The international journal of medical robotics + computer assisted surgery : MRCAS
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Robotic mitral valve repair using the da Vinci telemanupilation system has become the standard of care at many centres worldwide. We perform the first robotic MV repair in the United States in the year 2000. This article reviews our 6 year experience and current technique of robotic MV repair as well as future trends in the field. ⋯ Robotic MV repair operations are safe with excellent early results. Follow-up studies are needed to determine repair longevity. We must continue to improve the current technology in order to develop the next generation of tools that will facilitate robotic MV repairs.
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Cardiac surgery, traditionally conducted via median sternotomy, has been recently forwarded by progressively advanced technology facilitating sternal-sparing minimally invasive, access to the heart. Robotic systems, comprised of miniaturized surgical instruments mounted on long thin shafts with multiple degrees of range of motion coupled with a dual camera endoscope providing true three-dimentional high-magnification visualization have greatly propelled this field. ⋯ As minimally invasive and robotic surgical technology advances, so proceeds the spectrum of potential applications for robotic cardiac surgery.
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Multicenter Study Clinical Trial
Miniature robotic guidance for spine surgery--introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres.
Instrumented spinal fusion surgery is increasingly performed. Breaching of the pedicle occurs in 3-55% of screws; clinically significant screw misplacements occur in 0-7% of all transpedicular screw placements. Several techniques have reduced this incidence but none gained popularity due to cost as well as staff issues. Surgical robots offer distinct added value in accuracy and minimal invasiveness. The aim of this study is to introduce the SpineAssist--a novel spine surgery miniature robot, to discuss the various reasons that had prevented full success with its use, to identify patients related, technical related, and surgeon related issues, and to offer ways to avoid them. ⋯ It is expected that following a steep learning curve in the range of 5-10 cases, recommended to take place within 2-3 weeks time, the surgical team will gain sufficient experience in operating the SpineAssist miniature robotic device in order to achieve excellent surgical results. The system may be used for wide range of applications including but not limited to pedicle screws, trans-facet and trans-laminar screws, biopsy needles, vertebroplasty or kyphoplasty tools and more. The preoperative plan has to be logical, intraoperative fluoro images taken with care, gentle surgical technique must be kept - maintaining the integrity of the posterior elements, and avoiding pressure between the robot arms and the soft tissues. During the clinical development phase discussed in this study, both teams used an early version of the system. Based on the results of this study several significant software and hardware improvements have already been implemented. It is our hope that describing and analysing our findings will help in planning and preparing for the clinical utilization of the SpineAssist system in future sites and will shorten their learning curve. By the time this article is published wider clinical experience will have been gathered and we expect to soon follow up with an analysis of clinical utilization of this system in a larger study group.
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The aim of this paper was to outline the use of frameless stereotaxy for the safe insertion of C1/C2 transarticular screws in the clinical setting of patients with atlanto-axial instability. ⋯ Frameless stereotaxy can be applied safely in a clinical setting for transarticular screw fixation. Image guidance can facilitate preoperative planning and help determine an optimal trajectory that avoids the vertebral artery.