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Journal of International Journal of Nanomedicine – Dove Press

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About Journal Editors Publishing Fees Articles Articles Aims and Scope Call For Papers Interview: Dr Webster

An international, peer-reviewed journal focusing on the application of nanotechnology in diagnostics, therapeutics, and drug delivery systems throughout the biomedical field. Reflecting the growing activity in this emerging specialty, the aim of this journal is to highlight research and development leading to potential clinical applications in the prevention and treatment of disease.

Endorsed by the American Society for Nanomedicine

Journal Impact Factor:4.383 (5 year impact 4.742)

This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE).

Indexed in:

We are pleased to announce the following 2015 IJN award winners:

International Journal of Nanomedicine Distinguished Career Award: Dr Rebecca Carrier, Associate Professor in Chemical Engineering, Northeastern University, Boston, MA, USA.

International Journal of Nanomedicine Young Scholar Award Cate Lockhart Graduate student at the University of Washington, Seattle, WA, USA

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Journal of Nanomedicine & Nanotechnology

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Impact Factor: 4.68* Index Copernicus Value: 4.22 NLM ID: 101562615

This top best scholarly journal is using Editorial Manager System for online manuscript submission, review and tracking. Editorial board members of the JNMNT or outside experts review manuscripts; at least two independent reviewers approval followed by the editor is required for the acceptance of any citable manuscript.

Nanobiotechnology is the application of nanotechnology to the life sciences: The technology encompasses precision engineering as well as electronics, and electromechanical systems as well as mainstream biomedical applications in areas as diverse as gene therapy, drug delivery and novel drug discovery techniques.

Related Journals of Nanobiotechnology Nanomaterials & Molecular Nanotechnology, Nature Nanotechnology, Nano Letters, Advanced Materials, Nano Today

Nanotechnology is the engineering of functional systems at the molecular scale. It is the study and application of extremely small things and can be used across all the other science fields, such as chemistry, biology, physics, materials science, and engineering.

Related Journals of Nanotechnology Journal of Nanomedicine & Biotherapeutic Discovery, IEEE Transactions on Nanobioscience, Journal of Biomedical Nanotechnology, Photonics and Nanostructures - Fundamentals and Applications, Physica E: Low-Dimensional Systems and Nanostructures

A Nanocomposite is a multiphase solid material where one of the phases has one, two or three dimensions of less than 100nm, or structure having nano-scale repeat distance between the different phases that make up the material.

Related Journals of Nanocomposites Journal of Nanomedicine & Biotherapeutic Discovery, Scripta Materialia, Nanoscale, Lab on a Chip - Miniaturisation for Chemistry and Biology, Materials Science & Engineering A: Structural Materials: Properties, Microstructure and Processing

The Integrated Project Nanobiopharmaceutics aims at the development of innovative multidisciplinary approaches for the design, synthesis and evaluation of functionalised nano-carriers and nano-particle-based micro-carriers for the treatment of various diseases based on targeted, controlled delivery of therapeutic peptides and proteins (biopharmaceutics).

Related Journals of Nanobiopharmaceutics Journal of Nanomedicine & Biotherapeutic Discovery, Journal of Obsessive-Compulsive and Related Disorders, Journal of Homotopy and Related Structures, Journal of Venomous Animals and Toxins including Tropical Diseases

Nanoelectronics is one of the major technologies of Nanotechnology. It plays vital role in the field of engineering and electronics.

Related Journals of Nanoelectronics Nano Research & Applications, ACS Applied Materials and Interfaces, Biosensors and Bioelectronics, Journal of Physical Chemistry C, Nanomedicine: Nanotechnology, Biology, and Medicine

Nanomedicine is the medical application of nanotechnology. Nanomedicine ranges from the medical applications of nanomaterials, to nanoelectronic biosensors, and even possible future applications of molecular nanotechnology.

Related Journals of Nanomedicine Nanomaterials & Molecular Nanotechnology, International Journal of Nanomedicine, Nanomedicine: Nanotechnology, Biology and Medicine, Journal of Nanomedicine Research, European Journal of Nanomedicine

Nanotoxicology is a branch of toxicology concerned with the study of the toxicity of nanomaterials, which can be divided into those derived from combustion processes (like diesel soot), manufacturing processes (such as spray drying or grinding) and naturally occurring processes (such as volcanic eruptions or atmospheric reactions).

