S Duke Herrell

Vanderbilt University, Нашвилл, Michigan, United States

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Publications (135)412.58 Total impact

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    ABSTRACT: Purpose: Organ-level registration is critical to image-guided therapy in soft tissue. This is especially important in organs such as the kidney which can freely move. We have developed a method for registration that combines three-dimensional locations from a holographic conoscope with an endoscopically obtained textured surface. By combining these data sources clear decisions as to the tissue from which the points arise can be made. Methods: By localizing the conoscope's laser dot in the endoscopic space, we register the textured surface to the cloud of conoscopic points. This allows the cloud of points to be filtered for only those arising from the kidney surface. Once a valid cloud is obtained we can use standard surface registration techniques to perform the image-space to physical-space registration. Since our methods use two distinct data sources we test for spatial accuracy and characterize temporal effects in phantoms, ex vivo porcine and human kidneys. In addition we use an industrial robot to provide controlled motion and positioning for characterizing temporal effects. Results: Our initial surface acquisitions are hand-held. This means that we take approximately 55 s to acquire a surface. At that rate we see no temporal effects due to acquisition synchronization or probe speed. Our surface registrations were able to find applied targets with submillimeter target registration errors. Conclusion: The results showed that the textured surfaces could be reconstructed with submillimetric mean registration errors. While this paper focuses on kidney applications, this method could be applied to any anatomical structures where a line of sight can be created via open or minimally invasive surgical techniques.
    Full-text · Article · Jan 2016 · International Journal of Computer Assisted Radiology and Surgery
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    ABSTRACT: Concentric tube manipulators have the diameter of needles and are consequently amenable to delivery into the human body through small ports in an endoscope. When this is done, the surgeon must manipulate both the endoscope and one or more concentric tube robots simultaneously. In this paper we explore a hand-held approach to this user interface challenge, in which the surgeon has direct physical control of endoscope pose and can use finger and thumb controls to specify the motion of two concentric tube robots that pass through the endoscope. In experiments with the system, we explore whether the endoscope-robot combination can reach locations in the prostate that are inaccessible to the endoscope alone. We also compare joint space and task space control for three-degree-of-freedom concentric tube robots, and demonstrate experimentally that laser resection of prostate tissue is possible using an anthropomorphic phantom.
    No preview · Chapter · Jan 2016
  • Timothy Charles Boswell · Tracy Marien · Stanley Duke Herrell

    No preview · Article · Dec 2015
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    ABSTRACT: Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon’s functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection.
    No preview · Article · Jul 2015 · The International Journal of Robotics Research
  • N. Sarli · T. Marien · S.D. Herrell · N. Simaan
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    ABSTRACT: Transurethral resection of bladder tumors (TURBT) presents surgeons with challenges of limited tool dexterity. This paper investigates the limitations of dexterity and resection reach and accuracy within the intra-vesicular space of the bladder. The paper assumes the kinematics and geometry of current tools used for TURBT. The study presents a kinematic modeling framework and a simulation evaluation that aim to elucidate the limitations of current surgical tools. The kinematic framework also proposes a method for analyzing resection dexterity and accuracy in different regions of the bladder. The results demonstrate resection dexterity deficiencies in the areas neighboring the bladder neck and substantially higher dexterity in superior regions. In addition, the results of this work provide a currently missing quantified dexterity evaluation baseline for expected performance during manual TURBT against which future devices and robotic-assisted systems for resection can be compared.
    No preview · Article · Jun 2015 · Proceedings - IEEE International Conference on Robotics and Automation
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    Preview · Article · May 2015
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    Tracy Marien · S. Duke Herrell · Nicole Miller

