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Swedish Adds Third da Vinci® SI HD Robot-Assisted Surgical System
Swedish has the fastest-growing and most experienced robot-assisted surgical program in the Pacific Northwest region; Program achieves more than 3,000 robotic-assisted surgeries in five-year period
New robot offers enhanced high-definition 3D vision and a dual-console capability to support training
SEATTLE, Wash. – September 29, 2010 – One year ago, Swedish upgraded its da Vinci robot equipment and purchased two latest generation da Vinci robot-assisted surgical systems to help surgeons perform minimally invasive procedures in the operating room. The hospital also opened the world’s first integrated operating room specifically outfitted for the da Vinci SI HD robot. Today, Swedish is adding a third da Vinci SI HD robot to advance its pioneering use of robot-assisted surgery for patients.
“As the most experienced robot-assisted surgery center in the Pacific Northwest, our use of the device has increased significantly enough that a third system is required to support the demand for this type of minimally invasive surgery at our hospital,” said Dr. James Porter, medical director of the robotics surgery program at Swedish and a prostate cancer survivor who himself underwent robot-assisted surgery.
Swedish has been utilizing robot assisted surgery since 2005, and was one of the first medical centers in the region to perform robot-assisted surgery. Since then, Swedish-affiliated surgeons have performed more than 3,000 procedures using the da Vinci Surgical System. Doctors at the hospital have used the robot to perform minimally invasive cancer surgeries including prostate, kidney, colorectal, uterine, cervical, ovarian and lung, and to assist in complex gynecologic reconstruction, non-cancer colorectal and bariatric surgeries.
Da Vinci robot-assisted surgery is a growing trend around the world due to quicker recoveries, shortened hospital stays, less pain and scarring, and the potential for better clinical outcomes. One of the benefits of the Swedish robotics program is the experience of its medical staff. Most recently doctors from all over the country flew to Seattle to learn about a thoracic surgeon’s use of the da Vinci robot in chest surgeries. A prostate cancer surgeon demonstrated his unique use of the da Vinci to remove a tumor on a kidney and shared his experience with the American Urology Association. Another surgeon participated in a teaching session with doctors overseas to educate them about the robot.
“The Swedish robot-assisted surgical team continues to excel through this advanced technology and consistently maintains its position as a global leader in the field,” said Cal Knight, president and chief operating officer at Swedish. “Few hospitals can claim to offer the level of experience we have with the da Vinci robot-assisted surgical system.”
The new robot features a dual-console set-up, which allows for greater collaboration among surgeons and enhance training capabilities for the program. The robot-assisted surgery program at Swedish is also among the first in the region to create a robotic training program for fellows.
The latest da Vinci System at Swedish consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and EndoWrist instruments that allow surgeons to work more precisely than in conventional surgery. Unlike traditional laparoscopic micro-instruments, da Vinci instruments have a patented EndoWrist that can turn 540 degrees, allowing for much finer movements. The da Vinci System is designed to seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist instruments to “virtually” put the surgeon’s hands inside the patient. A special 3D HD, dual-lens endoscope provides a highly magnified view of the surgical site inside the patient, allowing surgeons to see the surgical site up to 12-times more closely than human vision allows.
Swedish Medical Center
About Swedish Medical Center
Established in 1910, Swedish has grown to become the largest, most comprehensive non-profit health-care provider in the Greater Seattle area over the last 100 years. It is comprised of three hospital campuses – First Hill, Cherry Hill and Ballard – a freestanding emergency department and ambulatory care center in Issaquah, Swedish Visiting Nurse Services, and the Swedish Physician Division – a network of more than 40 primary-care and specialty clinics located throughout the Puget Sound area.
