Miniature 6-axis force/torque sensor for force feedback in robot-assisted minimally invasive surgery

In order to restore force sensation to robot-assisted minimally invasive surgery(RMIS),design and performance evaluation of a miniature 6-axis force/torque sensor for force feedback is presented.Based on the resistive sensing method,a flexural-hinged Stewart platform is designed as the flexible structure,and a straightforward optimization method considering the force and sensitivity isotropy of the sensor is proposed to determine geometric parameters which are best suited for the given external loads.The accuracy of this method is preliminarily discussed by finite element methods(FEMs).The sensor prototype is fabricated with the development of the electronic system.Calibration and dynamic loading tests for this sensor prototype are carried out.The working ranges of this sensor prototype are 30 N and 300 N·mm,and resolutions are 0.08 N in radial directions,0.25 N in axial direction,and 2.4 N·mm in rotational directions.It also exhibits a good capability for a typical dynamic force sensing at a frequency close to the normal heart rate of an adult.The sensor is compatible with surgical instruments for force feedback in RMIS.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Current status of minimally invasive liver surgery for cancers

Hepatocellular carcinoma(HCC)patients have chronic liver disease with functional deterioration and multicentric oncogenicity.Liver surgeries for the patients should be planned on both oncological effects and sparing liver function.In colorectal patients with post-chemotherapy liver injury and multiple bilateral tumors,handling multiple tumors in a fragile/easy-to-bleed liver is an important issue.Liver surgery for biliary tract cancers is often performed as a resection of large-volume functioning liver with extensive lymphadenectomy and bile duct resection/reconstruction.Minimally invasive liver surgery(MILS)for HCC is applied with the advantages of laparoscopic for cases of cirrhosis or repeat resections.Small anatomical resections using the Glissonian,indocyanine greenguided,and hepatic vein-guided approaches are under discussion.In many cases of colorectal liver metastases,MILS is applied combined with chemotherapy owing to its advantage of better hemostasis.Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion.In the case of biliary tract cancers,MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing.A robotassisted procedure for dissection of major vessels and handling fragile livers may have advantages,and well-simulated robot-assisted procedure may decrease the difficulty for biliary tract cancers.

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.

Robot-assisted laparoscopic gastrectomy for gastric cancer

Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer.

Results of robot-assisted minimally invasive esophagectomy in 111 consecutive patients:an Asia cohort study

Background Robot-assisted minimally invasive esophagectomy(RAMIE)is becoming increasingly popular as a treatment for esophageal cancer.The purpose of this study was to use the da Vinci robotic system(Intuitive Surgical,Sunnyvale,CA,USA)to perform 111 consecutive cases of radical esophageal cancer and report the perioperative data of surgery and postoperative complications and short-term oncological outcomes.Methods We retrospectively analyzed 111 patients who underwent RAMIE conducted at Fujian Medical University Union Hospital from August 2016 to January 2021.Each patient’s characteristics,clinicopathological stage,postoperative pathological stage,surgery outcome,postoperative recovery,and short-term oncological outcomes were analyzed.Results Of the 111 patients who underwent RAMIE,77 were male and 34 were female,and the mean age was 62.1±8.8 years.Twenty-seven patients(24.3%)received preoperative neoadjuvant therapies,the most popular of which was preoperative induction chemotherapy in 16 cases(14.4%),followed by preoperative induction radiotherapy in 8 cases(7.2%)and preoperative induction chemotherapy plus immunization in 3 cases(2.7%).The vast majority of patients(110/111,99.1%)underwent radical resection,with a mean intraoperative bleeding amount of 99.9±68.4 mL and a mean operative time of 271.9±70.0 min.The mean total number of lymph nodes removed was 40.9±16.7,including 21.8±9.0 thoracic lymph nodes.Fifty-five(49.6%)patients had lymph node metastases,including 17(15.3%)with lymph node metastases in the left recurrent laryngeal nerve,24(21.6%)with lymph node metastases in the right recurrent laryngeal nerve,and 7(6.3%)with lymph node metastases in the bilateral recurrent laryngeal nerve.The positive rate of left recurrent nerve lymph nodes was 4.77%,and he positive rate of right recurrent nerve lymph nodes was 8.38%.The main postoperative complications included pulmonary infection in 24 cases(21.6%),celiac disease in 3 cases(2.7%),tracheoesophageal fistula in 1 case(0.9%),anastomotic fistula in 3 cases(2.7%),postoperative cardiac arrhythmias in 11 cases(9.9%),VTE in 3 cases(2.7%),and pleural effusion(requiring postoperative tube drainage)in 13 cases(11.7%).Additionally,2 cases of postoperative pneumothorax(1.8%),1 case of poor incision healing(0.9%),1 case of incomplete bowel obstruction(0.9%),1 case of neck hematoma(0.9%),and 1 case of postoperative admission to the intensive care unit(0.9%)occurred.The median length of stay was 10.9±6.1 days,and there were no cases of perioperative death.Conclusions Robotic esophageal cancer radical surgery is safe and feasible.The surgeon can be proficient in thoracic robotic surgery and mediastinal lymph node dissection and achieve high levels of perioperative safety and short-term efficacy.

