Fig 11 - uploaded by Sheila Russo
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Actuation assessment test with the anthropomorphic phantom: a) experimental setup, b)-c) approaching phases of the laser tip to the tissue phantom, d)-e) slicing phases of the laser tip on the tissue phantom. During experiments, optics is inserted in the phantom so as to point towards the front of the ASTRO system.
Source publication
Benign prostatic hyperplasia (BPH) is the most common pathology afflicting ageing men. The gold standard for surgical treatment of BPH is transurethral resection of the prostate (TURP). Laser assisted transurethral surgical treatment of BPH is recently emerging as a valid clinical alternative. Despite this, there are still some issues that hinder t...
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Purpose:
This study aimed to assess the clinical outcomes of prostatic urethral lift in Korean patients with bothersome lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).
Materials and methods:
Thirty-two men with symptomatic BPH were consecutively treated in a tertiary care center in Korea. To be included in the present ana...
Benign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of a...
PurposeTo prospectively investigate early and consecutive changes of lower urinary tract symptoms (LUTS), specifically storage symptoms after holmium laser enucleation of the prostate (HoLEP).Methods
Patients referred for HoLEP completed the International Prostatic Symptom Score (IPSS) the day before, at discharge, and 1, 2, 3, 4, 6, 8, 12, 16, 20,...
Citations
... En (Kundrat et al., 2021) se hace un estudio más particular, donde se analiza la implementación de una plataforma robótica para cirugía endovascular compatible con técnicas de imagen por resonancia magnética no ionizante evaluada mediante estudios de canulación. Otros desarrollan robots para intervenciones relacionadas con la próstata, como la plataforma ASTRO, que desarrolla un sistema de catéter robotizado para la cirugía de hiperplasia prostática benigna asistida por láser (Russo et al., 2015). ...
Este trabajo desarrolla la implantación de un entorno de trabajo cíber-físico para cirugía laparoscópica que permite utilizar un simulador quirúrgico con un brazo robótico, para así facilitar el aprendizaje y la investigación con este tipo de sistemas. Se propone y valida una configuración para cada uno de los elementos del quirófano que permite cumplir todas las restricciones funcionales. También se implanta un Modelo Cinemático Inverso para el brazo robótico redundante que devuelve la solución más adecuada que asegura el cumplimiento de estas restricciones. El entorno de trabajo se ha implementado haciendo uso de ROS y MATLAB, realizando una serie de pruebas a fin de validar el desarrollo de aplicaciones utilizando este framework.
... Because surgeons can make smaller incisions, robotic surgery is less invasive [8][9][10][11][12]. Smaller and more precise movements are possible in this type of surgery, giving it an advantage over conventional endoscopic techniques [13]. The figure: 1(a) explains the working principle of Robotics assisting in Minimally Invasive Surgery i.e., surgeon controls the operating robotic arm remotely and performs the operation according the visual feedback transmitted by the endoscope [15]. ...
R-MIS (Robotic assisted Minimally Invasive Surgery) is the future of surgeries allowing surgeons to perform the surgery with precision, comfort and accuracy even from the remote location. The use of the robotics in the surgery has reduced immense possibility of complication during the surgery. A robotic arm is simulated in MATLAB for R-MIS and the various drawbacks and difficulties are studied in this paper. Robotic Arm of six DOF (degree of freedom) is simulated and programmed to follow the pattern of input signal and then the lag, error, feedback response limitations were analyzed to better understand the restriction of the R-MIS. The forward and inverse kinematics designed for the arm showed the basic principle behind the arm movements.
... Then, according to the expanded form of Taylor's formula, after using the second-order central difference, the general difference form of each derivative in the X direction can be obtained. Meanwhile, according to the difference equation [40] and boundary conditions, it can be obtained as follows: (20) Meanwhile, the quality of each node can be expressed as m · h after difference, and according to equation (18), equation (19) and equation (20) the difference equation of the model is: ...
In the treatment of prostate cancer patients, surgery of radioactive seed implantation with the puncture robots is an effective treatment method. However, when the puncture needle enters the lesion tissue, there are complicated forces between the needle body and the soft tissue, which leads to the drift of the prostate and the deflection of the puncture needle, thereby affecting the puncture accuracy. In order to improve the positioning accuracy and ensure the best treatment effect, a sine rotation continuous puncture control method was proposed in this paper. First, by analyzing the interaction between the puncture needle and the soft tissue, the force balance equation and the deflection equation were established, according to the equations, it could be known that puncture friction is the main factor affecting the deflection of the puncture needle. Second, combined with the influence of puncture friction and the research on the theory of rotation puncture, the sine rotation puncture method was compared with the direct puncture method and the existing rotation puncture method; Observed with a 4D Color Doppler Ultrasound to verify the feasibility of the rotating puncture theory and the effectiveness of the sine rotation puncture method. Third, through the establishment of Euler Beam model, rotation angle analysis and puncture velocity test analysis, the influence of dynamic parameters of this method on the puncture accuracy was discussed, the optimization range of each factor was obtained; The experiment was designed by the quadratic regression orthogonal combination theory, the experiment process was observed and recorded by a 3D X-ray scanner, the regression equations were established between experiment factors and experiment indicators with the Design-Expert, and the best parameter combinations were acquired through optimization. Last, comparison tests and verification test were carried out to verify the rationality and reliability of the optimized sine rotation puncture control method.
