`UT@TA @@@ @@@@!! l=ST@TA EN DB TA     & . 67mGyW]%F ]q   Ku} S    m @ G5 :?<!Kavoussi1995 Female Germany(#Heart Valve Diseases/mo [Mortality]rtality Human Imaging, Three-Dimensional/is [Instrumentation] Male Middle Age *Mitral Valve/su [Surgery] *Robotics/is BC Kiaii2000= Kiaii2001"Kingsley200008 Kishi2001 Koehl1998G Koehl2000 Kondo1999#Kornberg1999 Kruger20000FLaPietra20000 Lee20002 Leman19980 Lenzi2000G Leroy2000 Leroy20016Lobontiu2001 Loscher1999+ Loulmet1999 Mack19999 Malassagne2001  Marescaux1998G Marescaux2000 Marescaux2001 Margossian1998 Margossian1998 Margossian19999 Margossian2000=McKenzie20011 Meiser19999! Meiser19999 Meiser20000= Menkis20010 Merrell2001- Mettler1998 Miller19988 Mohr19999 Mohr2000 Mohr2000h Mohr2000h Mohr2001. Moore1995/ Moore1995 Mutter19988G Mutter20000 Nagino19998Nakamura2001 Neisius2000N Neugebauer1998D Nicolai2000? Nifong20000 Nimura19999C Novick20000= Novick2001 Obertop19956 Olsson20011, Omote1999 Onnasch2000. Partin1995/ Partin19959B Peters20000K Pietrabissa1999+ Ponzio19999) Prophet19999 Raczkowsky2001 Rauch1999 Raumans2000C Rayman2000= Rayman2001'Reichart19988;Reichart1998rReichart1999rReichart1999r!Reichart19999#Reichart1999r%Reichart1999r&Reichart1999Reichart2000rHReichart2000r'Reichenspurner1998(Reichenspurner1998;Reichenspurner1998Reichenspurner1999Reichenspurner1999!Reichenspurner1999#Reichenspurner1999%Reichenspurner1999&Reichenspurner1999Reichenspurner2000HReichenspurner2000+ Relland1999FRibakove20000@ Riva20000 Rodas2001R Rosenfeld1996 Russier1998T Sackier19946 Saint2001@ Sala200006 Salomon2001* Sankholkar1998) Sankholkar1999  Sano1999 Satava1995 Satava1999D Schade20000 Schilling2000D Schneider2000(Schueler1998rDSchueler20000; Schulze1998# Schulze1999H Schulze2000 Schurr1999 Schurr20003 Shimi1998, Siewert1999 Smith2001G Soler2000N Stallkamp1998F Steinberg2000* Stephenson1998) Stephenson1999" Stephenson2000 Stevens1999 Stevens2000" Tabaie20000 Tassetti199884 Tewari2001(Tugtekin1998rQ Turner1996 Uesaka1999 Ulmann19999, Ungeheuer1999N Urban19984 Vallancien20011  van Leeuwen1995E Vandromme2000J Vaneerdeweg1999G Vix2000 Vogel1999 Voges2000( Wagner19981 Walther1999 Walther2000 Walther2000 Walther2000 Walther2001T Wang19949N Wapler1998, Wei1999# Weigand1999NWeisener19988' Welz1998u; Welz19988H Welz20002#Wildhirt1999HWildhirt2000r& Wintersperger19999 Worn2001y( Wunderlich1998JYsebaert1999;Zwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998r;Zwissler1998rZwissler1998r;Zwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998r;Zwissler1998r999;Zwissler1998rZwissler1998r1999;Zwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998r;Zwissler1998rZwissler1998rZwissler1998rZwissler1998rZwissler1998r9;Zwissler1998rZwissler1998r9;Zwissler1998rZwissler1998r;Zwissler1998rZwissler1998r9;Zwissler1998rZwissler1998r;Zwissler1998rZwissler1998r9;Zwissler1998rZwissler1998rZwissler1998r;Zwissler1998rZwissler1998r1999;Zwissler1998rZwissler1998r;Zwissler1998rZwissler1998rZwissler1998rZwissler1998r2 Leman19980 Lenzi2000: Lenzi2000G Leroy2000 Leroy2001 Leroy20015 Leroy20011 Link2001A Lister200006Lobontiu2001 Loscher1999+ Loulmet1999 Mack19999 Malassagne2001 Malassagne20015 Malassagne2001  Marescaux1998G Marescaux2000 Marescaux2001 Marescaux20015 Marescaux2001 Margossian1998 Margossian1998 Margossian19999 Margossian2000=McKenzie20011 Meier1999 Meiser19999! Meiser19999 Meiser20000 Meiser20000= Menkis20010 Merrell2001 Merrell2001- Mettler1998 Miller19988 Mohr19999 Mohr2000 Mohr2000h Mohr2000h> Mohr2000 Mohr2001  Mohr2001. Moore1995/ Moore19957 Muller-Wittig2001 Mutter19988G Mutter20000 Nagino19998Nakamura2001 Neisius2000D Nicolai2000? Nifong20000 Nimura19999C Novick20000= Novick2001 Obertop19956 Olsson20011, Omote1999L Omote1999 Onnasch2000> Onnasch2000A Ozer2000 Palm2000l. Partin1995/ Partin19959B Peters20000K Pietrabissa1999+ Ponzio19999) Prophet19999 Raczkowsky2001 Rauch1999 Raumans2000C Rayman2000= Rayman2001 Regehr2000'Reichart19988;Reichart1998rReichart1999rReichart1999r!Reichart19999#Reichart1999r%Reichart1999r&Reichart1999Reichart2000rReichart2000rHReichart2000r'Reichenspurner1998(Reichenspurner1998;Reichenspurner1998Reichenspurner1999Reichenspurner1999!Reichenspurner1999#Reichenspurner1999%Reichenspurner1999&Reichenspurner1999Reichenspurner2000Reichenspurner2000HReichenspurner2000$Reichenspurner2001+ Relland1999FRibakove20000@ Riva20000 Rodas2001 Rodas2001  Rogers2000 Russier19986 Saint2001@ Sala200006 Salomon2001* Sankholkar1998) Sankholkar1999  Sano1999 Satava1995 Satava1999D Schade200007Schaffer2001 Schilling2000> Schilling2000D Schneider2000(Schueler1998rDSchueler200001 Schulam2001; Schulze1998# Schulze1999H Schulze2000 Schurr1999 Schurr20003 Shimi1998A Siemionow2000A Siemionow2000, Siewert1999L Siewert1999 Smith2001 Smith20015 Smith2001G Soler2000F Steinberg2000* Stephenson1998) Stephenson1999" Stephenson2000 Stevens1999 Stevens2000" Tabaie20000 Tassetti199884 Tewari2001(Tugtekin1998r Uesaka1999 Ulmann19999, Ungeheuer1999L Ungeheuer19994 Vallancien20011  van Leeuwen1995E Vandromme2000J Vaneerdeweg1999G Vix2000 Vogel1999 Voges20007 Voss2001( Wagner19981 Walther1999 Walther2000 Walther2000 Walther2000> Walther2000 Walther2001 Walther2001, Wei1999L Wei1999# Weigand1999' Welz1998u; Welz19988H Welz20002#Wildhirt1999HWildhirt2000r& Wintersperger19999 Worn2001y( Wunderlich1998 Yeh2000JYsebaert1999;Zwissler1998r#/! 