(c) 2008 John J. Otrompke, JD

MEDICAL ROBOTICS MAGAZINE

ON-LINE EDITION

MEDICAL ROBOTICS MAGAZINE

Welcome to the on-line portal of Medical Robotics magazine. Our first print issue was released in January!
All contents (c) 2008 John J. Otrompke, JD

John_Otrompke@yahoo.com

CONFERENCE SCHEDULE

Here follows a list of some upcoming conferences pertaining to medical robotics:

March 14-15, Northampton
Association of Chartered Physiotherapists Interested in Neurology
http://www.acpin.net/events.html

March 17-19, Orlando
Third Annual World Robotic Urology Symposium
The Global Robotics Institute, www.GlobalRoboticsInstitute.com

April 9-12, Lisbon
World Congress on Brain Injury
http://www.internationalbrain.org/news.php?dep=0&page=1&list=85

May 30-31, Beijing
International Symposium on Robotic Cardiac Surgery
www.roboticsurgery301.net

June 12-13, Philadelphia
Robotic Surgery –Innovation of Today, Tomorrow and The Future, For Administrators and Surgeons
www.acius.net

June 12-14, Fellbach
Physiokongress
http://www.thieme.de/physioonline/physiokongress/2008/index.html

July 11-12, Seoul
12 Live Da Vinci Cases: YONSEI University Health system, www.yuhs.or.kr/en/mis

September 10-12, Prague
European Robotic Urology Symposium
congress@ismar.com

Papers at MIRA Describe Experiences in Liver Surgery Techniques

By John J. Otrompke, JD

Speakers at this year’s MIRA conference in Rome commented on difficulties inherent in liver procedures, and how robotic surgical technology can be used to gain an advantage in the tricky procedures.

Operating in the context of colon cancer which has metastasized to the liver can be especially difficult, according to one paper, ‘Robotic Minimally-Invasive Short-Interval Staged Approach to Synchronous Colon Cancer and Liver Metastases,’ by O. Mansouri and colleagues.

The paper noted that simultaneously resecting the liver in cases of colon cancer leads to a higher mortality. Mortality is between 7 and 12% when the resections are done simultaneously, versus 2% when staged resections are done. Further, mortality reaches 24% when the simultaneous liver resection is a major hepatectomy, according to the abstract.

The abstract noted that one patient, who received both operations with a Da Vinci surgical system on a short-interval basis, was mobiled the day after the operation, began oral feeding the second day afterward, was discharged on the 11th day after the operation in excellent condition.

Another abstract, by F.M. Bianco and colleagues, discussed a five-trocar technique in respect to data from 47 patients. The abstract noted that new tools are needed for liver procedures.

Both abstracts were by a surgical team operating at the University of Illinois at Chicago.

Two 2008 Studies Provide Data on Robotic Surgery Complications

MIRA 2008

Two large studies indicate equipment malfunctions occur and provide data on robotic surgery complications

By John J. Otrompke, JD

Two large studies released at MIRA 2008 provide data on Da Vinci equipment malfunctions, and indicate that complications from robotic surgery with the da Vinci decrease when the surgery is performed in a high-volume institution or a center of excellence. Nonetheless, the presenter of the studies called for surgeons who experience complications or equipment failure to register their results with a download from the device.

“Every surgeon should register errors when they occur,” said Dr. Kenneth Palmer, MD, a resident at Florida Hospital Celebration Health, who presented the two studies at MIRA. The studies were noteworthy for their size, as the first, ‘Robotic Equipment Malfunction During Robotic Prostatectomy: A Multi-Institutional Study,’ involved 11 institutions and a total case volume of 8,240.

The second study, ‘Intra Operative Complications During Robotic Assisted Laparoscopic Prostatectomy,’ involved 1,256 consecutive cases at Ohio State University.

The twelve institutions in the first study, regarding device malfunctions, included Vanderbilt University, the Prostate Cancer Center of Austin, Texas, Cornell and Ohio State Universities, and others, according to Palmer.