Related Journals of Nanotoxicology Nanomedicine & Nanotechnology, Microscale Thermophysical Engineering, Microelectronic Engineering, Nano Biomedicine and Engineering, Nano-Micro Letters

Nanoengineering is the practice of engineering on the nanoscale. It derives its name from the nanometre, a unit of measurement equalling one billionth of a meter. Nanoengineering is largely a synonym for nanotechnology, but emphasizes the engineering rather than the pure science aspects of the field.

Related Journals of Nanoengineering Research & Reviews: Journal of Pharmaceutics and Nanotechnology, Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology, Nanotoxicology, Precision Engineering, Nanomedicine, Nanotechnology

The spontaneous association of molecules under equilibrium conditions into stable, structurally well-defined aggregates.

Related Journals of Nanofabrications Nanomaterials & Molecular Nanotechnology, Microporous and Mesoporous Materials, International Journal of Nanomedicine, Beilstein Journal of Nanotechnology

Nanofluidics is often defined as the study and application of fluid flow in and around nanosized objects.

Related Journals of Nanofluidics Journal of Bionanoscience, Nanotechnology, Science and Applications, Journal of Nanobiotechnology, Plasmonics, Biomedical Microdevices

Nanohedron aims to exhibit scientific images, with a focus on images depicting nanoscale objects. The work ranges from electron microscopy images of nanoscale materials to graphical renderings of molecules. Scientific images lying outside the realm of nanoscience such as algorithmic art or confocal microscopy images of cells will also be considered.

Related Journals of Nanohedron Biomicrofluidics, IEEE Transactions on Nanotechnology, Microfluidics and Nanofluidics, Journal of Micromechanics and Microengineering

Nano Cars Into the robotics is new technology which is useful for designing robots. Difference in exisiting robotics and nano cars is this system works as nervous system where as in existing system stepper motors are used.

Related Journals of Nanocars Nanomedicine & Biotherapeutic Discovery, ACS Nano, Advanced Functional Materials, Journal of Physical Chemistry Letters, Biomaterials, Small, Nano Research

Nanothermite, as the name suggests, is thermite in which the particles are so small that they are measured in nanometers is an ultra-fine-grained (UFG) variant of thermite that can be formulated to be explosive by adding gas-releasing substances.

Related Journals of Nanothermite Nanoscale Research Letters, Microelectronics and Reliability, Journal of Nanoparticle Research, AIP Advances

A sequence of nanoscale C60 atoms arranged in a long thin cylindrical structure. Nanotubes are extremely strong mechanically and very pure conductors of electric current. Applications of the nanotube in nanotechnology include resistors, capacitors, inductors, diodes and transistors.

Related Journals of Nanotubes ACM Journal on Emerging Technologies in Computing Systems, Science of Advanced Materials, Journal of Nanophotonics

Having an organization more complex than that of a molecule.

Realated Journals of Supramolecule Plasmonics, Biomedical Microdevices, Biomicrofluidics, IEEE Transactions on Nanotechnology

Nanoionics is the study and application of phenomena, properties, effects and mechanisms of processes connected with fast ion transport (FIT) in all-solid-state nanoscale systems.

Related Journals of Nanoionics Nanomedicine, Nanotechnology, Microporous and Mesoporous Materials, International Journal of Nanomedicine

Nanolithography is the branch of nanotechnology concerned with the study and application of fabricating nanometer-scale structures, meaning patterns with at least one lateral dimension between 1 and 100 nm.

Related Journals of Nanolithography Nano Research, Scripta Materialia, Nanoscale, Lab on a Chip - Miniaturisation for Chemistry and Biology

Nanoparticles are particles between 1 and 100 nanometers in size. In nanotechnology, a particle is defined as a small object that behaves as a whole unit with respect to its transport and properties. Particles are further classified according to diameter.

Related Journals of Nanoparticles Journal of Nanoparticle Research, Journal of Nanoparticles, International Journal of Nanoparticles,

Exploitation of biomaterials, devices or methodologies on the nanoscale.

