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Surgical Robot at Fair
Surgical Robot at Fair July 31, 2010
Fairgoers Saturday are getting the chance to give surgery a try without the hassle of going to years of medical school. Crowds are gathering to see a travelling version Trinity Medical Center`s Da Vinci robotic surgery system. They could give the system a try by sitting down and using the controls to operate the surgical tools.
The system includes a 3-D high definition screen for surgeons to view the operation and tools that mimic what hands can do.
“I think people are excited about the idea of robotic surgery,” surgical nurse Vicki Miller says. “Technology - it`s great technology and you can see the kids are especially excited to see the latest technology in health care.”
Right now Trinity is using the robotic surgery system to perform procedures like prostate surgery and hysterectomies.....To leave a comment Click here
Dr. Jamison Jaffe Teams with Author and Patient Lloyd Martin to Preach About Prostate Cancer and Get Men to Talk with Doctors
There's a Doctor in the House - One Doctor and His Patient Take Message about Prostate Cancer to the Faithful July 30, 2010
Urologist, Jamison Jaffe and his patient author Lloyd Martin have taken to the road to spread the word about why men need to discuss prostate cancer screening with their doctors. They speak at churches and events throughout the Philadelphia area.
" I can’t stand the thought of losing one more husband, father or breadwinner," Martin says. “Prostate cancer affects one in six American men,” Jaffe says. “More than 192,000 men were diagnosed with prostate cancer in 2009. A man dies from prostate cancer every 19 minutes. More African-American men will get prostate cancer than men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer as white men....continue reading
Modular Software Design for Brachytherapy Image-Guided Robotic Systems Posted: July 30, 2010
2010 IEEE International Conference on Bioinformatics and Bioengineering Philadelphia, Pennsylvania USA May 31-June 03 ISBN: 978-0-7695-4083-2
Abstract: — Modular software design is a technique that increase reusability and portability of software composed from separate parts, called modules. We have designed and developed a reusable integrated software solution for robotic prostate brachytherapy procedure. The application is capable of concurrent handling of all aspects of the image-guided brachytherapy procedure: ultrasound image acquisition, anatomic delineation, target modeling, dosimetry planning and analysis, seed delivery, and visualization of all surgerical steps involved in the procedure. Based on force feedback and visual feedback, the control module of the application is capable of controlling the robotic system (i.e. motions of the ultrasound probe and the needles), supervising the flow of the procedure via built-in strategies for emergency handling and recovery, collision avoidance, manual takeover (if necessary), needle tracking and real-time dose updates. The implementation of the developed software solution to the two brachytherapy robotic systems has been presented. Additional information
Kim Williams / Staff Photo - Tressa Scott's spine at a 60 percent curve prior to surgery and less than a year ago.
Surgical robot for spine surgeries now resides in Plano July 29, 2010
The SpineAssist is one of three surgical robots in the United States and the only one in Texas. It is the only surgical robot designed specifically to operate on the spine. With more than 1,200 surgeries performed worldwide, about 300 are in the U.S. – all with no instances of nerve damage as a result of surgery.
The technology is new to Plano but has been on the drawing board for more than a decade according to Dr. Isador Lieberman, a fellowship-trained orthopedic and spinal surgeon on the medical staff at the Texas Back Institute and Texas Health Presbyterian Hospital Plano. He worked on the idea of robotic spinal surgery originally and ended up partnering with Technion University in Israel to perfect the technology.
The robot is basically a workstation that enables surgeons to pre-plan procedures in 3D based on the patient’s individual anatomy – creating a surgical blueprint – and a robotic arm that guides the surgeon during the procedure using the preoperative plan.
During surgery, the robot’s extension arm guides the surgeon to the pre-planned location, allowing the surgeon to operate through small incisions in the skin and underlying muscles in order to reach the exact location on the spine.
The procedures with SpineAssist are minimally invasive most of time; but when doctors perform spine surgery, there is always a margin of error allowed, even though the patient hopes for the best. The technology co-designed by Lieberman reduces that margin from an estimated 3 millimeters to one-half millimeter, which allows greater accuracy and enables surgeons to plan the surgery ahead of time using a computed tomography – imaging by sections – in a 3D simulation of the patient’s spine.
“The idea is to put screws in the back in a more precise manner,” Lieberman said. “The unit is precise because it is a more refined tool.”...continue reading
Kim Williams / Staff Photo - Tressa Scott's spine after surgery by Dr. Lieberman and the SpineAssist robot, showing a dramatic correction.
“WORDs of Wisdom” doctor interview series. Dr. Yukio Sonoda discusses the advantages of robotic surgery in gynecologic cancer treatment procedures.
First Robotic Hand Surgery Performed in America July 28, 2010
The medical director of the Hand Center at Northwest Hospital in Randallstown, Maryland, Stacey Berner, has become the first American surgeon to perform a new robotic hand surgery using the Da Vinci Surgical System.
Hand surgeries can be complex because of the small body parts found in the hand: smaller veins, nerves and the like. Dr Berner said “The new approach of using a Da Vinci Surgical System significantly increases access to hard to reach structures and potentially offers better results to patients.” For complete story Click here
New Robotic 8.5mm Endoscope PassPort® Now on the Market July 27, 2010
Patton Surgical Corporation, an Austin, Texas-based medical device company specializing in the development of laparoscopic surgical instrumentation, today announced the worldwide launch of its newest product, the Robotic 8.5mm Endoscope PassPort®, designed to be used with the da Vinci® Surgical System from Intuitive Surgical.
