Updates in Urologic Robot Assisted Surgery

Navaratnam, Anojan; Abdul-Muhsin, Haidar; Humphreys, Mitchell R.

doi:10.12688/f1000research.15480.1

Cited by 40 publications

(18 citation statements)

References 40 publications

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“…Although many robotic surgical systems have been designed for MIS interventions, just a few of them are able to work on flexible ureteroscopy [44].…”

Section: State Of the Art A Surgical Robotsmentioning

confidence: 99%

Position Based Model of a Flexible Ureterorenoscope in a Virtual Reality Training Platform for a Minimally Invasive Surgical Robot

et al. 2019

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Although the total number of ureteroscopy interventions during the past years has significantly increased, current flexible ureteroscopy procedures still present some limitations to urologic surgeons. However, nowadays different robotic systems have been developed in order to reduce those limitations. Flexible ureteroscopy robots provide a technological alternative which combines the benefits that this type of procedures offers to the patients, and solutions to the problems encountered from the surgeons perspective. In this paper, a virtual reality training platform for robot-assisted flexible ureterorenoscopy interventions is presented. A position based model for the virtual flexible endoscope is detailed and a standard user interface for the training platform is designed. Moreover, a comparative analysis of the performance of the training platform in different scenarios, including the navigation through a three-dimensional ureterorenal model, is presented. The obtained results determine that the training platform presents different computational rates depending on the complexity of the implemented environment and on the number of collisions and constraints that have to be handled. Nevertheless, the virtual model is visually plausible, effective for real-time user interaction and suitable for training.

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“…Although many robotic surgical systems have been designed for MIS interventions, just a few of them are able to work on flexible ureteroscopy [44].…”

Section: State Of the Art A Surgical Robotsmentioning

confidence: 99%

Position Based Model of a Flexible Ureterorenoscope in a Virtual Reality Training Platform for a Minimally Invasive Surgical Robot

et al. 2019

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“…Robotic-assisted surgery (RAS) is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. RAS cases have tripled over the past decade [ 1 ] largely replacing both open and traditional laparoscopic surgeries for many common procedures [ 2 ]. Similar to many other types of technology in health care, RAS has changed tasks and workflow [ 3 , 4 ], demanding additional skills or training and introducing new complexities ranging from skill building and learning curves to workspace and organizational issues associated with operating room (OR) layout.…”

Section: Introductionmentioning

confidence: 99%

Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design

Alfred¹,

Cohen²,

Cohen³

et al. 2021

JMIR Res Protoc

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Background The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. Objective This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals. Methods The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention (including through direct observation of a sample of surgeries in each observational phase), operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis. Results The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 (CSMC and MDRH: Pro00056245; VCMC: STUDY 270; MUSC: Pro00088741). After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites. Conclusions This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/25284

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“…The newly developed renal clearable nanofluorophores [5] and organic dyes [2b] are mainly taking the glomerular filtration pathway and have been used for detecting kidney dysfunction [6] or improving positive contrast of many cancers [7] for fluorescence‐guided surgery. However, none of them was reported to selectively target primary kidney cancers over normal kidney tissues and “light up” the tumor margins with positive contrast (hyperfluorescence), which is highly demanded in fluorescence‐guided partial nephrectomy to preserve kidney function and improve the quality of life of patients with kidney cancer [8] (Scheme 1 d). Considering that over 90 percent of kidney cancer is renal cell carcinoma (RCC) originating from the renal tubular epithelial cell [9] (Scheme 1 c), the fundamental understanding of the interactions and transport of renal clearable dyes and nanoparticles with/in renal tubules is essential to designing new strategies for selectively targeting of RCC.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, some other molecules can be actively excreted from peritubular capillaries into the lumen of the proximal tubules by utilizing the transporters on the basolateral side of proximal tubular cells,i nflux into the cells and efflux from the luminal side [4] (Scheme 1b). The newly developed renal clearable nanofluorophores [5] and organic dyes [2b] are mainly taking the glomerular filtration pathway and have been used for detecting kidney dysfunction [6] or improving positive contrast of many cancers [7] for fluorescence-guided surgery.H owever,n one of them was reported to selectively target primary kidney cancers over normal kidney tissues and "light up" the tumor margins with positive contrast (hyperfluorescence), which is highly demanded in fluorescence-guided partial nephrectomy to preserve kidney function and improve the quality of life of patients with kidney cancer [8] (Scheme 1d). Considering that over 90 percent of kidney cancer is renal cell carcinoma (RCC) originating from the renal tubular epithelial cell [9] (Scheme 1c), the fundamental understanding of the interactions and transport of renal clearable dyes and nanoparticles with/in renal tubules is essential to designing new strategies for selectively targeting of RCC.T he renal tubule-secretable fluorophores are particularly interesting because their enhanced interaction with basolateral side of renal tubules allows to fully investigate the correlation between renal transport of nanofluorophores and their ability of selective RCC targeting.…”

Section: Introductionmentioning

confidence: 99%

Hyperfluorescence Imaging of Kidney Cancer Enabled by Renal Secretion Pathway Dependent Efflux Transport

Zheng

Chong

et al. 2020

Angewandte Chemie

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Renal tubular secretion is an active efflux pathway for the kidneys to remove molecules but has yet to be used to enhance kidney cancer targeting.W ereport indocyanine green (ICG) conjugated with a2 100 Da PEG molecule (ICG-PEG45) as ar enal-tubule-secreted near-infrared-emitting fluorophore for hyperfluorescence imaging of kidney cancers, which cannot be achieved with hepatobiliary-and glomerularclearable ICG.T his pathway-dependent targeting of kidney cancer arises from the fact that the secretion pathway enables ICG-PEG45 to be effectively effluxed out of normal proximal tubules through P-glycoprotein transporter while being retained in cancerous kidney tissues with lowP-glycoprotein expression. Tuning elimination pathwaysa nd utilizing different efflux kinetics of medical agents in normal and diseased tissues could be an ew strategy for tackling challenges in disease diagnosis and treatments that cannot be addressed with passive and ligand-receptor-mediated active targeting.

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Updates in Urologic Robot Assisted Surgery

Cited by 40 publications

References 40 publications

Position Based Model of a Flexible Ureterorenoscope in a Virtual Reality Training Platform for a Minimally Invasive Surgical Robot

Position Based Model of a Flexible Ureterorenoscope in a Virtual Reality Training Platform for a Minimally Invasive Surgical Robot

Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design

Hyperfluorescence Imaging of Kidney Cancer Enabled by Renal Secretion Pathway Dependent Efflux Transport

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