Low-Cost Image Processing-Based Teleoperated Robotic Arm for Remote Surgical Assistance and Digital Health Integration

Digital health provides remote healthcare assistance, contributing to reducing inequalities in access to services. For its widespread adoption, it is essential to disseminate successful models implemented in countries with developed digital health networks, so that they can be adapted and replicated in developing regions. The dissemination of scientific studies on the topic, combining digital health activities within various contexts with scientific research, is crucial for promoting significant advancements in the understanding and application of these technologies. This study aims to conduct a comprehensive bibliometric analysis of global scientific production in digital health from 2019 to 2024, with special attention to Latin America and Brazil. A bibliometric analysis was conducted with searches in PubMed, Scopus, and Web of Science. The analysis used the Bibliometrix package in RStudio, and the data were filtered for the global dimension, Latin American countries, and Brazil. The authorship analysis was restricted to publications with at least one Brazilian author and was carried out through a manual check of each record. The protocol was registered on the Open Science Framework platform under the number 10.17605/OSF.IO/43WQ5. A total of 51,723 publications were included in the global dimension, 2,410 in Latin America, and 1,317 in the Brazilian analysis. The number of publications increased from 2019 to 2021. In the global scenario, the United States led scientific production in digital health, whereas Brazil led in Latin America. Digital health has expanded exponentially, consolidating itself as a strategic pillar in healthcare systems. Investments in international collaborations that encourage knowledge exchange, strengthen research networks, and drive scientific publications are essential. These partnerships are crucial for adapting digital tools to different socioeconomic contexts and ensuring equitable care for the population.

Camera Holding Robotic Devices in Urology

Laparoscopic robotic surgery requires intraoperative tool replacement owing to the limited number of surgical tools that can be used simultaneously. Currently, this process is performed by a surgical assistant. However, automatic tool replacement is essential for surgeons when operating alone. An initial design was constructed by analysing the FAST diagram of the surgical tool replacement process. It was then modified to arrive at the final design by considering the driving range of the robot arm. Based on the final design, both simulation and robot arm manufacturing were performed and validated. The results showed that the posture could be maintained during tool replacement, and the entire tool replacement process could be performed in 15s. The mechanism developed for the automatic replacement of surgical tools is expected to address the shortage of surgical staff and skill level of surgical assistants.

In his 1920 science fiction play R.U.R., Czech writer Karel Capek introduced the word "robot" to the English language. The play tells the story of a factory that produces roboti, which are living creatures that resemble humans and have the capacity for individual thought. While at first the roboti seem content to work for their human masters, they later rebel, ultimately leading to the extinction of the human race. 1 This play and similar depictions of robots in literature and film are probably responsible for the slightly negative reputation of robots in general. Only recently has this perception changed, thanks to the advent of robots that can vacuum our houses and perform other mundane chores. Raymond Goertz, while working for the US Atomic Energy Commission, is credited with the development of the first robotic arm in 1951. 2 It was designed to handle hazardous radioactive material. Unimation Inc. developed the first industrial robot in 1961; that robot handled molten die-castings and removed the human element from these labor-intensive, often dangerous tasks. With the development of the Programmable Universal Manipulation Arm (PUMA) in 1978, the robot was sophisticated enough to be introduced to medicine. The first working definition of the word "robot" was published, fittingly, by the Robotics Institute of America in 1980: ". . . a reprogrammable, multifunctional manipulator designed to move materials, parts, tools, or specialized devices through various programmed motions for the performance of a variety of tasks." 6 In 1988, the six-degrees-of-freedom flexible arm PUMA 560 was used to guide a needle under CT guidance into the brain. 4 With the introduction of robotic arms came the ability to use them as surgical assistants. In 1998, Okada et al. described a voice-controlled robot used to hold a thoracoscope. 5 This type of robot was also used in thoracoscopic spinal surgery. The military, having a vested interest in telepresence surgery, helped fund the development of the da Vinci Surgical System that was approved for use by the FDA in 2000 and designed to facilitate complex, minimally invasive intracavitary surgeries. 7 In 2004, the FDA cleared the first commercially available positioning device for the placement of spinal instrumentation. At present, several systems are commercially available that utilize robotics for spinal operations. In a recent review, Joseph et al. evaluated the current landscape regarding safety, accuracy, and radiation exposure with the use of these technologies. These authors concluded that "… the placement of pedicle screws with robotics appears to be safe, and accuracy appears to be superior to freehand placement, although the data are not conclusive." 3 There seems to be a significant level of interest in this technology; however, only time will tell if it will become commonplace in our field. In this issue of Neurosurgical Focus, we visually explore the expanding role of robotics and image guidance in spinal surgery. New robots used for the first time and existing robots used for novel applications graphically demonstrate how our field is evolving. The days of fearing robots are behind us as members of our specialty begin to embrace the concept of automation. Thankfully, unlike Capek's rogue roboti, surgical robots rising up against us and causing world destruction is unlikely!

