Comment on“Robotic surgery and liver transplantation:A single-center experience of 501 robotic donor hepatectomies”

To the Editor:We read with great interest the article by Schulze et al.entitled“Robotic surgery and liver transplantation:A single-center experience of 501 robotic donor hepatectomies”[1].It is the first single-center report including over 500 fully robotic donor hepatectomies.For the donors,the overall complication rate was 6.4%(n=32).Postoperative self-limiting bleeding(0.4%)and bile leakage from the resection plane(1.8%)were rare.

Deterministic Learning-Based Neural PID Control for Nonlinear Robotic Systems

Traditional proportional-integral-derivative(PID)controllers have achieved widespread success in industrial applications.However,the nonlinearity and uncertainty of practical systems cannot be ignored,even though most of the existing research on PID controllers is focused on linear systems.Therefore,developing a PID controller with learning ability is of great significance for complex nonlinear systems.This article proposes a deterministic learning-based advanced PID controller for robot manipulator systems with uncertainties.The introduction of neural networks(NNs)overcomes the upper limit of the traditional PID feedback mechanism’s capability.The proposed control scheme not only guarantees system stability and tracking error convergence but also provides a simple way to choose the three parameters of PID by setting the proportional coefficients.Under the partial persistent excitation(PE)condition,the closed-loop system unknown dynamics of robot manipulator systems are accurately approximated by NNs.Based on the acquired knowledge from the stable control process,a learning PID controller is developed to further improve overall control performance,while overcoming the problem of repeated online weight updates.Simulation studies and physical experiments demonstrate the validity and practicality of the proposed strategy discussed in this article.

Robotic Surgery: An Effective Treatment Option for Epiphrenic Diverticulum Associated with Nutcracker Esophagus

Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.

Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and potency.The long-term impact on the oncologic outcomes remains to be investigated.Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched cohort.Methods:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing RARP.We excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral nerve-sparing.Patients with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 months.At the time of RARP,dHACM was placed around the neurovascular bundle in the amnio group.Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively.Outcomes measured were biochemical recurrence(BCR),adjuvant and salvage therapy rates.Results:Propensity score matching resulted in two groups of 444 patients.Cumulative incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective randomization.Conclusion:The data suggest that using dHACM does not have a negative impact on BCR in patients.Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

Generative adversarial networks based motion learning towards robotic calligraphy synthesis

Robot calligraphy visually reflects the motion capability of robotic manipulators.While traditional researches mainly focus on image generation and the writing of simple calligraphic strokes or characters,this article presents a generative adversarial network(GAN)-based motion learning method for robotic calligraphy synthesis(Gan2CS)that can enhance the efficiency in writing complex calligraphy words and reproducing classic calligraphy works.The key technologies in the proposed approach include:(1)adopting the GAN to learn the motion parameters from the robot writing operation;(2)converting the learnt motion data into the style font and realising the transition from static calligraphy images to dynamic writing demonstration;(3)reproducing high-precision calligraphy works by synthesising the writing motion data hierarchically.In this study,the motion trajectories of sample calligraphy images are firstly extracted and converted into the robot module.The robot performs the writing with motion planning,and the writing motion parameters of calligraphy strokes are learnt with GANs.Then the motion data of basic strokes is synthesised based on the hierarchical process of‘stroke-radicalpart-character’.And the robot re-writes the synthesised characters whose similarity with the original calligraphy characters is evaluated.Regular calligraphy characters have been tested in the experiments for method validation and the results validated that the robot can actualise the robotic calligraphy synthesis of writing motion data with GAN.

Kinematic analysis of flexible bipedal robotic systems

In spite of its intrinsic complexities,the passive gait of bipedal robots on a sloping ramp is a subject of interest for numerous researchers.What distinguishes the present research from similar works is the consideration of flexibility in the constituent links of this type of robotic systems.This is not a far-fetched assumption because in the transient(impact)phase,due to the impulsive forces which are applied to the system,the likelihood of exciting the vibration modes increases considerably.Moreover,the human leg bones that are involved in walking are supported by viscoelastic muscles and ligaments.Therefore,for achieving more exact results,it is essential to model the robot links with viscoelastic properties.To this end,the Gibbs-Appell formulation and Newton's kinematic impact law are used to derive the most general form of the system's dynamic equations in the swing and transient phases of motion.The most important issue in the passive walking motion of bipedal robots is the determination of the initial robot configuration with which the system could accomplish a periodic and stable gait solely under the effect of gravitational force.The extremely unstable nature of the system studied in this paper and the vibrations caused by the impulsive forces induced by the impact of robot feet with the inclined surface are some of the very serious challenges encountered for achieving the above-mentioned goal.To overcome such challenges,an innovative method that uses a combination of the linearized equations of motion in the swing phase and the algebraic motion equations in the transition phase is presented in this paper to obtain an eigenvalue problem.By solving this problem,the suitable initial conditions that are necessary for the passive gait of this bipedal robot on a sloping surface are determined.The effects of the characteristic parameters of elastic links including the modulus of elasticity and the Kelvin-Voigt coefficient on the walking stability of this type of robotic systems are also studied.The findings of this parametric study reveal that the increase in the Kelvin-Voigt coefficient enhances the stability of the robotic system,while the increase in the modulus of elasticity has an opposite effect.