... The technology has been utilized mainly in precision surgery. It is popular in ophthalmology [38], where retinal laser photocoagulation is performed, and for less intrusive operations, such as prostate ablations [39]. Pulsed EM fields are harnessed at low energies to promote bone and cartilage regeneration. ...
This article reviewed the application of IEs to biomedicine, with an emphasis on the practice's potential benefits and necessary collaboration between specialist engineers and medical practitioners. The design of high-voltage generators for electroporation is a challenging task due to the stiff requirements for the voltage amplitude, controllability, isolation, and output impedance. electroporation has been acknowledged as a key tool for cancer treatment that has a growing importance despite the significant challenges that must still be faced, The future of this technology will require the development of versatile generators that overcome all of the current limitations and provide useful tools for research and clinical treatments. To achieve the goal, several IE technologies will play a fundamental role. Research on advanced topologies will be essential, as will be the use of faster and higher-voltage devices, such as those based on silicon carbide and gallium nitride. Advanced control architectures and will be required to accurately control the generator, monitor and optimize the treatment, and guarantee the safety of patients and medical teams. There is a brilliant future for the IEs that are applied to ER.
... Initial cadaveric experiments showed this system was capable of executing tasks necessary for HoLEP. 24 Russo et al. 145 presented another robot for laser-assisted transurethral resection of prostate, called the ASTRO (actuated and sensorized tool for laser-assisted surgery of the prostate). This robot uses a wire-driven multi-lumen catheter to steer a laser-fiber and fiber-optic based contact sensing. ...
The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.
... Transurethral robotic access has been first demonstrated in the 90's for prostate resection by Davies et al. [16]. More recent efforts focused on Holmium laser enucleation of the prostate using concentric tube robots [17] and a multi-lumen catheter [18]. Robotic transurethral intervention and visualization of the bladder lagged behind similar explorations of technology for prostate resection. ...
Staging and treatment of nonmuscle-invasive bladder tumors using transurethral resection of bladder tumors (TURBT) is challenging due to limitations in intravesicular tool dexterity, visualization and risk of bladder wall perforation. Currently, TURBT is achieved via a rigid resectoscope. This dexterity limitation is exacerbated when tumors are located in the bladder neck region. To address these limitations, an endoscopic robotic system called TURBot was developed. The paper presents the design considerations, modeling, and control challenges that were addressed to enable the first robot-assisted
in vivo
TURBT. The design and control of a slave robot comprised of a multisegment continuum robot capable of deploying a micro snake-like continuum robot for control of an ablation laser, a grasper, and a fiberscope is presented. A strategy for constrained telemanipulation is presented based on the redundancy resolution with varying task dimension that is commensurate with the level of constraint experienced by the robot during transurethral deployment. In addition to evaluation in animals, TURBot resection is compared against manual resection in a mockup user study using a human bladder phantom. The contributions of this paper present key steps that pave the way toward successful clinical robot-assisted TURBT.
... Computed-assisted medical interventions are being very important in modern surgery because they offer many benefits compared to conventional approaches, including increased accuracy, reduction of postoperative pain, reduction of complications and risks for the patient, decreased hospitality time. They are especially used in surgery navigation to provide freehand navigation or guidance for real time precise localization of specific anatomical structures within the human body [1][2][3][4][5] and in neurosurgical and orthopedic applications to monitor motor disorders [6][7][8][9][10][11]. ...
Objective: This paper proposes the development of a novel electromagnetic tracking system for navigation surgery. Main objective is to provide a system able to operate in a wide tracking volume to make easier and efficient the surgical procedures by assuring high measurement accuracy.
Methods: A new field generator consisting in five transmitting coils excited with Frequency Division Multiplexing technique has been developed. Attention is devoted to designing and arrangement of the coils to assure high sensitivity, system scalability and a homogeneous magnetic field inside working volume. A suitable technique based on Look-Up-Table is applied for sensor position calculation and an anthropomorphic robot is used for table calibration.
Results: Experimental tests highlight a good repeatability of the measurement data and a negligible noise influence for the proposed system. The obtained tracking volume is wider with respect to the commercial tracking device used in surgical applications and seem promising.
