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Highly realistic simulation for robot-assisted hypothalamic hamartoma real-time MRI-guided laser interstitial thermal therapy (LITT)
摘要： Purpose Real-time MRI-guided laser interstitial thermal therapy (LITT) is a challenging procedure due to its technical complexity, as well as the need for efficient multidisciplinary teamwork and transfer of an anesthetized patient between operating room (OR) and magnetic resonance (MR). A highly realistic simulation was developed to design the safest process before being applied to real patients. In this report, authors address the description of the methodology used for this simulation and its purposefulness. Methods The entire image planning, anesthetic, and surgical process were performed on a modified pediatric simulation mannequin with a brain made of medical grade silicone including a hypothalamic hamartoma. Preoperative CT and MR were acquired. Stereotactic insertion of the optical fiber was assisted by the Neuromate? stereotactic robot. Laser ablation was performed with the Medtronic Visualase? MRI-guided system in a 3T Phillips Ingenia? MR scanner. All the stages of the process, participants, and equipment were the same as planned for a real surgery. Results No critical errors were found in the process design that prevented the procedure from being performed with adequate safety. Specific proposals for team positioning and interaction in patient transfers and in MR room were validated. Some specific elements that could improve safety were identified. Conclusion Highly realistic simulation has been an extremely useful tool for safely planning LITT, because professionals were able to take actions in the workflow based not on ideas but on lived experiences. It contributed definitively to build a well-coordinated surgical team that worked safely and more efficiently.
关键词： Robotic surgery,Patient safety,Pediatric epilepsy surgery,Risk management,Laser ablation
更新于2025-09-23 15:19:57
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The feasibility of electromagnetic navigational bronchoscopic localization with fluorescence and radiocontrast dyes for video-assisted thoracoscopic surgery resection
摘要： Recently, some groups have reported the utilization of electromagnetic navigational bronchoscopy (ENB) for localization of pulmonary lesion. Its application for intraoperative visual localization with dyes to determine the target area has been increasing. In this paper, we reviewed the feasibility of ENB utilization for video-assisted thoracoscopic surgery (VATS) or robotic sublobar resection as a localization tool, and its future application in minimally invasive thoracic surgery.
关键词： localization,robotic surgery,video-assisted thoracoscopic surgery (VATS),Electromagnetic navigational bronchoscopy (ENB)
更新于2025-09-19 17:15:36
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Transoral Robot-Assisted Surgery in Supraglottic and Oropharyngeal Squamous Cell Carcinoma: Laser Versus Monopolar Electrocautery
摘要： Background: Monopolar electrocautery (EC) is the surgical cutting and haemostatic tool most commonly used for transoral robotic surgery (TORS). The aim of this study was to retrospectively compare EC e?cacy in the treatment of patients a?ected by T1 or T2 oropharyngeal and supraglottic squamous cell carcinomas with the more recently introduced laser ?bres. Methods: We considered all TORS patients admitted to our department from January 2010 to June 2019. The outcomes of patients treated with Thulium: yttrium aluminium garnet (YAG) laser (TY-TORS), CO2 laser (CO2-TORS) and EC (EC-TORS) were analysed in order to assess surgical performances, functional outcomes and postoperative complications. Results: Twenty patients satis?ed the enrolling criteria, of which nine underwent laser-TORS, and the remaining 11 underwent EC-TORS. In all candidates, TORS procedures were completed without the need for microscopic/open conversion. Close or positive margins were signi?cantly more frequent in EC-TORS (p = 0.028). A considerable di?erence was found in overall functional parameters: times of nasogastric tube and tracheostomy removal and time of hospital discharge were signi?cantly shorter in laser-TORS (p = 0.04, p = 0.05, p = 0.04, respectively). Conclusions: Laser-TORS showed better results in comparison with EC-TORS in term of tumour resection margins and patient functional outcomes. Our ?ndings can be justi?ed with the greater tissue thermal damage caused by EC-TORS, despite prospective randomized trials and increased patient numbers being needed to con?rm these preliminary conclusions.
