Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_537_Библиотеки_им_академика_М_И_Перельмана
.pdf
Fig. 10 Color-coded cutting sections (bottom image) with the associated regions placed in the
mandibular area on the top right image and the CT scan on the top left image
Finalized preplanning stage can be viewed in a 3D setting with the
associated placement of color-coded bone segments placed within the
mandibular segments, as can be seen in Fig. 11.
Fig. 11 3D view of reconstruction displayed in Fig. 10
https://t.me/medicina_free
In this application, a fibular osteotomy planning algorithm is presented
in [10] to plan fibular. The motion path of the robotic arm displayed in Fig.
9 follows the planned osteotomy planes with the automatic fibula
osteotomy completed under optical navigation. This surgical planning was
performed on 35 patients, and the authors achieved precision and
convenient preoperative planning. Safety and reliability of the osteotomy
trajectory are also other positive aspects observed. The associated system
used for the robotic application is displayed in Fig. 12 [10].
Fig. 12 An integrated technological robotic system that incorporates a robot and an Northern Digital
Inc. (NDI) tracker
Robotics is used during free flap reconstruction of head and neck
surgery in [32]. Extirpation of oropharyngeal tumors safely without the
need for lip-split incision or mandibulotomy is possible by using robotics;
therefore, use of robotics as a part of oropharyngeal reconstruction for
tumor excision is feasible. The authors investigated the effectiveness of
robotics use of head and neck cancer patients that underwent ablation
surgery and free-flap reconstruction. Patient demographics, location of the
tumor, pathologic stage, reconstruction methods, flap size, recipient vessel,
necessary pedicle length, and operation time are collected and investigated
in the five cases that were performed by the surgeons. Four radial forearm
free flaps and one anterolateral thigh free flap were performed. The authors
demonstrated the clinical applicability of robotics use in oropharyngeal
reconstruction, especially using a free flap. It is concluded that a robot can
https://t.me/medicina_free
assist the operator in insetting the flap at a deep portion of the oropharynx
without the need to perform a traditional mandibulotomy. Complications
including flap necrosis, hematoma, and wound dehiscence did not occur
[32].
6 Robotics and Facelift Plastic Surgery
Facelift, which is also known as rhytidectomy, is a surgical procedure for
rejuvenation of the face. The goal is to restructure face appearance and its
consequent antiaging effect by stretching the skin and the muscles of the
face along with the removal or insertion of fat as necessary [19].
Research and literature results reported on robotics applications for
facelift use are limited. One important aspect of the expected outcome from
the application is the cosmetics of the postoperative design. Procedures that
can be followed for local resection in malignant mandibular pathologies
include lip-split, angle-split, or visor flap incision with extension of the
incision into the neck for performing neck dissection. Data are collected
from three patients in [12] that had undergone robotics-assisted facelift
surgeries in India. Robotics assistance is used for neck dissection with a
modified facelift approach followed for achieving oncological safe
resections with good cosmesis by the authors. The skin incision was
planned such that a visible scar can be avoided. The analysis is conducted
by using primary, functional, and aesthetic outcomes’ data and bone defect
length. A 6-month follow-up with the patients indicated their satisfaction
with the aesthetic outcomes and functional results. The authors concluded
the robotics-assisted surgical method’s effectiveness for fulfilling cosmetic
satisfaction without compromising oncological outcomes.
Various surgical procedures have been performed in patients with
branchial cleft cysts, including transcervical, transcervical-transparotid,
transcervical-transmandibular, video-assisted trans-sternocleidomastoid
vertical muscle approach, endoscopic surgery, and robot-assisted surgery.
Branchial cleft cysts may require facelift of patients. From the cosmetic
point of view, endoscopic or robot-assisted surgery also have merit;
however, the facelift procedure does not require any special equipment and
devices. The facelift procedure has socioeconomic and technical advantages
over endoscopic or robot-assisted surgery [19].
https://t.me/medicina_free
There is also facelift approach to thyroidectomy that we don’t cover
here and leave it to the readers to discover in examples of articles that cover
the associated content such as [164–166].