    Preview · Article · Apr 2015 · The Journal of Urology
  • Christopher R. Mitchell · S. Duke Herrell
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    ABSTRACT: Recent technologic advances have ushered in an era of surgery with a focus on development of minimally invasive surgical techniques. Specifically, robotic platforms, with robotic-assisted instrumentation, have helped overcome previous barriers to widespread adoption of laparoscopic surgery. Along these lines, image guidance will soon be incorporated into many laparoscopic/robotic procedures to improve surgeon ease, accuracy, and comfort with these complex operations. Thus, we explore recent advances in image-guided surgery and emerging molecular imaging technologies for minimally invasive urologic surgery.
    No preview · Article · Nov 2014 · Urologic Clinics of North America
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    ABSTRACT: Purpose: To determine whether statin use at time of surgery is associated with survival following nephrectomy or partial nephrectomy for renal cell carcinoma (RCC). Statins are thought to exhibit a protective effect on cancer incidence and possibly cancer survival in a number of malignancies. To date, no studies have shown an independent association between statin use and mortality in RCC. Methods: A retrospective cohort study of 916 patients who underwent radical or partial nephrectomy for RCC from 2000 to 2010 at a single institution was performed. Primary outcomes were overall (OS) and disease-specific survival (DSS). Univariable survival analyses were performed using the Kaplan-Meier and the log-rank methods. Multivariable analysis was performed using a Cox proportional hazards model. The predictive discrimination of the models was assessed using the Harrell c-index. Results: The median follow-up of the entire cohort was 42.5 months. The 3-year OS estimate was 83.1% (95% CI: 77.6%-87.3%) for statin users and 77.3% (95% CI: 73.7%-80.6%) for nonstatin users (P = 0.53). The 3-year DSS was 90.9% (95% CI: 86.3%-94.0%) for statin users and 83.5% (95% CI: 80.1%-86.3%) for nonstatin users (P = 0.015). After controlling for age, American Society of Anesthesiology class, pT category, pN category, metastatic status, preoperative anemia and corrected hypercalcemia, and blood type, statin use at time of surgery was independently associated with improved OS (hazard ratio = 0.62; 95% CI: 0.43-0.90; P = 0.011) and DSS (hazard ratio = 0.48; 95% CI: 0.28-0.83; P = 0.009). The multivariable model for DSS had excellent predictive discrimination with a c-index of 0.91. Conclusions: These data suggest that statin usage at time of surgery is independently associated with improved OS and DSS in patients undergoing surgery for RCC.
    No preview · Article · Oct 2014 · Urologic Oncology
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    ABSTRACT: Objectives To examine racial differences in the distribution of histologic subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype.Materials and methodsTumors from 1,532 consecutive RCC patients who underwent nephrectomy at Vanderbilt University Medical Center (1998-2012) were classified as clear cell, papillary, chromophobe, and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between race, sex, age, ESRD and body mass index at diagnosis (BMI, kg/m2) according to histologic subtype.ResultsThe RCC subtype distribution was significantly different among blacks compared with whites (p<0.0001), with a substantially higher proportion of patients with papillary RCC among blacks than whites (35.7% vs. 13.8%). In multivariate analyses, compared to clear cell RCC, papillary cases were significantly more likely to be black (OR=4.15; 95% CI 2.64-6.52) and less likely to be female (OR=0.60; 95% CI 0.43-0.83). Chromophobe cases were significantly more likely to be female (OR=2.32; 95% CI 1.44-3.74). Both papillary (OR=6.26; 95% CI 2.75-14.24) and chromophobe (OR=7.07; 95% CI 2.13-23.46) cases were strongly and significantly more likely to have ESRD, compared to clear cell cases.Conclusion We observed marked racial differences in the proportional subtype distribution of RCCs diagnosed at a large tertiary care academic center. To our knowledge, no previous study has examined racial differences in the distribution of RCC histologies while adjusting for ESRD, which was the factor most strongly associated with papillary and chromophobe RCC compared to clear cell.
    No preview · Article · Oct 2014 · BJU International
  • Richard J. Hendrick · S. Duke Herrell · Robert J. Webster
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    ABSTRACT: Benign prostatic hyperplasia is the most common symptomatic disease in men. A new transurethral surgical intervention is available that has been shown to reduce bleeding, catheterization time, and hospitalization time in comparison to traditional Transurethral Resection of the Prostate (TURP). However, this new procedure, Holmium Laser Enucleation of the Prostate (HoLEP), is so challenging to accomplish that only a small number of expert surgeons are able to offer it. Toward facilitating broader use of HoLEP, we propose a new hand-held robotic system for the purpose of making the surgery easier to perform. In current HoLEP, the only way to aim the laser and/or manipulate tissue is to move the entire endoscope, stretching a large quantity of tissue. In contrast, our new robotic approach provides the surgeon with two concentric tube manipulators that can aim the laser and manipulate tissue simultaneously. The manipulators are deployed through a 5 mm working channel in a 26 French (8.66 mm) endoscope clinically used for transurethral procedures. This paper describes the design of the robot and experiments illustrating its ability to perform the motions expected to be useful in HoLEP.
    No preview · Conference Paper · May 2014
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    ABSTRACT: To compare biochemical recurrence (BCR)-free survival and predictors of BCR in intermediate-risk (IR) and high-risk (HR) patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs open radical prostatectomy (ORP). We conducted a retrospective study on 1336 men with D'Amico IR or HR prostate cancer who underwent RALP or ORP between 2003 and 2009. Exclusion criteria were use of neoadjuvant therapy, <6 months of follow-up, and insufficient clinicopathologic data. We compared demographic, clinical, and pathologic variables between groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine whether surgical approach influences BCR. A total of 979 IR and HR patients (237 ORP and 742 RALP patients) met inclusion criteria. Median follow-up was shorter for RALP (43 vs 63 months; P <.001). ORP patients had a higher median prostate-specific antigen level (7.9 vs 6.7 ng/mL; P <.002), significantly more Gleason sum 8-10 tumors, and more adverse pathologic features overall. There was no difference in positive surgical margins between groups. Pathologic features including extraprostatic extension, seminal vesicle involvement, lymph node involvement, pathologic Gleason sum, and positive surgical margin were significant independent predictors of BCR in multivariate analysis. Surgical approach (RALP vs ORP) did not predict BCR when controlling for other known predictors of BCR. Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are harbingers of BCR.
    No preview · Article · Apr 2014 · Urology
  • S Duke Herrell

