122 research outputs found
Clinical applications of Telerobotic ENT-Head and Neck surgery
No full textAbstractObjectiveTo review the published clinical data in Telerobotic ENT-Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development.MethodsA qualitative review was performed of publications in PubMed, Medline and the Cochrane Database identified from the following keyword searches: Telerobotic/Robotic ENT, Otorhinolaryngology, Head and Neck surgery, Thyroid and Parathyroid surgery. Preclinical studies and non-clinical review articles were excluded.ResultsForty-five publications were identified including 7 review articles. Transoral robotic surgery (TORS) was reported in 20 clinical studies, robotic-assisted thyroidectomy in 13 studies, parathyroidectomy in 4 studies and skull base surgery in 1 study. The majority of TORS publications relate to oropharyngeal malignancy which were Stage III and IV. Clinical benefits include avoidance or dose reduction of adjuvant chemoradiotherapy and improved swallow function. The primary clinical advantage of robotic-assisted neck surgery is the avoidance of a neck scar. The learning curve for robotic thyroidectomy is 50 cases. Body habitus is an important factor for assessment of robotic feasibility in transoral and neck surgery.ConclusionThe application of robotic-assisted parathyroidectomy, thyroidectomy and TORS suggests promising improvements in patient care. Randomised control trials are needed to assess clinical outcome, cost effectiveness and patient benefit in the existing applications. Continued development of robotic technology will expand the viable clinical applications in this specialty
An evaluation of emerging technologies in ENT - virtual reality simulation & robotic surgery
No full textVirtual reality (VR) simulation and robotic surgery represent two focus areas for research and development in Otolaryngology-Head & Neck Surgery. This thesis was driven by a desire to deliver improvements in surgical training and patient care. The development and long-term prospective clinical evaluation of three novel robotic applications in Head & Neck surgery were investigated. The results suggest that robotic assisted thyroidectomy and robotic assisted parathyroidectomy are safe, feasible alternatives to conventional surgery. The primary advantage is the avoidance of a neck scar. The approach occupies a niche role that is justified in patients who have cultural or biological drivers to avoid a neck scar. Improvement in surgical exposure was necessary. A novel soft-tissue retractor was designed and manufactured to address this issue. Transoral robotic surgery represents a promising treatment option for patients with obstructive sleep apnoea who cannot tolerate or fail all the other treatment modalities. Biometric measures represent an important tool when assessing patient suitability for TORS. Only those who have undergone appropriate training, proctoring and licensure should perform robotic surgery. Safe implementation is essential. The studies of VR temporal bone simulation served as a preparatory to introducing VR simulation for robotic head and neck surgery. The face, content and construct validation of a novel temporal bone simulator was demonstrated. Further studies were conducted to benchmark and pilot a VR skills curriculum and assess the role of case specific surgical rehearsal. Simulation training represented a useful adjunct. This body work demonstrates that both technologies can be integrated to deliver effective robotic surgical training to enhance surgical performance and improve patient care.Open Acces
Robotic head and neck surgery: history, technical evolution and the future
No full textThe first application of robotic technology in surgery was described in 1985 when a robot was used to define the trajectory for a stereotactic brain biopsy. Following its successful application in a variety of surgical operations, the da Vinci® robot, the most widely used surgical robot at present, made its clinical debut in otorhinolaryngology and head and neck surgery in 2005 when the first transoral robotic surgery (TORS) resections of base of tongue neoplasms were reported. Subsequently, the indications for TORS rapidly expanded, and they now include tumours of the oropharynx, hypopharynx, parapharyngeal space, and supraglottic larynx, as well as obstructive sleep apnoea (OSA). The da Vinci® robot has also been successfully used for scarless-in-the-neck thyroidectomy and parathyroidectomy. At present, the main barrier to the wider uptake of robotic surgery is the prohibitive cost of the da Vinci® robotic system. Several novel, flexible surgical robots are currently being developed that are likely to not only enhance patient safety and expand current indications but also drive down costs, thus making this innovation more widely available. Future directions relate to overlay technology through augmented reality/AR that allows real-time image-guidance, miniaturisation (nanorobots), and the development of autonomous robots
Clinical outcomes in relapsed oropharyngeal cancer after definitive (chemo)radiotherapy
No full textObjectives: To report clinical outcomes of relapsed oropharyngeal squamous cell carcinoma (OPSCC) after definitive intensity-modulated (chemo)radiotherapy [(C)RT].
