Abstract
Background
We evaluated a robotic telesurgical platform in managing thoracic trauma in an animal model.
Study design
The da Vinci® robot was used to evaluate and treat a random number of blinded injuries in ten porcine thoraces.
Results
Ninety-five percent of injuries were correctly identified. The median survey time was 20.5 min (range 16–63 min). The mean time to repair lung lacerations was 19.8 min (range 14–27.5 min) and to evacuate the hemothoraces, it was 5.3 min (range 4.5–6.5 min). Diaphragmatic lacerations required repositioning of the ports and the robot. Only two out of five lacerations were successfully repaired (mean time 38.8 min, range 32.5–45 min). All aortic injuries were correctly identified. One subject died of a pre-existing pneumonia.
Conclusions
A robotic telesurgical approach to the evaluation of stable thoracic trauma patients is safe and feasible in a porcine model. Diaphragmatic injuries can be repaired but require repositioning of the robot.
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References
Bellamy RF, Maningas PA, Vayer JS. Epidemiology of trauma: military experience. Ann Emerg Med. 1986;15:1384–8.
Bellamy R, Safar P, Tisherman SA, Basford R, Bruttig SP, Capone A, Dubick MA, Ernster L, Hattler BG Jr, Hochachka P, Klain M, Kochanek PM, Kofke WA, Lancaster JR, McGowan FX Jr, Oeltgen PR, Severinghaus JW, Taylor MJ, Zar H. Suspended animation for delayed resuscitation. Crit Care Med. 1996;24(2 Suppl):S24–47.
Green PS, Hill JW, Jensen JF, Shah A. Telepresence surgery. IEEE Eng Med Biol. 1995;14:324–9.
Bowersox JC, Cordts PR, LaPorta AJ. Use of an intuitive telemanipulator system for remote trauma surgery: an experimental study. J Am Coll Surg. 1998;186:615–21.
Ficarra V, Cavalleri S, Novara G, Aragona M, Artibani W. Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol. 2007;51(1):45–55.
Rassweiler J, Safi KC, Subotic S, Teber D, Frede T. Robotics and telesurgery—an update on their position in laparoscopic radical prostatectomy. Minim Invasive Ther Allied Technol. 2005;14(2):109–22.
Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M. The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc. 2006;20(9):1389–93.
Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc. 2002;16:1389–402.
McClure RS, Kiaii B, Novick RJ, Rayman R, Swinamer S, Kodera K, Menkis AH. Computer-enhanced telemanipulation in mitral valve repair: preliminary experience in Canada with the da Vinci robotic system. Can J Surg. 2006;49(3):193–6.
Meehan JJ, Elliott S, Sandler A. The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg. 2007;42:2110–4.
Abolhoda A, Livingston DH, Donahoo JS, Allen K. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg. 1997;12(3):356–60.
Manlulu AV, Lee TW, Thung KH, Wong R, Yim AP. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004;25(6):1048–53.
Pickard LR, Mattox KL. Thoracic trauma and indications for thoracotomy. In: Mattox KL, Moore EE, Feliciano DV, editors. Trauma. Norwalk: Appleton and Lange; 1980. p. 315–20.
Prabhakar G, Graeber G. Chest Trauma. In: Yim APC, Hazelrigg SR, Izzat MB, Landreneau RJ, Mack MJ, Naunheim KS, editors. Minimal access cardiothoracic surgery. London: WB Saunders; 2000. p. 308–15.
Beall AC Jr, Bricker DL, Crawford HW, Noon GP, De Bakey ME. Considerations in the management of penetrating thoracic trauma. J Trauma. 1968;8:408–17.
Beall AC Jr, Crawford HW, De Bakey ME. Considerations in the management of acute traumatic hemothorax. J Thorac Cardiovasc Surg. 1966;52:351–60.
Coselli JS, Mattox KL, Beall AC Jr. Reevaluation of early evacuation of clotted hemothorax. Am J Surg. 1984;148:786–90.
Culiner MM, Roe BB, Grimes OF. The early elective surgical approach to the treatment of traumatic hemothorax. J Thorac Cardiovasc Surg. 1959;38:780–97.
Milfeld DJ, Mattox KL, Beall AC Jr. Early evacuation of clotted hemothorax. Am J Surg. 1978;136:686–92.
Ochsner MG, Rozycki GS, Lucente F, Wherry DC, Champion HR. Prospective evaluation of thoracoscopy for diagnosing diaphragmatic injury in thoracoabdominal trauma: a preliminary report. J Trauma. 1993;34:704–10.
Sosa JL, Pombo H, Puente I, Sleeman D, Ginzburg E, McKinney M, Martin L. Thoracoscopy in the evaluation and management of thoracic trauma. Int Surg. 1998;83:187–9.
