Base Teórica: A histerectomia ainda é um procedimento cirúrgico frequente. Nos últimos 25 anos, muitos esforços foram feitos para reduzir o número de histerectomias abdominais, como o avanço tecnológico, que permitiu cirurgias menos invasivas. Visando ampliar o uso da cirurgia minimamente invasiva, foi desenvolvida a cirurgia robótica, com a vantagem de facilitar o uso da laparoscopia proporcionando movimentos mais ergonômicos e precisos. Apesar de ser tecnologia recente e do alto custo, vem ganhando cada vez mais espaço na prática clínica. Dados sobre tempo cirúrgico e tempo de internação pós-operatória tem sido alvo de várias publicações, uma vez que afetam os custos do procedimento. Objetivo: O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica, e comparação dos seus dados com outras vias de histerectomia já realizados no nosso meio. Métodos: Foi realizado estudo caso-controle para comparação de dados pré-operatórios, operatórios (como tempo cirúrgico total e sangramento) e pós-operatórios (tempo de recuperação pós-operatória, complicações, dor nas primeiras 24 horas após a cirurgia), em 80 pacientes, submetidas à histerectomia para tratamento de patologias uterinas benignas. Nós incluímos quatro grupos de pacientes: robótico, vaginal, abdominal e laparoscópico. O grupo robótico foi composto pelas primeiras 20 cirurgias realizadas em nosso hospital, e os grupos controle foram selecionados retrospectivamente a partir da data da última cirurgia robótica, constituindo uma amostragem não probabilística. Também foi realizado estudo transversal utilizando apenas as pacientes submetidas à cirurgia robótica em nosso serviço, para fins de documentação de nossa experiência inicial. Resultados: O grupo robótico foi responsável pelo maior tempo cirúrgico total (180,7 minutos), e pelo menor tempo de recuperação pós-operatória (23,7 horas), entre os quatro grupos. Não houve diferença entre os grupos na análise do sangramento transoperatório e das complicações pós-operatórias. Dados analisados sobre a dor pós-operatória não diferiram entre os grupos. No estudo transversal, foi demonstrada curva de aprendizado em tempo de docking e undocking, e houve correlação forte entre tempo cirúrgico total e índice de massa corporal da paciente. Conclusão: Análise do tempo cirúrgico total e do tempo de recuperação pós-operatória são relevantes, pois podem ser ferramentas necessárias para redução dos custos da cirurgia robótica. Nossa experiência inicial demonstra curva de aprendizado em alguns aspectos. / Background: Hysterectomy is a frequent surgical procedure. In the last 25 years, many efforts have been made to reduce the number of abdominal hysterectomies, such as the technological advances, which allowed less invasive procedures. Aiming to increase the use of minimally invasive surgery, the robotic surgery was developed, which advantage of more precise and ergonomic movements than laparoscopy. Although it is a recent and expensive technology, robotic surgery is gaining more space in clinical practice. Data from Total Surgical Time and Time of Postoperative Recovery has been target of publications, once they can affect the costs. Objective: The purpose of this study is to compare the surgical outcomes of patients undergoing robotic hysterectomy for benign cases to patients undergoing another types of hysterectomy performed in our institution. Methods: It was performed a case-control study to compare pre-operative, operative (as Total Surgical Time and bleeding) and postoperative (Time of Postoperative Recovery, complications, and pain at the first 24 hours after the surgery) in 80 patients undergoing hysterectomy for treatment of various benign uterine conditions. We have included four groups of patients: robotic, vaginal, abdominal and laparoscopic. The robotic group was composed by the first twenty patients undergoing robotic hysterectomy at our hospital, and the control groups were retrospectively selected from the date of the last robotic surgery, constituting a non-probabilistic sample. We also performed a crosssectional study with the 20 patients of robotic group, to document our initial experience. Results: The robotic group was responsible for the longer Total Surgical Time (180.7 minutes), and for the shortest Time of Postoperative Recovery (23.7 hours) among the four groups. There were no difference between the groups in analysis of estimated blood loss and postoperative complications. Data related to postoperative pain showed no difference between the groups. At cross-sectional study, it was demonstrated learning curve of docking and undocking times, and was found a strong correlation between Total Surgical Time and body mass index. Conclusion: Analysis of Total Surgical Time and Time of Postoperative Recovery are relevant, because they can be necessary tools to reduce the costs of robotic surgery. Our initial experience demonstrated learning curve in some ways.

