"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Monday, September 19, 2016

Large scale review of robotic surgical outcomes

Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. 
MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. 
We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. 
Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use."
Source: Surgical Endoscopy

Sunday, September 18, 2016


Prototype dexterous manipulator robot from Goldman et al. deployed through sheath into male urethra bladder model. 
Source: Herrell et al.

Friday, September 16, 2016

Preceyes goes clinical

As we reported earlier, the Preceyes system performed its first successful human trials. The official reports also arrived:
"Robot-assisted surgery have become commonplace over the last decade. However, never before has a robot been used to operate inside the eye for which even higher levels of control and precision are required. The PRECEYES Surgical System enables to execute the most delicate surgical tasks with an unprecedented level of control and precision. The technology promises to improve the safety and performance of existing ocular surgery as well as to enable new treatments, for example high-precision drug delivery.  Preceyes and the team at the University of Oxford’s Nuffield Laboratory of Ophthalmology have worked together to enable this landmark clinical trial. The trial is funded by the NIHR Oxford Biomedical Research Centre with support from Oxford University Hospitals NHS Foundation Trust, which runs the hospital. The clinical trial sponsored by the University of Oxford is assessing the robotic system to perform new gene therapy operations, which are currently under development and require ultra-precise surgery under the fovea. This has resulted in the world first robotic surgery inside the human eye."
"British surgeons have successfully performed the world’s first robotic operation inside the eye, potentially revolutionising the way such conditions are treated.
The procedure was carried out at John Radcliffe hospital in Oxford, where surgeons welcomed its success.
On completing the operation, Professor Robert MacLaren said: “There is no doubt in my mind that we have just witnessed a vision of eye surgery in the future.
“Current technology with laser scanners and microscopes allows us to monitor retinal diseases at the microscopic level, but the things we see are beyond the physiological limit of what the human hand can operate on.
“With a robotic system, we open up a whole new chapter of eye operations that currently cannot be performed.”

The procedure was necessary because the patient had a membrane growing on the surface of his retina, which had contracted and pulled it into an uneven shape. The membrane is about 100th of a millimetre thick and needed to be dissected off the retina without damaging it.
Surgeons normally attempt this by slowing their pulse and timing movements between heart beats, but the robot could make it much easier. Experts said the robot could enable new, high-precision procedures that are beyond the abilities of the human hand.
The surgeons used a joystick and touchscreen outside the eye to control the robot while monitoring its progress through the operating microscope. This gave medics a notable advantage as significant movements of the joystick resulted in tiny movements of the robot.
This is the first time a device has been available that achieves the three-dimensional precision required to operate inside the human eye.
Speaking at his follow-up visit at the Oxford eye hospital, Father Beaver said: “My sight is coming back.
“I am delighted that my surgery went so well and I feel honoured to be part of this pioneering research project.”
MacLaren said: “This will help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision.”
The robotic eye surgery trial involves 12 patients undergoing operations with increasing complexity. In the first part of the trial, the robot is used to peel membranes off the delicate retina without damaging it.
If this part is successful, as has been the case so far, the second phase of the trial will assess how the robot can place a fine needle under the retina and inject fluid through it.
Experts said this could lead to use of the robot in retinal gene therapy, a new treatment for blindness which is currently being trialled in a number of centres around the world."

Source: LinkedIn, Oxford University, Guardian, Surgical Prod Mag, BBC, RT

Wednesday, September 14, 2016

Monday, September 12, 2016

CIS news