Related Journals of Bionanoscience Journal of Bionanoscience, BioNanoScience, Nanomedicine, Nanotechnology, Microporous and Mesoporous Materials

OMICS International organises 1000+ Conferences across USA, Europe & Asia with support from 1000 more scientific societies and Publishes 700 open access journals which contains over 50000 eminent personalities, 10 million readers, reputed scientists as editorial board members.

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Nanomedicine: Nanotechnology, Biology and Medicine – ISSN …

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The mission of Nanomedicine: Nanotechnology, Biology, and Medicine (Nanomedicine: NBM) is to promote the emerging interdisciplinary field of nanomedicine.

Nanomedicine: NBM is an international, peer-reviewed journal presenting novel, significant, and interdisciplinary theoretical and experimental results related to nanoscience and nanotechnology in the life sciences. Content includes basic, translational, and clinical research addressing diagnosis, treatment, monitoring, prediction, and prevention of diseases. In addition to bimonthly issues, the journal website (click here) also presents important nanomedicine-related information, such as future meetings, meeting summaries, funding opportunities, societal subjects, public health, and ethical issues of nanomedicine.

The potential scope of nanomedicine is broad, and we expect it to eventually involve all aspects of medicine. Sub-categories include synthesis, bioavailability, and biodistribution of nanomedicines; delivery, pharmacodynamics, and pharmacokinetics of nanomedicines; imaging; diagnostics; improved therapeutics; innovative biomaterials; interactions of nanomaterials with cells, tissues, and living organisms; regenerative medicine; public health; toxicology; point of care monitoring; nutrition; nanomedical devices; prosthetics; biomimetics; and bioinformatics.

Article formats include Communications, Original Articles, Reviews, Perspectives, Technical and Commercialization Notes, and Letters to the Editor. We invite authors to submit original manuscripts in these categories. The journal website (click here) also presents important nanomedicine-related information, such as future meetings, meeting summaries, funding opportunities, societal subjects, public health, and ethical issues of nanomedicine.

* 2011 Journal Citation Reports, published by Thomson Reuters

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Nanomedicine – MIT Technology Review

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James Baker designs nanoparticles to guide drugs directly into cancer cells, which could lead to far safer treatments.

This article is the second in a series of 10 stories we're running over two weeks, covering today's most significant (and just plain cool) emerging technologies. It's part of our annual "10 Emerging Technologies" report, which appears in the March/April print issue of Technology Review.

The treatment begins with an injection of an unremarkable-looking clear fluid. Invisible inside, however, are particles precisely engineered to slip past barriers such as blood vessel walls, latch onto cancer cells, and trick the cells into engulfing them as if they were food. These Trojan particles flag the cells with a fluorescent dye and simultaneously destroy them with a drug.

Developed by University of Michigan physician and researcher James Baker, these multipurpose nanoparticles -- which should be ready for patient trials later this year -- are at the leading edge of a nanotechnology-based medical revolution. Such methodically designed nanoparticles have the potential to transfigure the diagnosis and treatment of not only cancer but virtually any disease. Already, researchers are working on inexpensive tests that could distinguish a case of the sniffles from the early symptoms of a bioterror attack, as well as treatments for disorders ranging from rheumatoid arthritis to cystic fibrosis. The molecular finesse of nanotechnology, Baker says, makes it possible to "find things like tumor cells or inflammatory cells and get into them and change them directly."

[To view an illustration of nanoparticles delivering a drug, click here.]

Cancer therapies may be the first nanomedicines to take off. Treatments that deliver drugs to the neighborhood of cancer cells in nanoscale capsules have recently become available for breast and ovarian cancers and for Kaposi's sarcoma. The next generation of treatments, not yet approved, improves the drugs by delivering them inside individual cancer cells. This generation also boasts multifunction particles such as Baker's; in experiments reported last June, Baker's particles slowed and even killed human tumors grown in mice far more efficiently than conventional chemotherapy.

"The field is dramatically expanding," says Piotr Grodzinski, program director of the National Cancer Institute's Alliance for Nanotechnology in Cancer. "It's not an evolutionary technology; it's a disruptive technology that can address the problems which former approaches couldn't."

