RESUMEN
The authors have previously reported on the laboratory development of the Acrobot Navigation System for accurate computer-assisted hip resurfacing surgery. This paper describes the findings of using the system in the clinical setting and including the improvements that have been made to expedite the procedure. The aim of the present system is to allow accurate planning of the procedure and precise placement of the prosthesis in accordance with the plan, with a zero intraoperative time penalty in comparison to the standard non-navigated technique. At present the navigation system is undergoing final clinical evaluation prior to a clinical study designed to demonstrate the accuracy of outcome compared with the conventional technique. While full results are not yet available, this paper describes the techniques that will be used to evaluate accuracy by comparing pre-operative computed tomography (CT)-based plans with post-operative CT scans. Example qualitative clinical results are included based on visual comparison of the plan with post-operative X-rays.
Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Interpretación de Imagen Asistida por Computador/métodos , Robótica/instrumentación , Programas Informáticos , Cirugía Asistida por Computador/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Gráficos por Computador , Simulación por Computador , Diseño de Equipo , Análisis de Falla de Equipo , Articulación de la Cadera/patología , Humanos , Modelos Biológicos , Robótica/métodos , Cirugía Asistida por Computador/métodos , Evaluación de la Tecnología Biomédica , Interfaz Usuario-ComputadorRESUMEN
A brief history of robotic systems in knee arthroplasty is provided. The place of autonomous robots is then discussed and compared to more recent 'hands-on' robotic systems that can be more cost effective. The case is made for robotic systems to have a clear justification, with improved benefits compared to those from cheaper navigation systems. A number of more recent, smaller, robot systems for knee arthroplasty are also described. A specific example is given of an active constraint medical robot, the ACROBOT system, used in a prospective randomized controlled trial of unicondylar robotic knee arthroplasty in which the robot was compared to conventional surgery. The results of the trial are presented together with a discussion of the need for measures of accuracy to be introduced so that the efficacy of the robotic surgery can be immediately identified, rather than have to wait for a number of years before long-term clinical improvements can be demonstrated.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/métodos , Robótica/instrumentación , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Diseño de Equipo , Análisis de Falla de Equipo , HumanosRESUMEN
Hip resurfacing is an alternative to total hip replacement (THR) and is particularly suitable for the younger, more active patient. However, it is a more demanding procedure. This paper describes a system that enables the surgeon to plan the surgery preoperatively with optimally sized and placed components, and then transfer this plan to an intraoperative system that registers computer models to the real patient and tracks surgical tools, allowing the surgeon to ensure that the bone is resected correctly and that the components are fitted in accordance with the plan. The paper describes a series of instruments used with the system which are locked to the bone. These instruments serve the dual purpose of soft tissue retraction and bone immobilization. The system will shortly be the subject of laboratory and clinical evaluation. Registration, a cornerstone of the tracked instrument system, has been tested, and accuracy measures are provided. Experimental results for the remainder of the system will be provided after clinical trials.
Asunto(s)
Artroplastia/métodos , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos de Cirugía Plástica/métodos , Robótica/métodos , Cirugía Asistida por Computador/métodos , Simulación por Computador , Articulación de la Cadera/fisiopatología , Humanos , Cuidados Intraoperatorios/métodos , Modelos Biológicos , Cuidados Preoperatorios , RadiografíaRESUMEN
PURPOSE: We developed a realistic and reusable computer assisted surgical training system for transurethral resection of the prostate. MATERIALS AND METHODS: A disposable prostate model is housed in a model abdomen. A software program that provides a 3-dimensional (D) illustration of the prostate model was developed. Resectoscope position with reference to the model is tracked by infrared emitting diodes attached to it, which in turn are monitored by an optical tracker. Movement of the loop in relation to the resectoscope is measured by a potentiometer attached to the working element. RESULTS: Resectoscope position was shown on the monitor superimposed on a 3-D image of the prostate model in real time. A 2-D image showed the amount of tissue resected and the proximity of the loop to the capsule. A series of thumbnail images were shown and the highlighted image represented the current position of the resectoscope. It is intended that this system should be interactive, providing continuous feedback on the progress of resection and acting as an interactive training aid. During the course of validating the system several problems were noted, mainly with model movement and permanent deformation of the model during resection. CONCLUSIONS: This system can exist as a stand-alone training aid after the problems have been addressed. The potential application of an in vivo system for routine transurethral prostate resection has great implications for training and quality control.