The international journal of medical robotics + computer assisted surgery : MRCAS
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In North America, the urological community has embraced surgical robotic technology in the performance of complex laparoscopic surgery. The performance of complex long-distance telesurgery requires further investigation prior to clinical application. ⋯ The completion of complex tasks such as robotic pyeloplasty is feasible using both land-line and satellite telesurgery. However, the clinical relevance of telesurgery requires further assessment.
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Haemodynamic changes associated with pneumoperitoneum and steep Trendelenburg position were investigated in non-obese, ASA I-II males, using general anaesthesia (sevoflurane in air/O2, 40%) undergoing robotic-assisted laparoscopic prostatectomy. ⋯ Pneumoperitoneum and steep Trendelenburg position significantly increase MAP and SVR. Trendelenburg position increased stroke volume. Pneumoperitoneum decreases aortic diameter. No significant changes in cardiac output or stroke volume were noted.
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Although patients benefit considerably from minimally invasive surgery, the use of new instruments such as robotic systems is challenging for surgeons, and extensive training is required. ⋯ Virtual reality is a useful technique for medical training. The simulator is currently in its early stages, but this preliminary work is promising.
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Comparative Study
Quantitative comparison of functional MRI and direct electrocortical stimulation for functional mapping.
Mapping functional areas of the brain is important for planning tumour resections. With the increased use of functional magnetic resonance imaging (fMRI) for presurgical planning, there is a need to validate that fMRI activation mapping is consistent with the mapping obtained during surgery using direct electrocortical stimulation (DECS). ⋯ There is a substantial effort to improve the techniques used to map functional areas, particularly using fMRI. It seems likely that fMRI will eventually provide a valid non-invasive means for functional mapping.
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Advanced gynecologic pathology and the surgical limitations of conventional laparoscopy have often been cited as impediments to converting hysterectomy from a procedure predominantly performed by laparotomy to one accomplished by laparoscopy. Recently, the use of robotic technology as a means to facilitate the laparoscopic completion of a hysterectomy was introduced. ⋯ The following paper demonstrates a safe and efficient surgical technique for completing a robot-assisted laparoscopic hysterectomy with the da Vinci Surgical System.