Patton Surgical’s patent-pending Robotic 8.5mm Endoscope PassPort is the first disposable 8.5mm endoscope trocar available for use with da Vinci Surgical Systems and the newest da Vinci Si™ 8.5mm 3D Endoscope.
The 8.5mm PassPort has been validated by Intuitive Surgical for use in da Vinci robotic procedures, specifically gynecological procedures, including hysterectomies, sacralcolpopexies, myomectomies and tubal ligations. Patton Surgical’s robotic 12x100mm PassPort has also been validated by Intuitive Surgical for use with da Vinci Surgical Systems and both products are available for purchase from Patton Surgical.
With the rapid expansion of robotic surgery, fueled by surgeon demand and, most importantly, patient value based on efficacy of procedure and low invasiveness, the PassPort double-shielded trocar offers several unique benefits. •It provides robotic-assisted surgeons with a port that adapts securely to the da Vinci camera mount, •allows for precise port placement due to its clear cannula with remote center bands •and has a low-profile cannula head to maximize range of motion. •Most notably, the PassPort robotic camera port is equipped with features designed to reduce complications before, during and after the procedure: 1) the protective SmartTip™ allows for controlled, blunt entry, 2) the unique seal design maintains a clear endoscope, and 3) the PassPort leaves behind a small fascial defect....read more
RoboticOncology.com: Robotic Surgeon Dr. David Samadi, MD Introduces His SMART Surgery Technique for Prostate Cancer Treatment July 26, 2010
NEW YORK, July 26 /PRNewswire/ -- As the surgeon behind the robot, Dr. David Samadi, Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai Medical Center in New York City, builds on oncologic principles learned with open radical prostate cancer surgery and transferred to a robotic approach. He calls this approach the SMART Surgery Technique (Samadi Modified Advanced Robotic Technique). He employs this technique at Mount Sinai where he recreates the traditional open anatomical surgical technique on the robotic surgery platform for prostate cancer treatment.
"The SMART technique is an advanced technique that should not be performed early in a robotic surgeon's learning curve," advised Dr. Samadi. Since 2003, Dr. Samadi has performed more than 3,000 Robotic Assisted Laparoscopic Prostatectomies (RALP); about half were done using the SMART technique. With the da Vinci robot and the SMART technique, Samadi is able to help his patients achieve continence rates of 97% and potency rates of 81% at 1 year, while giving them a 95% cure rate.
Dr. Samadi's SMART technique can be performed in 2 hours or less. It is a complicated prostate surgery procedure that involves dropping the bladder, transecting the medial and posterior bladder neck and dissecting the seminal vesicle. After this is completed, then Samadi tackles the main, yet intricate part of the procedure: removing the prostate while sparing the surrounding nerves. After the dorsal venous complex (DVC) dissection, the prostate is removed and bagged and the DVC is sewn up. The bladder neck is reconstructed and the procedure is finalized.
"What's important to note is that since there is no suture in the DVC, it results in a longer length of urethra, which results in better continence and less chance of nerve damage," explains Dr. Samadi. "Since there is minimum dissection performed on the sides of the prostate, there is less chance of damaging the nerves responsible for sexual function, which means a better sex life because the sexual function is ultimately improved."
Because of the intricacy of this technique, surgical experience is paramount. As evidenced in a report by Dr. Samadi in the July issue of the Journal of Endourology ("Improvements in Robot-Assisted Prostatectomy: The Effect of Surgeon Experience and Technical Changes on Oncologic and Functional Outcomes")....continue reading
Hartford Hospital Expands TV Teaching July 26, 2010
Hartford Hospital has installed a new HD, audio visual system in its operating room that will allow it to broadcast live surgeries. It’s all part of an effort to boost the hospital’s reputation as a leader in robotic surgery and increase its ability to train surgeons and students around the country.
The feeds will allow Hartford Hospital surgeons to discuss what they’re doing during a robotic procedure, as they’re doing it, with medical audiences across the nation.
While live surgery broadcasts are not necessarily a new thing, using HD quality technology for robotic procedures is. Hospital officials say it will provide a much higher quality picture, allowing viewers to see tissue and anatomy images as if they were at the controls of the robot.
“As a teaching hospital, the idea was to have a live, high-quality feed for interns, nurses and doctors who are interested in learning about robotic surgeries,” said Al Hofmann, who is the director of network services at Hartford Hospital. “Early on, that teaching was done with low-end gear that really wasn’t worth the effort because of the lack of clarity.”
Hartford Hospital’s technology upgrade cost about $500,000, Hofmann said. It includes an operating room equipped with three cameras that produce HD quality images and provide all the angles necessary to do teaching at the operating table.
There is also a live feed from the robot itself, which allows onlookers to get the exact same view as the operating physician. Other upgrades include....continue reading
Robotic Surgery — Through the Mouth July 26, 2010
Dr. Guy Petruzzelli, ENT surgeon, called me the other day, his voice full of excitement. “I’ve got a news blast!” he said. He had removed a cancer from the back of a patient’s tongue not in any convetional manner but through the patient’s mouth using the spindly arms of a robot. It was the first time such a surgery had been done in Illinois. No 6-inch incision, no tracheotomy, no serious recovery time necessary. The patient was doing great, Petruzzelli boasted. Just one day after being wheeled out of operating room 18, he was sitting up in his hospital bed eating pancakes and chatting with his wife, ready to be discharged....read more
Dr. Teodor Grantcharov demonstrating a surgery simulator
Life-saving dry run July 23, 2010
Every time Teodor Grantcharov returned from a week or two of vacation, the Toronto-based surgeon would notice a disconcerting problem. For the first 15 minutes back in the operating room, his minimally invasive surgery skills would feel shaky, forcing him to slow down and reacquaint himself with the work to avoid dangerous slip-ups.