7 Hair Transplantation and Robotics
Follicular unit extraction (FUE) and follicular unit transplantation (FUT)
are the two hair procedures performed, with FUE being the most commonly
performed procedure [167, 168]. Introduction of robotics improved the
manual application of FUE from precision and speed perspectives [19];
details of robotics use as a part of hair transplantation will be covered in
this section using a particular robotic system. One of the robotic systems
widely used for hair transplantation is ARTAS® (by ©Neidel), which is
displayed in Fig. 13 [169].
Fig. 13 ARTAS® used for hair transplantation (©Neidel) with patient chair
ARTAS robotic system has an adjustable patient chair, a robotic arm, a
control screen, and a computer workstation with a mobile and movable
https://t.me/medicina_free
nature. Robot’s functionality is internet access dependent. All data are
monitored, collected, and stored by the system. The robot has highresolution cameras and sensors installed for scanning of the treatment area.
The system is capable of calculating the hair group quantity, pattern and
quantity of the distribution, and hair length data. The dynamic changes are
displayed that are attained from the scanned area. During the punching
process, a sharp needle rotates through the surface of the skin, which is
followed by the push of a blunt sleeve over the sharp needle, which is then
penetrating the depth up to the level of the hair bulb [169]. This process
does not impact the hair root shaft or the hair bulb.
Resistance sensors are used for determining the depth of sharp and blunt
needles’ penetration. Drilling angle is also calculated by the system during
the penetration. One of the advantages of the automation is the real-time
readjustment of the parameters automatically. It is possible for the doctor to
manually adjust the robotic system; however, such interference is
recommended to only advanced users of the system [169]. Fixation of the
robot is essential during the setup of the process. The doctor determines the
appropriate needle size prior to the robotic surgical procedure; patients with
very dense and stable hair, such as dark-haired patients, require the use of
very fine 20-Gauge needles. Collection kits 18 and 19 are most widely used
in applications.
The treatment chair is designed to meet the needs of the range of the
robot’s reachability.
As a part of lean application, the position of the chair can be marked on
the floor. The cameras of the robotic system should be able to capture the
fine target points such as follicular units. To tighten the skin, an orientation
frame (“frame”) is inserted into the stunned area with the manual guidance
of the robot to this area. The location of the head is fixed with the fixation
of the frame on the head rind with (silicone) cords. The procedure starts
after the completion of autofocusing by the doctor.
Bleeding can occur if a patient stays longer than 2h in the robot chair
due to impatience of the patient. Local anesthetics may have to be injected
one more time in such a setting. Reliable setting adjustments are
automatically accomplished by the robot, including sharp and blunt punch
depth and punch angle. Setting adjustments are also made by the system as
the tissue setting changes therefore the default settings work well.
Impatience of the patient impacts the punching process and slows the
https://t.me/medicina_free
robot’s work. Calmness of the patient impacts the operating time of the
robotic system; faster heartbeat of the patient prolongs the working time
therefore calming the patient is an important part of the procedure.
The receiver channels for the follicular units can be produced
automatically which depends on the version of the robot. One important
advantage of an automated system is its ability to automatically analyze
certain aspects of the procedure. Follicular unit distribution area and count
of the punched units are automatically calculated by the robotic system.
Usable transplant and punched unit numbers are expected to be the same
under ideal conditions. Transplants with a lot of surrounding tissue are
obtained through the combined punching process that has an important role
in the survival of the hair roots. The robot is determined to deliver relatively
good hair root transplants with consistency when compared to other
methods. One other advantage of robotics use is the rareness of serious
complications in robot-assisted hair transplantation. Only operational side
effects have been observed with a suitable treatment within 2weeks [169].
Figure 14 is the Artas robotic system as a stand-alone unit. Additional
examples of robotic hair transplantation systems include the following:
Sunetics clinical laser system
Smartgraft
Restoration robotics
Venus
https://t.me/medicina_free
Fig. 14 Two different versions of the Artas robotic system used for hair transplantation
Another study that investigated the effectiveness of robotic surgery for
hair transplantation is explained in [170]. Similar to the improvement points
made in [169], the authors determined the usefulness of robotics during hair
transplantation, which allowed time savings and minimal invasiveness. The
importance of experienced staff is also mentioned in the article. Additional
and similar investigations are outlined in [170–175].