This year, Swedish broke ground on a new medical office building and hospital in the Issaquah Highlands (www.swedishissaquah.org), a freestanding emergency department and ambulatory care center in Redmond, as well as a medical office building and ambulatory care center in Ballard. In addition to general medical and surgical care, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, neuroscience, orthopedics, high-risk obstetrics, pediatric specialties, organ transplantation and clinical research. For more information, visit www.swedish.org and www.swedish100.org
Scarless Brain Surgery Is New Option for Patients September 28, 2010
Surgeons at the University of California, San Diego, School of Medicine and University of Washington Medical Center have determined that transorbital neuroendoscopic surgery (TONES) is a safe and effective option for treating a variety of advanced brain diseases and traumatic injuries. This groundbreaking minimally invasive surgery is performed through the eye socket, thus eliminating the removal of the top of the skull to access the brain. These findings were published in the September issue of Neurosurgery.
"By performing surgery through the eye socket, we eliminate the need for a full craniotomy, gain equivalent or better access to the front of the brain, and eliminate the large ear-to-ear scar associated with major brain surgery," said Chris Bergeron, MD, assistant professor of Surgery, Division of Head and Neck Surgery, at UC San Diego Health System. "This novel technique is also critical to protecting neurovascular structures such as the optic and olfactory nerves."
To achieve access, the surgeons make a small incision behind or through the eyelid. A tiny hole is then made through the paper-thin bone of the eye socket to reach the brain. This pathway permits repairs to be made without lifting the brain. The TONES approaches also protect the optic nerves, the nerves for smell, as well as the carotid and ophthalmic arteries.
"This approach has opened a new field of brain surgery," said study investigator, Kris Moe, MD, chief of the Division of Facial Plastic and Reconstructive Surgery and professor of Otolaryngology at University of Washington Medical Center. "The advantages to this transorbital approach are many, including reduced pain and decreased recovery time for the patient."...read more
First Robotic-Assisted Lobectomy on Long Island Performed by Winthrop-University Hospital Surgeons September 27, 2010
Doctors Use Robots to Execute Precision in this High-Performance, Minimally Invasive Technique A Milestone for NY-Area Healthcare
Mineola, NY – Winthrop-University Hospital, a leader in minimally invasive surgical techniques, is the first hospital on Long Island to perform Robotic Video Assisted Thoracic Surgery (VATS) lobectomy utilizing the ultra high-tech daVinci Surgical System.
The first robotic-assisted lung surgery on Long Island was performed on August 17, 2010 by Board certified cardiothoracic surgeon John Goncalves, MD, with the support of a dedicated robotics team. This leading-edge procedure utilized the daVinci’s state-of-the-art capabilities – including 3-D High Definition visualization of the chest cavity and precise, flexible surgical tools – to perform minimally invasive surgery to remove a tumor from the lung of 79-year-old Franklin Square resident, Enrique Figueroa.
“Winthrop’s success in performing the first robotic VATS lobectomy with the daVinci is a tremendous milestone – not only for the Hospital’s growing robotics program, but also for lung surgery techniques across Long Island,” said Garry Schwall, Winthrop’s Chief Operating Officer (COO). Following the success of Mr. Figuera's lung cancer surgery, Dr. Goncalves and his colleagues have performed several more robotic-assisted lung surgery cases, with the fifth and sixth taking place on Friday, September 24....continue reading
The top image shows EndoWrist actuators manipulating sutures. The bottom image shows console masters handled by surgeon to direct EndoWrist actuators. Source: Intuitive Surgical
Robotic Surgical System Overcomes Manual Limitations September 27, 2010
Comprising numerous technologies, from 3-D visualization to high-quality motors, the da Vinci surgical system is widely considered a breakthrough platform for performing complex, minimally invasive surgery.
The da Vinci surgical system incorporates high-end motion control technologies so that every motion provides the smooth, accurate movements reminiscent of a skilled surgeon - even at slow, calculated speeds. Each da Vinci S HD System contains more than 30 motors manufactured by Maxon Precision Motors. These motors are located at the heart of each manipulator.
The Maxon motors provide the inputs and outputs to the da Vinci System. Through a series of feedback controls, the motors and encoders receive inputs from the surgeon, are translated in real-time through the console electronics, and provide output signals to the motors in the manipulators. In turn, the manipulators exert forces back through the console electronics to the surgeon's hands. Maxon motors are designed with rare earth magnets in their stators and incorporate an ironless rotor design that eliminates magnetic cogging, even at slow operating speeds.