关键词： CO2 laser,transoral robotic surgery,cancer,thulium laser
更新于2025-09-12 10:27:22
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Robot assisted radical prostatectomy in patients with a history of Holmium laser enucleation of the prostate: The Indiana University Experience
摘要： Introduction: We sought to update our experience of oncologic and functional outcomes of robot-assisted radical prostatectomy (RARP) for prostate cancer in patients with history of holmium laser enucleation of the prostate (HoLEP). Methods: 27 patients with previous HoLEP who underwent RARP were matched 1:1 to RARP patients with no history of transurethral surgery. Demographic, operative, oncologic, continence, and erectile function outcomes were analyzed. Results: Median time between HoLEP and RARP was 31 months with a mean PSA doubling time of 4.28 ng/mL/yr. Operative times were significantly longer with higher bladder neck reconstruction rates and similarly low complication rates. Biochemical recurrence was relatively low (7%) in HoLEP group, identical to the comparative group. Continence at last follow up was not statistically significant between groups although time to continence favored the non-HoLEP cohort. Erectile function recovery was generally poor in the post HoLEP cohort (11%) although bilateral nerve sparing was rarely performed (11%). Compared to our initial experience, there were significant improvements in time to continence (16 vs 36 weeks). No T2 post-HoLEP RARP since 2010 has had a positive surgical margin. Conclusions: Post HoLEP prostatectomy remains feasible with similar perioperative and oncologic outcomes compared with matched cohorts. Functional recovery remains slowed yet may continue to improve with technical familiarity.
关键词： prostatectomy,robotic surgery,HoLEP
更新于2025-09-12 10:27:22
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Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy: Pooled Analysis of Comparative Studies
摘要： Context: The use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN). Objective: To perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF). Evidence acquisition: A systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software. Evidence synthesis: Six comparative studies were identi?ed. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No signi?cant difference was identi?ed between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular ?ltration rate (eGFR) values in the NIRF-RAPN group at short-term (1–3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26 ml/min; 95% con?dence interval [CI]: 6.46, 12.06; p < 0.001). In two studies, a renal scan-based assessment of split eGFR was available, and pooled analysis revealed higher split eGFR for NIRF-RAPN (WMD: 7.91 ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower % between preoperative and 1-mo eGFR (WMD: ?7.84%; 95% CI: ?8.85, ?6.83; p < 0.00001). Conclusions: Current evidence regarding the use of NIRF-guided selective clamping during RAPN is based on a limited number of studies from high-volume institutions. Notwithstanding these limitations, NIRF-RAPN can be safely performed, and it might offer better short-term renal functional outcomes. It remains to be determined whether this can ultimately translate into a clinical bene?t for patients undergoing RAPN, especially in the long term.
关键词： Robotic surgery,Indocyanine green,Near-infrared fluorescence,Partial nephrectomy
更新于2025-09-12 10:27:22
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Achieve Automated Organelle Biopsy on Small Single Cells Using a Cell Surgery Robotic System
摘要： Single cell surgery such as manipulation or removal of subcellular components or/and organelles from single cells is increasingly used for the study of diseases and their causes in precision medicine. This paper presents a robotic surgery system to achieve automated organelle biopsy of single cells with dimensions of less than 20 μm in diameter. The complexity of spatial detection of the organelle position is reduced by patterning the cells using a microfluidic chip device. A sliding mode nonlinear controller is developed to enable extraction of organelles, such as the mitochondria and the nucleus, from single cells with high precision. An image processing algorithm is also developed to automatically detect the position of the desired organelle. The effectiveness of the proposed robotic surgery system is demonstrated experimentally with automated extraction of mitochondria and nucleus from human acute promyelocytic leukemia cells and human fibroblast cells. Extraction is followed by biological tests to indicate the functionality of biopsied mitochondria as well as the cell viability after removal of mitochondria. The results presented here have revealed that the proposed approach of automated organelle biopsy on single small cells is feasible.
关键词： mitochondria,single cell manipulation,organelle biopsy,robotic surgery
更新于2025-09-04 15:30:14