Conclusion: The main characteristic of the developed system consists of: scalable and modular configuration of Field Generator, high measured sensitivity due to the increased number of transmitting coils with respect to the classical configuration and large tracking volume.
The development of the proposed magnetic tracking systems with high accuracy and wide working volume allows to promote broader utilization of advantaged techniques in surgery procedures for both improving the effectiveness and decreasing the invasiveness of medical interventions.
... Combining laser technology with robotic precision and accuracy presents a promising opportunity for improving surgical interventions. This combination was previously used for performing laser-assisted cutting or ablation in different robot-assisted interventions [41][42][43][44][45][46][47][48][49]. Recently, two studies demonstrated a successful robot-assisted laser welding of a cornea [22,50]. ...
Fast and reliable incision closure is critical in any surgical intervention. Common solutions are sutures and clips or adhesives, but they all present difficulties. These difficulties are especially pronounced in classical and robot-assisted minimally-invasive interventions. Laser soldering methods present a promising alternative, but their reproducibility is limited. We present a system that combines a previously reported laser soldering system with a robotic system, and demonstrate its feasibility on the incision-closure of ex-vivo mice skins. In this demonstration, we measured tearing forces of ~2.5N, 73% of the tearing force of a mouse skin without an incision. This robot-assisted laser soldering technique has the potential to make laser tissue soldering more reproducible and revolutionize surgical tissue bonding.
... [14][15][16] Several transurethral robots have been developed, mostly targeting benign prostatic hyperplasia (BPH). [17][18][19][20] In regards to transurethral robots that can be deployed for bladder pathologies, our group developed an early proof-of-concept robot for TURBT. 21 In addition, there were several efforts by other groups to use robotics for surveillance of bladder. ...
Introduction:
Transurethral Resection of Bladder Tumors (TURBT) can be a challenging procedure, primarily due to limitations in tool-tip dexterity, visualization and lack of tissue depth information. A transurethral robotic system was developed to revolutionize TURBT by addressing some of these limitations. The results of three pilot in-vivo porcine studies using the novel robotic system are presented and potential improvements are proposed based on experimental observations.
Materials & methods:
A transvesical endoscope with a mounted optically-tracked camera was placed through the bladder of the swine under general anesthesia. Simulated bladder lesions were created by injecting HistoGel processing gel mixed with blue dye trans-abdominally into various locations in the bladder wall under endoscopic visualization. A seven-degree-of-freedom (DoF) robot was then used for transurethral resection/ablation of these simulated tumors. An independent two-DoF distal laser arm (DLA) was deployed through the robot for laser ablation and was assisted by a manually controlled gripper for en-bloc resection attempts.
Results:
Lesions were successfully created and ablated using our novel endoscopic robot in the swine bladder. Full accessibility of the bladder, including the bladder neck and dome, was demonstrated without requiring bladder deflation or pubic compression. Simulated lesions were successfully ablated using the Holmium laser. En-bloc resection was demonstrated using the DLA and a manual grasper.
Conclusion:
Feasibility of robot-assisted en-bloc resection was demonstrated. Main challenges were lack of depth perception and visual occlusion induced by the transvesical endoscope presented challenges. Recommendations are given to enhance robot-assisted TURBT. Lessons learned through these pilot swine studies verify the feasibility of robot-assisted TURBT while informing designers about critical aspects needed for future successful clinical deployment.
... For force sensing, Russo et al. used FBG sensors in laser assisted transurethral surgery to sense contact forces. 34 A three-axis FBG force sensor was investigated by Guo et al. for robot finger. 14 Other applications for force sensing include a contact force sensing in eye surgery 2,15 and tool-to-tissue interaction force sensing in a hand-held micromanipulator. ...
Probe-based confocal laser endomicroscopy has a high potential to be a promising tool that can provide intraoperative high-resolution in vivo morphological imaging at cellular and subcellular levels for thyroidectomy, and allow real-time assessment of tumor margins. However, the typical images acquired with this technique cover a very small area limited by the field of view of the probe, accompanied by tissue deformation and inconsistent probe–tissue contact when operated manually. In this paper, a novel compact robotic device for large area scanning has been developed. The device can scan a large surface in a spiral trajectory by rotating the tip frame along the spiral groove of the base frame. The fiber Bragg grating sensor with a passive linear structure is used to detect and maintain a stable probe–tissue contact force during scanning. An active linear actuation is also integrated for adjusting the probe–tissue contact level prior to each scan. Results demonstrate that the scanning device ensures a suitable probe–tissue contact force and compensates for simulated hand tremor. Mosaicing results of lens tissue paper and porcine belly tissue with both bench and hand-held experiments show the effectiveness and usability of the device, demonstrating the potential clinical value of the system.