The surgeon's side cart employs motors referred to as masters to distinguish their dual role. The slave side, or manipulator motors, require the same precision, but also need to be able to be backdriven while an assistant surgeon moves the end effectors into position. The motors exhibit low hysteresis at the instrument tips.
Among the more than 30 motors used by Intuitive's engineers in the da Vinci system, are the RE 25 motor, some with and some without encoder feedback; RE 13 mm motors equipped with GP 13 series gearheads and 13 mm magnetic encoders; and RE 35 series motors with third-party encoders.
Maxon motors are key to each da Vinci system critical performance characteristic tests, including friction, backlash and compliance profiles, as well as a range of sensor feedback monitoring, says Mike Prindiville, manager, manufacturing engineering for Intuitive Surgical.
Although the prevalence of robotic-assisted, minimally invasive surgery has increased tremendously, training opportunities remain relatively limited. Because comprehensive practice and experience is necessary in order to develop proficiency with a sophisticated tool such as the da Vinci system, the development of training aids for robotic surgery is critical in helping meet the demand for this technique.
At the Nebraska Biomechanics Core Facility in the HPER Biomechanics Lab. at the University of Nebraska at Omaha, a group of Ph.D. students work with the Robotic Surgical Lab. at the university's medical center to develop a computer training program for robotic surgery where new surgeons can learn how to use this advanced technology.
Endoscope instrument used with the da Vinci robotic surgical system. Source: Intuitive Surgical
Two training platforms have been developed with National Instruments' LabVIEW graphical programming software. The first is designed for monitoring and recording a surgeon's performance during a training program and ensuring that the surgery is performed using the correct movements. This training platform also incorporates visual real-time feedback to show trainees how much force they apply on the training task or animate tissue. This visual feedback helps trainees reduce tissue damage inflicted during the procedure.
LabVIEW was also used to create a working environment for robotic surgery training in virtual reality. This second training platform offers flexibility to conduct research by collecting data and adjusting training tasks in the virtual simulator via Ethernet. Virtual robotic surgical training allows multiple surgeons to train simultaneously using software instead of actual medical equipment. This process provides problem-based training protocols for new surgeons to learn robotic surgery.
All of the data communications on the da Vinci robotic surgical system is acquired via TCP/IP using NI's USB-6009 data acquisition board to connect to the electromyography system and electrogoniometers. These connections acquire physiological measurements, such as muscle activations and joint angles, from the surgeons. Using this data, researchers and medical personnel can objectively evaluate surgical proficiency before and after the robotic surgical training protocol.
CyberKnife zaps tumours without scalpels, anesthesia or even surgeon September 25, 2010
OTTAWA - The CyberKnife is not actually a blade. Yet in its own way, the instrument can cut out the trappings of traditional surgery: no scalpel, no anesthesia, not even a surgeon.
On Thursday, Krista Kowalchuk became the first patient to be treated with the CyberKnife at an Ottawa hospital. She lay on a treatment table without anesthetic and promptly fell asleep as the programmed robotic arm homed in on two tumours in her spine and zapped them with carefully calibrated radiation beams.
In an adjoining room, a team of medical physicists sat behind a bank of computers, monitoring the robot's activity. At the end of the hour-long treatment, Kowalchuk went home with a slight soreness in her back, which her doctor had warned could be a side effect.
Having had conventional radiation therapy in the past as well as five brain surgeries to remove benign tumours, Kowalchuk said the CyberKnife was much less invasive and time-consuming. Instead of daily radiation therapy over five weeks, the CyberKnife took three days. "I work so to ask to take off every afternoon for five weeks, I mean, that's a big thing to ask," said Kowalchuk.
As followup, her physician is expected to use CT or MRI scans to determine if the tumours have shrunk or stopped growing.
When used to remove benign or cancerous tumours, the precision-guided radiation device has been shown to be as effective as surgery or conventional radiation therapy - without side effects such as fatigue, nausea and post- surgical pain....continue reading
Canon to develop robots for medicine, nursing September 23, 2010
Leading precision instrument manufacturer Canon Inc. plans to use its industrial robot and digital camera technology to develop a robot that uses artificial intelligence in the medical and nursing care fields, according to company sources.
