Last week we introduced our newest partner company, DectronUSA, manufacturer of articulated arms for use in a variety of industries. Far more than just monitor stands, Dectron also makes arms for use in medical settings. While putting last week’s article together, we came across a paper published in the National Library of Medicine about a medical procedure that was being pioneered at the time which made use of a Dectron articulated positioning arm.
The paper describes an innovative, hand-manipulated robotic system designed to enhance transurethral laser prostate surgery, specifically focusing on the holmium laser enucleation of the prostate (HoLEP) procedure. This system overcomes one of the primary challenges to surgeons when performing this clinically superior and technically demanding operation; clinically superior because it is minimally invasive to the patient, thereby reducing discomfort, risk of infection and recuperation time.
The robotic device integrates two concentric tube manipulators with a standard clinical endoscope and articulated arm from our partner, DectronUSA, creating a hand-held, counterbalanced configuration. This design allows the system to fit easily into existing clinical workflows, so that surgeons can maintain direct manual control over endoscope positioning while simultaneously controlling the manipulators through thumb and finger motions.
The system’s user interface module houses nine brushless motors and a transmission section that converts motor rotation into tube translation and rotation. The endoscope is equipped with fiber optic bundles for illumination, and a custom plastic tube separator at the tip constrains the exit axes of the manipulators. The Dectron spring-balanced positioning arm provides passive gravity compensation, so that the system is stabile and reduces fatigue to the surgical operator.
The primary clinical application of this robotic system is to facilitate the HoLEP procedure for treating benign prostatic hyperplasia (BPH). HoLEP offers significant clinical benefits over traditional methods, including a 50% reduction in catheterization time, a 33% decrease in hospitalization duration, and the elimination of blood transfusion requirements. Despite these advantages, HoLEP was rarely performed due to its technical difficulty. The robotic system makes this procedure much more accessible by providing independent control of the two articulated arms—one for tissue manipulation and retraction and the other for precise laser fiber aiming.
The study highlights several key innovations, including the introduction of the first hand-held robot specifically designed for transurethral prostate surgery and the novel use of field-of-view reachability as an optimization criterion for selecting tube parameters. Experimental findings from phantom and cadaver trials demonstrated the system’s effectiveness, with successful completion of prostate lobe resections and improved accuracy for surgeons using task space control compared to joint space control.
The implications of the robotic system trial extended beyond technical advancements; it had a significant impact on the field of Urology. By expanding access to a clinically superior procedure, reducing healthcare costs through shorter hospital stays and fewer re-operations, and improving patient outcomes in BPH treatment, the technology created new opportunities for medical device manufacturers and healthcare providers not to mention consistent superior outcomes for patients.
This advancement in robotic surgical systems utilizing Dectron articulating arm technology was an important advancement in minimally invasive prostate surgery. By addressing the technical challenges associated with HoLEP, it made a clinically superior procedure more widely available, benefiting patients, healthcare providers, and medical technology companies alike. The authors of the study emphasized that this system not only enhanced the feasibility of performing HoLEP but also contributed to the ongoing evolution of surgical robotics in the field of urology.
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