76 results found
Hughes-Hallett A, Mayer EK, Pratt PJ, et al., 2015, Quantitative analysis of technological innovation in minimally invasive surgery, British Journal of Surgery, Vol: 102, Pages: e151-e157, ISSN: 1365-2168
BackgroundIn the past 30 years surgical practice has changed considerably owing to the advent of minimally invasive surgery (MIS). This paper investigates the changing surgical landscape chronologically and quantitatively, examining the technologies that have played, and are forecast to play, the largest part in this shift in surgical practice.MethodsElectronic patent and publication databases were searched over the interval 1980–2011 for (‘minimally invasive’ OR laparoscopic OR laparoscopy OR ‘minimal access’ OR ‘key hole’) AND (surgery OR surgical OR surgeon). The resulting patent codes were allocated into technology clusters. Technology clusters referred to repeatedly in the contemporary surgical literature were also included in the analysis. Growth curves of patents and publications for the resulting technology clusters were then plotted.ResultsThe initial search revealed 27 920 patents and 95 420 publications meeting the search criteria. The clusters meeting the criteria for in-depth analysis were: instruments, image guidance, surgical robotics, sutures, single-incision laparoscopic surgery (SILS) and natural-orifice transluminal endoscopic surgery (NOTES). Three patterns of growth were observed among these technology clusters: an S-shape (instruments and sutures), a gradual exponential rise (surgical robotics and image guidance), and a rapid contemporaneous exponential rise (NOTES and SILS).ConclusionTechnological innovation in MIS has been largely stagnant since its initial inception nearly 30 years ago, with few novel technologies emerging. The present study adds objective data to the previous claims that SILS, a surgical technique currently adopted by very few, represents an important part of the future of MIS.
Dwyer G, Giataganas P, Pratt P, et al., 2015, A Miniaturised Robotic Probe for Real-Time Intraoperative Fusion of Ultrasound and Endomicroscopy, IEEE International Conference on Robotics and Automation (ICRA), Publisher: IEEE COMPUTER SOC, Pages: 1196-1201, ISSN: 1050-4729
Hughes-Hallett A, Mayer E, Pratt P, et al., 2014, A census of robotic urological practice and training: a survey of the robotic section of the European Association of Urology., Journal of Robotic Surgery, Vol: 8, Pages: 349-355, ISSN: 1863-2483
To determine the current state of robotic urological practice, to establish how robotic training has been delivered and to ascertain whether this training was felt to be adequate. A questionnaire was emailed to members of the European Association of Urology robotic urology section mailing list. Outcomes were subdivided into three groups: demographics, exposure and barriers to training, and delivery of training. A comparative analysis of trainees and independently practising robotic surgeons was performed. 239 surgeons completed the survey, of these 117 (48.9 %) were practising robotic surgeons with the remainder either trainees or surgeons who had had received training in robotic surgery. The majority of robotic surgeons performed robotic-assisted laparoscopic prostatectomy (90.6 %) and were undertaking >50 robotic cases per annum (55.6 %). Overall, only 66.3 % of respondents felt their robotic training needs had been met. Trainee satisfaction was significantly lower than that of independently practising surgeons (51.6 versus 71.6 %, p = 0.01). When a subgroup analysis of trainees was performed examining the relationship between regular simulator access and satisfaction, simulator access was a positive predictor of satisfaction, with 87.5 % of those with regular access versus 36.8 % of those without access being satisfied (p < 0.01). This study reveals that a significant number of urologists do not feel that their robotic training needs have been met. Increased access to simulation, as part of a structured curriculum, appears to improve satisfaction with training and, simultaneously, allows for a proportion of a surgeon's learning curve to be removed from the operating room.