Applications and prospects of robotic surgery in esophageal cancer

Esophageal cancer(EC)is among the most common malignances and one of the leading causes of cancer-related death worldwide.Surgery plays a significant role in the multidisciplinary treatment for esophageal cancer.Recent advances in minimally invasive esophagectomy(MIE),including conventional thoracoscopic surgery and more recent robotic surgery,has been shown to improve short-term outcomes compared to open surgery.Robot-assisted minimally invasive esophagectomy(RAMIE)was first performed in 2003 and has been increasingly utilized in tertiary medical centers.Compared to conventional video-assisted minimally esophagectomy(VAMIE),RAMIE provides certain advantages such as increased magnification,three-dimensional visual clarity and better lymphadenectomy,with superior short-term outcome and at least equivalent oncological results.This review focuses on the techniques,benefits and obstacles in applications of robotic esophagectomy for treating EC,meanwhile discussing the future of robotic esophageal surgery.

经皮椎弓根螺钉技术的解剖学基础及其临床意义

目的 :为经皮椎弓根螺钉技术提供解剖学基础并在此基础上分析经皮植入椎弓根螺钉较常规开放植入椎弓根螺钉临床应用的优点。方法 :选用 10具经防腐固定 ,在解剖显微镜下对胸腰段脊柱后部结构进行逐层解剖 ,重点观测脊神经后支及其分支、脊柱节段动静脉的后支的来源、走行以及分布规律。结果 :脊神经后支的内侧支经骨纤维管下行沿途支配横突棘肌 ,支配下方小关节突、筋膜和韧带。外侧支向外下行走 ,沿途支配背部深层肌肉。节段动脉的后支在椎间孔的上外方绕向后下方 ,走行于脊神经的下方和下位脊椎上关节突的外方 ,分为内外两支穿行于腰部深层肌肉。节段静脉后支与同名动脉伴行 ,并与对侧、相邻节段同名静脉在棘突和横突部位构成静脉丛。结论 :避免损伤脊神经后支和节段动静脉的后支并运用可视化操作系统的经皮椎弓根螺钉植入技术 ,是微创脊柱外科一种新的技术手段。

一个七自由度带力反馈的遥操作主手的开发

本文展示了一个机器人系统中具有力反馈(Haptic/Force Feedback)功能的遥操作主手的开发。此主手具有七自由度的串联结构,并集成了多个电机以提供力反馈。通过ROS(Robot Operating System)的Rviz仿真环境进行了运动学验证。详述了算法开发过程,如运动学、雅克比矩阵、可操作性、正逆动力学。逆动力学计算的结果可以提供跟力控相关的功能,如重力补偿。通过以上工作,此主手不仅可以作为遥操作的输入端,而且可以将外界的接触力反馈回主手,使其成为一个双向遥操作仪器(Bilateral Teleoperation Device)。因此它可以成为机器人遥操作场景下,尤其是机器人辅助微创手术RAMIS(Robot-assisted Minimally Invasive Surgery)中重要的遥操作工具。

Positioning system design of closed-loop magnetically driven laser steering manipulator for endoscopic microsurgery

This study presents a closed-loop magnetically driven laser steering manipulator positioning system for endoscopic microsurgery.A multimagnetic field strength sensor circuit is embedded in a 16−mm diameter analog laser steering manipulator.The magnetic field distribution of a cylindrical permanent magnet in three-dimensional space is first modeled using an integral model to overcome the large error induced by the magnetic dipole model when the sensor and permanent magnet are close.The integral in the model is then decomposed using the Gauss–Legendre quadrature to improve the computational efficiency of the formulation.Moreover,five commonly used global search optimization methods are compared.Then,the algorithm with the fastest computational rate among these five algorithms,the tree-seed algorithm,is fused with the Levenberg–Marquardt algorithm,which performs well in local search,to obtain a hybrid optimization algorithm.Finally,it is demonstrated through static and dynamic experiments that the system based on the hybrid algorithm can obtain satisfactory computational errors while maintaining a high computational rate.