013,#%) "78$'A&; [ nItsuremtntaoi]nT lemedecini/esi[ nItsuremtnta Authors4Journals &Keywords +`                               (RT 4{ Abbou, C. C. Adams, J. B. Antiphon, P.Applebaum, R. M. Arbter, K. Arezzo, A. Arnold, M. Attaran, M. Aupecle, B.Autschbach, R. Ayache, N. Banusch, J. Berrebi, A. Bisler, A. Bockholt, U. Boehm, D. Boehm, D. H. Boyd, W. D. Brenner, P.Broderick, T. J. Brucerius, J. Bucerius, J.Buckingham, R. A.Buckingham, R. O. Buess, G. Buess, G. F. Burdon, T. A.Buttenheim, P. M.Cadiere, G. B. Cardon, C.Carpentier, A.Carrozza, M. C.Chambers, C. E. Chapelle, T. Cheah, W. K.Chitwood, W. R., Jr. Chiu, A. M. Chopin, D. Cicco, A. Cichon, R.Clement, J. M. Colvin, S. B. Cossu, A. Cotin, S.Culliford, A. T. Cuschieri, A.d'Attellis, N.Damiano, R. J.Damiano, R. J., Jr. Dangel, M. Dario, P. Das, H. Daunt, D. Davies, B. Degueldre, M.Delingette, H.Derivaux, C. C. Detter, C. Dey, D. Diegeler, A. Diegler, A. Doarn, C. R.Dobkowski, W. B. Drangova, M. Ducko, C. T. Ehrman, W. J. Eisenberg, H. Ellgass, R. Engel, D. Epitaux, M. Esquenazi, S. Eyskens, E. Falcone, T. Falk, V.Fankhauser, H. Fann, J. I.Fernandez, M. A. Feussner, H. Folscher, D. Gagner, M.Galloway, A. C. Ganapathy, S.Garcia-Ruiz, A. Giorgi, C. Glauser, D. Goh, P. M. Goldberg, J.Goldberg, J. M. Gonchar, L. Gorman, P. J. Grossi, E. A.Grunenfelder, J.Guillonneau, B. Gulbins, H. Gulielmos, V.Gummert, J. F. Habazettl, H. Haluck, R. S. Hanjis, C. D. Hanna, G. B.Harnett, B. M. Hayakawa, N. Hefti, J. L.Hennipman, A. H. Hiller, A. Himpens, J. Hirzinger, G.Hoenicke, E. M.Howdieshell, T. R. Hoznek, A. Hubens, G. Huong, P. T. Ibrahim, M. Jablonsky, G. Jaccottet, A. Jacobs, S. Jamali, F. Jayet, C. Jonat, W. Kamiya, J. Kanai, M. Kappert, U. Karbalai, P.  &Acta Chir Belg Adv Card Surg Am J Surg Ann SurgAnn Thorac Surg Arch SurgAust N Z J Surg Baillieres Clin GastroenterolBmj Br Med J Can J SurgChilds Nerv SystComput Aided SurgComput Biol MedCurr Cardiol RepCurr Opin CardiolEur J Cardiothorac Surg Fertil SterilHeart Surg Forum Hum ReprodJ Am Coll Surg J Card Surg J Hepatobiliary Pancreat SurgJ Image Guid Surg$J Laparoendosc Adv Surg Tech AJ Reconstr MicrosurgJ Telemed TelecareJ Thorac Cardiovasc Surg J Urol Journal of Cardiac Surgery Lancet NeurosurgeryProc Inst Mech Eng [H] Semin Thorac Cardiovasc Surg Stud Health Technol Inform Surg EndoscThorac Cardiovasc SurgUrol Clin North Am  x*Anastomosis, Surgical*Artificial Intelligence*Bile Ducts, Intrahepatic *Bone Screws*Cardiopulmonary Bypass*Catheters, Indwelling*Clinical Competence *Colonoscopes*Computer Simulation*Computer Systems*Coronary Artery Bypass*Diagnostic Imaging("*Echocardiography, Transesophageal *Endoscopes *Endoscopy("*Heart Valve Diseases/su [Surgery]($*Heart Valve Prosthesis Implantation<9*Heart Valve Prosthesis Implantation/is [Instrumentation]*Image Enhancement($*Image Processing, Computer-Assisted *Imaging, Three-Dimensional *Laparoscopes *Laparoscopy*Laparoscopy/*methods*Laparoscopy/economics *Microsurgery*Military Medicine *Mitral Valve *Mitral Valve/su [Surgery] *Monitoring, Intraoperative *Neurosurgery<6*Operating Room Information Systems/trends/utilization*Patient Care Planning *Robotics *Robotics/*instrumentation*Robotics/economics*Robotics/instrumentation$*Robotics/is [Instrumentation]*Spinal Fusion*Sterilization Reversal*Surgical Equipment*Surgical Instruments,(*Surgical Procedures, Minimally Invasive@=*Surgical Procedures, Minimally Invasive/is [Instrumentation]$*Surgical Procedures, Operative *Telemedicine *Therapy, Computer-Assisted*Thoracic Arteries<6*Thoracic Surgery, Video-Assisted/is [Instrumentation]*Thoracoscopes *Thoracoscopy*Tissue Harvesting*User-Computer Interface*Video Recording*Video-Assisted SurgeryAbdomen/*surgery Acute Disease$Adenoma/complications/*surgery Adolescence4.Adrenal Gland Neoplasms/complications/*surgery$ Adrenal Glands/pathology/surgeryAdrenalectomy/*methodsAdultAgedAged, 80 and overAnalysis of VarianceAnastomosis, Surgical,&Anastomosis, Surgical/*instrumentation@=Anastomosis, Surgical/adverse effects/instrumentation/methods(%Anastomosis, Surgical/instrumentation4.Anastomosis, Surgical/instrumentation/*methods0-Anastomosis, Surgical/instrumentation/methods Anastomosis, Surgical/methods Aneurysm, Dissecting/etiology AnimalAortic Aneurysm/etiology Attitude of Health Personnel Balloon Occlusion/*methods Belgium82Bile Duct Neoplasms/*pathology/radiography/surgery BiopsyBladder/*surgeryBrain Diseases/*surgeryBrain Neoplasms/*surgeryBrain Neoplasms/diagnosisBrain/pathology/surgeryBrain/radiography/surgery($Cardiac Surgical Procedures/*methods0+Cardiac Surgical Procedures/*methods/trendsHDCardiac Surgical Procedures/adverse effects/instrumentation/*methods(#Cardiac Surgical Procedures/methodsCardiopulmonary Bypass,'Cardiopulmonary Bypass/*instrumentationD?Cardiopulmonary Bypass/adverse effects/instrumentation/*methods4/Cardiopulmonary Bypass/instrumentation/*methods Case Report Cattle("Cerebrovascular Disorders/etiologyChildChild, Preschool41Cholangiocarcinoma/*pathology/radiography/surgery<6Cholecystectomy, Laparoscopic/*instrumentation/methods,&Cholecystectomy, Laparoscopic/*methods<6Cholecystectomy, Laparoscopic/instrumentation/*methodsCholecystitis/surgeryCholelithiasis/surgeryClinical CompetenceColectomy/instrumentation($Colonoscopy/*instrumentation/methodsCombined Modality TherapyComparative StudyComputer GraphicsComputer SimulationComputer Systems4.Computer-Assisted Instruction/*instrumentationHBComputer-Assisted Instruction/*methods/statistics & numerical data0-Computer-Assisted Instruction/*methods/trendsCoronary Angiography,'Coronary Artery Bypass/*instrumentation$Coronary Artery Bypass/*methods 8 #&%!,)) ;$'"0" %/$# 1#3""7,", A = 11220798441n 2001 Feb rkRAVECAB: improving outcome in off-pump minimal access surgery with robotic assistance and video enhancemente 45-50OBJECTIVE: To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA). DESIGN: A case series. SETTING: London Health Sciences Centre, University of Western Ontario, London, Ont. PATIENTS AND METHODS: Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting. INTERVENTION: Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant. MAIN OUTCOME MEASURES: Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization. RESULTS: RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days. CONCLUSIONS: RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.'