Bergeles C, Pratt P, Merrifield R, et al., 2014, Multi-view stereo and advanced navigation for transanal endoscopic microsurgery, Medical Image Computing and Computer-Assisted Intervention – MICCAI 2014, Publisher: Springer, Pages: 332-339
Transanal endoscopic microsurgery (TEM), i.e., the local excision of rectal carcinomas by way of a bimanual operating system with magnified binocular vision, is gaining acceptance in lieu of more radical total interventions. A major issue with this approach is the lack of information on submucosal anatomical structures. This paper presents an advanced navigation system, wherein the intraoperative 3D structure is stably estimated from multiple stereoscopic views. It is registered to a preoperatively acquired anatomical volume based on subject-specific priors. The endoscope motion is tracked based on the 3D scene and its field-of-view is visualised jointly with the preoperative information. Based on in vivo data, this paper demonstrates how the proposed navigation system provides intraoperative navigation for TEM1.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Image guidance for all-tilepro display of 3-dimensionally reconstructed images in robotic partial nephrectomy, Urology, Vol: 84, Pages: 237-242, ISSN: 0090-4295
ObjectiveTo determine the feasibility of a novel low-barrier-to-entry image guidance system.MethodsInitially a randomized crossover study was performed to establish the interface (iPad or 3-dimensional mouse) that minimized both the amount of time required to perform a manual image registration and the error of that registration. A subsequent clinical feasibility study was undertaken on 5 patients undergoing robot-assisted partial nephrectomy. Randomized crossover study primary outcomes were time to task completion, NASA–Task Load Index score, and alignment error (translational and rotational). The Mann-Whitney U test was used to compare groups. Surgeon feedback was sought when assessing the system in a clinical setting.ResultsIn the initial randomized crossover study, the iPad-based system was able to achieve adequate alignment accuracy (Frobenius norm of 0.3; total error of 20.8 mm) in significantly less time (33 seconds; P <.01) than the 3-dimensional mouse interface. The platform received good feedback from the operating surgeon in all instances with the surgeon commenting particularly on the improved appreciation of hilar vascular anatomy.ConclusionIn this study, we have demonstrated the feasibility of a “low-barrier-to-entry” image guidance system in a clinical setting. The system was able to achieve swift and sufficiently accurate alignment, with little impact on the surgical workflow.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Image guidance for all-tilepro display of 3-dimensionally reconstructed images in robotic partial nephrectomy - REPLY, Urology, Vol: 84, Pages: 243-243, ISSN: 0090-4295
Hughes-Hallett A, Mayer EK, Pratt P, et al., 2014, The current and future use of imaging in urological robotic surgery: a survey of the European Association of Robotic Urological Surgeons, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 11, Pages: 8-14, ISSN: 1478-596X
BackgroundWith the development of novel augmented reality operating platforms the way surgeons utilise imaging as a real-time adjunct to surgical technique is changing.MethodsA questionnaire was distributed via the European Robotic Urological Society mailing list. The questionnaire had three themes: surgeon demographics, current use of imaging and potential uses of an augmented reality operating environment in robotic urological surgery.Results117 of the 239 respondents (48.9%) were independently practising robotic surgeons. 74% of surgeons reported having imaging available in theatre for prostatectomy 97% for robotic partial nephrectomy and 95% cystectomy. 87% felt there was a role for augmented reality as a navigation tool in robotic surgery.ConclusionsThis survey has revealed the contemporary robotic surgeon to be comfortable in the use of imaging for intraoperative planning it also suggests that there is a desire for augmented reality platforms within the urological community.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Intraoperative Ultrasound Overlay in Robot-assisted Partial Nephrectomy: First Clinical Experience, European Urology, Vol: 65, Pages: 671-672, ISSN: 1421-993X
Intraoperative ultrasound facilitates the localisation of partially or entirely endophytic renal tumours during laparoscopic or robot-assisted partial nephrectomy (RAPN) . A current limitation of intraoperative ultrasound is the requirement on the surgeon to relate the subsurface ultrasound image to the separate endoscopic view. Here we present the first clinical experience of live registered intraoperative ultrasound overlay.Registered ultrasound overlay was achieved using an approach previously described by our group, where the use of ultrasound in an ex vivo model for transanal microsurgery was examined . This method of live image registration can be best described as a three-step process of calibration, image registration, and finally image overlay, and it has demonstrated a registration accuracy <0.5 mm . Table 1 summarises the system hardware.
Hughes-Hallett A, Mayer EK, Marcus HJ, et al., 2014, Augmented reality partial nephrectomy: examining the current status and future perspectives, Urology, Vol: 83, Pages: 266-273, ISSN: 0090-4295
A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation.
Pratt P, Bergeles C, Darzi A, et al., 2014, Practical Intraoperative Stereo Camera Calibration, 17th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), Publisher: SPRINGER-VERLAG BERLIN, Pages: 667-675, ISSN: 0302-9743
Edgcumbe P, Pratt P, Yang G-Z, et al., 2014, Pico Lantern: A Pick-up Projector for Augmented Reality in Laparoscopic Surgery, 17th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 432-+, ISSN: 0302-9743
Pratt P, Bergeles C, Darzi A, et al., 2014, Practical intraoperative stereo camera calibration., Pages: 667-675
Many of the currently available stereo endoscopes employed during minimally invasive surgical procedures have shallow depths of field. Consequently, focus settings are adjusted from time to time in order to achieve the best view of the operative workspace. Invalidating any prior calibration procedure, this presents a significant problem for image guidance applications as they typically rely on the calibrated camera parameters for a variety of geometric tasks, including triangulation, registration and scene reconstruction. While recalibration can be performed intraoperatively, this invariably results in a major disruption to workflow, and can be seen to represent a genuine barrier to the widespread adoption of image guidance technologies. The novel solution described herein constructs a model of the stereo endoscope across the continuum of focus settings, thereby reducing the number of degrees of freedom to one, such that a single view of reference geometry will determine the calibration uniquely. No special hardware or access to proprietary interfaces is required, and the method is ready for evaluation during human cases. A thorough quantitative analysis indicates that the resulting intrinsic and extrinsic parameters lead to calibrations as accurate as those derived from multiple pattern views.