Robots built by the company are already being used on industrial assembly lines.
The company intends to market its industrial robots by the end of 2015, and then sell them for medical and nursing care as an extension of this strategy. The medical robots will have image-recognition and data-processing functions, while making use of artificial intelligence so the machines can change how they function depending on the situation.
The robots will help elderly people and young children by evaluating their physical condition based on posture and movements recorded by a camera. The machines also will be designed to automatically call an ambulance when a user appears to be suffering.
At medical facilities, the robots will be used to help diagnose diseases early and to send video images of patients to doctors in other locations....read more
Simulated Surgical Systems Licenses Hands-On Surgical Training ™ (HOST) Technology for Robotic Surgery Simulation Buffalo, NY (PRWEB) September 20, 2010
Simulated Surgical Systems sells the Robotic Surgery Simulator ™(RoSS) as a way to help surgeons hone their skills in robot-assisted surgery. The HOST software system takes this concept further, immersing the surgeon in a surgical environment using automation technology and an interactive checklist-based process.
have paired up to create technology that has the potential to revolutionize surgical training worldwide, developing the first procedure-based, hands-on surgical training software. Their patent-pending system, Hands-On Surgical Training ™ (HOST), guides surgeons through real-time operative procedures using the Robotic Surgical Simulator ™ (RoSS) interface. The HOST software has been licensed by Simulated Surgical Systems, LLC, the company that sells the RoSS.
Khurshid Guru, MD, a staff physician in Urology at Roswell Park Cancer Institute (RPCI), and Thenkurussi “Kesh” Kesavadas, PhD, director of the Virtual Reality Laboratory and a professor of mechanical and aerospace engineering at the University at Buffalo (UB), created RoSS as a way to help surgeons hone their skills in robot-assisted surgery so that they’ve logged hours of training before they perform a particular surgical procedure.
The HOST software system takes surgeons through surgical steps, prompting and guiding them through the critical stages of an operation before proceeding to the next step. A metrics tool evaluates user performance so that surgeons can track their progress. That step-by-step prompting system is unique in the field of computer-assisted surgical learning tools, as is HOST’s basis in observational learning. It’s an extremely effective system for training surgeons on emerging robot-assisted surgical techniques, says Dr. Guru.
The HOST software will debut in a prostatectomy module available late this year and will be followed by a hysterectomy module in early 2011.
Robotic surgery breakthrough helping Valley throat and mouth cancer patients September 20, 2010 By Jodie Heisner
MESA, AZ - A breakthrough surgery helping those with mouth and throat cancer is being offered by a surgeon right here in the Valley. “It’s nice when about every few years something comes along that’s really a giant step,” said Dr. Glen Rothman of Banner Desert Medical Center.
That giant step is being taken with small robotic arms and 3-D imaging. The procedure is done without the doctor even touching you. “Truly the ability to go through the mouth where my hands and my eyes cannot see, with tiny instrumentation and remove tumors in ways that really just did not exist before this technology,” said Dr. Rothman.
The procedure is helping patients with mouth and throat cancers similar to the type Michael Douglas is fighting. “It is my understanding that he has squamous cell cancer of his tongue base and that is one of the areas where the daVinci robot could really be used,” said Dr. Rothman. Douglas has opted for chemotherapy and radiation to treat the disease, but for those that choose the surgery with the daVinci robot there are benefits.
Without the robot the surgery involves cutting through the jaw leaving scarring. Typically patients are in the hospital for at least eight days. “We do it though the mouth with no incisions on the outside. Just a couple days in the hospital, none of those tubes, no external scars and a much faster, easier recovery,” said Dr. Rothman. It also helps to eliminate many of the facial deformities that often come with treatment for these types of cancer. It's a breakthrough that goes beyond the operating room.
Accuray’s CyberKnife at the ESTRO September 20, 2010
Leading radiosurgery systems maker Accuray Incorporated (ARAY - Analyst Report) has featured its CyberKnife VSI system at the European Society for Therapeutic Radiology and Oncology (ESTRO) meet in Barcelona. The company showcased multiple presentations, which underscore the system's unique motion management capabilities in treating lung cancer.