“With the Da Vinci robot, the computer board can go wrong, or there can be problems with the arms or with the optics,” said Palmer, noting that the carbon dioxide which is normally used to inflate the patient’s abdomen can also prevent camera fogging. “Defaults can be overridden, and the procedure can be converted to either laparoscopic or open surgery. Most critical failures can be identified before the procedure, because the Da Vinci performs a self-test. It all depends on the volume of the center or the experience of the surgeon,” Palmer added.

Of more than 8,000 Da Vinci prostatectomies performed in the study, critical failure occurred in 0.4% of the cases, leading to 23 cancellations, one laparascopic conversion, and eight open conversions. Recoverable failure occurred in 1.5% of cases, according to the abstract.

Medical complications were slightly more common, however. According to the second study, complications occurred in 64 out of 1,256 cases, or just over 5.1%. However, there was no mortality or immediate return for second procedure associated with these complications. The study involved a follow-up of 19.7 months.

The complications included four blood transfusions, four myocardial infarctions, and two lymphoceles, among others.

As with equipment problems, complications appeared to decrease with the experience of the center and surgeons.

Other doctors on the study included Dr. Vipul Patel, MD, founder of the Global Robotics Institute, which is hosting its third annual World Robotic Urology Symposium in Orlando, March 17-19 (see calendar). The studies were on-going, Palmer said.

Another study released by Palmer, Vatel and colleagues at MIRA 2008, ‘Robotic Assisted Laparascopic Radical Prostatectomy: Perioperative Outcomes of 1,500 Patients,’ reported positive results in 1,500 consecutive prostatectomy cases.

Robotic Rehabilitation Study Inspires Massive Follow-On at the Veterans’ Administration

Prior Study Found Significant Benefits of Robots by Interactive Motion Technology in Stroke Patients

By John J. Otrompke, JD

A successful study completed at Burke Medical Research Institute, results from which was published in the journal Neurorehabilitation and Neurorepair this month, inspired so much confidence in the Department of veterans’ Affairs that the VA has begun a study of robotic devices manufactured and marketed by Interactive Motion Technology (IMT) (T), testing the device in 160 patients, 70 of whom have already been recruited. The study aims to confirm results from a prior trial that found that use of the robots offers stroke patients double the benefit of using just therapists alone.

“This is a gold standard clinical trial which could form the basis for a new standard of care in evidence-based medicine for these patients,” said Dr. Albert Lo, MD, PhD, associate professor of clinical neuroscience and engineering at Brown University. Lo is also a physician at the Providence VA Medical Center, one of the sites where the trial, CSB 558, is taking place. Other centers are in Baltimore, Gainesville, Seattle and Westhaven.










The study aims to confirm the bedrock principle of neuroplasticity, on which IMT’s successful medical rehabilitation robotics program is founded. All in all, four separate robotic devices from IMT are being used. The article, “Intensive Sensory Motor Arm Training Mediated by Therapists or Robot Improves Hemiparesis in Patients with Chronic Stroke,” by Dr. Bruce T. Volpe, MD, went on-line on January 9, and will in hard copy in the print edition in March.

Numerous Ongoing Studies Illustrate Clinical Benefit

This is not the first time IMT’s commercial robots program has illustrated its beneficial application. “We’ve treated well over 300 patients with the IMT robots,” said Volpe, who is a professor of neurology and neuroscience at Cornell University Medical College, as well as a physician at Burke. Together with occupational therapist Avrielle Rykman, OT, clinical research coordinator for Burke’s robotics program, Volpe has trained as many as 50 staff from the VA at Burke in how to make the best use of the IMT robots.

Positive experiences with the IMT robots have led Volpe and Rykman to organize several other studies with the devices. In addition to the on-going VA study (for which the duo serve as clinical consultants), Burke is the home for three other clinical trials. The largest one, the ‘order effects study’ which investigates the proximal-distal relationship of the robots to the patient’s nervous system, looks at whether a clinical benefit is enjoyed if the patient is treated with a shoulder-elbow robot before the hand-wrist robot.

