03 May 2015
Spending on robot surgery is expected to increase by $17 billion in the next 6 years. This new surgical treatment has challenged hospitals with higher costs and varying performance. Healthcare executives struggle balancing the adoption of medical innovations with managing healthcare costs. This dilemma can be further complicated by industry structures relative to capital-intensive medical innovations. This research explores the interaction between industry structure and customer value. Specifically, how can hospitals apply an understanding of supplier industry structure and customer value to improve the value of a robotic surgery program (RSP)? This industry study represents an exhaustive longitudinal review of over 15 years of public data relative to robotic surgery, across three distinct time periods. Within the research, industry structure is evaluated using Porter’s 5-forces model. A framework based upon contributions from Grönroos as well as Menon, Homburg, and Beutin is introduced to assess customer value based upon clinical, financial and strategic (CFS) value. The implications of periodic industry structure on customer value were examined to identify opportunities for hospital executives to increase RSP customer value. There were several empirical and theoretical findings from this research. First, in the face of increasing industry structure the identification of favorable forces may create opportunities to increase RSP value. Secondarily, exploring customer value through the lens of core, add-on, relational and transactional benefits in the sub-context of CFS value aids in the identification of market power influences on customer value. The implications of the absence of high levels of relational and transactional benefits without high levels of core and add-on benefits may influence avenues of pursuit in improving RSP value overall. The research also suggests that clinical and strategic value was present despite varying degrees of industry structure. Finally, this study represents an empirical joint analysis of industry structure and customer value in robotic surgery. Some proponents may find the introduction of an integrative model for measuring customer value in robotic surgery, applicable to other capital-intensive medical innovations or disruptive technologies at large.
01 January 2015
Robotic surgery uses innovative technology to transcend a surgeon's skills when performing complex procedures. Currently, the only FDA approved robotic system is Intuitive's da Vinci Surgical System. While this system offers many advantages over other minimally invasive techniques, it also introduces a need for specialized training. Virtual reality simulators have emerged as valuable tools for standardized and objective robotic surgery skill training and assessments. In recent years, the idea of using video game technology in surgical education for laparoscopy has also been explored; however few have attempted to make a connection between video game experience and robotic surgical skills. Thus, the current study aims to examine the performance of video gamers in a virtual reality robotic surgery simulator. Furthermore, the video gamers' performance was compared to that of medical students, expert robotic surgeons, and "laypeople." The purpose of this study is to examine the hypothesis that video gamers acquire perceptual and psychomotor skills through video game play, similar to those used by robotic surgeons. Subjects completed a demographic questionnaire and performed three computer-based perceptual tests: a Flanker compatibility task, a subsidizing task, and a Multiple Object Tracking test. Participants then performed two warm-up exercises on the Mimic dV-Trainer to familiarize themselves with the system and eight trials of two core exercises to test their skills. After completing all trials, participants completed a post-questionnaire regarding their experience with the system. Expert video gamers (n=40), medical students (n=24), laypeople (n=42) and expert robotic surgeons (n=16) were recruited. Medical students and gamers were significantly faster than experts in the Flanker Task. The experts were significantly slower than the all other groups in the subsidizing task. Experts scored significantly higher, were significantly more efficient, and were significantly faster than laypeople, medical students, and gamers in the first trial of Ring & Rail 1 and Suture Sponge. In trial eight of Ring & Rail 1, experts scored significantly higher and were more efficient than laypeople. Experts were also significantly faster than all other groups. Experts scored significantly higher than laypeople and gamers in trial Suture Sponge. Experts were significantly more efficient and significantly faster than all other groups. Contrary to prior literature in laparoscopy, this study was unable to validate enhanced abilities of video gamers in a robotic surgery simulator. This study does further demonstrate that the transfer of skills developed through video game play is relevant to the surgical technique. This may be due to the differences of the systems and how the users interact within them. In a society where video games have become an integral past time, it is important to determine the role that video games play in the perceptual and psychomotor development of users. These findings can be generalized to domains outside of medicine that utilize robotic and computer-controlled systems, speaking to the scope of the gamers' abilities and pointing to the capacity within these systems.