The CyberKnife VSI robotic radiosurgery system offers the latest advancements in Accuray’s proprietary CyberKnife technology. Clinical findings from two CyberKnife sites in Europe were presented during a symposium on motion management in lung radiosurgery at the ESTRO. The presentations highlighted the benefits of the CyberKnife system in treating primary early-stage and metastatic lung cancer.
A key showpiece in the company’s exhibits at the ESTRO was the CyberKnife system’s best-in-class motion management capabilities, including the revolutionary Synchrony Respiratory Tracking System, which enables real-time monitoring and correction for tumors that move with a patient's breathing patterns. Accuray also demonstrated the expansion of extracranial (outside the skull) radiosurgery applications with CyberKnife through a number of oral and poster presentations on multiple cancer types.....read more
Prostate Cancer Surgery – The Vattikuti Institute Prostatectomy (Robotic Prostate Surgery) for Prostate Cancer
The Vattikuti Institute Prostatectomy (Robotic Prostate Surgery) for Prostate Cancer In this video, Dr. Mani Menon performs the Vattikuti Institute Prostatectomy, a procedure which uses robotic technology to assist in removal of prostate cancer. To learn more about Dr. Menon or this procedure, please visit www.drmanimenon.com
Robotic-Assisted Catheter Technique Improves Treatment for Atrial Fibrillation Posted: September 15, 2010
Atrial fibrillation (Afib) had Judith Johnson of Mount Olive Township in and out of the hospital for eight years. In addition, the side-effects of the various medications she took to balance her heart’s rhythm and blood pressure were making her sick.
Those difficult years are a distant memory since she underwent a robotic-assisted catheter ablation at the Atrial Fibrillation Center at Saint Barnabas Medical Center in 2009 that cured her Afib.
Ms. Johnson underwent one of the first robotic catheter ablations performed at the Atrial Fibrillation Center, electrophysiologist David Dobesh, MD, combined a sophisticated cardiac navigation system to map the electrical signal in her heart and the state-of-the-art robotic catheter for the precise placement of radiofrequency energy that eliminated the abnormal areas which were causing erratic electrical signals and giving rise to her Afib.
"The robotic catheter allows eletrophysiologists to more easily and rapidly access portions of the heart which were challenging with previous catheter technology," explained Dr. Dobesh.
"Ms. Johnson’s case is a good example of its potential to dramatically improve the procedure and shorten procedure time." Without the advantage of robotic technology, ablation is performed using a manual catheter technique that requires complex catheter manipulations with inadequate assurance that the tip of the catheter responds as desired while inside the patient’s heart....read more
OctoMag: An Electromagnetic System for 5-DOF W. Posted: September15, 2010
If you’re in need of eye surgery you might just find yourself strapped into this contraption. It’s a magnetic field generator used to manipulate a tiny, untethered probe.
It’s called OctoMag and the idea is that a robot less than half a millimeter in size is injected into your vascular system and, through the use of those coils, it busts up blood clots in the small passages inside of the eye.
Video: Robotic eye surgery controlled with magnets
We demonstrate five-degree-of-freedom (5-DOF) wireless magnetic control of a fully untethered microrobot (3-DOF position, 2-DOF pointing orientation). The microrobot can move through a large workspace, and is completely unrestrained in the rotation degrees of freedom. We accomplish this level of wireless control with an electromagnetic system that we call OctoMag.
OctoMag's unique abilities are due to its utilization of complex nonuniform magnetic fields, which capitalizes on a linear representation of the coupled field contributions of multiple soft-magnetic-core electromagnets acting in concert. OctoMag was primarily designed for the control of intraocular microrobots for delicate retinal procedures, but it also has potential uses in other medical applications or micromanipulation under an optical microscope.