    No preview · Article · Feb 2014 · Urology
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    ABSTRACT: Objective To compare biochemical recurrence (BCR)–free survival and predictors of BCR in intermediate-risk (IR) and high-risk (HR) patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs open radical prostatectomy (ORP). Materials and Methods We conducted a retrospective study on 1336 men with D'Amico IR or HR prostate cancer who underwent RALP or ORP between 2003 and 2009. Exclusion criteria were use of neoadjuvant therapy, <6 months of follow-up, and insufficient clinicopathologic data. We compared demographic, clinical, and pathologic variables between groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine whether surgical approach influences BCR. Results A total of 979 IR and HR patients (237 ORP and 742 RALP patients) met inclusion criteria. Median follow-up was shorter for RALP (43 vs 63 months; P <.001). ORP patients had a higher median prostate-specific antigen level (7.9 vs 6.7 ng/mL; P <.002), significantly more Gleason sum 8-10 tumors, and more adverse pathologic features overall. There was no difference in positive surgical margins between groups. Pathologic features including extraprostatic extension, seminal vesicle involvement, lymph node involvement, pathologic Gleason sum, and positive surgical margin were significant independent predictors of BCR in multivariate analysis. Surgical approach (RALP vs ORP) did not predict BCR when controlling for other known predictors of BCR. Conclusion Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are harbingers of BCR.
    No preview · Article · Jan 2014 · Urology
  • S Duke Herrell · Robert Webster · Nabil Simaan
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    ABSTRACT: To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice. Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted currently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and to allow for previously impossible needle access and ablation delivery. Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and transurethral bladder tumor, a purpose-specific robotic system for LESS, and a needle-sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator.
    No preview · Article · Nov 2013 · Current opinion in urology
  • S Duke Herrell