8 Conclusions and Future Work
Advancement of robotics and the associated technologies have come along
a long way for engineering plastic surgical procedures just like the
technologies and procedures outlined in [14, 18, 28, 33, 46, 135, 143–148,
160, 193–202]. Technologies incorporated into facial plastic surgeries in
addition to 3D printing and robotics included augmented reality, virtual
https://t.me/medicina_free
reality, simulation software, CT scan images, machine learning, deep
learning, artificial intelligence, cameras, sensors, laser technologies, and
software used for advanced data analysis. These technologies also impacted
the training of the surgeons and assistants in addition to the increased
personnel need for technicians for setting up robots. Robots such as da
Vinci require training of surgeons, and the associated staff experience is
essential for successful surgical outcomes as outlined throughout this work.
There are other robotics-associated advancements that are emerging,
and it wouldn’t be surprising to see them in the near future as a part of
facial plastic surgeries. Such technologies include soft robotics and nanoscaled robots. While soft robotics is used in several head and neck
surgeries, to the best of our knowledge, such robots are not used for plastic
surgeries for cosmetic purposes. Incorporation of these technologies into the
rehabilitation of patients as well as surgical procedures would be potential
advancements in this field of research and applications.
One other important aspect of robotics applications that we see a need
for improvement is rehabilitation before and after surgical procedures. As
outlined in [180–191], psychological well-being of plastic surgery patients
may prevent them from going through facial plastic surgeries if there isn’t a
necessity for the surgery. Robotics can be used for treating patients prior to
plastic surgeries, which may prevent them from undertaking plastic
surgeries; we invite researchers to invest in this area of research and
determine the effectiveness of robots for such applications.
Advancements in camera technologies can also be incorporated into
robotics in order to advance the surgical outcomes of facial plastic
surgeries. For instance, a facial landmark-guided surface matching method
for image-to-patient registration using an RGB-D camera is developed in
[25]. Five facial landmarks are localized from preoperative MR images by
the authors by using deep learning and RGB image using Adaboost with
multiscale block local binary patterns. The accuracy of the developed
noninvasive method is determined to be comparable with the state-of-theart similar technologies and helpful with time savings.
In addition, advancements in microsurgery that evolved super
microsurgery enabled advancements in surgical procedures. One example of
a robot is the world’s first dedicated robotic platform for
(super)microsurgery, named MicroSure’s MUSA (MicroSure, Eindhoven,
The Netherlands) [192]. This robot is designed to improve the stabilization
https://t.me/medicina_free
of movements of microsurgeons by filtering tremors and scaling down
motions. The robot is easy to maneuver, equipped with arms holding
surgical instruments that are compatible with conventional surgical
microscopes. Preclinical tests and clinical case series with MUSA have
confirmed the safety and feasibility of this robot in performing
microsurgical anastomosis.
There are improvements in the microsurgical techniques that can be
integrated into robotics that would allow tissue transfer improvement to
range from 96% to 100% [19]. Additional improvement opportunities in
applications include development of smartphone apps that may
revolutionize free flap monitoring [6] and employment of software use for
presurgical planning and flap design guided by dedicated software [30].
Some of the failures in robotics applications in surgical procedures are
determined to be careful planning, staff training, and issues that may arise
associated with the robot such as internet connection and optical tracker.
Smartphone applications and advancements in cameras, sensors, AI, etc.
can further advancement of facial plastic surgeries.
Given the most recent developments in nanorobotics, it wouldn’t be
surprising to see them taking place in facial plastic surgeries. One potential
application of such technology can be posttreatment of patients for
structural surface design. Integration of nano-scaled robots with AI would
be not surprising to see in applications. We strongly recommend integrating
psychological treatments and robotics for the well-being of surgical
candidates, which may help them to prevent from undertaking plastic
surgeries.
References
1. Naujokat, H., Spille, J., Bergholz, R., Wieker, H., Weitkamp, J. T., & Wiltfang, J. (2022).
Robot-assisted scaffold implantation and two-stage flap raising of the greater omentum for
reconstruction of the facial skeleton: Description of a novel technique. The International
Journal of Medical Robotics and Computer Assisted Surgery, 18(5), e2429.
