Search results

Members of an organization facing change often struggle to adapt and may create new routines. Drawing on insights from a case study of bariatric robotic surgery, the authors illustrate how a new ecology of space transforms the ostensive and performative aspect of a routine during the introduction of a new technological artifact. The authors discuss two types of space: experimental and reflective. The authors show that the reflective space through debriefings enables practitioners to discuss the new patterns of interdependent actions. Practitioners explore the different aspects of the performative struggle with new artifacts and try to integrate new actions and delineate the boundaries of this change during experimental performances. The findings of this study throw light on the role of the reflective space in addition to the experimental space in routine change, and suggest that socio-material ensembles can produce opportunities for reshaping routines.

Robotic surgery is limited by the lack of haptic feedback to the surgeon. The addition of tactile information may enable surgeons to feel tissue characteristics, appropriately tension sutures, and identify pathologic conditions. Tactile feedback may also enable expansion of minimally invasive surgery to other surgical procedures and decrease the learning curve associated with robotic surgery. This paper aims to explore a system to provide tactile feedback.

A pneumatic balloon‐based system has been developed to provide tactile feedback to the fingers of the surgeon during robotic surgery. The system features a polydimethyl siloxane actuator with a thin‐film silicone balloon membrane and a compact pneumatic control system. The 1.0 × 1.8 × 0.4 cm actuators designed for the da Vinci system feature a 3 × 2 array of 3 mm inflatable balloons.

The low‐profile pneumatic system and actuator have been mounted directly onto the da Vinci surgical system. Human perceptual tests have indicated that pneumatic balloon‐based tactile input is an effective means to provide tactile information to the fingers of the surgeon.

Application of a complete tactile feedback system is limited by current force sensing technologies.

The actuators have been designed such that they can be mounted directly onto the hand controls of the da Vinci robotic system, and are scalable such that they can be applied to various robotic applications.

The dynamics of the physician knowledge system in the Southern California Region of Kaiser Permanente are explored. The framing and analysis use concepts from the knowledge management literature and network theory. The criticality of this issue to the establishment of sustainable healthcare relates to the lynchpin nature of embedding evidence-based knowledge in healthcare practice and the simultaneous challenge of combining this with clinical knowledge that derives from practice.

The case study is compiled from longitudinal interviews with over 40 physicians and other stakeholders and an examination of archival information including published articles generated by the learning system.

The socio-technical approach to building this learning system was critical given the expectations of physicians for autonomy in making clinical decisions with respect to their patients. This robust learning system builds on rich professional and organizational networks, is led by physicians, and builds on and extends the foundation of evidence relating to quality and value. The goals of the physician practice and a robust measurement and feedback system provide focus for the learning system.

Accelerating the incorporation of evidence-based practice and increasing the scope and reach of the learning system entails building physician networks, having a robust system for critically examining and extending evidence, and a clear linkage to valued outcomes.

This detailed examination of the dynamics of knowledge absorption extends understanding of the capacity of medical care systems to absorb evidence-based knowledge.

The purpose of this paper is to present a robotic motion compensation system, using ultrasound images, to assist orthopedic surgery. The robotic system can compensate for femur movements during bone drilling procedures. Although it may have other applications, the system was thought to be used in hip resurfacing (HR) prosthesis surgery to implant the initial guide tool. The system requires no fiducial markers implanted in the patient, by using only non-invasive ultrasound images.

The femur location in the operating room is obtained by processing ultrasound (USA) and computer tomography (CT) images, obtained, respectively, in the intra-operative and pre-operative scenarios. During surgery, the bone position and orientation is obtained by registration of USA and CT three-dimensional (3D) point clouds, using an optical measurement system and also passive markers attached to the USA probe and to the drill. The system description, image processing, calibration procedures and results with simulated and real experiments are presented and described to illustrate the system in operation.

The robotic system can compensate for femur movements, during bone drilling procedures. In most experiments, the update was always validated, with errors of 2 mm/4°.

The navigation system is based entirely on the information extracted from images obtained from CT pre-operatively and USA intra-operatively. Contrary to current surgical systems, it does not use any type of implant in the bone to track the femur movements.