    No preview · Article · Nov 2013 · Current opinion in urology
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    ABSTRACT: Increased urinary volume decreases recurrence rates of nephrolithiasis. Current recommendations for goal volumes are not adjusted to reflect individual risk factors, such as obesity. Our intent was to develop and evaluate a goal urine volume for stone prevention based on predictive calcium modeling. Stone formers with a 24-h urine study (6/2001-9/2010) were identified. Patients with inadequate collections or non-calcium stones were excluded. Multivariate and univariate predictive models for daily calcium were evaluated and a univariate (weight) model was selected. A target calcium concentration constant (2.5 mM) was determined from current recommendations. Individualized weight-based goal urine volumes (WGUV) were calculated. Measured calcium concentration and expected calcium concentrations using a 2-L goal volume and WGUV were compared. 185 of 399 patients met inclusion criteria. Body weight was a strong predictor of calcium excretion in each model (p < 0.0001). While a 2-L goal urine volume would be expected to improve mean calcium concentrations for the cohort from 3.53 to 2.96 mM, the benefit is unequal between subsets with nearly twofold expected concentration for the highest weight quartile (3.98 vs. 2.10 mM) and higher expected concentration for males (3.35 vs. 2.59 mM). By contrast, a WGUV model improves expected concentrations for all subsets to <2.9 mM and the overall cohort to 2.50 mM. This study demonstrates a strong relationship between body weight and urinary calcium excretion in stone formers. We introduce the novel concept of individualized goal urine output using statistical modeling, which may be preferable to current recommendations.
    No preview · Article · Jul 2013 · Urolithiasis
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    ABSTRACT: Background: Registered medical images can assist with surgical navigation and enable image-guided therapy delivery. In soft tissues, surface-based registration is often used and can be facilitated by laser surface scanning. Tracked conoscopic holography (which provides distance measurements) has been recently proposed as a minimally invasive way to obtain surface scans. Moving this technique from concept to clinical use requires a rigorous accuracy evaluation, which is the purpose of our paper. Methods: We adapt recent non-homogeneous and anisotropic point-based registration results to provide a theoretical framework for predicting the accuracy of tracked distance measurement systems. Experiments are conducted a complex objects of defined geometry, an anthropomorphic kidney phantom and a human cadaver kidney. Results: Experiments agree with model predictions, producing point RMS errors consistently < 1 mm, surface-based registration with mean closest point error < 1 mm in the phantom and a RMS target registration error of 0.8 mm in the human cadaver kidney. Conclusions: Tracked conoscopic holography is clinically viable; it enables minimally invasive surface scan accuracy comparable to current clinical methods that require open surgery.
    Full-text · Article · Jun 2013 · International Journal of Medical Robotics and Computer Assisted Surgery
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    ABSTRACT: Purpose: The purpose of this guideline is to provide a clinical framework for follow-up of clinically localized renal neoplasms undergoing active surveillance, or following definitive therapy. Materials and methods: A systematic literature review identified published articles in the English literature between January 1999 and 2011 relevant to key questions specified by the Panel related to kidney neoplasms and their follow-up (imaging, renal function, markers, biopsy, prognosis). Study designs consisting of clinical trials (randomized or not), observational studies (cohort, case-control, case series) and systematic reviews were included. Results: Guideline statements provided guidance for ongoing evaluation of renal function, usefulness of renal biopsy, timing/type of radiographic imaging and formulation of future research initiatives. A lack of studies precluded risk stratification beyond tumor staging; therefore, for the purposes of postoperative surveillance guidelines, patients with localized renal cancers were grouped into strata of low- and moderate- to high-risk for disease recurrence based on pathological tumor stage. Conclusions: Evaluation for patients on active surveillance and following definitive therapy for renal neoplasms should include physical examination, renal function, serum studies and imaging and should be tailored according to recurrence risk, comorbidities and monitoring for treatment sequelae. Expert opinion determined a judicious course of monitoring/surveillance that may change in intensity as surgical/ablative therapies evolve, renal biopsy accuracy improves and more long-term follow-up data are collected. The beneficial impact of careful follow-up will also need critical evaluation as further study is completed.
    No preview · Article · May 2013 · The Journal of urology
  • Andrea Bajo · Ryan B. Pickens · S. Duke. Herrell · Nabil Simaan
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    ABSTRACT: Constrained motion control of robotic end-effectors is essential for safe operation in confined spaces such as the urinary bladder. This paper presents the clinical motivation for the development of new control algorithms for robotic-assisted transurethral bladder resection and surveillance using multisegment continuum robots. The anatomy, workspace, and access constraints for this procedure are identified and used as a guideline for the design of the telesurgical system and its control architecture. Constraints are mapped into the configuration space of the robot rather than in task space simplifying the modeling and the enforcement of virtual fixtures. The redundancy resolution is autonomously modified in order to exploit the remaining degrees of freedom using task priority. These methods are validated on a glass model of urinary bladder.
    No preview · Conference Paper · May 2013

Publication Stats

2k Citations
412.58 Total Impact Points

Institutions

  • 2003-2015
    • Vanderbilt University
      • • Division of Urologic Surgery
      • • Department of Biomedical Engineering
      • • Department of Neurology
      Нашвилл, Michigan, United States
  • 2013
    • American Urological Association
      Linthicum, Maryland, United States
  • 2011-2012
    • Nashville Online
      Нашвилл, Michigan, United States
    • Hackensack University Medical Center
      Hackensack, New Jersey, United States
  • 2002
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
  • 1998
    • Medical University of South Carolina
      • Department of Urology
      Charleston, South Carolina, United States
    • Loyola University Medical Center
      • Department of Urology
      مايوود، إلينوي, Illinois, United States