As it happens, that first quarter hour is often critical for the safety of patients. In gall bladder removals, for instance, mistakes in the initial minutes can trigger internal bleeding and other severe complications.
So Dr. Grantcharov figured that out-of-practice surgeons would benefit from some “warm up” on virtual-reality simulators that duplicate the OR phenomenon — but with any gaffes borne by life-like plastic mannequins, not real people.
A just-published, international study suggests he was right, finding that surgeons performed way better in actual surgery after they had done a virtual dry run.
“All the doctors we included in this study said the same thing: they said they could clearly feel the difference in the OR after they had done the warm-up,” said Dr. Grantcharov. “It makes much more sense.”
The St. Michael’s Hospital physician is now hoping to make simulators available for surgeons to regularly brush up on their skills before going at live patients, an intriguing new application for technology whose role in medicine is spreading rapidly.
High-tech simulators are coming into use across the country to teach doctors everything from how to restart a baby’s arrested heart to neuro-surgery, to the tricky business of inserting breathing tubes. Most of the machines include a sophisticated dummy that can mimic many of the qualities of a real patient, like pulse and breathing, under the guidance of a computer that throws in the kind of pressure-filled complications a doctor must learn to handle.
Aided by donations of more than $5-million, St. Michael is building a new simulator centre that will include two highly realistic operating rooms where entire surgical teams can practice on computerized mannequins....continue reading
Patients never complain when doctors train at center in Doral July 23, 2010
Hotel suite booked? Check. Suntan lotion? Check. Smock to absorb bloodstains? Check.
The Miami Anatomical Research Center (MARC) is attracting a different kind of tourist to Doral. Nearly every weekend, it hosts more than 100 doctors who learn new surgical techniques and how to use new medical devices on human cadavers
Funded by local investors who have worked in the medical training industry, the MARC opened in 2008 inside a 22,000-square-foot converted flower warehouse. With 38 surgical training stations, four simulated operating rooms and a 125-seat auditorium, it’s billed as the largest center for surgical training in North America.
Last year, it brought between 6,000 and 7,000 doctors to Doral – most from out of town, said Heloise Ribas Peixoto, MARC’s office manager. It is booked every weekend through the end of this year and it is attracting an increasing amount of events during the weekdays, she noted.
The MARC can handle up to 200 doctors at once. It hires firms to cater meals and wash surgical smocks, Peixoto said. Afterward, the doctors burn some of their paychecks off-site.
The center takes advantage of its location near Miami International Airport to attract international visitors, mostly doctors from Latin America and Europe. And, yes, the cadavers are flown in from around the country, too, to be used for simulated operations. Dr. Serge Kozacki, MARC’s lab director, said there are few body-part donors in South Florida.
Using operating tables with real equipment and piped-in saline solution, doctors perform procedures such as minimally invasive orthopedic implants and plastic surgery on the cadavers. The facility has video conferencing equipment, so footage of real surgeries being performed at hospitals can be beamed into the auditorium. Simulated surgeries at the MARC also can be recorded and broadcast online or to other parts of the building.
Since cadaver training is not allowed in most of South America, physicians must fly north for it, Kozacki said.
“Physicians highly respect the opportunity for hands-on training before operating on patients because there is no room for mistakes when working on a patient,” he said.
The cremated remains of the cadavers get a free ride back to their families....for complete article Click here
VADODARA: With the view to educate urologists on latest global medical practices in laparoscopy in urological surgeries, a three-day lecture-cum-live surgical demonstration instruction course will be conducted by Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH) in Nadiad. This course starting today is also a platform to orient doctors on robotic surgeries.
MPUH has invited world-renowned urologist Dr Thierry Piechaud from France as the main international faculty. Other well-known faculty includes doctors Mihir Desai from USA, P B Singh, Aneesh Srivastava, Rajesh Ahlawat, PP Rao and Jaydeep Date. The sessions will include live transmission of several laparoscopic surgeries besides lectures. Hundred participants selected from across the country will also get opportunities for hands-on experience.
"Everyone has accepted the fact that laparoscopy in urology is here to stay. Several urologists have acquired the skills of complex lap procedures. From basics we are now looking at advanced laparoscopy, and still further into robotics," said medical director of MPUH, Dr Mahesh Desai.
MPUH which is in process of buying robots for surgical processes is also looking at starting a course by next year. "During the three-day event we will be discussing on how this technology will be adopted and what changes would be required to be made," Desai said.
Robot surgeons to be used to carry out operations on patients without human assistance
Robot surgeons to be used to carry out operations on patients without human assistance July 21, 2010
Scientists have tested letting robots carry out operations Robot surgeons that can operate without human assistance may one day be able carry out routine procedures on real patients.
Research in the US has shown that a robot can locate and operate on a human organ and even take samples – all without a surgeon’s intervention.
Scientists at Duke University in North Carolina used a robotic arm combined with ultrasound to carry out test procedures on a section of raw turkey breast.
Turkey is often used in medical research because its texture is similar to human flesh and it scans in a similar way during ultrasound.
The robot used ultrasound to scan the tissue and locate the section that needed to be removed. It then used sophisticated artificial intelligence to take real-time 3D information and give the robot specific commands to perform.