The heart of Baker's approach is a highly branched molecule called a dendrimer. Each dendrimer has more than a hundred molecular "hooks" on its surface. To five or six of these, Baker connects folic-acid molecules. Because folic acid is a vitamin, most cells in the body have proteins on their surfaces that bind to it. But many cancer cells have significantly more of these receptors than normal cells. Baker links an anticancer drug to other branches of the dendrimer; when cancer cells ingest the folic acid, they consume the deadly drugs as well.

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Visionaries 2020: The Future of Nanomedicine By Robert A …

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Visionaries 2020

2009 Robert A. Freitas Jr. All Rights Reserved.

For countless centuries, physicians and their antecedents have sought to aid the human body in its efforts to heal and repair itself. Slowly at first, and later with gathering speed, new methods and instruments have been added to the physicians toolkit anesthesia and x-ray imaging, antibiotics for jamming the molecular machinery of unwanted bacteria, microsurgical techniques for physically removing pathological tissue and reconfiguring healthy tissue, and most recently biotechnology, molecular medicine, pharmacogenetics and whole-genome sequencing, and early efforts at gene therapies.

In most cases, however, physicians must chiefly rely on the bodys ability to repair itself. If this fails, external efforts may be useless. We cannot today place the component parts of human cells exactly where they should be, and restructure them as they should be, to ensure a healthy physiological state. There are no tools for working, precisely and with three-dimensional control, at the molecular level.

To obtain such tools, we need nanotechnology ( ). Nanotechnology is the engineering of atomically precise structures and, ultimately, molecular machines. The prefix nano- refers to the scale of these constructions. A nanometer is one-billionth of a meter, the width of about five carbon atoms nestled side by side. Nanomedicine is the application of nanotechnology to medicine.

The ultimate tool of nanomedicine is the medical nanorobot ( ) a robot the size of a bacterium, composed of many thousands of molecule-size mechanical parts perhaps resembling macroscale gears, bearings, and ratchets, possibly composed of a strong diamond-like material. A nanorobot will need motors to make things move, and manipulator arms or mechanical legs for dexterity and mobility. It will have a power supply for energy, sensors to guide its actions, and an onboard computer to control its behavior. But unlike a regular robot, a nanorobot will be very small. A nanorobot that would travel through the bloodstream must be smaller than the red cells in our blood tiny enough to squeeze through even the narrowest capillaries in the human body. Medical nanorobotics holds the greatest promise for curing disease and extending the human health span. With diligent effort, the first fruits of this advanced nanomedicine could begin to appear in clinical treatment sometime during the 2020s.

For example, one medical nanorobot called a microbivore ( ) could act as an artificial mechanical white cell, seeking out and digesting unwanted pathogens including bacteria, viruses, or fungi in the bloodstream. A patient with a bloodborne infection might be injected with a dose of about 100 billion microbivores (about 1 cc). When a targeted bacterium bumps into a microbivore, the microbe sticks to the nanorobots surface like a fly caught on flypaper. Telescoping grapples emerge from the microbivores hull and transport the pathogen toward the front of the device, bucket-brigade style, and into the microbivores mouth. Once inside, the microbe is minced and digested into amino acids, mononucleotides, simple fatty acids and sugars in just minutes. These basic molecules are then harmlessly discharged back into the bloodstream through an exhaust port at the rear of the device. A complete treatment might take a few hours, far faster than the days or weeks often needed for antibiotics to work, and no microbe can evolve multidrug resistance to these machines as they can to antibiotics. When the nanorobotic treatment is finished, the doctor broadcasts an ultrasound signal and the nanorobots exit the body through the kidneys, to be excreted with the urine in due course. Related nanorobots could be programmed to quickly recognize and digest even the tiniest aggregates of early cancer cells.

Medical nanorobots could also be used to perform surgery on individual cells. In one proposed procedure, a cell repair nanorobot called a chromallocyte ( ), controlled by a physician, would extract all existing chromosomes from a diseased cell and insert fresh new ones in their place. This process is called chromosome replacement therapy. The replacement chromosomes are manufactured outside of the patients body using a desktop nanofactory optimized for organic molecules. The patients own individual genome serves as the blueprint to fabricate the new genetic material. Each chromallocyte is loaded with a single copy of a digitally corrected chromosome set. After injection, each device travels to its target tissue cell, enters the nucleus, replaces old worn-out genes with new chromosome copies, then exits the cell and is removed from the body. If the patient chooses, inherited defective genes could be replaced with non-defective base-pair sequences, permanently curing any genetic disease and even permitting cancerous cells to be reprogrammed to a healthy state. Perhaps most importantly, chromosome replacement therapy could correct the accumulating genetic damage and mutations that lead to aging in every one of our cells.

