高于实施前,差异有统计学意义(t=4.225、2.399、2.385、2.597、2.421、3.560,P<0.05)。结论:采用风险控制运维管理体系可提高天玑骨科机器人TiRobot Recon导航系统的使用效果,强化人员操作熟练度,临床应用优势明显,具有应用价值。

Current Status,Challenges,and Prospects for New Types of Aerial Robots

New types of aerial robots(NTARs)have found extensive applications in the military,civilian contexts,scientific research,disaster management,and various other domains.Compared with traditional aerial robots,NTARs exhibit a broader range of morphological diversity,locomotion capabilities,and enhanced operational capacities.Therefore,this study defines aerial robots with the four characteristics of morphability,biomimicry,multi-modal locomotion,and manipulator attachment as NTARs.Subsequently,this paper discusses the latest research progress in the materials and manufacturing technology,actuation technology,and perception and control technology of NTARs.Thereafter,the research status of NTAR systems is summarized,focusing on the frontier development and application cases of flapping-wing microair vehicles,perching aerial robots,amphibious robots,and operational aerial robots.Finally,the main challenges presented by NTARs in terms of energy,materials,and perception are analyzed,and the future development trends of NTARs are summarized in terms of size and endurance,mechatronics,and complex scenarios,providing a reference direction for the follow-up exploration of NTARs.

Multimode Design and Analysis of an Integrated Leg-Arm Quadruped Robot with Deployable Characteristics

To improve locomotion and operation integration, this paper presents an integrated leg-arm quadruped robot(ILQR) that has a reconfigurable joint. First, the reconfigurable joint is designed and assembled at the end of the legarm chain. When the robot performs a task, reconfigurable configuration and mode switching can be achieved using this joint. In contrast from traditional quadruped robots, this robot can stack in a designated area to optimize the occupied volume in a nonworking state. Kinematics modeling and dynamics modeling are established to evaluate the mechanical properties for multiple modes. All working modes of the robot are classified, which can be defined as deployable mode, locomotion mode and operation mode. Based on the stability margin and mechanical modeling, switching analysis and evaluation between each mode is carried out. Finally, the prototype experimental results verify the function realization and switching stability of multimode and provide a design method to integrate and perform multimode for quadruped robots with deployable characteristics.

An Automatic Implementation of Oropharyngeal Swab Sampling for Diagnosing Respiratory Infectious Diseases via Soft Robotic End-Effectors

The most widely adopted method for diagnosing respiratory infectious diseases is to conduct polymerase chain reaction(PCR)assays on patients’respiratory specimens,which are collected through either nasal or oropharyngeal swabs.The manual swab sampling process poses a high risk to the examiner and may cause false-negative results owing to improper sampling.In this paper,we propose a pneumatically actuated soft end-effector specifically designed to achieve all of the tasks involved in swab sampling.The soft end-effector utilizes circumferential instability to ensure grasping stability,and exhibits several key properties,including high load-to-weight ratio,error tolerance,and variable swab-tip stiffness,leading to successful automatic robotic oropharyngeal swab sampling,from loosening and tightening the transport medium tube cap,holding the swab,and conducting sampling,to snapping off the swab tail and sterilizing itself.Using an industrial collaborative robotic arm,we integrated the soft end-effector,force sensor,camera,lights,and remote-control stick,and developed a robotic oropharyngeal swab sampling system.Using this swab sampling system,we conducted oropharyngeal swab-sampling tests on 20 volunteers.Our Digital PCR assay results(RNase P RNA gene absolute copy numbers for the samples)revealed that our system successfully collected sufficient numbers of cells from the pharyngeal wall for respiratory disease diagnosis.In summary,we have developed a pharyngeal swab-sampling system based on an“enveloping”soft actuator,studied the sampling process,and imple-mented whole-process robotic oropharyngeal swab-sampling.