The robot arm then manipulated the same biopsy device used by human surgeons to reach a section of tissue and take samples. The robot guided the plunger to eight different locations on the simulated prostate tissue in 93 percent of its attempts....to read more click on .pdf file
Stanford surgery professor Catherine Mohr tends to look at things her own way. In a recent TED talk about building green, she presented hard numbers to dispel some hype. In the following guest post, Mohr works through the economics of her own speciality: robotic surgery. Granted, she has a horse in this race: Mohr is also director of medical research at Intuitive Surgical, which produces surgical robots.
Is Robotic Surgery Cheaper? By Catherine Mohr Posted:July 21, 2010
There has been quite a bit of attention paid recently to medical technology and the high costs of high-tech medicine, but does high-tech really mean higher cost? The example of the Da Vinci surgical robot shows that sometimes spending money can actually save money.
In 2000, a new medical technology was introduced: the surgical robot. In that first year, only about 1,000 surgeries were done worldwide with these robots, and those surgeries cost a lot. When you total up the cost of all the instruments and supplies, the robots themselves, and training and service contracts for keeping those robots running, the average additional cost for using the Da Vinci was almost $11,500 for each surgery performed. Hardly a recipe for enthusiastic adoption. But it was gradually adopted – driven both by novelty and the promise of the early clinical results, which seemed to indicate that the minimally invasive surgery the robot enabled made for better patient outcomes with fewer complications.
Fast forward to 2009, and there are large numbers of academic papers attesting to the superior outcomes delivered by the Da Vinci. There were 1,200 systems worldwide in 2009, and more than 200,000 robotic surgeries were performed, including prostatectomies, gynecologic surgery, cardiac surgery and transoral ENT procedures. A startling 75% of the radical prostatectomies performed in the U.S. in 2009 were done with the Da Vinci – an unprecedented rate of adoption of a new technique in the traditionally conservative discipline of surgery. Several hospitals have even bought multiple systems, and Intuitive Surgical, the maker of these robots (and where I’m employed!), has grown from a little Silicon Valley startup into a billion-dollar company.
Are improved patient outcomes enough to explain how disruptive a force robotic technology has been in the surgical market when it seemed to come with such a price premium? Unlikely. Although patients were going home earlier, experiencing considerably less post-operative pain, and going back to work within two weeks rather than more than six weeks after surgery, these societal costs (while extremely important to the patient!) are not costs that the insurance company or hospital sees. So while they strongly drive the patient’s desire for robotic surgery, they don’t give the hospital any additional incentive to provide it. But, as expected, the answer to the mystery of the hospital’s incentive can be found in the economics of how paying more for technology in one part of patient care may result in lower overall costs for treating the patient’s condition....continue reading
Robot gives surgeons another weapon against throat cancer Posted July 20, 2010
It started with hoarseness that refused to go away.
Then swallowing became difficult. Within a month, Madonna Griffin could no longer eat. By the time she finally learned what was causing the hoarseness, she could barely breathe.
It took Dr. Yadro Ducic just one look down her throat to identify the cause. A 2-inch tumor was growing in the 38-year-old Azle grandmother's larynx, blocking her airway.
"I could look down herthroat and see this big cancer," said Ducic, co-medical director of the Skull Base Center at Baylor All Saints Medical Center in Fort Worth. "But the voice box was obstructing the view."
To remove the tumor, Ducic turned to the da Vinci Surgical System, which gave him a much better view of the throat from different angles. "The nice thing about the robot is you can see around the corner so you can operate around the corner," he said. "It allows you to take out things you can't otherwise."...continue reading
Use of Flexible Robotics Reduces Trauma in Vascular Surgery July 19, 2010
Newswise — Research conducted by surgeons from the Methodist DeBakey Heart & Vascular Center shows that using robotics reduces blood vessel trauma during minimally invasive procedures to repair diseased arteries. Research results were presented at the Society for Vascular Surgery‘s 2010 Vascular Annual Meeting in Boston.
“When we manipulate a catheter through a diseased artery using the standard manual approach, the catheter follows along the walls of the artery. This movement can dislodge plaque into the bloodstream, where it can travel to the brain and cause a stroke or damage other organs like the kidneys,” said Dr. Jean Bismuth, vascular surgeon at Methodist and principal investigator for the study. “We have shown that using robotics significantly reduces this risk because we can navigate precisely down the center of the vessel, avoiding contact with the walls of the artery.”
The research also showed a reduction in the time it takes to access a vessel, which translates into less radiation exposure for the patient and the surgeon, and the potential to standardize catheter navigation, which may lead to more predictable procedures.
“At Methodist we have been using the Hansen Medical robot to safely and successfully conduct minimally invasive treatments for atrial fibrillation, with Dr. Miguel Valderrabano leading this effort. This new research into robotic vascular therapies is early, but it may help open up higher levels of safety for treating our patients with ischemic vascular and cardiac disease, as well,” said Dr. Alan Lumsden, chair of the department of cardiovascular surgery at The Methodist Hospital and co-investigator on the study. About the study
Dr. Pier Cristoforo Giulianotti
Interview: Robotic surgery makes Dr. Giulianotti think about art CHICAGO, Jul 17, 2010
Dr. Pier Cristoforo Giulianotti has completed more than 1,000 successful major procedures without laying a finger on a patient. Using hand controllers, foot pedals, and 3-D visualization, he performs complex surgeries sitting just a few meters away from the operating table.
As the president of the Clinical Robotic Surgery Association, an organization of robotic surgeons worldwide formed last year, 57- year-old Dr. Giulianotti is leading the reimagining of surgical operations. There are three "da Vinci" systems housed within his university department, each with a price tag upwards of 1 million U.S. dollars. Intuitive Surgical, Inc., the sole manufacturer of the surgical systems, have installed 1,482 around the world as of March, according to the company's 2010 SEC filings.
Modern robotic surgery technology originated in the 1980's with a NASA research project on telemedicine, or the capability to utilize virtual reality to connect physicians to patients and use robotics for treatment. The project was heavily funded by the U.S. Army, but the patents were later sold to Intuitive Surgical, Inc. in the 1990's....continue reading
Corindus Vascular Robotics, Inc. Vascular robotics for PCI procedures Posted: July 17, 2010
Description Corindus designs, manufactures and commercializes precision vascular robotic systems for use in minimally invasive procedures. Products / Services The Company’s initial product, the CorPath™ 200 system, is the world’s first to precisely drive coronary guidewires and stent/balloon catheters during percutaneous coronary intervention (PCI) procedures performed in a cath lab. Technology / Differentiation Precise device manipulation is a key challenge in PCI procedures today. Via CorPath’s stability and precision-controlled movements, the system empowers interventional cardiologists to improve their accuracy and potentially improve clinical outcomes in PCI procedures. Currently, these procedures are performed manually and rely on the variable dexterity of a physician’s hands while standing bedside in a hazardous and stressful environment. Market / Customers Currently, PCI procedures are performed in a cath lab using x-ray angiography imaging, which exposes physicians to significant occupational hazards—including (1) radiation exposure (cancer, cataracts), as well as (2) chronic orthopedic ailments (spine) and fatigue due to the required use of heavy lead-protection garments. Indeed, there are many published studies showing that the cath lab is a hazardous work environment. For the first time in a cath lab, the CorPath™ system significantly reduces radiation exposure, fatigue, and other occupational hazards by protecting physicians from radiation and allowing them to operate in an ergonomically correct position. Status First-in-man study completed March 2010 with CorPath™ 200 system. Regulatory clearances will be initiated in 2010. For more information Click here
Robotic prostate surgery in India with modern healthcare protocols July16, 2010
Robotic prostate surgery in India with modern healthcare protocols is providing excellent results to the patients who come to India to get their robotic prostate surgery. It is proving to be beneficial for the foreign patients who want robotic prostate surgery at less price. Robotic prostate surgery in India is done in cities like Mumbai and Chennai which has world class hospitals equipped with necessary medical infrastructure with 24 hours service support. The surgery is conducted by Indian surgeons whom are regarded among the best in the world. All in excellent medical services are offered to the patients at an affordable price. To know more about robotic prostate surgery in India visit forerunnershealthcare.com
A medical student from Beth Israel Deaconess Medical Center is shown testing the new haptically-enhanced virtual surgery simulator.
Designing Touch-Sensitive Virtual Reality Tools To Train and Test Tomorrow’s Surgeons Posted July 16, 2010
Rensselaer Polytechnic Institute Researchers Receive $2.3 Million NIH Grant To Develop and Validate Virtual Reality Hardware, Software for Training and Certifying Laparoscopic Surgeons
Minimally invasive surgery is increasingly common and effective for operating inside the human abdomen. In these laparoscopic procedures, which use slender, handheld tools inserted into the body of the patient, the skill of the surgeon is the most important factor determining the success of the operation. A team of interdisciplinary researchers led by Rensselaer Polytechnic Institute has won a $2.3 million federal grant to develop a touch-sensitive virtual reality simulator that will standardize how surgeons are trained and certified to perform laparoscopic procedures.
The skills needed to perform most minimally invasive laparoscopic operations — including, for example, gallbladder removal and gastric band surgery — can be reduced to a handful of basic tasks: cutting in very specific patterns, tying knots, stitching, and manipulating very small items. Studies show that being proficient at these tasks is critical for performing laparoscopic surgery.
The new four-year grant, awarded by the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health, tasks Rensselaer Professor Suvranu De and his team of researchers with developing new hardware and software that effectively trains surgeons to perform these fundamental tasks, as well as objectively assesses the performance of physicians who are seeking to become certified in laparoscopic surgery. This new testing and training system will employ haptic technology, or touch feedback, which realistically replicates the sensation a surgeon would feel in his or her hands during an actual procedure. De, an expert in multiscale computer modeling and haptics, is joined by researchers at Beth Israel Deaconess Medical Center and Tufts University.
“We want to give surgeons the best tools possible, so they can better hone their skills and successfully treat their patients,” said project leader De, associate professor in the Department of Mechanical, Aerospace, and Nuclear Engineering at Rensselaer. “Just as training on virtual reality simulators has shown to be highly effective for jet pilots, we know that physicians show increased success in surgery the more times they perform it. We’re creating new tools that make it easier than ever for them to practice. These same tools will also be used in certification tests to make sure surgeons have all the required skills mastered before they start operating on patients.”
It has been reported that physicians who performed less than 100 laparoscopic procedures have significantly more complication rates in contrast to experienced surgeons, De said. The new virtual reality simulator will be developed to adhere to the standard and recommendations laid out in the Fundamentals of Laparoscopic Surgery – a comprehensive program being developed by a joint committee of the Society of American Gastrointestinal Endoscopic Surgery (SAGES) and the American College of Surgeons (ACS) for training and credentialing surgeons.
The new system features real laparoscopic tools, which are connected to equipment nearly identical to that used in actual surgical situations. Realistic computer-generated models of the simulation scene are displayed on a monitor, and the users interact with simulation both visually and using their sense of touch. The haptics technology ensures that a physician cutting or stitching tissue with the simulator will feel with their hands the lifelike toughness, sponginess, and resistance of virtual tissue. By pairing haptics with automation, the simulator will also be able to literally guide the hands of trainees, so they can see and feel the correct movements as they learn specific surgical tasks. The research team plans to make these simulations available over the Internet. For complete story Click here
Robotic surgery and demographics in patients choosing to undergo radical prostatectomy
July 14, 2010
A group of researchers reported on the differences in patient demographics in those men choosing to undergo radical prostatectomy in a UK centre where there is no influence of robotic surgery and in those choosing radical prostatectomy in a US centre where there is a strong robotic influence.