Right now, medical nanorobots are just theory. To actually build them, we need to create a new technology called molecular manufacturing. Molecular manufacturing is the production of complex atomically precise structures using positionally controlled fabrication and assembly of nanoparts inside a nanofactory, much like cars are manufactured on an assembly line. The first experimental proof that individual atoms could be manipulated was obtained by IBM scientists back in 1989 when they used a scanning tunneling microscope to precisely position 35 xenon atoms on a nickel surface to spell out the corporate logo IBM. Similarly, inside the nanofactory simple feedstock molecules such as methane (natural gas), propane, or acetylene will be manipulated by massively parallel arrays of tiny probe tips to build atomically precise structures needed for medical nanorobots. In 2006, Ralph Merkle and I founded the Nanofactory Collaboration ( ) to coordinate a combined experimental and theoretical R&D program to design and build the first working diamondoid nanofactory that could build medical nanorobots.

How are these ideas being received in the medical community? Initial skepticism was anticipated, but over time people have begun taking the concept more seriously. (In late 1999 when my first book on nanomedicine came out, googling the word returned only 420 hits but this number rose fourfold in 2000 and fourfold again in 2001, finally exceeding 1 million hits by 2008.) Of course, most physicians cannot indulge themselves in exploring the future of medicine. This is not only understandable but quite reasonable for those who must treat patients today with the methods available today. The same is true of the medical researcher, diligently working to improve current pharmaceuticals, whose natural curiosity may be restrained by the knowledge that his or her success no matter how dramatic will eventually be superseded. In both cases, what can be done today, or next year, is the most appropriate professional focus.

But only a fraction of todays physicians and researchers need look ahead for the entire field of medicine to benefit. Those practitioners who plan to continue their careers into the timeframe when nanomedical developments are expected to arrive e.g., younger physicians and researchers, certainly those now in medical and graduate programs can incrementally speed the development process, while simultaneously positioning their own work for best effect, if they have a solid idea of where the field of medicine is heading. Those farther along in their careers will be better able to direct research resources today if the goals of nanomedicine are better understood.

The potential impact of medical nanorobotics is enormous. Rather than using drugs that act statistically and have unwanted side effects, we can deploy therapeutic nanomachines that act with digital precision, have no side effects, and can report exactly what they did back to the physician. Test results, ranging from simple blood panels to full genomic sequencing, should be available to the doctor within minutes of sample collection from the patient. Continuous medical monitoring by embedded nanorobotic systems, as exemplified by the programmable dermal display ( ), can permit very early disease detection by patients or their physicians. Such monitoring will also provide automatic collection of long-baseline physiologic data permitting detection of slowly developing chronic conditions that may take years or decades to develop, such as obesity, diabetes, calcium loss, or Alzheimers.

Drug companies? Rather than brewing giant batches of single-action drug molecules, Big Pharma can shift to manufacturing large quantities of generic nanorobots of several basic types. These devices could later be customized to each patients unique genome and physiology, then programmed to address specific disease conditions, on site in the doctors office at the time of need. Could personal nanofactories ( ) in patients homes eventually do some of this manufacturing? Yes, especially if creative designs for new devices or procedures are placed online as open-source information. But basic issues such as IP rights, quality control, legal liability, trustworthiness of design improvements and software upgrades, product branding, government regulation and the like should allow Big Pharma to retain a significant role in medical nanomachine manufacture even in an era of widespread at-home personal manufacturing.

Doctors and hospitals? For commonplace pathologies such as cuts or bruises, colds or flu, bacterial infections or cancers of many kinds, individuals might keep a batch of generic nanorobots at the ready in their home medical appliance, ready to be reprogrammed at need either remotely by their doctor or by some generically-available procedure, allowing patients to self-treat in the simplest of cases. Doctors in this situation will act in the role of consultants, advisors, or in some cases gatekeepers regarding a particular subset of regulated conventional treatments. This will free up physicians and hospitals to deal with the most difficult or complex cases, including acute physical trauma and emergency care. These practitioners can also concentrate on rare disease conditions; many diseases also have few symptoms and thus go unrecognized for a long time. Medical specialists will also be needed to plan and coordinate major body modifications such as cosmetic surgeries and genetic upgrades, as well as more comprehensive procedures such as whole-body rejuvenations that may involve cell repair of most of the tissue cells in the body and might require several days of continuous treatment in a specialized facility.

