bedah robotik supervised
autonomous in vivo pada
jaringan lunak adalah layak
studi menunjukkan, Melebihi standar teknik operasi
Date:
May 4, 2016
Source:
Children's National
Health System
Summary:
Ahli bedah dan ilmuwan telah menunjukkan bahwa, operasi otonom robot jaringan lunak
pada subjek hidup ( in vivo ) dalam pengaturan bedah terbuka adalah layak dan
melebihi teknik klinis standar dalam lingkungan klinis yang dinamis , menurut
sebuah studi baru .
...............................
Ahli bedah dan ilmuwan dari Sheikh Zayed Institute for Innovation Bedah Pediatric di Sistem Kesehatan Anak Nasional adalah yang pertama untuk menunjukkan bahwa operasi otonom robot jaringan lunak pada subjek hidup ( in vivo ) dalam pengaturan bedah terbuka layak dan melebihi teknik klinis standar di lingkungan klinis yang dinamis .
Penelitian , yang diterbitkan hari ini di Science Translational Medicine , melaporkan hasil operasi jaringan lunak dilakukan pada kedua jaringan babi mati dan babi hidup menggunakan teknologi eksklusif robot bedah , Smart Tissue Autonomous Robot ( STAR ) , dikembangkan di Children's National. Teknologi ini menghilangkan tangan dokter bedah dari prosedur , memanfaatkan ahli bedah sebagai pengawas , dengan penjahitan jaringan lunak mandiri direncanakan dan dilakukan oleh sistem robot STAR .
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Supervised
autonomous in vivo robotic surgery on soft tissues is feasible
Outperforms standard surgery techniques, study shows
Date:
May 4, 2016
Source:
Children's National
Health System
Summary:
Surgeons and scientists have
demonstrated that supervised, autonomous robotic soft tissue surgery on a live
subject (in vivo) in an open surgical setting is feasible and outperforms
standard clinical techniques in a dynamic clinical environment, according to a
new study.
...............................
Surgeons and scientists from Sheikh Zayed Institute for Pediatric Surgical
Innovation at Children's National Health System are the first to demonstrate
that supervised, autonomous robotic soft tissue surgery on a live subject (in
vivo) in an open surgical setting is feasible and outperforms standard clinical
techniques in a dynamic clinical environment.
The study, published today in Science Translational Medicine,
reports the results of soft tissue surgeries conducted on both inanimate porcine
tissue and living pigs using proprietary robotic surgical technology, Smart
Tissue Autonomous Robot (STAR), developed at Children's National. This
technology removes the surgeon's hands from the procedure, instead utilizing
the surgeon as supervisor, with soft tissue suturing autonomously planned and
performed by the STAR robotic system.
Soft tissues are the tissues that connect, support or surround other
structures and organs of the body such as tendons, ligaments, fascia, skin,
fibrous tissues, fat, synovial membranes, muscles, nerves and blood vessels.
Currently more than 44.5 million soft tissue surgeries are performed in the
U.S. each year.
"Our results demonstrate the potential for autonomous robots to
improve the efficacy, consistency, functional outcome and accessibility of
surgical techniques," said Dr. Peter C. Kim, Vice President and Associate
Surgeon-in-Chief, Sheikh Zayed Institute for Pediatric Surgical Innovation.
"The intent of this demonstration is not to replace surgeons, but to
expand human capacity and capability through enhanced vision, dexterity and
complementary machine intelligence for improved surgical outcomes."
While robot-assisted surgery (RAS) has increased in adoption in healthcare
settings, the execution of soft tissue surgery has remained entirely manual,
largely because the unpredictable, elastic and plastic changes in soft tissues
that occur during surgery, requiring the surgeon to make constant adjustments.
To overcome this challenge, STAR uses a tracking system that integrates
near infrared florescent (NIRF) markers and 3D plenoptic vision, which captures
light field information to provide images of a scene in three dimensions. This
system enables accurate, uninhibited tracking of tissue motion and change
throughout the surgical procedure. This tracking is combined with another STAR
innovation, an intelligent algorithm that guides the surgical plan and
autonomously makes adjustments to the plan in real time as tissue moves and
other changes occur. The STAR system also employs force sensing, submillimeter
positioning and actuated surgical tools. It has a bed-side lightweight robot
arm extended with an articulated laparoscopic suturing tool for a combined eight
degrees-of-freedom robot.
"Until now, autonomous robot surgery has been limited to applications
with rigid anatomy, such as bone cutting, because they are more
predictable," said Axel Krieger, PhD, and technical lead for Smart Tools
at Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's
National. "By using novel tissue tracking and applied force measurement,
coupled with suture automation software, our robotic system can detect
arbitrary tissue motions in real time and automatically adjust."
