The Smart Tissue Autonomous Robot (STAR): the role of intelligence and autonomy in surgical robotics P.C.W. Kim You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Introduction Robot-based surgery first emerged in the mid-eighties, with orthopedic and neurosurgical applications [ ]. The RoboDoc® system, reported by Taylor et al. [ ], was designed to assist the surgeon during hip replacement surgery. In neurosurgery, Kwoh et al. described the use of a robotic arm coupled to a navigation system to perform brain stereotactic biopsy, avoiding the need for a stereotactic frame [ ].…
The challenge of endo- and transnasal surgery Endonasal surgery refers to surgery of the nasal cavities and sinuses, while transnasal surgery here refers to surgery using an endonasal approach to anatomic structures lying beyond the nasal cavities and paranasal sinuses: infratemporal fossa, endo-orbital structures anterior and ventral skull base, and petrous apex. In current practice, endonasal surgery remains strongly affected by its origins: Messerklinger, Agrifolio and…
Micro-technologies and systems for robot-assisted laser phonomicrosurgery (μRALP): a new microrobot prototype driven by an endoscope for laser treatment of pathologies of the vocal folds L. Tavernier N. Andreff T. Ortmaier G. Peretti L.S. Mattos The history of transoral robotic surgery (TORS) began just over 10 years ago with the first animal model in 2005 [ ], followed by first-in-man procedures in 2006 [ , ]. Across the world, one medical…
Robot-assisted surgery in thyroid procedures B. Lallemant Introduction More than ever, our patient's new expectations direct our surgical practice. Thus, the growing place of esthetic considerations in our society has contributed to the development of minimally invasive techniques. In thyroid surgery, several techniques have been developed to avoid cervical scars. Initially, endoscopic procedures reduced scar size in a few selected cases. Subsequently, the scar could be hidden away…
Introduction C.H. Frenkel B.W. O'Malley G.S. Weinstein Introduction Transoral robotic surgery (TORS) has significantly improved the intraoperative and postoperative management of difficult-to-reach head and neck neoplasms. Prior to the development of TORS, open surgical approaches greatly impacted postoperative functional outcome and quality of life. These open procedures, when used to eradicate lesions of the oropharynx, hypopharynx, skull base and nasopharynx, involved long operative times, prolonged hospital stay and increased…
The aim of this chapter is to provide some details about the technology involved in the da Vinci® surgical manipulator system. It does not claim either to be a user manual, or to provide a complete description of its technology. Our aim is limited to provide some basic information about the only commercially available ENT surgical robot, as an introduction to the later chapters which focus…
This chapter aims to complete the basic knowledge provided in by chapter 4 , by analyzing the state of the art of surgical robot control methods. Classes of surgical robots Until now, five classes of surgical robot are distinguished, although most of these are still experimental. Master-slave manipulators These currently constitute the main class of surgical robot. The surgeon is the driver of a master control…
Regardless of purpose, robotics fundamentally describes a combination of mechanics, sensors, electronics and software. Since surgical manipulators can be extremely specific depending of their intended application, it is not possible to consider surgical robotics without a basic knowledge of what a robot is made of—in the same way as it is impossible to discuss surgery without a knowledge of fundamental anatomy. In this chapter we will…
The craniofacial region is a complex association of bone structures and soft tissue through which numerous essential neurovascular and sensory structures pass. Remodeling by pathologic processes and previous treatments often hinders the surgeon's spatial orientation, which is further aggravated by the natural narrowness of the approaches and by frequently hemorrhagic conditions. The endoscopes generally used for surgery in this region seriously deform imaging geometry. Thus, even…
Computer-assisted surgery consists in using the calculation power, data storage and graphic display capabilities of microcomputers to make a real-time match between the spatial coordinates of sensors affixed onto an instrument used by the surgeon and the corresponding points on patient imaging. The result is displayed on-screen, visible to the surgeon, who thus has the illusion of navigating among the patient’s anatomic structures. The position of…
From stereotactic frames to image-guided surgery B. Lombard In the history of medicine, the advent of a new technology has often heralded a leap forward, either by enhancing the physician's perceptual acuity, revealing new diagnoses, or by placing a new tool in the physician's hand, improving the act of treatment. Thus it was, for example, with the microscope, electrocardiograph and X-rays, each of which gave birth to…
Acknowledgments We acknowledge Jonathan Russin, Joshua Bakhsheshian, and Robert F. Spetzler for their authorship of the previous edition of this chapter. Please access Videos to view the corresponding videos for this chapter. Introduction Surgical understanding of the vascular anatomy of the petrous temporal bone and cerebellopontine angle (CPA) is critical to optimally manage lesions in this region. Many pathological entities occur within the lateral skull base,…
During the last quarter century, the management of many skull base tumors has shifted away from complete surgical resection toward subtotal resection to preserve function, and then control of growth. This is particularly true for vestibular schwannomas (i.e., acoustic neuromas) and is now applicable to glomus jugulare tumors. The principal modality for such treatment is Gamma Knife surgery, although other conformal radiation treatment systems are available…
Intraoperative neurophysiological monitoring is a valuable tool for improved patient outcomes because it permits the surgeon to evaluate functional changes in structures at risk. Facial nerve monitoring has reached a level of consistency that makes it a state-of-the-art adjunct to lateral and posterior skull base approaches. The techniques for monitoring auditory function continue to evolve. Lower cranial nerve monitoring may be included for other complex neurotologic…
Please access Videos to view the corresponding videos for this chapter. Facial nerve paralysis can occur during the course of otologic and neurotologic surgery, either intentionally where sacrifice of the facial nerve is inevitable or inadvertently despite meticulous dissection. In such circumstances, one must be prepared to repair the nerve with the best possible technique. Direct anastomosis of the injured nerve stumps continues to offer the…
Facial paralysis (FP) can be devastating, both emotionally and functionally. A lack of facial expression removes the visible thumbprint of personality in day-to-day interactions. The inability to smile or simply make a symmetric facial expression takes an emotional toll on a patient’s self-esteem. Although other aspects of the facial nerve function, including oral competence and nasal airway patency, may be affected by FP, care of the…
Please access Videos to view the corresponding videos for this chapter. Historically, cerebrospinal fluid (CSF) leak rates of approximately 20% were observed after translabyrinthine craniotomy. With refinement of closure technique, CSF leak rates have decreased significantly to 0% to 3%. The egress of CSF from the subarachnoid space into surgical wounds may result in the leakage of CSF from the wound, ear canal (if the tympanic…
The extreme lateral infrajugular transcondylar (ELITE) approach was born out of the anatomical constraints and operative challenges presented by the cranial base. The transcondylar approach was devised as an avenue for access to the foramen magnum and ventral medulla. , In 1986, Heros described the extreme lateral inferior suboccipital approach for access to vertebral and vertebrobasilar artery lesions. The ELITE approach is a unique transcondylar and…
Acknowledgments The authors are grateful to their patients for their time and effort in laboratory testing. We also thank Drs. Jose Fayad, Robert Shannon, and William Hitselberger, who contributed to the previous edition of this chapter. Please access Videos to view the corresponding videos for this chapter. Loss of auditory nerve integrity, as often occurs after the removal of vestibular schwannomas (VS) in neurofibromatosis type 2…