Base Teórica: A histerectomia ainda é um procedimento cirúrgico frequente. Nos últimos 25 anos, muitos esforços foram feitos para reduzir o número de histerectomias abdominais, como o avanço tecnológico, que permitiu cirurgias menos invasivas. Visando ampliar o uso da cirurgia minimamente invasiva, foi desenvolvida a cirurgia robótica, com a vantagem de facilitar o uso da laparoscopia proporcionando movimentos mais ergonômicos e precisos. Apesar de ser tecnologia recente e do alto custo, vem ganhando cada vez mais espaço na prática clínica. Dados sobre tempo cirúrgico e tempo de internação pós-operatória tem sido alvo de várias publicações, uma vez que afetam os custos do procedimento. Objetivo: O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica, e comparação dos seus dados com outras vias de histerectomia já realizados no nosso meio. Métodos: Foi realizado estudo caso-controle para comparação de dados pré-operatórios, operatórios (como tempo cirúrgico total e sangramento) e pós-operatórios (tempo de recuperação pós-operatória, complicações, dor nas primeiras 24 horas após a cirurgia), em 80 pacientes, submetidas à histerectomia para tratamento de patologias uterinas benignas. Nós incluímos quatro grupos de pacientes: robótico, vaginal, abdominal e laparoscópico. O grupo robótico foi composto pelas primeiras 20 cirurgias realizadas em nosso hospital, e os grupos controle foram selecionados retrospectivamente a partir da data da última cirurgia robótica, constituindo uma amostragem não probabilística. Também foi realizado estudo transversal utilizando apenas as pacientes submetidas à cirurgia robótica em nosso serviço, para fins de documentação de nossa experiência inicial. Resultados: O grupo robótico foi responsável pelo maior tempo cirúrgico total (180,7 minutos), e pelo menor tempo de recuperação pós-operatória (23,7 horas), entre os quatro grupos. Não houve diferença entre os grupos na análise do sangramento transoperatório e das complicações pós-operatórias. Dados analisados sobre a dor pós-operatória não diferiram entre os grupos. No estudo transversal, foi demonstrada curva de aprendizado em tempo de docking e undocking, e houve correlação forte entre tempo cirúrgico total e índice de massa corporal da paciente. Conclusão: Análise do tempo cirúrgico total e do tempo de recuperação pós-operatória são relevantes, pois podem ser ferramentas necessárias para redução dos custos da cirurgia robótica. Nossa experiência inicial demonstra curva de aprendizado em alguns aspectos. / Background: Hysterectomy is a frequent surgical procedure. In the last 25 years, many efforts have been made to reduce the number of abdominal hysterectomies, such as the technological advances, which allowed less invasive procedures. Aiming to increase the use of minimally invasive surgery, the robotic surgery was developed, which advantage of more precise and ergonomic movements than laparoscopy. Although it is a recent and expensive technology, robotic surgery is gaining more space in clinical practice. Data from Total Surgical Time and Time of Postoperative Recovery has been target of publications, once they can affect the costs. Objective: The purpose of this study is to compare the surgical outcomes of patients undergoing robotic hysterectomy for benign cases to patients undergoing another types of hysterectomy performed in our institution. Methods: It was performed a case-control study to compare pre-operative, operative (as Total Surgical Time and bleeding) and postoperative (Time of Postoperative Recovery, complications, and pain at the first 24 hours after the surgery) in 80 patients undergoing hysterectomy for treatment of various benign uterine conditions. We have included four groups of patients: robotic, vaginal, abdominal and laparoscopic. The robotic group was composed by the first twenty patients undergoing robotic hysterectomy at our hospital, and the control groups were retrospectively selected from the date of the last robotic surgery, constituting a non-probabilistic sample. We also performed a crosssectional study with the 20 patients of robotic group, to document our initial experience. Results: The robotic group was responsible for the longer Total Surgical Time (180.7 minutes), and for the shortest Time of Postoperative Recovery (23.7 hours) among the four groups. There were no difference between the groups in analysis of estimated blood loss and postoperative complications. Data related to postoperative pain showed no difference between the groups. At cross-sectional study, it was demonstrated learning curve of docking and undocking times, and was found a strong correlation between Total Surgical Time and body mass index. Conclusion: Analysis of Total Surgical Time and Time of Postoperative Recovery are relevant, because they can be necessary tools to reduce the costs of robotic surgery. Our initial experience demonstrated learning curve in some ways.

