An official website of the United States government
Deep Brain Stimulation (DBS) surgeries are not new, although they were only granted approval in the U.S. by the U.S. Food and Drug Administration (FDA) in 2002 for advanced Parkinson’s Disease (PD). In 2016, DBS surgery was approved for earlier stages of PD. This does not mean that DBS surgery, generally considered minimally invasive, does not come without commensurate risks. The Mayo Clinic identifies DBS as a serious and potential risky procedure, whereby those eligible must carefully weigh pros and cons. The aim of this paper is to provide a general overview of deep brain stimulation surgery and to present the findings of available informational resources on 14 hospital and medical center web sites that were reviewed, pertaining to surgical procedures and policies: pre-operative to post-operative. The article focuses on critiquing available educational DBS materials and their adequacy in addressing potential risks of DBS surgery. The findings indicate that hospital informational resources on the DBS surgical technique reaffirm each other’s educational materials and that they positively inform patient decision-making. These factors can be linked to better post-operative recovery. However, the materials provided by the hospitals overemphasize the positive aspects of DBS with relatively little detail about potential side effects. This article also outlines the potential short-term and long-term side effects of DBS surgery as identified by the DBS educational literature found on the hospital web sites reviewed.
more »
« less
Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision
The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.
more »
« less
- Award ID(s):
- 2031594
- PAR ID:
- 10232265
- Date Published:
- Journal Name:
- Frontiers in Robotics and AI
- Volume:
- 8
- ISSN:
- 2296-9144
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Introduction: New financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions. Materials and Methods: This study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient’s hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models. Results: Predictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve—AUC). Predictions based only on pre-operative variables have an accuracy of 74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature. Conclusions: This study is among the first to develop a methodology for making specific, data-driven, personalized treatment recommendations to reduce the 30-day readmission rate. The reported predicted reduction in readmissions can lead to more than $20 million in savings in the U.S. annually.more » « less
-
Pyloric interventions are surgical procedures employed to increase the gastric emptying rate in gastroparesis patients. In this study, we use anin silicomodel to investigate the consequences of pyloric intervention on gastric flow and emptying for two phenotypes of gastroparesis: antral hypomotility and decreased gastric tone. The transpyloric pressure gradient predicted by thein silicomodel, based on viscous fluid flow equations, is compared againstin vivomeasurements. Both phenotypes exhibit a similar pre-procedural emptying rate reduction, but after pyloric surgery, antral hypomotility case with preserved gastric tone shows significant improvements in emptying rates, up to 131%, accompanied by bile reflux from the duodenum into the stomach. Conversely, severely reduced gastric tone cases exhibited a post-procedural reduction in the net emptying rate due to the relatively larger bile reflux. In cases with a combination of antral hypomotility and reduced gastric tone, post-procedural improvements were observed only when both conditions were mild. Our findings highlight the pivotal role of the relative increase in pyloric orifice diameter in determining post-operative emptying rates. The study suggests a possible explanation for the selective response of patients toward these procedures and underscores the potential ofin silicomodelling to generate valuable insights to inform gastric surgery.more » « less
-
Background: The implementation of telemedicine by healthcare providers was accelerated by the COVID‐19 pandemic and in most health systems has reached a lower but steady percentage of total visits. As health systems navigate the integration of telemedicine modalities into care delivery models, understanding the way each discipline can optimally utilize this technology has become increasingly important. The purpose of this study was to determine how specialists who perform surgical procedures as part of their practice want to implement telemedicine into their practice and when they believe it can be most effectively used within their work schedule. Methods: A survey regarding opinions about the use of telemedicine in the postoperative period was conducted in late 2019 prior to the onset of the COVID‐19 pandemic and re‐administered about one year later. The respondents were identified by department and division as physicians who perform at least some surgical procedures. All respondents practice as part of a single urban, academic, multispecialty group across the DC‐Maryland‐Virginia area. These healthcare professionals were asked about their experiences in telemedicine, willingness to incorporate telemedicine into their practice for post‐operative visits during their global surgical period, and their opinions on how accepting patients in general may be of telemedicine. The follow‐up survey provided an opportunity to examine how opinions evolved after having obligatory telehealth experience during the pandemic. Survey responses were analyzed and descriptive statistics are presented in this study. Results: A total of 77 unique respondents participated in the surveys, and we evaluated the responses of the 75 participants who had any telemedicine (TM) experience. Respondents were 74.7% male, 66.7% were aged 36‐55, and 46% had between 1‐10 years of practice experience while the rest reported >11 years of experience. Additionally, specialties included traditional surgical specialties, interventional radiology, ophthalmology, and dermatology. Of those who completed the second survey, 77.1% expressed that the COVID‐19 exposure to TM increased their interest in video TM follow‐ups for post‐operative visits. Respondents further believed that 93.6% of patients in general also express a similar sentiment. However, just 46.7% believe TM would increase their productivity even if the technological infrastructure was perfect. When asked about preferences for when they would perform TM visits, 40.0% said they would want to conduct them as a part of regular hours and 41.3% said they would want these visits during a dedicated time within working hours. If given the chance to offer TM outside regular hours or during the weekend, the majority of respondents was against it or unsure, 77.4% and 88.0%, respectively. Discussion: Although a majority of the respondents surveyed think patients are interested in telemedicine and are themselves interested in using telemedicine follow‐ups in the post‐surgical period, less than half believe that telemedicine would increase productivity. Also, there is great variability in preference for dedicated timeblocks for telemedicine versus integration into traditional clinic schedules. As health systems continue to iterate on optimal models to integrate telehealth into efficient care delivery, it is important to better understand how physicians performing surgical procedures consider the value proposition of telemedicine for post operative care. Further study is required to understand the barriers to utilizing telehealth and how its implementation could impact reimbursement, work hours, the future of work as well as patient access, patient convenience, and patient satisfaction.more » « less
-
The use of robotics for laparoscopic surgery has been an established field for over a decade. However, with the influx of advanced tools and algorithms for general purpose robotics, there is a need to incorporate these advancements into medical robotics technology. The daVinci Research Kit and its software framework provides a step towards these advancements. This paper presents the development of new tools and utilization of previously developed tools used for general purpose robotics, and their tailored use in medical robotics. Additionally, a method for computing haptic forces for tele-operated surgical robots is presented. The technique utilizes elastic, Spherical Proxy Regions (SPR) to readily compute directional interaction forces and manipulate them to create a dynamic behavior at the surgeon/user's manipulator.more » « less
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3389/frobt.2021.610677