A Novel Disturbance Observer Based Fixed-Time Sliding Mode Control for Robotic Manipulators With Global Fast Convergence

This paper proposes a new global fixed-time sliding mode control strategy for the trajectory tracking control of uncertain robotic manipulators.First,a fixed-time disturbance observer(FTDO) is designed to deal with the adverse effects of model uncertainties and external disturbances in the manipulator systems.Then an adaptive scheme is used and the adaptive FTDO(AFTDO) is developed,so that the priori knowledge of the lumped disturbance is not required.Further,a new non-singular fast terminal sliding mode(NFTSM) surface is designed by using an arctan function,which helps to overcome the singularity problem and enhance the robustness of the system.Based on the estimation of the lumped disturbance by the AFTDO,a fixed-time non-singular fast terminal sliding mode controller(FTNFTSMC)is developed to guarantee the trajectory tracking errors converge to zero within a fixed time.The settling time is independent of the initial state of the system.In addition,the stability of the AFTDO and FTNFTSMC is strictly proved by using Lyapunov method.Finally,the fixed-time NFESM(FTNFTSM) algorithm is validated on a 2-link manipulator and comparisons with other existing sliding mode controllers(SMCs) are performed.The comparative results confirm that the FTNFTSMC has superior control performance.

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.

Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer

Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.

Robotic vs laparoscopic abdominoperineal resection for rectal cancer:A propensity score matching cohort study and metaanalysis

BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.

Robotics in total knee replacement:Current use and future implications

Robotic total knee replacement(TKR)surgery has evolved over the years with the aim of improving the overall 80% satisfaction rate associated with TKR surgery.Proponents claim higher precision in executing the pre-operative plan which results in improved alignment and possibly better clinical outcomes.Opponents suggest longer operative times with potentially higher complications and no superiority in clinical outcomes alongside increased costs.This editorial will summarize where we currently stand and the future implications of using robotics in knee replacement surgery.

Path Planning for Robotic Arms Based on an Improved RRT Algorithm

The burgeoning robotics industry has catalyzed significant strides in the development and deployment of industrial and service robotic arms, positioning path planning as a pivotal facet for augmenting their operational safety and efficiency. Existing path planning algorithms, while capable of delineating feasible trajectories, often fall short of achieving optimality, particularly concerning path length, search duration, and success likelihood. This study introduces an enhanced Rapidly-Exploring Random Tree (RRT) algorithm, meticulously designed to rectify the issues of node redundancy and the compromised path quality endemic to conventional RRT approaches. Through the integration of an adaptive pruning mechanism and a dynamic elliptical search strategy within the Informed RRT* framework, our algorithm efficiently refines the search tree by discarding branches that surpass the cost of the optimal path, thereby refining the search space and significantly boosting efficiency. Extensive comparative analysis across both two-dimensional and three-dimensional simulation settings underscores the algorithm’s proficiency in markedly improving path precision and search velocity, signifying a breakthrough in the domain of robotic arm path planning.

基于RobotStudio的视觉分拣打磨工作站仿真设计

为解决中小型零件混流自动化生产等问题,提出基于RobotStudio的工业机器人视觉分拣打磨工作站的仿真设计方案。根据零件的生产工艺流程,利用UG软件创建视觉分拣打磨工作站的整体布局;通过分析工作站各个模块功能,设计了各模块的结构;利用RobotStudio软件构建了工作站仿真模型。以视觉引导Smart组件和输送链跟踪仿真为例,阐述了ABB工业机器人通过视觉引导获取工件空间位姿的四元数和欧拉角的转换方法,并介绍了视觉拍照、机器人与工业相机通信等动态仿真的设置过程,以及输送链跟踪动态效果的设置方法。为实现工作站全过程仿真,设计了整体工作站逻辑,编制了仿真工作站离线程序,并将仿真工作站同步到实验平台调试验证。该设计可为智能制造生产线的设计、制造及应用提供参考。

International experts consensus guidelines on robotic liver resection in 2023

The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.

Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center

Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P < 0.001], lymph node metastasis(HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately(HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated(HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ Ⅲ(HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index(C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685(95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging(8th edition): 0.541(95% CI: 0.493-0.589)( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.

Modeling and Adaptive Neural Network Control for a Soft Robotic Arm With Prescribed Motion Constraints

This paper presents a dynamic model and performance constraint control of a line-driven soft robotic arm.The dynamics model of the soft robotic arm is established by combining the screw theory and the Cosserat theory.The unmodeled dynamics of the system are considered,and an adaptive neural network controller is designed using the backstepping method and radial basis function neural network.The stability of the closed-loop system and the boundedness of the tracking error are verified using Lyapunov theory.The simulation results show that our approach is a good solution to the motion constraint problem of the line-driven soft robotic arm.

Robotic versus laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: A propensity score-matched analysis

Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy(RDP) for pancreatic ductal adenocarcinoma(PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC. Methods: Patients who underwent RDP or laparoscopic distal pancreatectomy(LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed. Results: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time(209.7 vs. 163.2 min;P = 0.003), lower open conversion rate(0% vs. 4.8%;P < 0.001), higher cost(15 722 vs. 12 699 dollars;P = 0.003), and a higher rate of achievement of an R0 resection margin(90.5% vs. 61.9%;P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant intergroup difference(9.5% vs. 9.5%). The median disease-free survival(34.5 vs. 17.3 months;P = 0.588) and overall survival(37.7 vs. 21.9 months;P = 0.171) were comparable between the groups. Conclusions: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.

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。

Importance of Photo-Realistic and Dedicated Simulator in Agricultural Robotics

Agricultural robotics is a comparatively new field. Recently, it has gotten special attention because of agricultural labor shortages and rising labor costs. With the increasing operational use of agricultural robots, the need for a dedicated robotic simulator for such activity has been noted here. The need of a dedicated and specialty simulator for agricultural robotics research is the main focus area of this paper. Moreover, limitations have been pointed out when conventional robot simulators are used directly in agricultural settings. In a nutshell, it has been tried to emphasize that a dedicated simulator for agricultural robotics would be a timely advance and would accelerate the growth of agricultural robots.

Robot-assisted adrenalectomy:Step-by-step technique and surgical outcomes at a high-volume robotic center

Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.