ROBOTICS
First robotic liver transplant in U.S. performed by Washington University surgeons
Groundbreaking surgery performed at Barnes-Jewish Hospital in St. Louis
IMAGE: TRANSPLANT SURGEON ADEEL KHAN, MD, CONTROLS A SURGICAL ROBOT. A SURGICAL TEAM FROM WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS LED BY KHAN RECENTLY PERFORMED THE FIRST ROBOTIC LIVER TRANSPLANT IN THE U.S. IN MAY AT BARNES-JEWISH HOSPITAL. view more
CREDIT: KATIE GERTLER/WASHINGTON UNIVERSITY
A surgical team from Washington University School of Medicine in St. Louis recently performed the first robotic liver transplant in the U.S. The successful transplant, accomplished in May at Barnes-Jewish Hospital, extends to liver transplants the advantages of minimally invasive robotic surgery: a smaller incision resulting in less pain and faster recoveries, plus the precision needed to perform one of the most challenging abdominal procedures.
The patient, a man in his 60s who needed a transplant because of liver cancer and cirrhosis caused by hepatitis C virus, is doing well and has resumed normal, daily activities. Typically, liver transplant recipients require at least six weeks before they can walk without any discomfort. The patient was not only walking easily one month after surgery but also cleared to resume golfing and swimming.
“The transplant was a success: The operation went smoothly, the new liver started working right away, and the patient recovered without any surgical complications,” said transplant surgeon Adeel Khan, MD, the leader of the team that conducted the trailblazing surgery. Khan is an associate professor of surgery at the School of Medicine. “Liver transplantation is one of the most complex abdominal operations and heavily relies on a specialized team for good outcomes. Here at Washington University and Barnes-Jewish Hospital, we are very fortunate to have the support needed to develop a world-class robotic-transplant team that allows us to safely perform complex operations. This team is a big part of our success.”
A liver transplant traditionally is performed as an “open” procedure, with a surgeon making a 3- to 4-inch vertical and 12- to 16-inch horizontal incision just below the rib cage to remove a patient’s diseased liver and place the healthy donated liver. There has been a push by transplant surgeons to shift the procedure to one that is minimally invasive – with smaller incisions that typically result in less pain and faster recoveries. Yet, most transplant surgeries have been thought to be too complicated for a minimally invasive approach – whether performed laparoscopically or robotically — and liver transplants are particularly challenging. Diseased livers are prone to excessive bleeding during surgery to remove them, and attaching the new liver to the patient’s circulatory system requires delicately sewing several tiny blood vessels together.
Robotic surgeries are a kind of minimally invasive surgery. Surgeons maintain complete control of the robot’s tools and perform the operations remotely — usually just a few feet away from the patient — using joystick-like controls. High-resolution cameras provide a magnified, 3D view of the surgical site viewable via a large monitor. The high-tech instrumentation allows for very precise, fine manipulations that would be impossible using traditional techniques.
For this robotic liver transplant, the surgeons operated through several half-inch keyhole incisions and made a single 6-inch vertical incision between the abdominal muscles for removing the diseased organ and placing the new liver, which is about the size of a football, inside the abdomen. This incision is considerably smaller than the one used traditionally and does not require cutting through abdominal muscles, enabling a faster recovery.
While the patient’s physical recovery has been on schedule, he did require extra time in the hospital due to cognitive symptoms that are not unusual in older patients after major surgery.
The robotic liver transplant took just over eight hours — on the high end but within the expected time frame for traditional open liver transplants, which usually take six to eight hours. Future robotic liver transplants likely will be completed faster as the OR team gains experience and gets more used to the subtleties of the new surgical technique, Khan said.
A South Korean team reported the first robotic liver transplant in the world in 2021. That surgery involved transplanting half a liver from a living donor instead of the whole organ, and the surgery was partially robotic; the diseased liver was removed laparoscopically and the new liver implanted robotically. Khan said his team is the first to perform a robotic liver transplant in which a whole liver was transplanted.
“Liver transplantation is the most difficult of the abdominal organs to consider for a minimally invasive approach — given the difficulty of removing a failing liver and successfully implanting the new organ — but Dr. Khan has shown that this is possible,” said William Chapman, MD, the Eugene M. Bricker Professor of Surgery, director of Washington University’s Division of General Surgery and chief of the transplant surgery section. “Further experience with this technique will be needed to establish the extent of the benefits of performing liver transplant as a minimally invasive approach.”