\ULondon Health Sciences Centre, University of Western Ontario. douglas.boyd@lhsc.on.ca yBoyd, W. D. Kiaii, B. Novick, R. J. Rayman, R. Ganapathy, S. Dobkowski, W. B. Jablonsky, G. McKenzie, F. N. Menkis, A. H.m 0008-428x Journal ArticleA Can J SurgCoronary Artery Bypass/*methods Human *Robotics *Thoracic Arteries *Thoracoscopy *Tissue Harvesting Treatment Outcome Video Recordingmlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11220798n11505061 2342 2001 Aug^XReal-time internet connections: implications for surgical decision making in laparoscopy 165-71 ` ZOBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.'Department of Surgery, Medical College of Virginia Campus at Virginia Commonwealth University, Richmond, Virginia, and Cinterandes Foundation, Cuenca, Ecuador.NHBroderick, T. J. Harnett, B. M. Doarn, C. R. Rodas, E. B. Merrell, R. C. 0003-4932 Journal ArticleAnn Surglehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11505061ations are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.'Department of Surgery, Medical College of Virginia Campus at Virginia Commonwealth University, Richmond, Virginia, and Cinterandes Foundation, Cuenca, Ecuador.NHBroderick, T. J. Harnett, B. M. Doarn, C. R. Rodas, E. B. Merrell, R. C. 0003-4932 Journal ArticleAnn Surglehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11505061 G 1097753970 2000XQVirtual university applied to telesurgery: from teleeducation to telemanipulation 195-201sPROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.' IRCAD Strasbourg, France.TMMarescaux, J. Soler, L. Mutter, D. Leroy, J. Vix, M. Koehl, C. Clement, J. M.Journal Article Stud Health Technol Inform0**Computer Simulation Computer Systems Computer-Assisted Instruction/*instrumentation Human Image Processing, Computer-Assisted/instrumentation Robotics/instrumentation Surgery/*education Surgical Procedures, Minimally Invasive/*instrumentation Telemedicine/*instrumentation *User-Computer Interfacelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1097753911420476 234u1M 2001 Jul\VTelerobotic laparoscopic cholecystectomy: initial clinical experience with 25 patients 1-7 . (OBJECTIVE: To determine the safety and feasibility of performing telerobotic laparoscopic cholecystectomies. This will serve as a preliminary step toward the integration of computer-rendered three-dimensional preoperative imaging studies of anatomy and pathology onto the patient's own anatomy during surgery. SUMMARY BACKGROUND DATA: Computer-assisted surgery (CAS) increases the surgeon's dexterity and precision during minimally invasive surgery, especially when using microinstruments. Clinical trials have shown the improved microsurgical precision afforded by CAS in the minimally invasive setting in cardiac and gynecologic surgery. Future applications would allow integration of preoperative data and augmented-reality simulation onto the actual procedure. METHODS: Beginning in September 1999, CAS was used to perform cholecystectomies on 25 patients at a single medical center in this nonrandomized, prospective study. The operations were performed by one of two surgeons who had previous laboratory experience using the computer interface. The entire dissection was performed by the surgeon, who remained at a distance from the patient but in the same operating room. The operation was evaluated according to time of dissection, time of assembly/disassembly of robot, complications, immediate postoperative course, and short-term follow-up. RESULTS: Twenty of the 25 patients had symptomatic cholelithiasis, 1 had a gallbladder polyp, and 4 had acute cholecystitis. Twenty-four of the 25 laparoscopic cholecystectomies were successfully completed by CAS. There was one conversion to conventional laparoscopic cholecystectomy. Set-up and takedown of the robotic arms took a median of 18 minutes. The median operative time for dissection and the overall operative time were 25 and 108 minutes, respectively. There were no intraoperative complications. There was one postoperative complication of a suspected pulmonary embolus, which was treated with anticoagulation. All patients were tolerating diet at discharge. CONCLUSIONS: Laparoscopic cholecystectomy performed by CAS is safe and feasible, with operative times and patient recovery similar to those of conventional laparoscopy. At present, CAS cholecystectomy offers no obvious advantages to patients, but the potential advantages of CAS lie in its ability to convert the surgical act into digitized data. This digitized format can then interface with other forms of digitized data, such as pre- or intraoperative imaging studies, or be transmitted over a distance. This has the potential to revolutionize the way surgery is performed.'zsDepartment of Digestive Surgery, Universite Louis Pasteur, Strasbourg, France. jacques.marescaux@ircad.u-strasbg.frRKMarescaux, J. Smith, M. K. Folscher, D. Jamali, F. Malassagne, B. Leroy, J. 0003-4932 Journal ArticleAnn SurgAcute Disease Adult Aged Aged, 80 and over Cholecystectomy, Laparoscopic/*methods Cholecystitis/surgery Female Human Male Middle Age Retrospective Studies *Robotics *Therapy, Computer-Assisted Treatment Outcomelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11420476 cal Competence11505061 2342 2001 Aug^XReal-time internet connections: implications for surgical decision making in laparoscopy 165-71 ` ZOBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.'Department of Surgery, Medical College of Virginia Campus at Virginia Commonwealth University, Richmond, Virginia, and Cinterandes Foundation, Cuenca, Ecuador.NHBroderick, T. J. Harnett, B. M. Doarn, C. R. Rodas, E. B. Merrell, R. C. 