Robotic Surgical Instruments for Dexterity Enhancement in Thoracoscopic Coronary Artery Bypass Graft

García-Ruiz, Antonio; Smedira, Nicholas G.; Loop, Floyd D.; Hahn, Joseph F.; Miller, Jeffrey H; Steiner, Charles P.; Gautier, Michel

doi:10.1089/lap.1997.7.277

Cited by 82 publications

(37 citation statements)

References 7 publications

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“…The surgeon tele-operates a slave robot that manipulates the surgical instruments from a master console that provides full six degrees of freedom manipulation, enhanced 3D imaging, and often force feedback. Robotic surgical systems such as DaVinci [1] and ZEUS [2] are in wide use today, performing a variety of abdominal, pelvic, and thoracic procedures. However, despite significant advances in robot-assisted surgery, delicate tasks like knot-tying are still cumbersome and time-consuming, in some cases taking longer than with conventional MIS [3].…”

Section: Introductionmentioning

confidence: 99%

A System for Robotic Heart Surgery that Learns to Tie Knots Using Recurrent Neural Networks

et al. 2008

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Abstract-Tying suture knots is a time-consuming task performed frequently during Minimally Invasive Surgery (MIS).Automating this task could greatly reduce total surgery time for patients. Current solutions to this problem replay manually programmed trajectories, but a more general and robust approach is to use supervised machine learning to smooth surgeongiven training trajectories and generalize from them. Since knottying generally requires a controller with internal memory to distinguish between identical inputs that require different actions at different points along a trajectory, it would be impossible to teach the system using traditional feedforward neural nets or support vector machines. Instead we exploit more powerful, recurrent neural networks (RNNs) with adaptive internal states. Results obtained using LSTM RNNs trained by the recent Evolino algorithm show that this approach can significantly increase the efficiency of suture knot tying in MIS over preprogrammed control.

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Section: Introductionmentioning

confidence: 99%

A System for Robotic Heart Surgery that Learns to Tie Knots Using Recurrent Neural Networks

et al. 2008

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“…There is a lack of depth perception on the video image, and the hand-held endoscopic camera often yields an unsteady picture in highly magnified surgical fields. With recent advancements in computers 5 and robotic systems, it was hypothesized that robotics would prove to be an enabling technology for endoscopic cardiac surgery. 6,7 This study reports the 1-year follow-up of the first prospective, nonrandomized trial in North America of endoscopic coronary artery bypass grafting (ECABG).…”

Section: Discussionmentioning

confidence: 99%

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Prasad¹,

Ducko²,

Stephenson³

et al. 2001

Annals of Surgery

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ObjectiveTo follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. Summary Background DataRecently there has been an interest in using robotics and computers to enhance the surgeon's ability to perform endoscopic cardiac surgery. This interest has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instruments, it has not been possible to perform coronary surgery. MethodsNineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to construct the LITA-LAD anastomosis. All other required grafts were completed by conventional techniques. ResultsSeventeen LITA-LAD grafts (89%) had adequate intraoperative flow. The mean LITA-LAD graft flow was 38.5 Ϯ 5 mL/ min. At 8 weeks, LITA-LAD grafts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 Ϯ 4.2 months, all patients were NYHA class I and there were no adverse cardiac events. ConclusionsThe results from the first prospective clinical trial of robotically assisted endoscopic coronary bypass surgery in the United States showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabling technology allowing the performance of endoscopic coronary anastomoses.During the past 10 years, surgeons have begun to explore strategies to decrease the invasiveness of cardiac surgery. Great strides have been made in the development of beating heart surgery, which eliminates cardiopulmonary bypass. 1 Techniques also have been developed to decrease the size of the incision, and some procedures can now be performed through small thoracotomies 2 and limited sternotomies. The next step in the evolution of minimally invasive cardiac surgery would be the development of a completely endoscopic procedure. The explosion of arthroscopic and laparoscopic techniques during the past several decades has revolutionized orthopedic and general surgery. However, endoscopic techniques have had little impact on microsurgical disciples, such as cardiac surgery. There are several reasons for this shortcoming. Traditional endoscopic instruments are not well suited for microsurgery 4 because of their length and the fulcrum effect. The length of the instruments magnifies even the smallest surgical tremor, making microsurgery difficult

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“…A number of systems, such as telepresence operation systems have been developed to solve these problems by increasing the dexterity, adding motion tracking and filtering tremor motions (Satava, 1995;Hill et al, 1998;Garcia-Rutz et al, 1997). It can also be applied in the field of surgical education that students can perform VATS surgery by using virtual reality surgical simulators, instead of the real patients (Playter and Raibert, 1997;Delp et al, 1997).…”

Section: Vats Future Perspectivesmentioning

confidence: 99%

Video-assisted thoracic surgery—The past, present status and the future

Luh

Liu

2006

J. Zhejiang Univ. - Sci. B

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Robotic Surgical Instruments for Dexterity Enhancement in Thoracoscopic Coronary Artery Bypass Graft

Abstract: The use of robotic enhancement technology leads to an efficient performance of sutured coronary artery bypass anastomoses in a plastic model. The robotic device enhances dexterity, precision, and reduces surgeon's fatigue while preserving the quality of hand suturing.

Cited by 82 publications

References 7 publications

A System for Robotic Heart Surgery that Learns to Tie Knots Using Recurrent Neural Networks

A System for Robotic Heart Surgery that Learns to Tie Knots Using Recurrent Neural Networks

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Video-assisted thoracic surgery—The past, present status and the future

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