Robot-assisted ileocystoplasty for the treatment of adult neurogenic bladder: A video demonstration and outcomes

Ileocystoplasty is one of the treatment options in the armamentarium for the management of adults with neurogenic bladder dysfunction,after failure of less invasive treatment alternatives,such as intravesical onabotulinum toxin A injection therapy and sacral neuromodulation.It has traditionally been performed as open surgery and can be associated with significant morbidity,especially in the early postoperative period.[1]Complications associated with open ileocystoplasty include prolonged postoperative ileus,wound infections,and pain.Performing robot-assisted ileocystoplasty can reduce the morbidity associated with open surgery[2]and has been shown to be safe and feasible in experienced hands,[3]although it may be associated with increased operative duration because of its learning curve.Our technique of robot-assisted ileocystoplasty and early postoperative outcomes is demonstrated in this video(Supplemental Digital Content,https://links.lww.com/CURRUROL/A47).Robotic console time was 180 minutes,with minimal blood loss.Eight-hourly catheter aspiration and flushes were performed to manage the mucus in the urine.There were no metabolic acidosis or electrolyte derangements postoperatively.The patient was discharged on postoperative day 5.Postoperative cystogram at week 2 showed no leak and the patient is doing well at 1 year postoperatively.Robotic ileocystoplasty is safe and feasible and can reduce the morbidity associated with open surgery with good outcomes.

老年脆性骨盆骨折经皮逆行耻骨支螺钉固定

[目的]探讨老年骨盆脆性骨折(fragile fracture of pelvis, FFP)行经皮逆行耻骨支螺钉固定治疗耻骨支骨折的临床效果。[方法]回顾性分析本院2019年6月—2020年12月采用经皮逆行耻骨支螺钉固定的25例老年骨盆脆性骨折(27侧耻骨支),记录临床及影像结果。[结果]所有患者均顺利完成手术,术中无神经、血管损伤的并发症发生。所有患者随访(17.8±0.7)个月,恢复完全负重活动时间平均(7.8±0.6)周。与术后3个月相比,末次随访时,Majeed评分显著增加(P<0.05),髋内-外旋ROM、伸-屈ROM无显著变化(P>0.05)。末次随访疗效按Majeed标准临床结果评定为优19侧,良7侧,可1侧,优良率96.3%。影像方面,按Matta标准评价骨折复位质量,优21侧,良6侧,优良率100.0%。影像骨折愈合时间<8周11侧,占40.7%;8~12周16侧,占59.3%。与术后3个月相比,末次随访时Tonnis髋退变评级无显著变化(P>0.05)。[结论]逆行耻骨支经皮螺钉治疗老年脆性骨盆骨折具有手术创伤小、失血少、并发症少、功能恢复快等优点。

Control Evaluation of Antagonistic Series Elastic Actuation for a Robotic Endoscope Joint

Haptic feedback is typically missing during telemanipulation of surgical robots in minimally invasive surgeries,i.e.,surgeons cannot feel the interaction forces between the instruments and tissues.Instead,surgeons have to solely rely on visual feedback,which increases complexity of guiding the instruments and poses the safety threat of unperceivable contacts outside the field of view.We propose a novel series elastic actuation design for articulated robotic endoscopes to overcome these limitations and evaluate an according device with one joint.Similar to the actuation of human fingers,the joint is driven by antagonistic tendons.Springs are integrated in the transmission between the tendons and the motors outside of the endoscope shaft.We estimated the joint angle and thereby the endoscope shape,measured spring deflection,estimated tendon forces from that deflection,and implemented force control for the endoscope joint.Zero torque control and impedance control were evaluated under application of both a continuous force and an impact force to the endoscope tip.The springs reduced impact forces at the tip of the endoscope through their inherent compliance.At the same time,feeding back the estimated force resulted in a stable tendon force control and a tunable endoscope joint control:Zero torque control effectively reduced the external forces,while the endoscope joint showed the expected stiffness in impedance control.These results show that antagonistic series elastic actuation is a promising concept for endoscope joint actuation and that it can lead towards safer robot–tissue interactions in surgical robotics.