Background Over the last few years, telemedicine services (TMs) have increasingly been used in European health and care systems. TMs include remote assistance with teleconsultation and telemonitoring. The expected benefits to individuals include easier access to information and personalized care. However, while the effectiveness and utility of TMs among cancer patients are well-established in Europe, several evidences highlighted the fact that TMs may widen existing inequities in health. Therefore, the aim of this study is to identify barriers and facilitators contributing to inequities to TMs among cancer patients in Europe. Methods Medline (via Ovid) and Scopus databases were searched in March 2023 for all publications providing evidence on factors influencing the access to and use of TMs services among cancer patients aged 18 and over in Europe published between January 2018 and March 2023. The PROGRESS-plus framework was used to stratify health opportunities, patients characteristics and outcomes. Results A total of 1683 peer reviewed publications were identified and after screening, 26 articles were retained in our scoping review. All included studies focused on TMs used by cancer patients through mobile or web-based applications. On one hand, socioeconomic status and language were the most cited influential factors as well as having an internet connection and a (mobile) device to the access to TMs. On the other hand, factors that influence the use of TMs are the level of education with digital skills and (e-)health literacy, social support, age and presence of comorbidities. Conclusions Identifying and addressing factors influencing access to and use of TMs among cancer patients will enable the development and tailoring of TMs that align more effectively with the needs and expectations of cancer patients. Integration of patient-centered care in TMs is necessary to enhance equity and allow a better implementation of TMs in European health and care systems. Key messages • The main factors influencing the access to and use of TMs are socioeconomic status and level of education respectively. • TMs must be developed and used to tackle inequities already present among cancer patients instead of widening the gap.

A single-center randomized controlled study. The objective of this study was to introduce a novel robotic system with an independent arm ("Orthbot Intelligent Orthopedic Minimally Invasive System"; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation. Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement. A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG. The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system. The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.

The objective of this study was to describe the technique of laparoscopic hysterectomy using a computer-enhanced robotic surgical system. Eleven patients underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy using a computer-enhanced surgical robot. Four trocars were used: one for the camera, two for the robotic arms controlled by the operating surgeon from the surgeon's console, and an additional port for use by the surgical assistant. Ages ranged from 27 to 77 years, and weight ranged from 54 to 100 kg. Operative time ranged from 4.5 to 10 hours. Estimated blood loss ranged from 50 to 1500 ml. The patients tolerated the procedure and recovered satisfactorily. This is the first case series reporting the use of a computer-enhanced surgical robot for performing hysterectomy in humans. It is feasible and well tolerated in this series of patients. As this technology develops, the applications for its use in gynecology and gynecologic oncology will increase.

BackgroundInnovations in surgical instruments have made single-port surgery more widely accepted and lead to a reduced demand for surgical assistants. As COVID-19 has ravaged the world, maintaining minimum medical staffing requirements and proper social distancing have become major topics of interest. We sought to evaluate the feasibility of applying the unisurgeon approach in single-port video-assisted thoracoscopic surgery aided by a robotic camera holder.MethodsOperative time, blood loss, setup time, postoperative hospital stays, and the number of participating surgeons in single-port video-assisted thoracoscopic lung resections were gathered for investigation after the introduction of the ENDOFIXexo robotic endoscope holder system. In this cohort, we collected 213 patients who underwent single port video thoracoscope surgery, including 57 patients underwent robotic endoscope arm assisted surgery and case-matched 52 patients in the robotic arm–assisted group with patients in the human-assisted group through propensity score–matched analysis.ResultsIn wedge resection, a single surgeon was able to completely operate on all lobes of target lesions. However, for anatomical resections, namely segmentectomy, the success rate was 95%, and for lobectomy, the success rate was only 64%. No significant differences between setup times, blood loss, or operative times between the two groups were observed.ConclusionsWhen an experienced uniport surgeon is assisted by a robotic endoscope holder, wedge resection is the most suitable procedure to be performed through unisurgeon single-port video-assisted thoracoscopic surgery without increasing setup time, operative time, or short-term complications. Verification of the technique’s applicability for use in anatomic resections requires further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09054-8.

Minimally invasive arthroscopic surgery is a very challenging procedure that requires the manipulation of instruments in limited intraarticular space using distorted and sometimes uninformative images. Localizing the arthroscope reliably and at all times w.r.t. surrounding tissue is of fundamental importance to prevent unintended injury to patients. However, even highly-trained surgeons can struggle to localize the arthro-scope using poor image feedback. In this paper, we propose and demonstrate for the first time a visual Simultaneous Localisation and Mapping (SLAM) system, termed ArthroSLAM, capable of robustly and reliably localizing an arthroscope inside a human knee joint. The proposed system fuses the information obtained from the arthroscope, an external camera mounted on an arthroscope holder, and the odometry of a robotic arm manipulating the scope, in an Extended Kalman Filter framework. Also for the first time, we implement five alternative strategies for localization and compare them to our method in a realistic setup with a human cadaver knee joint. ArthroSLAM is shown to outperform the alternative strategies under various challenging conditions, localizing reliably and at all times with a mean Relative Pose Error of up to 1.4mm and 0.7°. Additional experiments conducted with degraded odometry data also validate the robustness of the method. An initial evaluation of the sparse map of a knee section computed by our method exhibits good morphological agreement. All results suggest that ArthroSLAM is a viable component for the robotic orthopedic surgical assistant of the future.