P. Cheetham and colleagues published their findings in the July 10 online edition of the Journal of Robotic Surgery.
Demographic and pathologic data were prospectively recorded in parallel for 78 consecutive men undergoing robot-assisted radical prostatectomy in a tertiary care academic US centre and 69 consecutive men concurrently undergoing open radical prostatectomy in a similar UK centre.
Although average patient age was significantly younger in the US cohort (58.8 years, range 43.1–77.6 vs. 62.2 years, range 51.7–70.5; P = 0.002), the US cohort encompassed a wider age range and older patients than the UK cohort. Average preoperative prostate-specific antigen (PSA) was significantly lower in the US group (6.0, range 2.0–6.0 vs. 8.60, range 4.6–12.6; P < 0.01).
Biopsy Gleason score, clinical stage, final pathology Gleason score, pathologic staging and positive margin rate were not significantly different between the two groups. Blood loss and transfusion rate were significantly lower in the US group. 16.7% of men in the US cohort had overall positive surgical margins compared to 29% in the UK group (P = 0.07).
"This data confirms our belief that patient age ranges are different in a setting influenced by robotic surgery," the researchers concluded. "Although pathologic parameters were similar, the age distribution of robotic surgery patients was much wider, suggesting robotics attracts men previously reluctant to undergo surgery in the open setting or to pursue active surveillance protocols. Larger studies are needed to verify this finding," they added. Source
Cost Effective Training System for Laparoscopic and Robotic Surgery Posted: July 14, 2010
Due to the benefits of robotics-based laparoscopic surgery, more and more countries are adopting these techniques. The biggest challenge towards this trend being that surgeons are still accustomed to the traditional ways and need to go through extensive training procedures before using laparoscopic and robotic surgery techniques. Acquiring such expertise is not very straightforward because
It is unethical to learn and practice skills in the operation theater (OT),
It is impossible to master laparoscopic surgical skills, like hand eye coordination and depth perception, while practicing on an animal or any other object.
Computer-based simulators have been proposed as a solution to this problem and nowadays are being widely used for training purposes in the west. These simulators allow surgeons to practice their skills in a virtual environment over and over again until a certain level of expertise is acquired after which they can start practicing in OTs with the help of experts. The problem with such simulators is their enormous cost, e.g., state-of-the-art simulators for laparoscopic surgery, like LapSim and ProMIS, cost thousands of dollars, which makes their wide-spread usage in developing countries, like Pakistan, very difficult. Commercial Minimal Invasive Surgical simulators like LapSim costs start from $50,000. A commercial surgical like daVinci costs $1.5 to 2 million, whereas a training system for robotic surgery starts from around $100,000. In fact, to the best of our knowledge, Dr Asif Zafar’s Telemedicine and eHealth Training Center at the Holy Family Hospital, Rawalpindi, is the only center in Pakistan that has acquired such simulators and thus maintains the sole training lab for MIS.
School of Electrical Engineering & Computer Science (SEECS) at the National University of Sciences and Technology (NUST) in collaboration with Holy Family Hospital, Rawalpindi is trying to solve this problem by developing a cost-effective training system for laparoscopic and robotic surgery in Pakistan. The proposed system, illustrated in the image below, includes a simulator for MIS and a set of robotic arms controlled over a network for practicing robotic surgery from several remote machines at distant locations.
Proposed MIS Training System
About the system:
The proposed system can be divided into three main modules. A simulator for laparoscopic training, a set of input controls to manipulate the laparoscopic instruments within the simulator and a set of robotic arms that will be controlled using these input controls.
The surgeon will be able to physically manipulate objects using the robotic arms. The same exercises would be performed in a virtual environment in a simulator and then performed in reality using the robotic arms. This will allow the user to not only practice for laparoscopic surgery but also for robotic surgery.
The key behind the cost-effectiveness of our new proposed system of training is the usage of open-source tools and libraries for software development and the availability talented human resources in Pakistan. The system will have a minimal invasive surgery simulator, a robotic surgery simulator as well as emulator (a set of robotic arms working over a mannequin) and input controls with haptic feedback. For the simulator, real life complications and videos of laparoscopic surgery collected by Holy Family Hospital, will be simulated in the simulator. Therefore the training system will have basic as well as advanced training.
For the robotic arms, commercial systems like daVinci have custom robotic arms with custom laparoscopic instruments. We will be designing our robotic arms around conventional laparoscopic instruments (which are mass produced in Sialkot) that will lead to a very cost effective system. Our design will significantly reduce the costs and would be totally new and built from scratch....continue reading
Credentialing standards for robotic surgeons debated Posted: July, 14, 2010
Recent reports of da Vinci operations gone awry because of doctors' inexperience with the new technology have led to concerns that some hospitals' credentialing standards for surgeons who use the robot are too loose.
Doctors at Orlando Health's Winnie Palmer Hospital and Florida Hospital's Celebration Health, say measures have been taken at their hospitals to ensure patient safety and successful operations.
"We're developing strict guidelines for these types of surgeries," said Dr. Jessica Vaught, a gynecologic surgeon who leads Winnie Palmer's robotic surgical training program. "Robotics is an exciting new field, but it's one that needs a lot of regulation."