2. Albergotti, W. G., Byrd, J. K., Nance, M., Choi, E. C., Koh, Y. W., Kim, S., et al. (2016).
Robot-assisted neck dissection through a modified facelift incision. The Annals of Otology,
Rhinology, and Laryngology, 125, 123–129.
3. Park, Y. M., Lee, W. J., Yun, I. S., et al. (2013). Free flap reconstruction after robot-assisted
neck dissection via a modified face-lift or Retroauricular approach. Annals of Surgical
Oncology, 20, 891–898.
https://t.me/medicina_free
4.
Silverman, D. A., Birkeland, A. C., & Bewley, A. F. (2022). Oropharyngeal reconstruction after
transoral robotic surgery. Current Opinion in Otolaryngology & Head and Neck Surgery, 30(5),
384–391.
5. Lin, L., Sun, M., Xu, C., Gao, Y., Xu, H., Yang, X., et al. (2022). Assessment of robot-assisted
mandibular contouring surgery in comparison with traditional surgery: A prospective, singlecenter, randomized controlled trial. Aesthetic Surgery Journal, 42(6), 567–579.
6. Konczalik, W., Nikkhah, D., & Mosahebi, A. (2017). Applications of smartphone thermal
camera imaging system in onitoring of the deep inferior epigastric perforator flap for breast
reconstruction. Microsurgery, 37, 457–458. https:// doi. org/ 10. 1002/ micr
[Crossref]
7. Won, J., Hong, J. W., Kim, M. J., Yun, I. S., Baek, W. Y., Lee, W. J., et al. (2022). Methodology
in conventional head and neck reconstruction following robotic cancer surgery: A bridgehead
robotic head and neck reconstruction. Yonsei Medical Journal, 63(8), 759.
8. Lin, L., Shi, Y., Tan, A., Bogari, M., Zhu, M., Xin, Y., et al. (2016). Mandibular angle split
osteotomy based on a novel augmented reality navigation using specialized robot-assisted arms
—A feasibility study. Journal of Cranio-Maxillofacial Surgery, 44(2), 215–223.
9. Shi, Y., Lin, L., Zhou, C., Zhu, M., Xie, L., & Chai, G. (2017). A study of an assisting robot for
mandible plastic surgery based on augmented reality. Minimally Invasive Therapy & Allied
Technologies, 26(1), 23–30.
10. Guo, Y., Xu, W., Tu, P., Han, J., Zhang, C., Liu, J., & Chen, X. (2022). Design and
implementation of a surgical planning system for robotic assisted mandible reconstruction with
fibula free flap. International Journal of Computer Assisted Radiology and Surgery, 1, 1–13.
11. Sun, T., Lei, B., Zhong, Y., Chen, Z., & Yang, B. (2022). Accuracy and security analysis of a
Cranio-maxillofacial plastic surgery robot equipped with Piezosurgery in Genioplasty. The
Journal of Craniofacial Surgery.
12. Rao, V., Subash, A., Sinha, P., Prasad, R., Majumdar, K., & Puranik, P. (2020). Modified
facelift approach for posterior segmental mandibulectomy: A blend of oncology and cosmesis.
European Archives of Oto-Rhino-Laryngology, 277(4), 1205–1210.
13. Morris, M. X., Rajesh, A., Asaad, M., Hassan, A., Saadoun, R., & Butler, C. E. (2022). Deep
learning applications in surgery: Current uses and future directions. The American Surgeon.
00031348221101490.
14. Sosa, D., Carola, N., Levitt, S., Patel, V., & Tokgöz, E. (2023). Surgical approaches used for
total knee arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3-031-31099-7.
15. Miloro, M. (2004). In G. E. Ghali, P. E. Larsen, & P. D. Waite (Eds.), Peterson’s principles of
oral and maxillofacial surgery (Vol. 1, p. 37). BC Decker.
16. Eldaly, A. S., Avila, F. R., Torres-Guzman, R. A., Maita, K., Garcia, J. P., Palmieri Serrano, L.,
& Forte, A. J. (2022). Simulation and artificial intelligence in rhinoplasty: A systematic review.
Aesthetic Plastic Surgery, 10, 1–10.
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана