The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and...The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.展开更多
As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital c...As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.展开更多
Digital surgery is being increasingly used in phraseology and clinical application,driven by the advancing tide of technology.Its scope in treating patients with colorectal cancer is reviewed.A search was performed to...Digital surgery is being increasingly used in phraseology and clinical application,driven by the advancing tide of technology.Its scope in treating patients with colorectal cancer is reviewed.A search was performed to include a breadth of digital technologies,including virtual reality(VR),augmented reality(AR),artificial intelligence(AI),mobile health,and simulation.Many digital roles were identified in the 60 studies included.These were clinician-facing or patient-facing throughout the patient’s journey(screening,preoperative,intraoperative,postoperative)and involved the broader team(trainees,oncology,pathology).Colorectal cancer screening was improved via the use of digital technology,including virtual health assistants.Preoperative patient-facing VR enhances consent and reduces perioperative anxiety.For surgeons,enhanced awareness of vascular and visceral anatomy relative to the tumour helped with surgical planning,with the emerging concepts of‘virtual colectomy’and‘digital clone’.Pathologically,AI more accurately predicts lymph node metastasis following endoscopic polyp cancer excision,thus reducing over-treatment with surgery,and assesses the response to neoadjuvant treatment to guide selective surgery.Intraoperatively,AI facilitates real-time detection of anatomical landmarks,including autonomic nerves,ureters,and areolar tissue,to indicate the dissection plane.These intraoperative studies lacked a control group and outcome reporting(intraoperative,clinical,oncological,or functional),highlighting that this technology requires further development and study.There is a paucity of evidence regarding AR,such as intraoperative holographic overlay.Postoperative patient-facing digital technology can promote enhanced recovery,improve physical activity,and reduce sick-role maladaptation.For clinicians,AI can predict the short-term(complications)and long-term(survival)patient prognosis.VR could play an increasing role in training,with some evidence from validated virtual curricula.In summary,digital surgery has potential applications throughout the patient journey and along the virtuality continuum,showing advantages over conventional approaches in the preoperative and postoperative phases.Intraoperative,AI and AR methods have not yet been shown to have clinically significant advantages.As its scope grows,there are emerging implications for training,regulation,and ethics.展开更多
文摘The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.
文摘As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.
文摘Digital surgery is being increasingly used in phraseology and clinical application,driven by the advancing tide of technology.Its scope in treating patients with colorectal cancer is reviewed.A search was performed to include a breadth of digital technologies,including virtual reality(VR),augmented reality(AR),artificial intelligence(AI),mobile health,and simulation.Many digital roles were identified in the 60 studies included.These were clinician-facing or patient-facing throughout the patient’s journey(screening,preoperative,intraoperative,postoperative)and involved the broader team(trainees,oncology,pathology).Colorectal cancer screening was improved via the use of digital technology,including virtual health assistants.Preoperative patient-facing VR enhances consent and reduces perioperative anxiety.For surgeons,enhanced awareness of vascular and visceral anatomy relative to the tumour helped with surgical planning,with the emerging concepts of‘virtual colectomy’and‘digital clone’.Pathologically,AI more accurately predicts lymph node metastasis following endoscopic polyp cancer excision,thus reducing over-treatment with surgery,and assesses the response to neoadjuvant treatment to guide selective surgery.Intraoperatively,AI facilitates real-time detection of anatomical landmarks,including autonomic nerves,ureters,and areolar tissue,to indicate the dissection plane.These intraoperative studies lacked a control group and outcome reporting(intraoperative,clinical,oncological,or functional),highlighting that this technology requires further development and study.There is a paucity of evidence regarding AR,such as intraoperative holographic overlay.Postoperative patient-facing digital technology can promote enhanced recovery,improve physical activity,and reduce sick-role maladaptation.For clinicians,AI can predict the short-term(complications)and long-term(survival)patient prognosis.VR could play an increasing role in training,with some evidence from validated virtual curricula.In summary,digital surgery has potential applications throughout the patient journey and along the virtuality continuum,showing advantages over conventional approaches in the preoperative and postoperative phases.Intraoperative,AI and AR methods have not yet been shown to have clinically significant advantages.As its scope grows,there are emerging implications for training,regulation,and ethics.
