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Raymond J. Leveillee - One of the best experts on this subject based on the ideXlab platform.
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Patient Positioning and Trocar Placement for Robotic Urologic Procedures
Robotic Urologic Surgery, 2011Co-Authors: Rajan Ramanathan, Robert I. Carey, Alvin Lopez-pujals, Raymond J. LeveilleeAbstract:Robotic-assisted laparoscopic urologic surgery is fast becoming established as a standard of care for many urologic diseases. As more experience and long-term follow-up of procedures is accumulating, the safety of robotic technology is becoming well established. In this chapter we wish to describe logistical issues pertaining to Patient Positioning for the two areas of commonly performed urologic operations: those in the pelvis (prostate/ureter/bladder), and those for the upper tract (kidney/ureter/adrenal), in and around the kidney. General principles of Patient Positioning and port placement will be described followed by specific examples of complex situations, and how to overcome them.
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Patient Positioning for Robotic Urologic Procedures
Robotic Urologic Surgery, 1Co-Authors: Robert I. Carey, Raymond J. LeveilleeAbstract:Advances in robotic-assistedlaparoscopic surgery have exponentially increased since the introduction of the da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA). “Robotic” surgery has become more prevalent in many centers of surgical excellence around the world. The radical retropubic prostatectomy for treatment of prostate cancer has become a focal point of experience for robotic-assisted operations in the pelvis. The most common robotic-assisted renal operation has been the dismembered pyeloplasty. Although necessary long-term follow-up of these procedures has not yet been achieved, it is becoming increasingly apparent that robotic technology is changing the standard of care for complex urologic procedures. In this chapter, we describe logistical issues pertaining to Patient Positioning for these two most commonly performed urologic operations. Emphasis will be placed on Patient and staff safety issues, ergonomics, and optimizing surgical exposure.
Jonathan M. Vigdorchik - One of the best experts on this subject based on the ideXlab platform.
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Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty.
The Journal of arthroplasty, 2016Co-Authors: Michael T. Milone, Ran Schwarzkopf, Patrick Meere, Kaitlin M. Carroll, Seth A. Jerabek, Jonathan M. VigdorchikAbstract:Abstract Background To our knowledge, no study has assessed the ability of rigid Patient Positioning devices to afford arthroplasty surgeons with ideal acetabular orientation throughout surgery. The purpose of this study is to use robotic arm–assisted computer navigation to assess the reliability of pelvic position in total hip arthroplasty performed on Patients positioned with rigid Positioning devices. Methods A prospective cohort of 100 hips (94 Patients) underwent robotic-guided total hip arthroplasty in the lateral decubitus position from the posterior approach, 77 stabilized by universal lateral positioner, and 23 by peg board. Before reaming, computed tomography–templated computer software generated true values of pelvic anteversion and inclination based on the position of the robot arm registered to the Patient's preoperative pelvic computed tomography. Results Mean alteration in anteversion and inclination values was 1.7° (absolute value, 5.3°; range, −20° to 20°) and 1.6° (absolute value, 2.6°; range, −8° to 10°), respectively. And 22% of anteversion values were altered by >10° and 41% by >5°. There was no difference between hip positioners used ( P = .36). Anteversion variability was correlated with body mass index ( P = .02). Conclusion Despite the use of rigid Patient Positioning devices—a lateral hip positioner or peg board—this study reveals clinically important malposition of the pelvis in many cases, especially with regard to anteversion. These results show a clear need to pay particular attention to anatomic landmarks or computer-assisted techniques to assure accurate acetabular cup Positioning. Patient Positioning should not be solely trusted.
Allston J. Stubbs - One of the best experts on this subject based on the ideXlab platform.
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Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation.
Arthroscopy techniques, 2015Co-Authors: Sandeep Mannava, Elizabeth A. Howse, Austin V. Stone, Allston J. StubbsAbstract:Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine Patient Positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for Patient Positioning and operative setup improves Patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases.
Lei Xing - One of the best experts on this subject based on the ideXlab platform.
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accuracy of surface registration compared to conventional volumetric registration in Patient Positioning for head and neck radiotherapy a simulation study using Patient data
Medical Physics, 2014Co-Authors: Ruijiang Li, Y Na, Lei XingAbstract:Purpose: 3D optical surface imaging has been applied to Patient Positioning in radiation therapy (RT). The optical Patient Positioning system is advantageous over conventional method using cone-beam computed tomography (CBCT) in that it is radiation free, frameless, and is capable of real-time monitoring. While the conventional radiographic method uses volumetric registration, the optical system uses surface matching for Patient alignment. The relative accuracy of these two methods has not yet been sufficiently investigated. This study aims to investigate the theoretical accuracy of the surface registration based on a simulation study using Patient data. Methods: This study compares the relative accuracy of surface and volumetric registration in head-and-neck RT. The authors examined 26 Patient data sets, each consisting of planning CT data acquired before treatment and Patient setup CBCT data acquired at the time of treatment. As input data of surface registration, Patient’s skin surfaces were created by contouring Patient skin from planning CT and treatment CBCT. Surface registration was performed using the iterative closest points algorithm by point–plane closest, which minimizes the normal distance between source points and target surfaces. Six degrees of freedom (three translations and three rotations) were used in both surface and volumetric registrations and the results were compared. The accuracy of each method was estimated by digital phantom tests. Results: Based on the results of 26 Patients, the authors found that the average and maximum root-mean-square translation deviation between the surface and volumetric registrations were 2.7 and 5.2 mm, respectively. The residual error of the surface registration was calculated to have an average of 0.9 mm and a maximum of 1.7 mm. Conclusions: Surface registration may lead to results different from those of the conventional volumetric registration. Only limited accuracy can be achieved for Patient Positioning with an approach based solely on surface information.
W Hsi - One of the best experts on this subject based on the ideXlab platform.
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SU-FF-J-36: Commissioning of a Six-Degree-Of-Freedom Robotic Patient Positioning System in a Proton Gantry
Medical Physics, 2006Co-Authors: C Allgower, Jonathan B. Farr, A Mascia, A Schreuder, W HsiAbstract:Purpose: To report on commissioning of a robotic Patient Positioning system with six degrees of freedom and three digital radiographic panels in a gantry for protonradiotherapy.Method and Materials: A new proton gantry with a robotic Patient positioner was commissioned in early 2006. The Patient Positioning “couch” is a Motoman UP200 industrial robot with six degrees of freedom. Image‐guided Patient Positioning is done with three digital radiographic panels and the DIPS software system. DIPS is in use elsewhere, but this was the first time it is used with three X‐Ray sources and panels instead of one or two. The beamline and gantry‐90 panels are mounted on retractable arms, and an additional gantry‐axis panel swings down from above the Patient and does not rotate with the gantry. We believe this was the first time an industrial robot was used for Patient Positioning in a proton gantry. The presentation includes in overview commissioning methods, which involve theodolites, room lasers, and testing with phantoms. Results: The Patient Positioning system meets tight clinical specifications demanded for protonradiotherapy. It is capable of correcting Patient position in all six degrees of freedom, namely position in X/Y/Z, pitch, roll, and rotation about the vertical. The first Patient treatment with this system will have taken place shortly prior to the 2006 AAPM meeting. Conclusion: This Patient Positioning system is unique, and provides greater degrees of freedom to adjust Patient position than conventional ones. It is early to judge its clinical performance just as it comes online, but we are optimistic about the outcome.