• Archives of Plastic Surgery
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• v.48 no.2
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• pp.194-198
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• 2021

Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed in an attempt to seek smaller and indistinct incisions. Robotic surgery system has been evolving under the concept of minimal invasive technique which is a recent trend in surgery. One of the latest version is the da Vinci SP Surgical System (Intuitive Surgical). In this report, we will share our experiences. Two patients underwent robot-assisted nipple-sparing mastectomy, each followed by immediate robot-assisted expander insertion and prepectoral direct-to-implant breast reconstruction, respectively. There was no open conversion or major postoperative complication. One patient experienced mild infection, which was resolved by intravenous antibiotic treatment. Simple docking process, multi-joint instruments, and thirdarm functionality are among the new surgical system's advantages. The present cases suggest that robot-assisted nipple-sparing mastectomy with immediate reconstruction using the da Vinci SP Surgical System is feasible and safe. The promising features and potential application of da Vinci SP in breast reconstruction need further study.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.373-377
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• 2022

Currently, robot-assisted latissimus dorsi muscle flap (RLDF) surgery is used in treating patients with Poland syndrome and for breast reconstruction. However, conventional RLDF surgery has several inherent issues. We resolved the existing problems of the conventional system by introducing the da Vinci single-port system in patients with Poland syndrome. Overall, three patients underwent RLDF surgery using the da Vinci single-port system with gas insufflation. In the female patient, after performing RLDF with silicone implant, augmentation mammoplasty was also performed on the contralateral side. Both surgeries were performed as single-port robotic-assisted surgery through the transaxillary approach. The mean operating time was 449 (335-480) minutes; 8.67 (4-14) minutes were required for docking and 59 (52-67) minutes for robotic dissection and LD harvesting. No patients had perioperative complication and postoperative problems related to gas inflation. The single-port robot-assisted surgical system overcomes the drawbacks of previous robotic surgery in patients with Poland syndrome, significantly shortens the procedure time of robotic surgery, has superior cosmetic outcomes in a surgical scar, and improves the operator's convenience. Furthermore, concurrent application to another surgery demonstrates the possibility in the broad application of the robotic single-port surgical system.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.25.1-25.6
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• 2017

Background: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. Conclusions: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

• Journal of Chest Surgery
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• v.48 no.2
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• pp.99-104
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• 2015

Background: We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Methods: Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Results: Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were $194.8{\pm}48.6$ minutes and $126.1{\pm}22.6$ minutes in mitral valve repair operations and $132.0{\pm}32.0$ minutes and $76.1{\pm}23.1$ minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was $128.3{\pm}43.1$ minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Conclusion: Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

• PNF and Movement
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• v.20 no.2
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• pp.295-306
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• 2022

Purpose: This study aimed to investigate the effect of robot-assisted gait training on the active ranges of motion, gait abilities, and biomechanical characteristics of gait in patients who underwent lower extremity surgery, and to verify the effectiveness and clinical usefulness of robot-assisted gait training. Methods: This study was conducted on 14 subjects who underwent lower extremity surgery. The subjects participated in robot-assisted gait training for 2 weeks. The active ranges of motion of the lower extremities were evaluated, and gait abilities were assessed using 10-m and 2-min walk tests. An STT Systems Inertial Measurement Unit was used to collect data on biomechanical characteristics during gait. Spatiotemporal parameters were used to measure cadence, step length, and velocity, and kinematic parameters were used to measure hip and knee joint movement during gait. Results: Significant improvements in the active ranges of motion of the hip and knee joints (flexion, extension, abduction, and adduction) and in the 10-m and 2-min walk test results were observed after robot-assisted gait training (p < 0.05). In addition, biomechanical characteristics of gait, spatiotemporal factors (cadence, step length, and velocity), and kinematic factors (gait hip flexion-extension, internal rotation-external rotation angle, and knee joint flexion-extension) were also significantly improved (p < 0.05). Conclusion: The results of this study are of clinical importance as they demonstrate that robot-assisted gait training can be used as an effective intervention method for patients who have undergone lower extremity surgery. Furthermore, the findings of this study are clinically meaningful as they expand the scope of robot-assisted gait training, which is currently mainly applied to patients with central nervous system conditions.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.10a
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• pp.131-134
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• 2005

This paper presents a computer-aided simulation and robotic-assisted execution technology of external fixation method to achieve fracture reduction and deformity correction in long bones. Combining the kinematic analysis with a graphic model of the tibia and the fixator allowed 3D simulation and visualization of the adjustments required to reduce fracture or correct bone deformity as a pre-operative planning tool. The developed robot model provided accurate deformity correction with small residual deformity based on the results of the planning. By incorporating the robot model with image-guided system and computer-aided planning, the integrated system could be useful for computer-aided pre-operative planning and robotic-assisted execution in fracture treatment and bone deformity surgery.

• Journal of Institute of Control, Robotics and Systems
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• v.20 no.8
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• pp.801-806
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• 2014

LAS (Laparoscopy Assisted Surgery) has been substituted alternatively for traditional open surgery. However, when using a commercialized robot assisted laparoscopic such as Da Vinci, surgeons have encountered some problems due to having to depend only on information by visual feedback. To solve this problem, a haptic function is required. In order to realize the haptic teleoperation system, a force feedback and bilateral control system are needed. Previous research showed that the perturbation value estimated by a SPO (Sliding Perturbation Observer) followed a reaction force that loaded on the surgical robot instrument. Thus, in this paper, the force feedback problem of surgical robots is solved through the reaction force estimation method. This paper then introduces the possibility of the haptic function realization of a laparoscopic surgery robot using a bilateral control system. For bilateral control, the master uses an impedance control and the slave uses a SMC (Sliding Mode Control). The experiment results show that a torque and force sensorless teleoperation system can be implemented using a bilateral control structure.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.55-60
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• 2022

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

• International Journal of Control, Automation, and Systems
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• v.4 no.1
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• pp.30-41
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• 2006

The goal of this work is to develop and test a robot-assisted surgery system for spinal fusion. The system is composed of a robot, a surgical planning system, and a navigation system. It plays the role of assisting surgeons for inserting a pedicle screw in the spinal fusion procedure. Compared to conventional methods for spinal fusion, the proposed surgical procedure ensures minimum invasion and better accuracy by using robot and image information. The robot plays the role of positioning and guiding needles, drills, and other surgical instruments or conducts automatic boring and screwing. Pre-operative CT images intra-operative fluoroscopic images are integrated to provide the surgeon with information for surgical planning. Some experiments employing the developed robotic surgery system are conducted. The experimental results confirm that the system is not only able to guide the surgical tools by accurately pointing and orienting the specified location, but also successfully compensate the movement of the patient due to respiration.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.10a
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• pp.144-148
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• 2005

The goal of this work is to develop and test a robot-assisted surgery system for spinal fusion. The system is composed of a robot, a surgical planning system, and a navigation system. It plays the role of assisting surgeons for inserting a pedicle screw in the spinal fusion procedure. Compared to conventional methods fer spinal fusion, the proposed surgical procedure ensures minimum invasion and better accuracy by using robot and image information. The robot plays the role of positioning and guiding needles, drills, and other surgical instruments or conducts automatic boring and screwing. Pre-operative CT images and intra-operative fluoroscopic images are integrated to provide the surgeon with information for surgical planning. Several experiments employing the developed robotic surgery system are conducted. The experimental results confirmed that the system is not only able to guide the surgical tools by accurately pointing and orienting the specified location, but also successfully compensate the movement of the patient due to his/her respiration.