Heunis, Jacobus Stephanus
Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: This thesis describes the process of developing a user interface for a seven degree of freedom (DOF), minimally invasive surgical robot. For the first two main stages of the overall project, completed by previous students, a primary slave manipulator (PSM) and a secondary slave manipulator (SSM) were developed. The stage in this thesis concentrates on creating a joystick that can control the combined movement of the PSM and SSM. Background information on the field of robotic surgery, with specific reference to current systems’ user interfaces, is given and the technical aspects of the PSM and SSM are determined. This is followed by the motivation and main objectives of the thesis. Objectives were divided into the main categories of mechanical design, electronic design, control system design and testing. The mechanical design of the joystick progresses through a concept development stage, before a final seven DOF articulated arm design is presented and evaluated based on engineering specifications. Aluminium is used as the construction material; electromagnetic brakes are specified for each joint, leading to the final assembly, which is a constructed joystick fulfilling all requirements. The electronic design implements magnetic rotary encoders for the joystick’s position and orientation tracking as well as designs of the necessary power and control circuitry to enable correct joystick functioning. The interfacing of the PSM and SSM had to enable successful communication capabilities between the master and the slave. Several necessary adjustments were therefore made to the slave system, after which the joystick and robot were electronically interfaced to provide a direct serial communication line. For control system design, the joystick and robot were modelled according to the Denavit-Hartenberg principle, which allows direct relation between the position and orientation of the respective end effectors on the joystick and robot sides. Forward kinematic equations were then applied to the joystick; the desired position and orientation of the robot end effector were determined, and inverse kinematic equations were applied to these data to establish the robot’s joint variables. This stage ended with the development of two operational modes: one where only the SSM motors are controlled in order for the slave to follow the master’s movements, and the other where the PSM’s motors are controlled separately. The simultaneous control of all robot motors could not be demonstrated due to fundamental mechanical flaws in the PSM and SSM designs. Finally, testing was undertaken to demonstrate movement control of the robot by the joystick. The intuitiveness of the product was also tested successfully. The study ends with the presentation of the conclusions, the main conclusions being the successful development and testing of a joystick that controls the movement of a surgical robot, as well as the achievement of all main thesis objectives. / AFRIKAANSE OPSOMMING: Hierdie tesis beskryf die proses vir die ontwikkeling van ’n gebruikerskoppelvlak vir ’n sewevryheidsgraad-, minimaal indringende chirurgiese robot. In die eerste twee hoofstadia van die algehele projek, voltooi deur ander studente, is ’n primêre slaafmanipuleerder (PSM) en ’n sekondêre slaafmanipuleerder (SSM) ontwikkel. Die stadium in hierdie tesis konsentreer op die skep van ’n stuurstok waarmee die gekombineerde beweging van die PSM en SSM beheer kan word. Agtergrondinligting oor die gebied van robotiese chirurgie word verskaf, met spesifieke verwysing na die gebruikerskoppelvlakke van huidige stelsels, en die spesifikasies van die PSM en SSM word vasgestel. Daarna volg die beweegrede sowel as die belangrikste oogmerke van die projek. Die oogmerke is in die hoofafdelings van meganiese ontwerp, elektroniese ontwerp, beheerstelselontwerp en toetsing verdeel. Die meganiese ontwerp van die stuurstok behels ’n konsepontwikkelingstadium, wat uitloop op ’n finale sewevryheidsgraad-ontwerp, wat dan op grond van ingenieurspesifikasies aangebied en beoordeel word. Aluminium word as boumateriaal gebruik; elektromagnetiese remme word vir elke koppeling gespesifiseer, en die finale samestel is ’n gekonstrueerde stuurstok wat aan alle vereistes voldoen. Die elektroniese ontwerp behels die gebruik van magnetiese draaikodeerders om die stuurstok se posisie en oriëntasie te bepaal, sowel as meganismes met die nodige krag- en beheerstroombaanwerk om die stuurstok reg te laat funksioneer. ’n Koppelvlak tussen die PSM en die SSM moes suksesvolle kommunikasie tussen die meester en die slaaf bewerkstellig. Verskeie nodige aanpassings is dus aan die slaafstelsel aangebring, waarna die stuurstok en robot elektronies gekoppel is om ’n direkte reekskommunikasielyn te skep. Vir beheerstelselontwerp is die stuurstok en robot volgens die Denavit- Hartenberg-beginsel gemodelleer, wat ’n direkte verhouding tussen die posisie en oriëntasie van die onderskeie eindpunt-effektors aan die stuurstok- en robotkant daarstel. Voorwaartse kinematiese vergelykings is daarna op die stuurstok toegepas; die gewenste posisie en oriëntasie van die robotiese eindpunt-effektor is bepaal, waarna terugwaartse kinematiese vergelykings op hierdie data toegepas is om die robot se koppelingveranderlikes te bepaal. Hierdie afdeling word afgesluit met die ontwikkeling van twee bedryfsmodusse: een waar slegs die SSM-motore beheer word sodat die slaaf die meester se bewegings kan navolg, en die ander waar die PSM se motore afsonderlik beheer word. Die gelyktydige beheer van al die robotmotore kon nie getoon word nie weens fundamentele meganiese tekortkominge in die PSM- en SSM-ontwerp. Laastens is ’n toets uitgevoer om die bewegingsbeheer van die robot deur die stuurstok te toon. Die intuïtiwiteit van die produk is ook suksesvol getoets. Die studie sluit af met die projekgevolgtrekkings, waarvan die belangrikste die suksesvolle ontwikkeling en toetsing van ’n stuurstok is wat daarin slaag om die beweging van ’n chirurgiese robot te beheer, sowel as die verwesenliking van alle hoofprojekoogmerke.