A recent Wall Street Journal article highlighted the case of a botched operation with the da Vinci robot at a New Hampshire hospital to illustrate problems that have arisen from inexperienced doctors using the machine. A follow-up story referred to a case in which a 42-year-old man died following robotic surgery last summer at a Boca Raton, Fla., hospital. An attorney for the man's family said the urologist who operated on him had never before performed the procedure he was attempting with the robot, according to the report.
"These articles highlighted important problems. We agree surgeons need more education. They need more support from the hospital," said urologist Vipul Patel, a world-renowned robotic surgeon who is largely responsible for the development of Florida Hospital's robotics program and its Nicholson Center for Surgical Advancement, which focuses on robotic surgery and training.
Because robotic surgery is still an emerging, albeit fast-growing field, there are no standards for credentialing surgeons to use the machine. That is left to each hospital.
"It's a political hot potato because no one wants to come up with standards for everyone else. Nobody wants to restrict surgeons from doing robotics surgery because they haven't done enough cases in a certain year," said Dr. Graham Greene, a urologic oncologist at Lakeland Regional Medical Center who specializes in robotic assisted prostatectomies. He said surgeons at the hospital performed about 100 robotic-assisted prostatectomies....continue reading
Doctor Performs County's 1st Tubal Reconstruction to achieve Pregnancy using Robotic Surgery July 13, 2010
Robotic surgery at Valley Baptist means less pain, faster recovery times for Valley women
HARLINGEN -- Dr. Susan Hunter, Obstetrician-Gynecologist, has performed Cameron County's first fallopian tubal reconstruction procedure using robotic-assisted surgery, resulting in a Valley woman being able to successfully conceive and give birth to a child.
Dr. Hunter used the da Vinci® robotic surgical system at Valley Baptist Medical Center-Harlingen for the procedure. Prior to the procedure, the patient was not able to become pregnant for several years. "The robot allows us to do more delicate and precise procedures than can be done by any other method, such as open surgery or laparoscopic surgery," Dr. Hunter said.
Dr. Hunter said the procedure was used to "reconstruct" the delicate end of a fallopian tube which was closed because of scarring and prior surgery.
"With the robot, we cleared up the scarring, and re-constructed the opening in the tube to allow the egg from the ovary to pass through the tube, and then into the uterus," Dr. Hunter said. "This required very fine suturing and very fine technique -- which the robot allowed me to do. The precision of the robot helped minimize the chances for scarring to recur -- which improved her chances to get pregnant."...read more
Beaufort Memorial staff trained on surgery robot July 13, 2010
Beaufort Memorial Hospital purchased the da Vinci Surgical System last summer and is one of the only hospitals in the region to use the robotic, computer-assisted instrument, and the only one performing hysterectomies with it.
A number of Beaufort Memorial physicians have been trained to use the system, including Dr. Glenn Werner,Dr. Randall Royal, Dr. Allahna Coggins, Dr. Ardra Davis-Tolbert, Dr. Patricia Thompson and Dr. Claude Tolbert.
NGPG Surgical Associates Free Surgical Weight Loss Seminars Posted: July 13, 2010
GAINESVILLE–Northeast Georgia Physicians Group (NGPG) Surgical Associates will offer a free, no obligation, informational session about morbid obesity's impact on overall individual health and a discussion of contemporary surgical treatment options.
Alex Nguyen, MD, a surgeon with NGPG Surgical Associates and medical director of the Robotic Surgical Program at Northeast Georgia Medical Center, will provide individual consultation.
Fellowship trained in minimally invasive surgery, minimally invasive robotic surgery and bariatirc surgery at the University of Texas, Dr. Nguyen was the first surgeon in Georgia to perform robotic gastric bypass surgery.
The sessions are designed for all potential patients, supporting family members and accompanying friends with several opportunities to attend:
Saturday, July 17, 9 a.m. Monday, July 26, 6 p.m. Saturday, August 14, 9 a.m. Monday, August 23, 6 p.m.
Robot-assisted surgery performed at AIIMS Posted July 12, 2010
The Department of Urology at the All India Institute of Medical Sciences has successfully conducted a challenging operation on a 50 year-old patient suffering from cancer of the urethra and urinary bladder.
“Dr. P. N. Dogra, professor and Head of Department (Urology), performed a robot assisted anterior pelvic exenteration on the patient and in this operation the urinary bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, urethra and pelvic lymph nodes were removed. This was done for the first time in the Department. It is a major surgery and required high-tech surgical skills,” said a release issued by the Institute.
The Institute has also initiated a drive to maximise the use of the robot so that maximum number of patients can benefit. Facilities and programmes are being developed to do advance robotic surgery on prostate, urinary bladder and kidney besides other robotic operations to offer state-of- the art robotic surgical technology to patients suffering from various urological diseases.
Robotic surgery at AIIMS is being done on a regular basis and now its use has been extended in a wide spectrum of diseases in the field of urology and other specialities. The Department of Urology is also developing a training programme in robotic surgery, including the virtual simulation system for imparting this skill to future surgeons.
kidney removal surgery in India at pocket - friendly cost July 11, 2010
India is gaining popularity internationally due to available of robotic kidney removal surgery in India at pocket friendly cost. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal. It is estimated that 75-80% of health care services and investments in India are now provided by the private sector. You have two kidneys, which help to make urine. They lie deep in your back just in front of your lowest ribs. One of your kidneys is diseased and needs to be taken out. After your operation, the other kidney will make enough urine for your needs. Hospitals of kidney removal surgery in India are located at Mumbai, Delhi, Chennai and Bangalore which are having world class medical healthcare facilities and special wards for international patients....read more
Part robot, part human July 11, 2010
When Henry Miller was diagnosed with prostate cancer last summer, he immediately began researching his options. The Ewing native eventually decided to undergo treatment using a rapidly growing medical tool -- robotic surgery.