Robotic Surgery and Prostate Cancer Expert Dr. David Samadi Compares Robotic Prostatectomy and Traditional Open Prostatectomy September 14, 2010
When given a diagnosis of prostate cancer, the first step to undertake is how to treat it. Patients can be easily overwhelmed by the prostate cancer treatment advice offered to them by their doctors, friends or family, as well as the amount of information on prostate removal and robotic surgery they find on the Internet. "This can easily add to a patient's stress level, especially when they are trying to decide between a traditional open or robotic prostatectomy," said Dr. David Samadi, Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at The Mount Sinai Medical Center in New York.
There are many important differences between traditional open and robotic prostatectomies, which Dr. Samadi hopes to help clarify for patients struggling with a treatment decision. "Robotic surgery is minimally-invasive -- patients suffer less pain and trauma thanks to the smaller incisions as opposed to open surgery," said Samadi. Patients are generally very pleased with this part of the surgery as it allows them to return to work and recover faster than traditional open surgery patients. "Ideally, patients should expect to take three to four weeks off from work or strenuous activity, because of typical fatigue experienced from surgery," explained Samadi. Open surgery patients usually need 6-8 weeks to recover physically, and usually require the use of a catheter for a longer time than robotic surgery patients....continue reading
Robotic surgery device treats throat cancer September 14, 2010
A new surgical procedure to treat throat cancer using robotics can greatly reduce recovery time, patient discomfort and at the same time save money.
Throat cancer, usually found in people 50 and older with a history of tobacco and alcohol dependence, is diagnosed about 290,000 times worldwide each year.
Approved by the Food and Drug Administration for use in December, the procedure uses a robotic machine called the da Vinci Surgical System. The machine’s two, pencil-size arms — with pinchers — are manipulated by a surgeon with hand controls. The surgeon sees what’s going on through a small 3D camera positioned between the two arms.
Previously, doctors had to slice open a person’s face and jaw “like a book” to get to throat tumors.
The robot requires no incisions, which speeds recovery time and shortens costly hospital stays. The new surgery lasts no more than two hours, compared to between six and 10 hours for the old way. And recovery time spent in the hospital runs from one to three days compared to one to two weeks after the previous procedure.
CLEVELAND -- The image of a gallbladder on the tv monitor is so realistic, a hush settles over the room as an instructor demonstrates simulated surgery.
This is more often today how medical students and doctors are learning surgical procedures -- not on cadavers, live animals or live patients. "There has been a huge change in how physicians are trained," said Gary Zamler, CEO of Cleveland-based Simbionix, maker of simulators for teaching many minimally-invasive surgical and diagnostic procedures.
The simulation devices are used by medical schools and teaching hospitals.
Simbionix, which began in Israel in 1997, moved its headquarters to Cleveland to be near the city's world-leading medical facilities. Since the move Simbionix has become the world leader in virtual reality medical simulators.
"We are now operating in 40 countries around the world," Zamler said.
In a recent visit to Simbionix, located in the former Baker Electric car factory on Euclid Avenue, WKYC saw demonstrations of gallbladder surgery on one simulator and placing a stent in a heart artery in another.
The simulators are not only used for medical training but could have application in testing the readiness of students and doctors to conduct some medical procedures.
Simbionix has adapted its training to I-Phone and I-Pad applications to allow training-on-the-go.
It is presently developing real-patient surgical simulations. By downloading a patient's pictures from a CT scanner a surgeon would be able to do a trial run of surgery on an actual patient, simulated, before ever making an incision in the patient.
Indian doctors to bring robotic cancer surgery to Uganda September 9, 2010
Cancer care treatment in developed countries has improved largely because of technology, but in poor countries like Uganda it is still a big problem. There is hope however. Doctors from HCG Cancer Care Network in India set foot in Kampala recently to expand their services here. They were headed by Dr B. S Ajaikumar the CEO of the Cancer Care Network.
The doctors displayed the latest technology known as cyber knife robotic radiosurgery system which they use back in India. Dr Ajaikumar said HCG was the first to introduce the technology in India and so far, there are two centres which use it in that country.
