Prokar Dasgupta

Technology Insight: telementoring and telesurgery in urology

The rapid expansion of the field of minimally invasive surgery has been accompanied by a number of controversies. These novel surgical techniques offer benefits to the patient with regard to length of hospital stay, return to full activity, and cosmesis; also, they are often more cost-effective than open procedures. On the other hand, they are technically demanding, have a significant learning curve, and can be associated with high initial complication rates unless performed by experienced endoscopic surgeons. Telemedicine, which uses real-time video and information transfer, offers the potential to increase the availability of minimally invasive surgery through video-assisted surgery and through remote instruction. At present, remote communities, especially those within developed countries, can most immediately benefit from telesurgical approaches. Enthusiasm must be tempered by the issues of cost, security, surgeon liability and availability of the technology itself which have yet to be fully resolved. In this Review, the field of telemedicine, focusing specifically on telementoring and telesurgery, and its relevance to urology are discussed. From early experimental work to current clinical usage, the advantages of and problems in this evolving field are explored.

The history of robotics in urology

Despite being an ancient surgical specialty, modern urology is technology driven and has been quick to take up new minimally invasive surgical challenges. It is therefore no surprise that much of the early work in the development of surgical robotics was pioneered by urologists. We look at the relatively short history of robotic urology, from the origins of robotics and robotic surgery itself to the rapidly expanding experience with the master–slave devices. This article credits the vision of John Wickham who sowed the seeds of robotic surgery in urology.

The Evolution and Ergonomics of Robotic-Assisted Surgical Systems

A surgical robot has been defined as “a computer-controlled manipulator with artificial sensing that can be reprogrammed to move and position tools to carry out a range of surgical tasks” (Dasgupta et al, 2005). The first fully automated surgical device used in clinical practice was developed by Wickham (Harris et al, 1997) to resect prostates in the 1980’s at Guy’s Hospital in London. Currently, robotic devices are available in many surgical specialities fulfilling an increasing number of roles. The most commonly used is the da Vinci™ master-slave system (Intuitive Surgical, Ca, USA). The da Vinci TM system is widely available commercially. It is composed of three components: surgeon console, patient-side cart and imageprocessing/insufflation stack. Its stereoscopic vision, motion scaling and EndoWrist™ technology with seven degrees of freedom (DOF) are major advancements. By far the most common procedure performed with the assistance of the da Vinci™ system is laparoscopic radical prostatectomy. Other urological procedures performed using robotic assistance include cystectomy, nephrectomy, partial nephrectomy, pyelolithotomy and pyeloplasty. Other specialities adopting this technology include cardiothoracic surgery, gynaecology, and general surgery. Ergonomically ineffectual instruments and monophasic monitors in laparoscopy are linked to surgeon’s musculoskeletal injuries and fatigue (Van Der Zee et al, 1997). Robotic surgery offers a different approach for the surgeon’s position, with added visual benefits and increased dexterity. Research in the ‘dry lab’ environment has shown that the robotic techniques, though somewhat slower, offered more precision than conventional laparoscopy (Nio et al, 2002). Laparoscopy naive surgeons have a shorter learning curve with robotic-assisted techniques compared with equivalent laparoscopic tasks. Research is ongoing in the assessment of fatigue when using robotic-assisted, laparoscopic and open techniques (Elhage et al, 2007). It is suggested that the improved ergonomic conditions offered by robotic systems may allow surgeons to operate more efficiently and with greater precision. As a result patients may have less morbidity and a shorter recovery time. O Access Database www.i-techonline.co m

Urine cytology: appropriate usage maximizes sensitivity and reduces cost.

Objective:u2002 Urine cytology is costly because of the skilled manpower required for analysis. Inappropriate requests are a significant drain both financially and on the cytopathologists time. The present study aimed at identifying the extent and cause of this misuse and reduce it.

CHAPTER 1 – Equipment and Technology in Robotics

We review the evolution and current status of robotic equipment and technology in urology. We also describe future developments in the key areas of virtual reality simulation, mechatronics and nanorobotics. The history of robotic technology is reviewed and put into the context of current systems. Experts in the associated fields of nanorobotics, mechatronics and virtual reality simulation simulation review the important future developments in these areas.