"I'm a very active person, and I was concerned about being able to stay active," Miller said. "My research told me that robotic surgery was less invasive and had a faster recovery time."
Miller underwent a prostatectomy, the surgical removal of the prostate gland, at Trenton's Capital Health Regional Medical Center in September. His surgeon, Michael Cohen, used a da Vinci robot to perform the procedure.
The machine, which can range from $1 million to $2.25 million depending upon the model, has been hailed as a breakthrough in minimally invasive surgery. With its multiple remote-controlled arms and 3-D high-definition camera, it allows surgeons to operate through tiny incisions with more precision and visual clarity.
For the 26 New Jersey hospitals that have them, da Vinci robots can be a major draw. Patients like Miller will often seek out robotic surgery options after doing research.....continue reading
Robots Take Over Operating Rooms July 8, 2010
These days when a patient is told they need to have surgery, a robot is oftentimes a doctor's right hand in the operating room. Robotic assisted surgery is changing the way many traditional surgeries are performed. Today at noon on Healthline 3, bariatric and general surgeon Dr. Bill Norwood will be participating in a live Web cast to talk about this medical advance. He will also be taking your questions. Just click on the orange Healthline 3 box to the right to see the live streaming Web cast from noon to 12:30 p.m. If you have a question during the course of the conversation, you can fill out the information screen and submit it. You can also talk live to Dr. Norwood by calling (318) 219-4569. We hope you'll join us! Click here to view video
Incidence of Surgical Site Infection Associated with Robotic Surgery. July 7,2010
Objective. Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data. Design. Retrospective cohort study. Setting. A 689-bed academic medical center. Patients. All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007. Methods. SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification. Results. Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; [Formula: see text]). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81-11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79-30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68-70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68-69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5-10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups. Conclusions. Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot. Article from pubmed
Learn to code for robotic-assisted surgery, as new technologies become more commonplace
Posted: July 3, 2010
Robotic-assisted surgery, also known as “minimally invasive surgery” (MIS), has become almost commonplace in hospital operating suites throughout the United States, predominantly with the daVinci® robotic system or the ZEUS® robotic system.
The use of robotics in surgery continues to evolve, and this poses challenges for hospitals and providers to stay abreast of these changes. In turn, coders may also struggle to stay current in terms of how to code for these procedures.
The pros and cons of robotic-assisted or MIS systems are well documented. The biggest pro of MIS systems is that they allow surgeons to execute exact surgical micro-movements of the robotic instrument as a laparoscopic procedure. The daVinci® also includes 3D images and the ability to rotate the instruments 360 degrees. The biggest con to the robotic systems is the purchase price plus all the specialty-specific tools and other add-ons necessary to outfit the surgical suite.
In addition to cost of the equipment, robotic procedures also require longer operating room time and turn-around time, as well as qualified physicians and operating room staff who are educated in how to use the robot. Some third-party insurance payers consider MIS surgery investigational and will not reimburse hospitals or surgeons when they perform robotic procedures, so it’s important to obtain pre-authorization from third-party payers and insurance carriers prior to surgery. In come cases, patients may be willing to pay for the surgery out of pocket if their insurance policy does not cover robotics or investigational surgeries.....continue reading
Hiep T. Nguyen, MD
Man O/R Machine? Physicians weigh in on the pros and cons of robotic surgery July 1, 2010
"Unlike many adult surgeries, where they are removing organs, most of our surgeries involve reconstruction," says Dr. Hiep T. Nguyen. "A lot of the reconstruction requires very delicate suturing and because of that, the robot was just perfect."
When performing any surgical procedures on children, special considerations must be taken into account. When the robot first came out, a lot of people thought it was "overkill" for pediatric surgery, says Dr. Nguyen.
"But what we found is, no matter what the size of the patient, you can do things safely as long as you have a team that works with the robot regularly," he says.
For example, adults can sustain the weight of the robot's arms on their bodies because of ample fat and muscle, but this can cause injury to a child. The extent of laparoscopy can also be minimized with the work of anesthesiologists, who use carbon dioxide to inflate the abdomen to create room for the robotic arms. The anesthesiologists must have a firm grasp of pediatric physiology to ensure that the anesthesia is administered safely.
The average patient at Children's Hospital Boston is about 3 to 4 years old, but the number tends to change with the advancements in robotic techniques.
"Around the country, most people who do pediatric robotic surgery are using it for pyeloplasty. For us, we expand to so many other indications that the age varies significantly," says Dr. Nguyen.
So far, Dr. Nguyen's youngest surgical patient was about 3 months old....read more
NC Society of Otolaryngology and Head & Neck Surgery Presents 2010 Meeting Posted: July 1, 2010
The NC/SC Otolaryngology and Head & Neck Surgery Assembly will be held July 16-18 at the Grove Park Inn Resort in Asheville.
The program has been approved for 10.5 CME hours and features keynote speaker Michael Parker, MD, President of the American Academy of Otolaryngic Allergy Foundation.
Dr. Parker will give two presentations at the Assembly, “Asthma: Testing and Treating for the Otolaryngologist” and “Pearls and Pitfalls in Allergy Management.” Other topics include head and neck cancers, chronic cough, dizziness diagnosis, robotic surgery, and an update on CPT coding. For more information Click here
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