The cancer clinic which they set up at Kanjokya Street in Kamwokya will start off as an information centre with free access to the internet where people will get information related to the disease. “We shall be sending one of our doctors every month to run a consultation clinic,” Dr Ajaikumar said while addressing the media at Protea Hotel. The clinic will run for four days every week.....continue reading
AUA steps up efforts to develop robotic standards Posted: September 9, 2010
Educational efforts for surgeons have not kept pace with the rapid implementation of robotic surgery in clinical practice. The AUA Office of Education is taking steps to address this shortcoming by developing both a curriculum and a training program. In this interview, Elspeth M. McDougall, MD, chair of the AUA Office of Education, discusses the goals and challenges of this initiative. Dr. McDougall is professor of urology and director of the Surgical Education Center at the University of California, Irvine. She was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, professor and chairman of urology, University of Wisconsin, Madison.
Q What is the current status of standards for both robotic surgery and credentialing?
A Unfortunately, there are no established standards for credentialing or even certifying with respect to robotic surgery training. Through its Laparoscopy & Robotic Surgery Committee, the AUA has identified a need and an initiative to develop such standards. It is a much-needed focus for the specialty of urology. There's no other specialty that's better equipped to help develop both a curriculum and a training program because we have the most experience with the robot clinically.
I think that the best way to develop a curriculum is through the input of expert educators who can identify the critical aspects of what the curriculum should involve and how best to teach it. In addition, it's important to build into the curriculum the errors and complications to be identified and how to manage them appropriately.
The knowledge component of the curriculum has already been developed and is available free on the AUA web site as the "AUA Handbook of Laparoscopic and Robotic Fundamentals." The Laparoscopy & Robotic Surgery Committee is finalizing the skill tasks for testing, and this should be completed within the next year. The construct and validity testing of this curriculum will be the time-consuming part of the project and will likely require 2 to 3 years to complete.....read more
TransOral Robotic Surgery, in progress, at Henry Ford Hospital in Detroit. The surgery, performed by Tamer A. Ghanem, M.D., Ph.D., offers patients a new option to remove certain head and neck cancer tumors without visible scarring, while preserving speech and the ability to eat.
New robotic head and neck cancer surgery preserves speech, without scarring September 7, 2010
DETROIT – An incisionless robotic surgical procedure is offering patients a new option to remove certain head and neck cancer tumors without visible scarring, while preserving speech and the ability to eat.
Henry Ford Hospital in Detroit is among the first in the country to perform TransOral Robotic Surgery (TORS) using the da Vinci® Surgical System. Unlike traditional surgical approaches to head and neck cancer, TORS patients are able to return to their normal lives only a few days after surgery without significant pain and disfigurement.
"TORS offers shorter post-operative recovery than standard open surgical approaches, giving patients the opportunity to quickly and successfully return to their normal lives," says Tamer A. Ghanem, M.D., Ph.D., director of Head and Neck Oncology and Reconstructive Surgery Division in the Department of Otolaryngology–Head & Neck Surgery at Henry Ford Hospital.
"TORS allows surgeons to completely remove tumors of the head and neck while preserving speech, swallowing, and other key quality of life issues such as eating. There also is no visible scaring or disfigurement."
Led by Dr. Ghanem, Henry Ford Hospital has performed more than a dozen TORS procedures since it was approved in January by the U.S. Food and Drug Administration to remove malignant and benign tumors of the mouth, tongue, tonsils, and parts of the throat.
Prior to TORS, patients would traditionally begin treatment with radiation therapy, or a combination of chemotherapy and radiation therapy, depending on the stage of their cancer. Side effects of radiation – dry mouth, loss of taste and difficulty swallowing – can potentially be avoided with TORS
Traditional surgery has side effects as well. It requires a long incision be made across the lip and jaw to access the tumor. This approach can results in significant swelling, longer post-operative recovery, damage to surrounding structures, and speech and swallowing problems.
With TORS, surgeons can access tumors through the mouth using the slender operating arms of the da Vinci, thus not requiring an open skin incision.
"Surgeons operate with greater precision and control using the TORS approach," says Dr. Ghanem, "minimizing the pain, and reducing the risk of possible nerve and tissue damage associated with large incisions."