Design and Prototyping of a Three Degrees of Freedom Robotic Wrist Mechanism for a Robotic Surgery SystemLiu, Taoming January 2011 (has links)
No description available.
Effects of a new technology on expertise. Case of robotics in bariatric surgery / Effets d’une nouvelle technologie sur l’expertise. Le cas de la robotique dans la chirurgie bariatriqueKiwan, Lea 16 June 2017 (has links)
Cette thèse s’intéresse aux effets des technologies d’assistance robotique sur l’expertise individuelle et collective des médecins dans un bloc opératoire de chirurgie gastrique. Notre recherche est fondée sur l’analyse de l’émergence des routines organisationnelles et de leur mise en évidence en mobilisant l’approche naturaliste de la décision. D’un point de vue managérial, nos résultats démontrent que la technologie introduite atténue l’expertise individuelle en dégradant respectivement la détection des signes cliniques et la coordination au sein de l’équipe. Nous établissons des recommandations concernant la mise en œuvre d’une technologie dans le cadre des équipes restreintes. Notre méthodologie consiste à fusionner des sources hétérogènes : entretiens, observation in situ, vidéos, débriefing, auto-confrontation... elle ouvre ainsi la voie à de nouvelles stratégies d’analyse de données jusqu’à lors essentiellement utilisées en psychologie. Enfin, nos contributions théoriques ont permis un enrichissement de l’approche naturaliste en lui adjoignant les rôles tenus par le leader et la mise en évidence du rôle de l’expertise individuelle dans la formation de nouvelles routines fonctionnelles. / The aim of this research is the understand the effect of a new technology, a robotic system, on the individual and collective expertise of practitioners in bariatric surgery. Our analysis is based on the emergence of organizational routines while taking into consideration naturalistic decision making approach. From the managerial perspective, our results demonstrate that the implementation of this technology decrease individual expertise. This is done through the degradation of individual situation awareness and coordination between team members. We established recommendations for an efficient technology implementation by restricted teams. Our methodology consists of mixing heterogenic sources: interviews, observations, videos, debriefing with auto-confrontation… this opens the door for new analysis strategies till now used mainly in psychology. Finally, our theoretical contributions reinforced the naturalistic approach while insisting on the important role of a team leader and the role of individual expertise in the development of new functional organizational routines.
Understanding Decision Making In Robotic Surgery: A Knowledge Gap Survey and Cognitive Task Analysis of Robotic ProstatectomyLusty, Avril 28 July 2021 (has links)
Robotic surgery is at the forefront of surgical innovation and presents novel challenges for both postgraduate learners and seasoned specialists. Robotic teaching is underway, often without formalized robotic curricula. Research into robotic surgical steps and surgical decision-making that should be imparted to learners has been neglected. As such, I aimed to determine the knowledge gap of urology residents for a robotic prostatectomy. Further, I also aimed to determine the patterns and cognitive rules used by experienced surgeons to complete a robotic prostatectomy. This master’s thesis included a knowledge gap survey, completed by urology residents, and compared to urologic oncologists, of a robotic prostatectomy and contained both open-ended and rating scale questions. A cognitive task analysis (CTA) was then performed as a series of semi-structured interviews in which incident-probing questions were used to make urologic oncologists explain visual cues and decision-making processes. 42 surveys were administered to urology residents and urologists at The Ottawa Hospital over 10 weeks. There was disagreement between urology resident and urologist responses from the rating scale responses, from the following procedural steps: vesicourethral anastomosis, apical dissection, and seminal vesicle dissection. The open-ended responses found discrepancies between the residents’ and urologists’; understanding of anatomy and surgical decision-making, and of cause-and-consequence cognitive awareness. Subsequently, 16 CTA interviews of four urologic oncologists were completed. After data coding and thematic analysis was performed, CTA grids for each surgeon described a map of a robotic prostatectomy including the steps and goals of the procedure, procedural landmarks, key visual cues for each step, complications and/or error prevention, and management. Specific content not yet described in the literature also includes how the lack of haptic feedback is compensated by robotic surgeons. Additional findings included a gap in urology resident knowledge and understanding of a robotic prostatectomy. The CTA of a robotic prostatectomy documented the surgical decision-making rules, patterns and visual cues urologic oncologists use to avoid errors, and to manage intraoperative surgical complications. This information is key to expanding the understanding of robotic prostatectomy surgical decision-making and training and can be used to produce robust robotic educational curricula.