Washington University and Barnes-Jewish Hospital have focused heavily on robotic surgery as part of a concerted effort to advance minimally invasive surgeries and improve patient outcomes. The robotic transplant team was formed five years ago, with an initial focus on kidney transplants. To date, the team has performed more than 30 robotic kidney transplants, all with good outcomes. The team also performs living-donor kidney removal surgery, and other robotic surgeries involving the liver, bile ducts, pancreas and stomach.
“Over the span of several years, we have built a dedicated robotic transplant team that is second to none and has been instrumental to our success,” Khan said. “Once we had this team in place, it allowed us to grow in both number and complexity of the cases while maintaining very good patient outcomes. We have five surgeons on the transplant service doing robotic surgery, and this number will increase to seven by the end of the summer. Since starting our program, we have mentored over 30 transplant centers around the country in building successful robotic programs of their own. Transplant teams from other centers come to observe our process, and we also visit their sites and mentor them as they develop their skills. We are probably one of the very few places in the country that has the support, expertise and team to take robotic transplant surgery to this level.”
Robotics: New skin-like sensors fit almost everywhere
Automated production for different objects
Peer-Reviewed Publication“Detecting and sensing our environment is essential for understanding how to interact with it effectively,” says Sonja Groß. An important factor for interactions with objects is their shape. “This determines how we can perform certain tasks,” says the researcher from the Munich Institute of Robotics and Machine Intelligence (MIRMI) at TUM. In addition, physical properties of objects, such as their hardness and flexibility, influence how we can grasp and manipulate them, for example.
Artificial hand: interaction with the robotic system
The holy grail in robotics and prosthetics is a realistic emulation of the sensorimotoric skills of a person such as those in a human hand. In robotics, force and torque sensors are fully integrated into most devices. These measurement sensors provide valuable feedback on the interactions of the robotic system, such as an artificial hand, with its surroundings. However, traditional sensors have been limited in terms of customization possibilities. Nor can they be attached to arbitrary objects. In short: until now, no process existed for producing sensors for rigid objects of arbitrary shapes and sizes.
New framework for soft sensors presented for the first time
This was the starting point for the research of Sonja Groß and Diego Hidalgo, which they have now presented at the ICRA robotics conference in London. The difference: a soft, skin-like material that wraps around objects. The research group has also developed a framework that largely automates the production process for this skin. It works as follows: “We use software to build the structure for the sensory systems,” says Hidalgo. “We then send this information to a 3D printer where our soft sensors are made.” The printer injects a conductive black paste into liquid silicone. The silicone hardens, but the paste is enclosed by it and remains liquid. When the sensors are squeezed or stretched, their electrical resistance changes. “That tells us how much compression or stretching force is applied to a surface. We use this principle to gain a general understanding of interactions with objects and, specifically, to learn how to control an artificial hand interacting with these objects,” explains Hidalgo. What sets their work apart: the sensors embedded in silicon adjust to the surface in question (such as fingers or hands) but still provide precise data that can be used for the interaction with the environment.
New perspectives for robotics and especially prosthetics
“The integration of these soft, skin-like sensors in 3D objects opens up new paths for advanced haptic sensing in artificial intelligence,” says MIRMI Executive Director Prof. Sami Haddadin. The sensors provide valuable data on compressive forces and deformations in real time – thus providing immediate feedback. This expands the range of perception of an object or a robotic hand – facilitating a more sophisticated and sensitive interaction. Haddadin: “This work has the potential to bring about a general revolution in industries such as robotics, prosthetics and the human/machine interaction by making it possible to create wireless and customizable sensor technology for arbitrary objects and machines.”
Further information
- Scientific video showing the entire process: https://www.youtube.com/watch?v=i43wgx9bT-E
- Sonja Groß and Diego Hidalgo are currently serving as research associates and leading authors of the paper “Soft Sensing Skin for Arbitrary Objects: An Automatic Framework” at the Munich Institute of Robotics and Machine Intelligence (MIRMI), TUM. Working alongside them are senior scientists Dr.-Ing. Amartya Ganguly and Dr.-Ing. Abdeldjallil Naceri, who bring their extensive expertise to contribute to the research conducted at MIRMI. With MIRMI, TUM has created an integrative research centre for science and technology to develop innovative and sustainable solutions for key challenges of our time. Led by Prof. Sami Haddadin as Executive Director, the institution has leading expertise in key areas of robotics, perception and data science. More information: https://www.mirmi.tum.de/.
Additional editorial information:
Photos for download: http://go.tum.de/679599; http://go.tum.de/838963; http://go.tum.de/816901; http://go.tum.de/289008
METHOD OF RESEARCH
Case study
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Soft Sensing Skin for Arbitrary Objects: An Automatic Framework
No comments:
Post a Comment