Electromagnetic navigation improves minimally invasive robot-assisted lung brachytherapy.
ABSTRACT Recent advances in minimally invasive thoracic surgery have renewed an interest in the role of interstitial brachytherapy for lung cancer. Our previous work has demonstrated that a minimally invasive robot-assisted (MIRA) lung brachytherapy system produced results that were equal to or better than those obtained with standard video-assisted thoracic surgery (VATS) and comparable to results with open surgery. The purpose of this project was to evaluate the performance of an integrated system for MIRA lung brachytherapy that incorporated modified electromagnetic navigation and ultrasound image guidance with robotic assistance.
The experimental test-bed consisted of a VATS box, ZEUS and AESOP surgical robotic arms, a seed injector, an ultrasound machine, video monitors, a computer, and an endoscope. Our previous custom-designed electromagnetic navigational software and the robotic controller were modified and incorporated into the MIRA III system to become the next-generation MIRA IV. Inactive brachytherapy seeds were injected as close as possible to a small metal ball target embedded in an opaque agar cube. The completion time, the number of attempts, and the accuracy of seed deployment were compared for manual placement, standard VATS, MIRA III, and the new MIRA IV system.
The MIRA IV system significantly reduced the median procedure time by 61% (104 s to 41 s), tissue trauma by 75% (4 attempts to 1 attempt), and mean seed placement error by 64% (2.5 mm to 0.9 mm) when compared to a standard VATS. MIRA IV also reduced the mean procedure time by 48% (85 s to 44 s) and the seed placement error by 68% (2.8 mm to 0.9 mm) compared to the MIRA III system.
A modified integrated system for performing minimally invasive robot-assisted lung brachytherapy was developed that incorporated electromagnetic navigation and an improved robotic controller. The MIRA IV system performed significantly better than standard VATS and better than MIRA III.
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ABSTRACT: In a prospective study, 14 patients with primary non-oat cell lung carcinoma were treated with intraoperative Iodine125 (I125) implantation of the lung tumor via lateral thoracotomy or median sternotomy. Staging mediastinal node dissection was performed in each case. Patients were selected when wedge or segmental resections were not technically feasible, such that lobectomy or completion pneumonectomy would have been required or pulmonary function studies were poor. Doses ranged from 8,000 cGy at the periphery to 20,000 cGy at the center. With a minimum 12 month follow-up, mean and median survivals were 16.7 and 15.1 months, respectively. Local control was achieved in 10 of 14 patients (71%) with all local failures occurring in pathologic stage III patients. When separated according to tumor size, local control was obtained in six of seven tumors of less than 3 cm and four of five tumors of 3-5 cm. Both cases with masses greater than 5 cm failed locally. There was one operative mortality and two postoperative complications. All other patients were discharged within one week of surgery. There was no radiation pneumonitis. I125 lung brachytherapy is an excellent alternative treatment for T1 and T2 tumors when medical conditions preclude curative resection.Journal of Surgical Oncology 02/1992; 49(1):25-8. · 2.64 Impact Factor
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ABSTRACT: Previous studies have failed to establish clear advantages for the use of stereoscopic visualization systems in minimal-access surgery. The aim of this study was to objectively assess whether stereoscopic visualization improves performance on bench models using the da Vinci robotic system. Eleven surgeons carried out a series of four tasks. Positional data streamed from the da Vinci system was analyzed by means of a previously validated custom-designed software-package. An independent blinded observer scored errors. Statistical analysis included the Wilcoxon signed rank test. A p < 0.05 was deemed significant. We found significant improvements in all tasks and for all parameters (p < 0.05). In addition, a significantly lower number of errors was scored using the stereoscopic mode as compared to the standard two-dimensional image (p < 0.001). Robotic-assisted performance on bench models is more efficient and accurate using stereoscopic visualization.Surgical Endoscopy 04/2004; 18(4):611-6. · 3.43 Impact Factor
Article: Applications of robotics in surgery.[show abstract] [hide abstract]
ABSTRACT: The end of the 20th century brought an increased use of computerized technology in medicine and surgery. The development of robotic surgical systems opened new approaches in general and cardiac surgery. Two leading robotic companies, Computer Motion, Inc. and Intuitive Surgical, Inc. have developed the Zeus and Da Vinci respectively, as very effective tools for surgeons to use. Both of them consist of a surgeon console, located far from the operating table, and three robotic arms, which reproduce inside the patient's body the movements performed by the surgeon at the console. The advantages of robotic surgery over laparoscopy and open surgery include: better eye-hand coordination, tremor filtration, steadiness of camera, 3-D vision, motion scale, more degrees of freedom for instruments etc. Of course, there are also some disadvantages, like the lack of tactile feedback, long time of set up, long learning curve, high cost etc. However, the advantages seem to overcome the disadvantages and more and more operations are conducted using robots. The impact of robotics in surgery is therefore very promising and in the future it will probably open even more new ways in the surgical practice and education both in Romania and across the globe.Chirurgia (Bucharest, Romania: 1990) 97(6):549-55. · 0.78 Impact Factor