Seventy patients are already in the process of completing the order effects study at Burke, and another 80 have already been recruited and will be treated in 2008. “We already have all the patients recruited; one of the hardest things with any study is patient recruitment,” said Volpe.

Another IMT robot trial currently underway at Burke is a vertical study, which uses an anti-gravity robot to treat patients with subluxation, or shoulder dislocation. There are currently 30 patients in the study of the vertical robot.

Other studies look at patients who have suffered from spinal cord injuries, or even the use of IMT robots in patients who are children who suffer from cerebral palsy, such as the study just beginning now at Blythedale Hospital in Valhalla, New York, according to Avrielle Rykman.




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Compassionate Care

Robots by Interactive Motion Technologies offer promising treatments for patients who have been considered very difficult to treat in the past. The Burke spinal cord study, for example, is currently treating five patients who were previously paralyzed with IMT robots. “One of the patients was in a car accident, two were in diving accidents, and one was in a skiing accident, for example,” said Dr. Volpe, noting that the patients are between the age of 16 and their mid-40s. “We are treating the 40-year-old patient 25 years after his injury,” Volpe noted.

The patients, who have all had their spinal cords broken off around cervical five area, suffer from paraplegia and quadriparesis. “The patients have very weak arms, and we are trying to treat the muscles in the area of the broken neck, which controls the biceps and forearms. Currently, the IMT robot appears to add functional capacity in their arms,” said Volpe.

Unfortunately, some patients do not qualify for the studies, according to Avrielle Rykman. “For those patients who don’t qualify, either because they had multiple strokes, or brain bleeds, we offer a compassionate care program, in which patients are treated for 6 weeks,” she said.

And another very exciting study has begun at Blythedale Hospital, looking at the use of IMT robots in treating children who suffer from cerebral palsy. Both Avrielle Rykman and Dr. Volpe trained five staff from Blythedale, including the medical director, two physical therapists and a research technician.

MIRA 2008: Two New Miniature Robotic Device Models Unveiled at MIRA May Lead to Even Less Invasive Robotic Surgery

By John J. Otrompke, JD

Two studies released by Dr. Marco Zenati and colleagues at MIRA 2008 offered fascinating insights into what may become two new miniature robots of the future: a highly-articulated device for epicardial injections, and miniature device called the Heartlander which can crawl on the surface of the heart.

The first device, which consists of many articulated, rigid cylindrical links, was successfully tested in animals and in a human cadaveric environment, according to the first paper, ‘An Highly-Articulated Robotic Surgical System for Minimally Invasive Epicardial Interventions,’ while the Heartlander crawled with inchworm-like locomotion on the surface of a beating animal heart. “The Heartlander is an organ-mounted robotic system, like examples we are familiar with in the field of orthopedic surgery and elsewhere,” said Zenati, a researcher at the University of Pittsburgh.

The epicardial intervention device is joystick controlled by the physician and allows the use through its ports of catheter-based instruments which are already commercially available.

With this device, epicardial ablation, pericardial biopsy, and left atrial appendage ligation, as well as pulmonary vein isolation, were all performed, without adverse events.

Devices used in conjunction with the epicardial robot included a radiofrequency ablation catheter, an endobiopsy catheter, and the EndoLoop.

With the Heartlander, which also uses a magnetic tracking system, epicardial injection, pacing-lead placement, and radiofrequency ablation were all performed.

The device requires about 10 to 15 minutes to create a real-space 3-D model of the heart by acquiring and elaborating the surface points of the organ, which otherwise would not be available without rotating the heart, Zenati said.

The Heartlander is 5 millimeters high, and equipped with an injection needle.

Studies pertaining to the Heartlander were presented in November of 2007 at the Scientific Sessions of the American Heart Association, he noted.