The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology re...The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation （for chronic orchialgia） and robotic assisted microsurgical testicular sperm extraction （microTESE）.展开更多
In order to enhance the effect of comeal grafting, an assisting microsurgical robot has been developed. As one of principal issues for the robotic system design, type and size synthesis of the robotic mechanism is dis...In order to enhance the effect of comeal grafting, an assisting microsurgical robot has been developed. As one of principal issues for the robotic system design, type and size synthesis of the robotic mechanism is discussed. For this purpose, timeline subtask is analyzed with surgical component motion in manual comeal grafting microsurgery, as the reference of robotic mechanism synthesis. On the basis of study on the kinematic correlation between the arm structures and the wrist structures, configuration of joint is determined for the surgical task and motion in type synthesis of the mechanism. The objective for size synthesis of robotic mechanism is optimization of the mechanism dexterity as a manipulation capability. The condition number based on Jacob matrix is chosen as dexterity measure of the mechanism. The prototype is developed.展开更多
Subretinal injection(SI)is recognized as the most effective method for treating retinal degenerative and genetic diseases,enabling targeted delivery of therapeutic agents such as viral vectors or stem cells directly i...Subretinal injection(SI)is recognized as the most effective method for treating retinal degenerative and genetic diseases,enabling targeted delivery of therapeutic agents such as viral vectors or stem cells directly into the subretinal space(SRS).However,this procedure is typically performed under extremely constrained intraocular conditions,characterized by limited visualization,lack of tactile feedback,and the inherent fragility of retinal tissues,significantly increasing the risk of surgical complications and potential vision impairment.To overcome these challenges,an integrated force-sensing microneedle equipped with a flexible joint was developed and integrated into an ophthalmic surgical robotic system.This advanced system provides precise needle-tip pose control and real-time puncture force feedback.Leveraging these capabilities,force-guided autonomous retinal puncture was achieved,ensuring accurate and consistent drug delivery into the SRS.Comparative experiments conducted on live Bama pigs demonstrated the robotic system's superiority over manual SI techniques,as evidenced by more stable puncture trajectories,smoother insertion velocities,precise insertion depths,and a greater than 90%reduction in average puncture force,despite respiratory and cardiac-induced disturbances,thus significantly enhancing surgical precision and minimizing the risk of iatrogenic retinal injury.Postoperative evaluations further validated that the robotic approach markedly reduced drug reflux into the vitreous cavity,underscoring its reliability and safety for SI.展开更多
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive ...The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.展开更多
文摘The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation （for chronic orchialgia） and robotic assisted microsurgical testicular sperm extraction （microTESE）.
基金This project is supported by National Hi-tech Research and DevelopmentProgram of China (863 Program, No.2002AA420110).
文摘In order to enhance the effect of comeal grafting, an assisting microsurgical robot has been developed. As one of principal issues for the robotic system design, type and size synthesis of the robotic mechanism is discussed. For this purpose, timeline subtask is analyzed with surgical component motion in manual comeal grafting microsurgery, as the reference of robotic mechanism synthesis. On the basis of study on the kinematic correlation between the arm structures and the wrist structures, configuration of joint is determined for the surgical task and motion in type synthesis of the mechanism. The objective for size synthesis of robotic mechanism is optimization of the mechanism dexterity as a manipulation capability. The condition number based on Jacob matrix is chosen as dexterity measure of the mechanism. The prototype is developed.
基金supported in part by the National Key R&D Program of China(No.2023YFB4705801)the Progect of Medical Engineering Laboratory of Chinese PLA General Hospital(Grant No.2022SYSZZKY13)+1 种基金the National Natural Science Foundation of China(Nos.52175008 and 92048301)the National Outstanding Youth Science Fund Project of National Natural Science Foundation of China(Grant No.52025054)。
文摘Subretinal injection(SI)is recognized as the most effective method for treating retinal degenerative and genetic diseases,enabling targeted delivery of therapeutic agents such as viral vectors or stem cells directly into the subretinal space(SRS).However,this procedure is typically performed under extremely constrained intraocular conditions,characterized by limited visualization,lack of tactile feedback,and the inherent fragility of retinal tissues,significantly increasing the risk of surgical complications and potential vision impairment.To overcome these challenges,an integrated force-sensing microneedle equipped with a flexible joint was developed and integrated into an ophthalmic surgical robotic system.This advanced system provides precise needle-tip pose control and real-time puncture force feedback.Leveraging these capabilities,force-guided autonomous retinal puncture was achieved,ensuring accurate and consistent drug delivery into the SRS.Comparative experiments conducted on live Bama pigs demonstrated the robotic system's superiority over manual SI techniques,as evidenced by more stable puncture trajectories,smoother insertion velocities,precise insertion depths,and a greater than 90%reduction in average puncture force,despite respiratory and cardiac-induced disturbances,thus significantly enhancing surgical precision and minimizing the risk of iatrogenic retinal injury.Postoperative evaluations further validated that the robotic approach markedly reduced drug reflux into the vitreous cavity,underscoring its reliability and safety for SI.
文摘The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.