Cost containment? Costs can be held down because molecular manufacturing can have intrinsically cheap production costs (probably on the order of $1/kg for a mature molecular manufacturing system) and can be a green technology generating essentially zero waste products or pollution during the manufacturing process. Nanorobot life cycle costs can be very low because nanorobots, unlike drugs and other consumable pharmaceutical agents, are intended to be removed intact from the body after every use, then refurbished and recycled many times, possibly indefinitely. Even if the delivery of nanomedicine doesnt reduce total health-care expenditures which it should it will likely free up billions of dollars that are now spent on premiums for private and public health-insurance programs.

Many are working to extend the bounds of conventional medicine, so here it is relatively difficult for one person to make a big difference. Few are given the opportunity (the perspective, the resources, and the willingness) to look a bit farther down the road, identifying an exciting long-term vision for medical technology and then planning the detailed steps necessary to achieve it. Planning and executing these steps toward the long-term vision has been my career and my passion for the last two decades. As the technologies Im working on come more clearly into focus, more people will acknowledge them as realistic and their enhanced trust in the longer-term vision will help speed the development of medical nanorobotics.

Robert A. Freitas Jr. is senior research fellow at the Institute for Molecular Manufacturing (IMM) in California, after serving as a research scientist at Zyvex Corp. in Texas during 2000-2004. He is the author of Nanomedicine (Landes Bioscience, 1999, 2003), the first technical book series on medical nanorobotics. Web site Freitas is the 2009 winner of the Feynman Prize in nanotechnology for theory.

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University of South Florida Nanomedicine Research Center

§ September 12th, 2015 § Filed under Nano Medicine Comments Off on University of South Florida Nanomedicine Research Center

Who we are:

The UNRC is based at the University of South Florida College of Medicine, and membership is open to all persons from the Colleges of Medicine, Public Health, Nursing, Arts and Sciences, and Engineering interested in collaborating on nanomedicine projects. The Director of the UNRC is Shyam S. Mohapatra, PhD, Professor of Medicine in the Department of Internal Medicine Division of Allergy and Immunology. The main mission of the UNRC is to bring together a dedicated, creative, interdisciplinary group of faculty and staff to conduct research on the application of nanoengineering methods and materials to the development of novel, highly effective and useful therapies and diagnostic methods for human diseases.

Nanomethods have wide applicability for developing new approaches to the diagnosis and treatment of virtually all human diseases. Research at UNRC focuses in three major areas: nanomedicine, tissue engineering and cell technology. Nanomedicine includes such goals as the optimization of targeted drug delivery vehicles to minimize harmful side effects, the application of microelectronics/microfluidics platforms for early detection of disease conditions, and the development of point-of-care devices for field use. Tissue engineering research at UNRC has to do with the nanoscale construction of specialized cell scaffolds and artificial matrices. These biocompatible tissue hybrids have the potential to revolutionize treatment of a number of diseases from cardiovascular to neurodegenerative. Cell technology covers a range of novel applications such as using specific cell types as nanoparticle carriers and studying the potential of progenitor cells in regenerative medicine.

Goals of the UNRC:

The main mission of the UNRC is to bring together a dedicated, creative, interdisciplinary group of faculty and staff to conduct research on the application of nanoengineering methods and materials to the development of novel, highly effective and useful therapies for human diseases. read more

Areas of Interest:

The members of the UNRC have wide-ranging research interests and an exciting, creative approach to applying nanomethods. Targeted drug delivery is one of the main research areas of the UNRC, and progress in this field is a critical need in cancer treatment and severe respiratory illness. Infectious diseases are spreading at ever-increasing rates in many areas of the world and new nanomaterials being tested at UNRC show great promise in fine-tuning the immune response to destroy microbial invaders without harming the bodys own tissue. Regenerative medicine is another important focus of research. read more

Programs at the UNRC:

The UNRC sponsors a number of nanomedicine speakers during the year as well as an annual international nanomedicine conference. The USF College of Medicine offers a Masters Degree program with a focus on interdisciplinary nanomedicine research taught and mentored by faculty members of the UNRC. read more

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Robotic Surgery > Surgery | Carolinas HealthCare System > NC & SC

§ September 8th, 2015 § Filed under Nano Medicine Comments Off on Robotic Surgery > Surgery | Carolinas HealthCare System > NC & SC

Robotic Surgery: Care that is Beyond Human.