Nelson, Gunnar Beck
22 June 2022
XMARCUS: A Pathway Towards Remote Robotic Surgery Training}, is a compilation work of human-robot, human-artificial intelligence, and human-computer interaction. The thesis provides a technical overview of the history of robotic surgery, present innovation, and future impacts. We present a behaviorist overview and describe our view of the overall direction of robotic surgery to enhance surgical training. We also discuss application towards future directions of translational medicine, adoption of surgical tools, and innovation within medicine. XMARCUS indicates the possibility of another artificial intelligence winter within surgery domain and presents a direction towards surgical training. Our macroscopic perspective and development of demo applications on third-party consoles demonstrates how to enhance robotic surgery training, provide future directions of minimally invasive surgery, and further enhance medical education. We also present the argument for a definitive direction of applications of artificial intelligence, the breakdown of its very definition, along with its proper application, in order to connect both the surgical and software communities for further steps in translational medicine. XMARCUS is not only a pathway towards applicable accessibility for surgical training, but also is a framework to allow further innovation in translational medicine for robotic surgery. The thesis consists of 14 chapters divided into 3 parts. Part 1 provides a technical history background focused on the history of robotic surgery, the present hardware breakdown, applications and advancement of artificial intelligence and computer vision practices within the field. Part 2 highlights the disconnect between both surgical and software communities, and a pathway to integrating both fields towards translational medicine, specifically focusing on artificial intelligent practices by integrating machine learning for computer vision in the endoscopic space. Part 3 presents future research directions and important research questions to address, highlighting the future of surgery with the lack of physician accessibility to implementing artificial intelligence practices, focuses on providing an integration of remote robotic surgery training. / Master of Science / XMARCUS: A Pathway Towards Remote Robotic Surgery Training} is an avocation, proof of concept, and general overview of robotic surgery, its present predicament, and future impact of software engineering. There is an ever pressing need to integrate artificial intelligence practices within robotic surgery and minimally invasive surgery procedures. However, computing has faced a number of artificial intelligence winters with no viable means of application. Due to the lack of available data and machine learning models trained on such data, there is another permanence of an artificial intelligence winter, especially surgical applications. We also present the XMARCUS dataset, with over 12,000 images and a walk-through for crowdsource annotation process using Intel's OpenVino framework, where there has been less viable data. The focus is on the general overview of artificial intelligence, within the domain of machine learning for computer vision practices. This includes a discussion of virtual coaching and remote surgical training, specifically methods to further develop robotic surgery simulation software, in order to advance not solely the endoscopic space, but also the surgical training. Human-computer interaction models and theories, such as the Diffusion of Innovation, showcase the adaptation and timing of certain technologies, for viable application. We also present another concept focusing on the timing of technology to be introduced to help with translational medicine. Finally, we show an application in a series of proof concepts of remote virtual coaching for remote robotic surgical training including the psychomotor skills and FDA policy overview for implementing novel software practices to advance robotic surgery. With consideration towards remote surgery training and the universal push for creating credentialing and guidelines in robotic surgery, we discuss further disparities to showcase an ethical framework to enhance surgical training and implement novel software engineering practices.
Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview studyRandell, Rebecca, Honey, S., Alvarado, Natasha, Greenhalgh, J., Hindmarsh, J., Pearman, A., Jayne, D., Gardner, Peter H., Gill, A., Kotze, A., Dowding, D. 04 March 2020 (has links)
Yes / To capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice. A literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered. Nine hospitals in England where robot-assisted surgery is used for colorectal operations. Forty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists. Interviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential. We captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.
Sudhakaran Nair, Sudhesh
22 October 2013
No description available.
A Novel System for Wireless Robotic Surgery Through the Use of Ultrasonic Tracking Coupled with Advanced Modeling TechniquesLilly, Bradford R. 09 July 2012 (has links)
No description available.
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