0003-4932 Journal ArticleAnn Surglehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11505061 ;' z10225184134y 1998 JuljdPort-Access cardiac surgery using endovascular cardiopulmonary bypass: theory, practice, and results 275-80BACKGROUND: Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients. METHODS: Since its first application in April 1995, more than 1100 procedures have been performed worldwide using the EndoCPB endovascular cardiopulmonary bypass system. The authors' experience consists of 60 Port-Access coronary artery bypass grafting procedures, 34 Port-Access mitral valve procedures (18 replacements, 16 repairs), 5 atrial septal defect closures, and 3 atrial myxoma removals. RESULTS: The patient survival rate was 99%, the incidence of perioperative stroke was 1%, and the incidence of aortic dissection was 1%. In the Port-Access mitral valve and atrial septal defect patients, the survival rate was 100% with no peri- or postoperative complications. Peri- and postoperative transesophageal echocardiography revealed no perivalvular leak or remaining mitral insufficiency after valve repair. CONCLUSIONS: The EndoCPB endovascular cardiopulmonary bypass system allows the application of true Port-Access minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection.'TMDepartment of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany.nF@Reichenspurner, H. Welz, A. Gulielmos, V. Boehm, D. Reichart, B. 0886-0440 Journal Articlea J Card Surg Adult Aged Aged, 80 and over Aneurysm, Dissecting/etiology Aortic Aneurysm/etiology Cardiac Surgical Procedures/adverse effects/instrumentation/*methods Cardiopulmonary Bypass/adverse effects/instrumentation/*methods Cerebrovascular Disorders/etiology Coronary Artery Bypass/methods Echocardiography, Transesophageal Female Heart Arrest, Induced Heart Atrium/surgery Heart Catheterization/instrumentation Heart Neoplasms/surgery Heart Septal Defects, Atrial/surgery Heart Valve Prosthesis Implantation Human Incidence Male Middle Age Mitral Valve/surgery Mitral Valve Insufficiency/etiology Myxoma/surgery Safety Sternum/surgery Surgical Procedures, Minimally Invasive/adverse effects/instrumentation/methods Survival Ratelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10225184m11276447102 1998b\3D-video- and robot-assisted minimally invasive ASD closure using the Port-Access techniques 104-6 "BACKGROUND: Video-assisted minimally invasive surgical methods with endovascular-based femoral cardiopulmonary bypass (CPB) and balloon occlusion of the aorta (Port-Access technique) were used to close an ostium-secundum atrial septal defect (ASD) in 7 patients. METHODS: Minor modifications were made to the system to provide drainage of the superior vena cava. The surgery was performed through a small (3.5-5cm) right anterolateral thoracotomy with 3D video and robotic arm assistance. RESULTS: The operative procedures were completely uneventful and the patients were discharged four days postoperatively in good condition and with excellent cosmesis. CONCLUSION: Using the modifications described, the Port-Access surgical method can be recommended for minimally invasive closure of an ASD.'Departments of Cardiac Surgery and Anesthesiology, University Hospital Grosshadern, Marchioninistr.15, D-81366 Munich, Germany. hcr@hch.uni-muenchen.deTNReichenspurner, H. Boehm, D. H. Welz, A. Schulze, C. Zwissler, B. Reichart, B..(1098-3511 Clinical Trial Journal ArticleHeart Surg Forum81Adolescence Adult Balloon Occlusion/*methods Cardiopulmonary Bypass/instrumentation/*methods Combined Modality Therapy Female Follow-Up Studies Heart Septal Defects, Atrial/diagnosis/*surgery Human Male Middle Age *Robotics Thoracic Surgery, Video-Assisted/*methods Thoracoscopy/*methods Treatment Outcomenlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11276447 10384178 118c13 1999 Juld|uUse of the voice-controlled and computer-assisted surgical system ZEUS for endoscopic coronary artery bypass grafting 11-6OBJECTIVE: With the aim of performing a completely endoscopic coronary bypass anastomosis, we have undertaken an experimental and clinical study using robotic instrumentation and voice-controlled camera guidance. METHODS: The ZEUS Robotic Surgical System (Computer Motion Inc, Goleta, Calif) consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion) positions the endoscope via voice control. PHASE I: In a phantom model, vascular grafts were anastomosed to the left anterior descending coronary artery (LAD) of 50 pig hearts with either 2- or 3-dimensional visualization. PHASE II: In 6 dogs (FBI 20-25 kg) the left internal thoracic artery (LITA) was harvested endoscopically. Then the animals were placed on an endovascular cardiopulmonary bypass system (Port-Access, Heartport, Inc, Redwood City, Calif). Anastomosis of the LITA to the LAD was performed endoscopically with the telemetric ZEUS instruments. Flow rates through the LITA were measured by Doppler analysis. PHASE III: Two patients were operated on with the ZEUS system. After endoscopic harvesting of the LITA and cardiopulmonary bypass with the Port-Access system, the bypass graft (LITA-LAD) was anastomosed endoscopically with the ZEUS system through three thoracic ports. RESULTS: In the dry laboratory, the time range required for the robotically assisted coronary anastomosis was 35 to 60 minutes with 2-dimensional visualization and 16 to 32 minutes with 3-dimensional visualization. In the animal experiments, the median time for endoscopic harvesting of the LITA was 86 minutes (range 56-120 minutes) and for the anastomosis, 42 minutes (range 35-105 minutes); flow rates through the LITA ranged between 22 and 45 mL/min. In the clinical cases, preparation times for the LITA were 83 and 110 