To compare the effectiveness of STAR to other available surgical
procedures, the study included two different surgeries performed on inanimate
porcine tissue (ex vivo), linear suturing and an end-to-end intestinal
anastomosis, which involves connecting the tubular loops of the intestine. The
results of each surgery were compared with the same surgical procedure
conducted manually by an experienced surgeon, by laparoscopy, and by RAS with
the daVinci Surgical System.
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Untuk membandingkan efektivitas STAR untuk prosedur bedah lain yang tersedia , studi termasuk dua operasi yang berbeda dilakukan pada jaringan babi mati ( ex vivo ) , penjahitan linear dan an end-to-end intestinal anastomosis , yang melibatkan menghubungkan loop tubular dari usus . Hasil dari setiap operasi dibandingkan dengan prosedur bedah yang sama dilakukan secara manual oleh seorang ahli bedah yang berpengalaman , dengan laparoskopi , dan oleh RAS dengan sistem bedah daVinci .
Intestinal anastomosis was the surgical procedure conducted on the living
subjects (in vivo) in the study. The Children's National research team
conducted four anastomosis surgeries on living pigs using STAR technology and
all subjects survived with no complications. The study compared these results
to the same procedure conducted manually by an experienced surgeon using
standard surgical tools.
"We chose the complex task of anastomosis as proof of concept because
this soft tissue surgery is performed over one million times in the U.S.
annually," said Dr. Kim.
All surgeries were compared based on the metrics of anastomosis including
the consistency of suturing based on average suture spacing, the pressure at
which the anastomosis leaked, the number of mistakes that required removing the
needle from the tissue, completion time and lumen reduction, which measures any
constriction in the size of the tubular opening.
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Semua operasi dibandingkan berdasarkan metrik
dari anastomosis termasuk konsistensi penjahitan berdasarkan jarak jahitan rata
, tekanan di mana anastomosis bocor , jumlah kesalahan yang diperlukan
menghapus jarum dari jaringan , waktu penyelesaian dan pengurangan lumen , yang
mengukur setiap penyempitan dalam ukuran pembukaan tubular .
The comparison showed that supervised autonomous robotic procedures using
STAR proved superior to surgery performed by experienced surgeons and RAS
techniques, whether on static porcine tissues or on living specimens, in areas
such as consistent suture spacing, which helps to promote healing, and in
withstanding higher leak pressures, as leakage can be a significant
complication from anastomosis surgery. Mistakes requiring needle removal were
minimal and lumen reduction for the STAR surgeries was within the acceptable
range.
In the comparison using living subjects, the manual control surgery took
less time, eight minutes versus 35 minutes for the fastest STAR procedure,
however researchers noted that the duration of the STAR surgery was comparable
to the average for clinical laparoscopic anastomosis, which ranges from 30
minutes to 90 minutes, depending on complexity of the procedure.
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Dalam perbandingan menggunakan subjek hidup , operasi kontrol manual mengambil sedikit waktu , delapan menit dibandingkan 35 menit untuk prosedur STAR tercepat , namun para peneliti mencatat bahwa durasi operasi STAR adalah sebanding dengan rata-rata untuk anastomosis laparoskopi klinis , yang berkisar dari 30 menit sampai 90 menit , tergantung pada kompleksitas prosedur .
Dr. Kim said that since supervised, autonomous robotic surgery for soft
tissue procedures has been proven effective, a next step in the development
cycle would be further miniaturization of tools and improved sensors to allow
for wider use of the STAR system.
He added that, with the right partner, some or all of the technology can be
brought into the clinical space and bedside within the next two years.
The Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's
National Health System is a hub for innovation focused on making pediatric
surgery more precise, less invasive and pain free. Founded in 2010 through a
$150 million gift from the government of Abu Dhabi, the institute currently has
more than 20 investigators primarily affiliated with the institute and more
than 70 technical and scientific staff, including postgraduate and graduate
students and fellows. The institute is further supported by, and has access to,
more than 600 clinicians and clinician-scientists with Children's National and
the Children's Research Institute, the research arm of Children's National.
Story Source:
The above post is reprinted from materials provided byChildren's National Health
System. Note: Materials may be edited for content and
length.
Journal Reference:
1.
Azad Shademan, Ryan S. Decker, Justin D. Opfermann, Simon Leonard, Axel
Krieger and Peter C. W. Kim.Supervised autonomous robotic soft tissue
surgery.Science Translational Medicine, 2016 DOI:10.1126/scitranslmed.aad9398
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