World's First Implantable Artificial Kidney September 6, 2010
Researchers at the University of California at San Francisco have developed a prototype for an artificial kidney:
The device, which would include thousands of microscopic filters as well as a bioreactor to mimic the metabolic and water-balancing roles of a real kidney
The treatment has been proven to work for the sickest patients using a room-sized external model developed by a team member in Michigan. Roy’s goal is to apply silicon fabrication technology, along with specially engineered compartments for live kidney cells, to shrink that large-scale technology into a device the size of a coffee cup. The device would then be implanted in the body without the need for immune suppressant medications, allowing the patient to live a more normal life.
The researchers hope to begin clinical trials in five to seven years.
Designed to alleviate the pain caused by joint degeneration, MAKOplasty allows the surgeon to target only the part of the knee impaired by osteoarthritis. With only a small incision, the MAKOplasty procedure uses a surgeon-controlled robotic arm to sculpt the joint and perfectly place the implant, thereby increasing the likelihood of a superior outcome. In addition, most patients spend minimal time in the hospital and are back to normal activity after a month or less of physical therapy.
MAKOplasty benefits include: •Better surgical outcomes •Reduced hospitalization •Less tissue damage •Protection of the natural joint and surrounding tissues •Decreased wear and loosening •Smaller incision •Greater comfort post-surgery •Increased activity post-surgery •Shorter duration of physical therapy
Michael Douglas Has Stage IV Throat Cancer; Experts Weigh In
What is this disease? How is it treated? Based on what he's revealed, what do we know about Douglas's treatment and prognosis?
To answer these and other questions, WebMD spoke with two experts: •Gady Har-El, MD, chairman of the department of otolaryngology-head and neck surgery at New York's Lenox Hill Hospital. •Ted Teknos, MD, co-director of the head and neck disease committee and professor of otolaryngology-head and neck surgery at Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, Ohio.
What is throat cancer?
Surprisingly, doctors don't use the term "throat cancer." Several different kinds of cancer can involve different parts of the throat and mouth.
Michael Douglas says he has a walnut-sized tumor at the base of his tongue. If that's truly where his cancer started, he likely has oropharyngeal cancer. Oropharyngeal cancer may involve the base of the tongue, the tonsils and surrounding tissues, the soft palate, or the front and back walls of the throat. Doctors use the term "insidious" to describe base-of-tongue tumors. That's because there is no pain sensation at the base of the tongue, so the tumors can become quite advanced before symptoms appear.
Can throat cancer be cured? If caught in its early stages, this "throat cancer" can be cured 85% of the time by surgery or radiation. Later stages are more problematic.
Douglas says his doctors have diagnosed "late stage IV" cancer. "For the advanced stage IV cancers, it depends on the situation with the lymph nodes in the neck," Har-El says. "There is over a 60% chance of remission if it has not spread to the lymph nodes. But if it already has spread to the lymph nodes in the neck, the odds of remission are more like 40% or 30%."
Douglas says his cancer has spread to his head and neck, but that his doctors say his odds of survival are 80%. Teknos says there's no reason to doubt this assessment. "We think he is still in the curable category, stage IVa," he says. "Of course we don't know, but his curability could be quite acceptable."
Interestingly, oropharyngeal cancer caused by HPV is much more easily cured -- even at late stages -- than cancer caused by smoking and drinking....complete story
Michael Douglas talks about his diagnosis with throat cancer on The Late Show with David Letterman. Aired: August 31,2010 Posted: September 1, 2010
Formal Training Improves Robot-Assisted Prostatectomy Outcomes Posted: September 1, 2010
Formal training in robotic prostatectomy, compared with the more typical transition from laparoscopic prostatectomy done by performing on a consecutive cohort of patients, improves the pathologic and surgical outcomes associated with the robot-assisted procedure, a study has shown.
In a prospective comparison of the robot-assisted laparoscopic radical prostatectomy (RALP) outcomes achieved by surgeons formally trained in the robotic technique and those with formal training in conventional laparoscopic radical prostatectomy (LRP), the robot-trained group had significantly lower overall postsurgical margin (PSM) rates, T3 tumor margin rates, and apical and lateral margin rates, as well as shorter procedure times, Dr. Eric O. Kwon and colleagues reported in the August issue of Urology....read more
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