minutes, respectively, and anastomosis times, 42 and 40 minutes, respectively. Doppler flow rates measured 125 and 85 mL/min, respectively. Both patients had an uneventful follow-up angiogram and postoperative course. CONCLUSIONS: With sophisticated robotic technology, a completely endoscopic anastomosis of the LITA to the LAD is possible, allowing technically precise operations within acceptable time limits.'f_Department of Cardiac Surgery, University Hospital Munich-Grosshadern, D-81366 Munich, Germany.xrReichenspurner, H. Damiano, R. J. Mack, M. Boehm, D. H. Gulbins, H. Detter, C. Meiser, B. Ellgass, R. Reichart, B. 0022-5223 Journal ArticleJ Thorac Cardiovasc SurgAnastomosis, Surgical/instrumentation/methods Animal Coronary Angiography Coronary Artery Bypass/instrumentation/*methods Coronary Disease/physiopathology/radiography/surgery/ultrasonography Disease Models, Animal Dogs Echocardiography, Doppler Endoscopes Endoscopy/instrumentation/*methods Follow-Up Studies Hemodynamics Human Robotics/education/instrumentation/*methods Swine Therapy, Computer-Assisted/education/instrumentation/*methods Thoracic Arteries/transplantation Time Factors Treatment Outcome *User-Computer Interfacechttp://www1.mosby.com/mosbyscripts/mosby.dll?action=searchDB&searchDBfor=art&artType=abs&id=a98728&target= http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10384178ary Artery Bypass/*methodsCoronary Disease/*surgeryEndoscopy/methods8520340  3119 7018 1995 Dec 2C"Robots in operating theatres1479-82i4-Robots designed for surgery have three main advantages over humans. They have greater three dimensional spatial accuracy, are more reliable, and can achieve much greater precision. Although few surgical robots are yet in clinical trials one or two have advanced to the stage of seeking approval from the UK's Medical Devices Agency and the US Federal Drug Administration. Safety is a key concern. A robotic device can be designed in an intrinsically safe way by restricting its range of movement to an area where it can do no damage. Furthermore, safety can be increased by making it passive, guided at all times by a surgeon. Nevertheless, some of the most promising developments may come from robots that are active (monitored rather than controlled by the surgeon) and not limited to intrinsically safe motion.'& Southmead Hospital, Bristol, UK.*#Buckingham, R. A. Buckingham, R. O.810959-8138 Journal Article Review Review, Tutorial BmjGreat Britain Human Neurosurgery/instrumentation Operating Rooms Orthopedic Equipment Otolaryngology/instrumentation Rehabilitation/instrumentation Robotics/*instrumentation Surgical Equipment/*trends Urology/instrumentationjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8520340\ary Artery Bypass/*methods110055924844 2000 AugClinical use of a computer-enhanced surgical robotic system for endoscopic coronary artery bypass grafting on the beating heartw198-202JDThe aim of the study was to perform endoscopic coronary artery bypass grafting on the beating heart using a surgical robotic system. In the study, the surgical system ZEUS was used in combination with 3D visualization for endoscopic coronary artery bypass grafting in 25 patients. In a total of 10 cases, the coronary artery anastomosis was done on the beating heart using endoscopic stabilizers without cardiopulmonary bypass. In all cases, total OR time ranged from 4.0 to 8.0 hours (median 5.5 h); the times for endoscopic coronary artery anastomoses ranged from 14 to 50 minutes (median 25 minutes) with no difference between arrested-heart or beating-heart procedures. All patients had an uneventful angiographic control result. An endoscopic coronary artery anastomosis is possible on the arrested as well as on the beating heart.'|uDepartment of Cardiac Surgery, University Hospital Munich-Grosshadern, Munich, Germany. boehm@hch.med.uni-muenchen.de`YBoehm, D. H. Reichenspurner, H. Detter, C. Arnold, M. Gulbins, H. Meiser, B. Reichart, B. 0171-6425 Journal ArticleThorac Cardiovasc SurgCardiopulmonary Bypass Comparative Study Coronary Angiography Coronary Artery Bypass/instrumentation/*methods Coronary Disease/radiography/*surgery Equipment Design Feasibility Studies Heart Arrest, Induced Human Human Engineering Imaging, Three-Dimensional/instrumentation/*methods Interior Design and Furnishings Operating Rooms/organization & administration Robotics/instrumentation/*methods Thoracoscopy/*methods Time Factors Treatment Outcome lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11005592r Tp8153867L8 1n 1994 JanLFRobotically assisted laparoscopic surgery. From concept to development 63-6The evolution of laparoscopy from a monocular view to the video screen has enabled all in the operating room to see the procedure. This has meant the surgeon must rely on an assistant to hold the scope, which has many drawbacks. Robotic enhancement technology creates a symbiotic relationship between the surgeon and robot and leads to great improvement in the performance of the case. '\UDepartment of Surgery, University of California, San Diego Medical Center 92103-9981. Sackier, J. M. Wang, Y.f 0930-2794 Journal Articler Surg EndoscaHAHuman Laparoscopes Laparoscopy/instrumentation/*methods *RoboticsWjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8153867103988956t2  1999haMacroscopic classification and preoperative diagnosis of intrahepatic cholangiocarcinoma in Japans 101-7n|vWe reviewed the records of 64 patients with resected intrahepatic cholangiocarcinoma (ICC) according to the macroscopic classification proposed by the Liver Cancer Study Group of Japan, in which ICC is classified into three types based on the macroscopic appearance of the cut sur-face of the tumor: mass-forming, periductal-infiltrating, and intraductal growth