<p>The advancement of robotic-assisted surgery (RAS) has revolutionized the field by enabling surgeons to perform intricate procedures with enhanced precision, improved depth perception, and more precise control. Despite these advancements, current RAS systems still rely on teleoperation, where surgeons control the robots remotely. The complexity of the master-slave control mechanism, along with the technical challenges involved, can impose significant mental workloads on surgeons. As excessive mental workload (MWL) can adversely affect performance and increase the likelihood of errors, addressing operator mental overload has become crucial for successful operation in RAS. To tackle this problem, there has been increased interest in developing robots that can provide operators with varying levels of assistance based on their MWL (i.e., adaptive system) during task execution. However, the research in this area is notably limited, primarily due to two key factors: the absence of a real-time MWL assessment framework and the lack of effective intervention strategies to mitigate MWL in RAS.</p> <p>This Ph.D. dissertation aims to fill these gaps by designing the adaptive system in RAS and exploring its impact on surgical task performance. The dissertation comprises three studies. The first study demonstrated the feasibility of the adaptive system in RAS by introducing an MWL-triggered semi-autonomous suction tool as a proof-of-concept. Building upon the insights gained from the first study, the second study focused on enhancing the adaptive system's adaptability to more complex RAS tasks. In particular, the second study proposed a task-independent MWL model that had potential to be applied to various RAS tasks. Additionally, more intelligent interventions were investigated. Furthermore, the third study aimed to investigate the benefits of adaptive system in RAS training by introducing a personalized and adaptive training program based on human MWL profile. The findings of this dissertation revealed evidence supporting the effectiveness of the adaptive system in moderating subjects’ MWL, and its potential in enhancing task performance in RAS. This dissertation highlights the potential of incorporating adaptive systems into future RAS platforms, so that to provide valuable support and assistance to surgeons during critical moments and facilitate surgical training by identifying and addressing the specific needs of surgeons.</p>

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24799号 / 医博第4991号 / 新制||医||1066(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 石見 拓, 教授 川口 義弥 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Robotic surgery procedures may include long, thin flexible instruments that are inserted by the robot into the patient. As the robot inserts these devices, due to their geometry, they are prone to buckling failure. To mitigate buckling failure, a support system is needed on the robot. This system supports the device but also adapts to the varying ex vivo length of the device as it is inserted. This work presents four collapsible support systems designed to mitigate buckling failure of long, thin instruments while accounting for changing length. The Ori-Guide is an origami-inspired system that has enabled a part reduction from traditional rigid systems with over 70 parts to 3 parts. This system was enabled through the development of a novel origami pattern that integrates both actuation and support into the same pattern. This system was made from PET and performed as well as a rigid system. The PET used in the Ori-Guide was thermo-processed to hold a folded shape. The heat treatment put the Ori-Guide into tension and enabled a stiffer support system. Work was done to investigate the effect of thermo-processing on PET films used in origami-inspired engineering applications. It was discovered that there is a strong correlation between crystallization and the stiffness of a crease in the polymer film. The Zipper-Tube Reinforcement (ZTR) was developed to provide constant support along the entire length of the device, something that no other support device provides. This enables higher loads on the device and thinner and more flexible devices. It was developed as a tube that envelopes the device and zips to provide a tube to support the device then unzips to lay flat rolled about a mandrel for storage. The Wires in Tension concept was developed by focusing on adding tension to the support system. It provided support to the device but required high levels of force on the robot arm so the Orthogonal Beams was developed. The Orthogonal Beams employs geometry as the primary support rather than tension and therefore could provide higher support with less force on the robot. These systems all proved effective ways to support flexible devices. The concepts could also find application in other fields. The merits of each system are discussed in detail, including a discussion on other possible applications.

No description available.

No description available.

No description available.

No description available.

Surgical education has the arduous task of providing effective and efficient methods of surgical skill acquisition and clinical judgment while staying abreast with the latest surgical technologies within an ever-changing field. Robotic surgery is one such technology. Many surgeons in practice today were either never taught or were not effectively taught robotic surgery during training, leaving them to navigate the robotic learning curve and reach mastery independently. This dissertation examines the impact of a video review guide on improving robotic surgical skills. Using Kolb’s Experiential Learning Theory as a framework, the literature review argues that video review can be used as a catalyst for reflection, which can deepen learning and improve self-assessment. Reflection, however, is not an innate skill but must be explicitly taught or guided. The researcher argues that a written video review guide can help novice surgeons develop reflective practice, resulting in improved surgical skills and a shorter robotic learning curve. A between-group quasi-random experiment was conducted to test this theory. The participants performed a pre-test technical simulation, conducted an independent video review, and then repeated the same simulation as a post-test. The intervention group received a surgical video review guide created by the researcher using Gibb’s Reflective Cycle and additional evidence-based strategies during the video review. The participants also completed an exit survey measuring the perceived usefulness of video review guides. Data analysis found that overall, both groups significantly improved their surgical skills; however, there was no statistical difference between the two groups. The participants perceived both the surgical video review guide and video review guides in general as useful. Implications for practice and recommendations for future research were discussed. This research underscores the potential of reflective guides as a low-cost and independent method to develop reflective practitioners further and improve surgical practice.