Carolinas HealthCare System is proud to be the leader in robotic surgery - a sophisticated technique that blends the accuracy of a robot with the talent of specially-trained surgeons. Robotic-assisted surgery is less invasive and provides surgical teams optimal visibility and unsurpassed precision to do what is not possible with human hands alone.

Learn more about our treatments for the following conditions:

As part of our commitment to deliver the very best in talent and technology, we are proud to continue our investment in robotic-assisted surgery and offer its benefits to patients across North Carolina.

Large incision and scar

Tiny incisions, minimal scaring

Hospital stay lasting two to three days

Hospital stay less than a day in most cases

Greater risk of infection at incision site

Less risk of infectiofn or other complications

Recovery time of up to six-eight weeks

Able to drive within 72 hours in most cases; back to normal activities in about two weeks

All of ourrobotic-trained surgeons atCarolinas HealthCare Systemare experts in a variety of specialties including:

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Robotic Heart Surgery

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Traditionally, heart surgery is performedby dividing the breastplate with a saw (sternotomy). Robotic heart surgery allows surgeons to perform some of the same operations through tiny incisions. The reason is that robotic instruments have the same range of motion of a surgeons hands but are smaller than a dime. Robotic heart surgery requires a highly trained and experienced surgeon and team to perform.

With robotics, the surgeon sits at a console in the operating room controlling the instruments while looking at a high-definition 3D image from the camera inside the patient. The surgeon controls the robot at all times. It does not do anything without the surgeon directing it (just as a pilot controls an airplane). Many types of cardiac surgical procedures can be performed with robotic assistance including: mitral valve repair or replacement, atrial septal defect closure, procedures to correct atrial fibrillation (MAZE), correction of HOCM (Hypertrophic Obstructive Cardiomyopathy), removal of cardiac tumors, tricuspid valve repair or replacement, coronary artery bypass surgery (TECAB or Totally Endoscopic Coronary Artery Bypass, robotic assisted MIDCAB or Minimally Invasive Direct Coronary Artery Bypass, hybrid procedures with robotic coronary bypass and coronary stents), pacemaker lead placement, and others. The most important factor in selecting a center for robotic heart surgery is training and experience. Recent media reports have expressed appropriate concern over the safety of robotics by surgeons and teams that are inadequately trained and prepared for these advanced procedures. I have spent over a decade focused on the mastery of robotic surgery at every level and personally trained our team extensively. Many hospitalsand surgeons claim to do robotic heart surgery, but very few are doing it routinely and through only tiny incisions. We mostly do what I consider to be totally endoscopic procedures, meaning that the incisions are so small (usually 8-15 mm) that you cannot see into the chest directly to do any portion of the procedure. Many programs use the robot to do all or some parts of the surgery with larger rib spreading mini-thoracotomies through which the operation could easily be done without the robot. Unfortunately, these larger incisions can be even more painful than a sternotomy. Some make similar incisions and perform surgery without the robot.

It would be incredibly hard if not impossible to do these procedures through incisions of 8-15 mm without the robot. One way to understand the value of robotics compared to non-robotic minimally invasive techniques would be to compare use of chopsticks versus fork and hand to eat a meal. You certainly can eat with chopsticks but you lose the ability to easily move in more than 2 dimensions. In the simplest terms the robotic system allows the surgeon to have the same dexterity (or range of motion) of a human hand but with tiny incisions. Also the robotically-controlled high-definition 3-D camera and retractor allow the surgeon to constantly adjust the exposure and view of the surgical area. In the case of mitral valve surgery, the ability to see and work on the valve up close and in its natural position definitely makesvalve repair much easier.