types. There were 24 patients with the periductal-infiltrating type, 28 with the mass-forming type, and 12 with the intraductal growth type. The mass-forming type essentially showed expansive growth irrespective of hilar invasion. The periductal-infiltrating type of tumor exhibited diffuse infiltration along the portal pedicle, and preoperative planning of the resection procedure was similar to that for primary bile duct carcinoma of the hepatic confluence. Vascular resection and reconstruction was required in some patients with advanced disease. In the intraductal growth type of tumor, precise determination of tumor extent was difficult because of the ambiguity caused by abundant mucin secreted by the tumor and/or by the superficial mucosal spread of the tumor along the bile duct. Percutaneous transhepatic cholangioscopy provided the most reliable information for designing the operative procedure. The macroscopic classification is useful for preoperative diagnosis of tumor extent and for planning the surgical procedure.'vpFirst Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan.\USano, T. Kamiya, J. Nagino, M. Uesaka, K. Kondo, S. Kanai, M. Hayakawa, N. Nimura, Y.p 0944-1166 Journal Article-$J Hepatobiliary Pancreat SurgaBile Duct Neoplasms/*pathology/radiography/surgery *Bile Ducts, Intrahepatic Cholangiocarcinoma/*pathology/radiography/surgery Human Japan Retrospective Studies Tomography, X-Ray ComputedNhttp://link.springer-ny.com/link/service/journals/00534/bibs/6n2p101.html http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10398895r7554840a252C 1995 Marh<6Virtual reality and telepresence for military medicine 229-36\VThe profound changes brought about by technology in the past few decades are leading to a total revolution in medicine. The advanced technologies of telepresence and virtual reality are but two of the manifestations emerging from our new information age; now all of medicine can be empowered because of this digital technology. The leading edge is on the digital battlefield, where an entire new concept in military medicine is evolving. Using remote sensors, intelligent systems, telepresence surgery and virtual reality surgical simulations, combat casualty care is prepared for the 21st century.'rlUniformed Services University of Health Science, Walter Reed Army Medical Center, Washington, DC 20307, USA. Satava, R. M. 0010-4825 Journal ArticleComput Biol Med*Artificial Intelligence Computer Graphics *Computer Simulation Diagnosis, Computer-Assisted Forecasting Human *Military Medicine Robotics Surgical Procedures, Operative *Telemedicine Therapy, Computer-Assisted War Wounds and Injuries/surgeryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=755484010555633 13411 1999 Novr<5Emerging technologies for surgery in the 21st centuryk1197-202 Laparoscopic surgery is a transition technology that marked the beginning of the information age revolution for surgery. Telepresence surgery, robotics, tele-education, and telementoring are the next step in the revolution. Using computer-aided systems such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated and will permit surgeons to perform surgical procedures beyond the current limitations of human performance, especially at the microscale or on moving organs. More fundamentally, there will be an increased reliance on 3-dimensional images of the patient, gathered by computed tomography, magnetic resonance imaging, ultrasound, or other scanning techniques, to integrate the entire spectrum of surgical care from diagnosis to preoperative planning to intraoperative navigation to education through simulation. By working through the computer-generated image, first with preoperative planning and then during telepresence or image-guided procedures, new approaches to surgery will be discovered. These technologies are complemented by new educational opportunities, such as tele-education, surgical simulation, and a Web-based curriculum. Telementoring will permit further extension of the educational process directly into the operating room.'^WYale University School of Medicine, New Haven, Conn 06510, USA. richard.satava@yale.edun Satava, R. M.e810004-0010 Journal Article Review Review, Tutorial  Arch SurgiHAForecasting Human Surgical Procedures, Operative/*methods/*trendsHlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10555633T,81131776881 2001JDRobotic stabilization that assists cardiac surgery on beating hearts 355-61Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) requires surgeons the precision of hand skill and the mental concentration, since it needs to work on beating hearts. We propose a surgical robot system that compensates motions of organs during operations. The motion canceling robot system consists of three technologies visual synchronization, motion synchronization and master slave control. In this paper, we verify the effectiveness of the prototype system by in-vivo experiment.'leDepartment of Mechano-Informatics, University of Tokyo, 7-3-1, Hongo, Bunkyoku, Tokyo 113-8656 Japan.Nakamura, Y. Kishi, K.Journal Article Stud Health Technol InformComputer Systems Coronary Artery Bypass/*instrumentation Equipment Design Human Myocardial Contraction Phantoms, Imaging Robotics/*instrumentation Support, Non-U.S. Gov't Surgical Procedures, Minimally Invasive/*instrumentation *User-Computer Interfacelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1131776810326852 177949 1999 Aprd^Self-guided robotic camera control for laparoscopic surgery compared with human camera control 321-4<6BACKGROUND: In laparoscopic surgery, the surgeon no longer has direct visual control of the operation area, and a camera assistant who maneuvers the laparoscope is essential. Problems of cooperation between the two