Marcus HJ, Hughes-Hallett A, Cundy TP, et al., 2013, Comparative Effectiveness of 3-D versus 2-D and HD versus SD Neuroendoscopy: A Preclinical Randomized Crossover Study, Neurosurgery
Sridhar AN, Hughes-Hallett A, Mayer EK, et al., 2013, Image-guided robotic interventions for prostate cancer, Nat Rev Urol, Vol: advance online publication, ISSN: 1759-4820
Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance-such as ultrasonography or MRI-to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.
Marcus H, Hughes-Hallett A, Pratt P, et al., 2013, Operative working spaces in keyhole neurosurgery: An MRI study, Hamlyn Symposium on Medical Robotics, Pages: 91-91
Di Marco A, Pratt P, Jeyakumar J, et al., 2013, Validation of a novel three-dimensional stereoscopic viewer for transanal endoscopic microsurgery, Clinical Congress of the American College of Surgeons
Gao Q, Chang PL, Rueckert D, et al., 2013, Modeling of the bony pelvis from MRI using a multi-atlas AE-SDM for registrationand tracking in image-guided robotic prostatectomy, Computerized Medical Imaging and Graphics
Di Marco A, Pratt P, Yang G-Z, et al., 2013, A novel three-dimensional stereoscopic viewer for transanal endoscopic microsurgery: A report of two clinical cases, Hamlyn Symposium on Medical Robotics, Pages: 119-120
Pratt P, Hughes-Hallett A, Di Marco A, et al., 2013, Multimodal reconstruction for image-guided interventions, Hamlyn Symposium on Medical Robotics, Pages: 59-60
Cohen DC, Pratt P, Sridhar AN, et al., 2012, First demonstrations of live augmented reality image guidance in robotic prostatectomy, EAU Robotic Urology Section Congress (ERUS), Publisher: WILEY-BLACKWELL, Pages: 132-133, ISSN: 1464-4096
Latt WT, Chang TP, Di Marco A, et al., 2012, A Hand-held Instrument for in vivo Probe-based Confocal Laser Endomicroscopy during Minimally Invasive Surgery, 25th IEEE\RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 1975-1980, ISSN: 2153-0858
Pratt P, Di Marco A, Payne C, et al., 2012, Intraoperative ultrasound guidance for transanal endoscopic microsurgery, Med Image Comput Comput Assist Interv, Vol: 15, Pages: 463-470
Local excision of rectal cancer with transanal endoscopic microsurgery has proved to be a viable alternative to conventional, more radical techniques, but the reduced sensory experience presents significant challenges for the surgeon. Accurate identification and complete removal of lesions and subsurface targets is currently a difficult task, often exacerbated by intraoperative tissue deformation. This work describes novel ultrasound calibration and effective visualisation methods designed to meet these requirements, relying solely on optical measurements and pattern tracking. Detailed quantitative phantom and porcine validation experiments confirm that the technique is both practical and an accurate means for assessing lesion thickness intraoperatively, leading directly to human clinical trials.
Pratt P, Mayer E, Vale J, et al., 2012, An effective visualisation and registration system for image-guided robotic partial nephrectomy, Journal of Robotic Surgery, Vol: 6, Pages: 23-31, ISSN: 1863-2483
Di Marco A, Pratt P, Darzi A, 2012, A novel method for exploring human anatomy: the Anatomage Table, Hospital Radiology and Imaging Europe, Vol: 7, Pages: 40-43, ISSN: 1748-1082
Win Tun Latt, Tou Pin Chang, di Marco A, et al., 2012, A hand-held instrument for in vivo probe-based confocal laser endomicroscopy during minimally invasive surgery, Intelligent Robots and Systems (IROS), 2012 IEEE/RSJ International Conference on, Pages: 1982-1987, ISSN: 2153-0858
Stoyanov D, Pratt P, Edwards E, et al., 2012, Quantitative tissue measurements in transoral robotic surgery, Hamlyn Symposium on Medical Robotics, Pages: 107-108
Cohen D, Sridhar A, Pratt P, et al., 2012, From bench to bedside: The novel use of 3D MRI for image-guided robotic prostatectomy, Hamlyn Symposium on Medical Robotics, Pages: 63-64
Pratt P, Edwards E, Arora A, et al., 2012, Image-guided transoral robotic surgery for the treatment of oropharyngeal cancer, Hamlyn Symposium on Medical Robotics, Pages: 21-22
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