The new computer‐enhanced operating environment is making a compelling impact on healthcare: improving efficiency in the operating room (OR) with better communications, streamlined networks and effective personnel utilization; increasing the number of procedures that can be performed in a minimally invasive fashion for reduced patient pain, trauma and recovery time; and enabling new procedures that would otherwise be impossible to perform due to human limitations. To maximize the benefits to the hospital, staff and, most importantly, patients, the introduction of robotics necessitates careful evaluation of the technology along several criteria. Computer Motion suggests using its “four cornerstones of robotic surgery” to assess the appropriateness of the technology or equipment under consideration: OR readiness; procedural compatibility; precision and dexterity enhancement; and open architecture and upgradability. Evaluating along these four cornerstones helps ensure the equipment or technology will meet the feasibility, accuracy, utilization, system longevity, patient safety and surgeon/OR team benefits required by today’s OR environment and staff.

This paper aims to provide an insight into recent advancements and developments of robotics for Natural Orifice Transluminal Surgery (NOTES) procedures.

Following an introduction that highlights the evolution from Minimally Invasive Surgery (MIS) to NOTES in the medical field, this paper reviews the main robotics systems that have been designed and implemented for MIS and NOTES, summarising their advantages and limitations and remarking the technological challenges and the requirements that still should be addressed and fulfilled.

The state-of-the-art presented in this paper shows that the majority of the platforms created for NOTES are laboratory prototypes, and their performances are still far from being optimal. New solutions are required to solve the problems confronted by the proposed systems such as the limited number of DOFs, the limited resolution, the optimal fixation and stiffening of the instruments for enabling stable and precise operation, the effective transmission of forces to the tip tools, the improvement of the force feedback feeling and the proper visualization and spatial orientation of the surgical field. Advances in robotics can contribute significantly to the development and future implementation of the NOTES procedure.

This paper highlights the current trends and challenges ahead in robotics applied to NOTES procedure.

The purpose of this paper is to review some of the recent innovations in robotics for a wide range of medically‐related applications.

The paper includes in‐depth interviews with developers of medical application‐related robots and a review of recent writings and technical papers on the topic.

Robots are finding all kinds of application in the medical field, from surgery to logistics to patient care and more. The future will surely see even more medical robot developments.

Managers and medical personal will learn how rapidly the medical robotics field is growing with successful applications appearing frequently.

The medical field will see how robotic technology is addressing needs, reducing costs and improving patient care and will learn where to turn for medical robotic answers.

The aim of this research is the development of a problem-based curriculum for robotic surgical training and its evaluation.

First, the aim and objectives of the curriculum are defined and the background learning theories that guide our work are introduced. The methodology for designing the simulator-based training is presented and finally the output of this work is reported, that is the SAFROS training paradigm, resulted as a balanced synthesis of behavioural and constructivist learning theories.

The evaluation of basic skills tasks of the curriculum revealed a high acceptance among the trainees.

Within this paper, a first implementation and evaluation of the basic skills tasks is described. Further cooperation between pedagogues and software engineers is required in order to put in practice the whole curriculum. Then, further training experiments with surgeons are necessary to check the validity of the whole curriculum. The authors also need to establish proficiency criteria that can come from the achievements of expert surgeons using the simulator and the robot and use them as final goals to be achieved by trainees in future courses. In the field of subjective evaluation, a possible future extension might be a bigger number of questions. Moreover, the innovative method of text mining in its application to opinion mining decisions can be further applied.

In this paper, an innovative approach for the development of a simulator-based curriculum for robotic surgical training is presented and first evaluation results based on ratings from trainees are also presented. The value of this paper is relevant to medical trainers and curriculum designers.

Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups.

The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations.

There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”.

The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns.

This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.

Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of regular and minimally invasive surgery through using millimeter‐scale robotic manipulators under the control of the surgeon. In this paper, the telesurgical system will be introduced with discussion of kinematic and control issues and presentation of in vitro experimental evaluation results.