naturally arise, and a robotic assistant that automatically controls the laparoscope can offer a highly desirable alternative to this situation. METHODS: A self-guided robotic camera control system (SGRCCS) based upon a color tracking method has been developed and its use evaluated in 20 cases of laparoscopic cholecystectomy and compared with using human camera control. RESULTS: In 83% of the patients the procedures were successfully completed with the SGRCCS. Set-up time for the robot averaged 21 minutes; and the surgical time with and without the robot averaged 54 and 60 minutes, respectively. Using the robot instead of a human camera assistant significantly reduced both the frequency of the camera correction, 2.2 per hour compared with 15.3 per hour, and frequency of the lens cleaning, 1.0 per hour compared with 6.8 per hour. Subjective assessment by the surgeon revealed that the robot performed better than the human assistant in 71 % of the cases. CONCLUSIONS: In laparoscopic surgery, the SGRCCS offered optimal camera guidance and helped to maintain the surgeon's concentration during the operation.'hbDepartment of Surgery, Technische Universitat, Munchen, Klinikum rechts der Isar, Munich, Germany.^WOmote, K. Feussner, H. Ungeheuer, A. Arbter, K. Wei, G. Q. Siewert, J. R. Hirzinger, G.o 0002-9610 Journal Articlet Am J Surg,Cholecystectomy, Laparoscopic/*instrumentation/methods Comparative Study *Endoscopes Human Quality Control *Robotics Support, Non-U.S. Gov't Time Factors Treatment Outcome Video Recording/methodsGlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10326852I0112855311411 2000 NovF?Telesurgical laparoscopic cholecystectomy between two countriese 1085,%Telesurgery is a form of operative videoconferencing in which a remotely located surgeon observes a procedure through a camera and provides visual and auditory feedback to the operative site. With the use of more robotic devices in laparoscopic surgery, various forms of telesurgery have been tried. We describe the first two international telesurgical, telementored, robot-assisted laparoscopic cholecystectomies performed in the world, between the Johns Hopkins Institute, Baltimore, Maryland, USA, and the National University Hospital, Singapore.'|Minimally Invasive Surgical Center, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore.2,Cheah, W. K. Lee, B. Lenzi, J. E. Goh, P. M. 1432-2218 Journal Article Surg Endosclehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11285531B 110749773A3U 2000NH3-D Image Guidance for Minimally Invasive Robotic Coronary Artery Bypass224-231e BACKGROUND: The introduction of a robot-assisted microsurgical system has made endoscopic coronary artery bypass grafting (ECABG) possible. Despite the success of this approach, surgeons still require better visualization tools for pre-surgical planning and intra-operative image guidance. Such visualization tools could, for example, assist in the placement of thoracic ports to acquire optimum access to the target vessels. In this paper we discuss the essential steps toward image-guided completely endoscopic coronary bypass surgery with robot assistance, and we present our preliminary efforts toward the development of a three-dimensional (3-D) virtual cardiac surgical planning platform (VCSP) for ECABG. METHODS: Preoperative 3-D images of the thorax acquired with computed tomography and electrocardiogram-gated magnetic resonance imaging are imported into VCSP. Using VCSP, a user may interactively visualize and manipulate the simulated thoracic ports in 3-D within the reconstructed thoracic region. We have also implemented a virtual endoscope to simulate the endoscopic view observed by the surgeon during the operation. Once the port placements for optimal access to the target vessels are determined, the positions of the simulated tools can be recorded and marked on the patient to specify the positions for port incisions. RESULTS: A static thorax phantom was used to verify the port placements obtained from VCSP simulations. The angles and the distances between the ports, the endoscope and the markers that were placed on the surface of the phantom were measured, and the results were compared with those obtained from simulation. The physical measured distances and angles agreed with the simulated results with average errors of 4 mm and 2 degrees, respectively. CONCLUSIONS: The VCSP image-guided surgical system allows a surgeon to visualize a patient's thorax in a 3-D interactive environment for planning surgical procedures, and to determine the optimum port placement based on preoperative 3-D images. However, during an operation, the positions and orientation of the heart and the coronary arteries are changed from their corresponding locations in the preoperative images due to carbon-dioxide insufflation, lung deflation, and dynamic motions of the beating heart. One of our future goals of this project is the use of mathematical models that correct for these changes so that our system could be applied to intra-operative image guidance.'The John P. Robarts Research Institute, The London Health Science Centre University of Western Ontario, London, Ontario, Canada.