Materials and methods: Data for all relapsed patients treated for OPSCC with definitive (C)RT between 2010-2016 was collected. Primary end-point was post-failure survival (PFS).
Results: Overall, 273 OPSCC patients completed definitive (C)RT. Of these, 42 cases (n = 26 human papilloma virus (HPV)-negative; n = 16 HPV-positive) had relapsed (n = 23 persistent disease; n = 19 recurrent disease) and were included in the final analysis. Two-year PFS for the entire population was 30.6%; 20.5% for HPV-negative and 43.8% for HPV-positive patients. Salvage curative surgery was associated with a significantly higher 2-year PFS rate (56.2%) compared to palliative treatment (22.9%) and best supportive care (0%) (p < 0.001). A positive trend in 2-year PFS was recorded in the early complete response cases (49.5%) versus patients who did not achieve a complete response within 3 months of the end of (C)RT (23.0%) (p = 0.11).
Conclusion: A higher PFS rate is achieved when relapsed OPSCC cases are treated with salvage curative intent. HPV-positive disease and early complete response within 3 months from the end of (C)RT may be related to better PFS
Tuning the optical properties of ZnO nanorods by variation of precursor concentration through hydrothermal method
No full textUnderstanding the Value involved in a Landlord-Tenant relation upon application of Circular economy: Qualitative study in the Netherlands
No full textThe concept of circular economy has gained popularity as an affordable and viable solution to housing problems, providing a cyclical alternative flow model that reuses materials. Despite the Netherlands being one of the first countries to move towards circular housing, implementation issues and a lack of motivation from some stakeholders remain. This study aims to identify the impact of circular economy on the relationship between landlords and tenants in the Dutch rental real estate market. By conducting a literature review and semi-structured interviews with industry experts and stakeholders, the study seeks to answer the research question: "How will circular rental real estate investment affect the relationship between tenants and landlords?" The study will add to the existing knowledge by establishing practical relevance in terms of costs and rent prices and creating awareness of the perceived value available in circular housing.Civil Engineering | Construction Management and Engineerin
Robotic parathyroid surgery: current perspectives and future considerations
No full textRobotic parathyroidectomy represents a novel surgical approach in the treatment of primary hyperparathyroidism when the parathyroid adenoma has been pre-operatively localised. It represents the "fourth generation" in the evolution of parathyroid surgery following a process of surgical evolution from cervicotomy and 4-gland exploration to a variety of minimally invasive, open and endoscopic, targeted approaches. The existing evidence (levels 2-3) supports it as a feasible and safe technique with equivalent results to targeted open parathyroidectomy for primary hyperparathyroidism in carefully selected patients. However, it takes longer to perform and is more costly than conventional parathyroidectomy. It offers superior cosmesis by completely avoiding a neck scar making it a valid option for those patients who for biological and/or cultural reasons may wish to avoid a neck scar. Robotic parathyroidectomy is not for every patient, surgeon, or hospital. Its application should be confined to high-volume centres and experienced surgeons. Intensive training and proctorship are required for its safe implementation combined with careful patient selection. This particularly relates to the patient's body habitus (BMI < 30 kg/m2) and concordance among the different imaging modalities used pre-operatively. With robotic market competition driving down costs, its role may change. For now, robotic parathyroidectomy occupies a niche role and can only be justified in a select subset of patients
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