Pons F, Lang-Lazdunski L, de Kerangal X, Chapuis O, Bonnet PM, Jancovici R. The role of videothoracoscopy in management of precordial thoracic penetrating injuries. Eur J Cardiothorac Surg. 2002;22:7–12.
Lang-Lazdunski L, Mouroux J, Pons F, Grosdidier G, Martinod E, Elkaïm D, Azorin J, Jancovici R. Role of videothoracoscopy in chest trauma. Ann Thorac Surg. 1997;63:327–33.
Alexander AD. Impacts of telemation on modern society. In: Proceedings of the First CISM-ITOMM Symposium. 1972; vol. 1, p. 121–36.
Rayman R, Croome K, Galbraith N, McClure R, Morady R, Peterson S, Smith S, Subotic V, Van Wynsberghe A, Primak S. Long-distance robotic telesurgery: a feasibility study for care in remote environments. Int J Med Robot. 2006;2(3):216–24.
Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK. Transatlantic robot-assisted telesurgery. Nature. 2001;413:379–80.
Rayman R, Croome K, Galbraith N, McClure R, Morady R, Peterson S, Smith S, Subotic V, Van Wynsberghe A, Patel R, Primak S. Robotic telesurgery: a real-world comparison of ground- and satellite-based internet performance. Int J Med Robot. 2007;3:111–6.
Anvari M, McKinley C, Stein H. Establishment of the world’s first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community. Ann Surg. 2005;241:460–4.
Butner S, Ghodoussi M. Transforming a surgical robot for human telesurgery. IEEE Trans Robot Autom. 2003;19:818–24.
Anvari M, Broderick T, Stein H, Chapman T, Ghodoussi M, Birch DW, McKinley C, Trudeau P, Dutta S, Goldsmith CH. The impact of latency on surgical precision and task completion during robotic-assisted remote telepresence surgery. Comput Aided Surg. 2005;10(2):93–9.
Hanley EJ, Miller BE, Herman BC, Marohn MR, Broderick TJ, Shih SP, Sterbis JR, Doarn CR, Harnett B, Hasser CJ, Talamini MA, Meireles O, Moses GR, Marchessault R, Schenkman NS. Remote stereoscopic robotic telesurgery using the public internet. In: Abstracts of the 10th World Congress of Endoscopic Surgery and the 14th International Congress of the European Association for Endoscopic Surgery, Berlin, Germany, 13–16 September 2006. Surg Endosc. 2007;21(Suppl 13):S1–294.
Rayman R, Primak S, Patel R, Moallem M, Morady R, Tavakoli M, Subotic V, Galbraith N, van Wynsberghe A, Croome K. Effects of latency on telesurgery: an experimental study. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2005;8(Pt 2):57–64.
Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skill via an innovative “bench station” examination. Am J Surg. 1997;173(3):226–30.
Rothlin MA, Schob OM, Schlumpf R. Telepresence for the laparoscopic surgeon. In: Zucker KA, editor. Surgical laparoscopy. 2nd ed. New York: Lippincott, Williams & Wilkins; 2001. p. 797–802.
Satava RM, Jones SB. Preparing surgeons for the 21st century. Implications of advanced technologies. Surg Clin North Am. 2000;80:1353–65.
Zajtchuk R, Sullivan GR. Battlefield trauma care: focus on advanced technology. Mil Med. 1995;160:1–7.
Lee AL, Inculet RI, Fortin D, Malthaner RA. Video assisted thoracic surgery lobectomy—total endoscopic/closed chest dissection: technique and initial results. Can J Surg. 2006;49:29. Abstract #74.
Acknowledgments
The expertise of Ms. Sherri Van Lingen, Mr. Dave Harrison, Mr. Dave Browning, and the staff at CSTAR was invaluable in the conduction of these experiments. Supported by the Lawson Health Research Institute Internal Research Fund #IRF-094-04.
Conflict of interest
The authors did not receive financial, property, or intellectual aid from any commercial source. The authors had full control of the design of the study, methods used, outcome parameters, analysis of data, and production of the written report.
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Originally presented as a poster at the Canadian Association of Thoracic Surgeons (CATS) Canadian Surgical Forum, Halifax, Nova Scotia, Canada, 13 September 2008.
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Bhatia, P.D., Bottoni, D.A. & Malthaner, R.A. Telesurgical evaluation of stable thoracic trauma patients: a feasibility study. Eur J Trauma Emerg Surg 37, 297–303 (2011). https://doi.org/10.1007/s00068-011-0094-5
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DOI: https://doi.org/10.1007/s00068-011-0094-5