@:Chiu, A. M. Dey, D. Drangova, M. Boyd, W. D. Peters, T. M. 1098-3511 Journal articleHeart Surg Forumlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11074977ation into the surgical curriculum.'f`Department of Surgery, The Milton S. Hershey Medical Center, Hershey, PA, USA. rhaluck@psghs.edu"Haluck, R. S. Krummel, T. M. 0004-0010 Journal Article Arch SurgClinical Competence Computer-Assisted Instruction/*methods/trends Human Operating Rooms Surgery/*education/trends Surgical Procedures, Operative/methods *User-Computer Interfacelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10896371o# X112764612+1n 1999f`Continuous transesophageal echocardiographic (TEE) monitoring during port-access cardiac surgery 54-9 BACKGROUND: Since the introduction of the closed-chest minimally invasive heart surgery using the Port-Access system a variety of monitoring techniques including fluoroscopy, transesophageal echocardiography (TEE) and invasive pressure measurements have been described. We investigated whether or not single TEE is feasible for perioperative monitoring of the placement, localization and proper function of the endovascular cardiopulmonary bypass (CPB) devices. METHODS: Fifty-one patients (35 mitral valve repair or replacement [MVR], 8 coronary artery bypass grafting [CABG], 5 atrial septal defects [ASD] and 3 left atrial myxoma) were subjected to Port-Access surgery (PAS). Intraoperative Omniplane-TEE (2D- and color-flow Doppler techniques) was used as the leading monitoring device for correct positioning of the endopulmonary vent catheter and the venous cannula, and for the visualization of the guide wire and the endoaortic occlusion catheter (Endoclamp). After balloon inflation, its proper positioning and function during endo-aortic occlusion, sufficient delivery of cardioplegia into the coronary ostia, absence of leakage flow and adequate venting were controlled. Left and right radial artery catheters as well as aortic root pressure measurements served as controls. Additional fluoroscopy was used as standby device. RESULTS: In 46 patients (90.1%) sufficient perioperative monitoring was provided by single TEE. In five cases additional intermittent fluoroscopy was necessary for correct positioning of the guide wire (CABG) and the Endoclamp (three MVR and one ASD). Dislocation of the Endoclamp into the left ventricle was observed once but was successfully corrected by TEE guidance. Weaning from CPB and de-airing were easily guided with TEE. We did not observe balloon-mediated aortic injury or aortic valve dysfunction, and myocardial recovery from CPB was uneventful. All cases of MVRs showed sufficient results (68% without evidence of regurgitation, 32% showed residual mitral valve incompetence of less than grade II). Neither perivalvular leakage (MV-replacement) nor shunt- (residual ASD) flow were detectable. CONCLUSIONS: We recommend single TEE as a safe and effective on-line imaging device for monitoring the endovascular CPB system during PAS. Fluoroscopy with its potential risk for the patients and the staff due to x-ray exposure should only be used in the presence of peripheral vascular disease or when echocardiographic imaging is insufficient.'Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig Maximilians University, Marchionistr. 15, D-81337 Munich, Germany. Costas.Schulze@hch.med.uni-muenchen.dejdSchulze, C. J. Wildhirt, S. M. Boehm, D. H. Weigand, C. Kornberg, A. Reichenspurner, H. Reichart, B.2,1098-3511 Evaluation Studies Journal ArticleHeart Surg Forum*#*Cardiopulmonary Bypass *Echocardiography, Transesophageal Heart Diseases/*surgery/ultrasonography Human *Monitoring, Intraoperative Postoperative Complications/ultrasonography Sensitivity and Specificity *Surgical Procedures, Minimally Invasive *Thoracoscopy Ultrasonography, Doppler, Colorlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11276461  +r,)Coronary Artery Bypass/*methods/mortalityD?Coronary Artery Bypass/adverse effects/instrumentation/*methods4/Coronary Artery Bypass/instrumentation/*methods4.Coronary Artery Bypass/instrumentation/methods$Coronary Artery Bypass/methodsCoronary CirculationCoronary Disease/*surgery4/Coronary Disease/mortality/radiography/*surgeryHDCoronary Disease/physiopathology/radiography/surgery/ultrasonography(%Coronary Disease/radiography/*surgery85Coronary Disease/radiography/*surgery/ultrasonographyCoronary Disease/surgeryCost-Benefit AnalysisCushing Syndrome/etiology Diagnosis, Computer-Assisted0,Diagnosis, Computer-Assisted/instrumentation0,Digestive System Surgical Procedures/methodsDisease Models, AnimalDisease-Free SurvivalDogsEchocardiographyEchocardiography, Doppler$!Echocardiography, Transesophageal$Education, Medical, Continuing$effects/instrumentation/methodsElectric StimulationElectrocoagulation Endoscopes EndoscopyEndoscopy/*methods82Endoscopy/adverse effects/instrumentation/*methods("Endoscopy/instrumentation/*methodsEndoscopy/methodsEquipment DesignEquipment SafetyEvaluation Studies Fallopian Tube Patency TestsFallopian Tubes/*surgeryFeasibility Studies Feedback FemaleFollow-Up Studies Forecasting Germany Great Britain40Gynecologic Surgical Procedures/*instrumentationHeart Arrest, InducedHeart Atrium/surgery(%Heart Catheterization/instrumentation,'Heart Diseases/*surgery/ultrasonography("Heart Neoplasms/diagnosis/*surgeryHeart Neoplasms/surgery4/Heart Septal Defects, Atrial/diagnosis/*surgery($Heart Septal Defects, Atrial/surgery(#Heart Valve Diseases/mo [Mortality],'Heart Valve Diseases/mortality/*surgery Heart Valve Diseases/surgeryHeart Valve Prosthesis(#Heart Valve Prosthesis Implantation84Heart Valve Prosthesis Implantation/*instrumentation0,Heart Valve Prosthesis Implantation/*methods85Heart Ventricle/pathology/radiography/ultrasonography Hemodynamics$History of Medicine, 20th Cent.Hospital MortalityHumanHuman Engineering$!Hydronephrosis/diagnosis/*surgery Hysterectomy/instrumentation0*Image Enhancement/instrumentation/*methods(#Image Processing, Computer-Assisted83Image Processing, Computer-Assisted/instrumentation0+Imaging, Three-Dimensional/*instrumentation0*Imaging, Three-Dimensional/instrumentation83Imaging, Three-Dimensional/instrumentation/*methods4/Imaging, Three-Dimensional/is [Instrumentation] Incidence Infant Infertility, Female/*surgery$Interior Design and Furnishings0,Internal Mammary-Coronary Artery Anastomosis@