Watch out for drive by robotic surgery and bait and switch marketing. Dont be fooled by the word robotic. Drive by robotics is what I would call doing surgery through a fairly standard incision but using the robot to do part of the operation. We see no advantage to this approach over standard non-robotic procedures. This is often done for marketing purposes so a program can advertise itself as doing robotic heart surgery and attract patients. Many programs use the robot to do the operation using mini thoracotomies through which the operation could easily be done without the robot. We believe this offers little advantage to the patient given the size of the incisions and associated pain. Bait and switch marketing is where a program or surgeon uses the robot to get you in his/her office and then signs you up for a non-robotic procedure when a robot could easily be used to do your procedure. Keep in mind, however, that most patients undergoing heart surgery need a standard incision depending on what their problem is. However, many heart surgery procedures are easily performed with the robot. The purpose of this website is to provide you with detailed information and empower you so that you can make informed choices about your medical care. Ultimately the decisions are yours. Request an appointment with Dr. T. Sloane Guy to discuss robotic heart surgery.

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Robotic surgery | University of Maryland Medical Center

§ September 8th, 2015 § Filed under Nano Medicine Comments Off on Robotic surgery | University of Maryland Medical Center

Toggle: English / Spanish

Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer.

Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance

You will be given general anesthesia so that you are asleep and pain-free.

The surgeon sits at a computer station and directs the movements of a robot. Small surgical tools are attached to the robot's arms.

Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.

The surgeon can make small, precise movements using this method. This can allow the surgeon to do a procedure through a small cut that once could be done only with open surgery.

Once the robotic arm is placed in the abdomen, it is easier for the surgeon to use the surgical tools than with laparoscopic surgery through an endoscope.

The surgeon can also see the area where the surgery is performed more easily. This method lets the surgeon move in a more comfortable way, as well.

Robotic surgery can take longer to perform. This is due to the amount of time needed to set up the robot. Also, many hospitals may not have access to this method.

Robotic surgery may be used for a number of different procedures, including:

Robotic surgery cannot be used for some complex procedures.

The risks for any anesthesia are:

Reactions to medications

Problems breathing

The risks for any surgery are:

Robotic surgery has as many risks as open and laparoscopic surgery. However, the risks are different.

You cannot have any food or fluid for 8 hours before the surgery.

You may need to cleanse your bowels with an enema or laxative the day before surgery for some types of procedures.

Stop taking aspirin, blood thinners such as warfarin (Coumadin) or Plavix, anti-inflammatory medications, vitamins, or other supplements 10 days before the procedure.

You will be taken to a recovery room after the procedure. Depending on the type of surgery performed, you may have to stay in the hospital overnight or for a couple of days.

You should be able to walk within a day after the procedure. How soon you are active will depend on the surgery that was done.

Avoid heavy lifting or straining until your doctor gives you the OK. Your doctor may tell you not to drive for at least a week.

Surgical cuts are smaller than with traditional open surgery. Benefits include:

Eichel L, McDougall EM, Clayman RV. Fundamentals of laparoscopic and robotic urologic surgery. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 9.

Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 17.

Oleynikov D. Robotic surgery. Surg Clin N Am. 2008;88:1121-1130.

Hu JC, Gu X, Lipsitz SR, Barry MJ, D'Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs. open radical prostatectomy. JAMA. 2009;302(14):1557-1564.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. 1997-2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Robotic Surgery | Gwinnett Medical Center

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Minimally invasive. Extraordinary results. When medication and non-invasive procedures are unable to relieve symptoms, surgery remains the accepted and most effective treatment for a range of gynecologic conditions. These include, but are not limited to, cervical and uterine cancer, uterine fibroids, endometriosis, uterine prolapse, and menorrhagia (excessive bleeding).

Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has been the standard approach to gynecologic procedures for many years. Yet, open surgery can cause significant pain, trauma, a long recovery process and a threat to surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can understandably cause significant anxiety.

Fortunately, less invasive options are available. Some gynecologic procedures enable surgeons to access the target anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, robot-assisted surgery with the da Vinci Robotic Surgical System may be the most effective, least invasive treatment option. Through tiny, 12 cm incisions, surgeons using the robot can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.

Gwinnett Medical CenterLawrenceville andGwinnett Medical CenterDuluth, are proud to offer our community the latest in minimally invasive procedures through state-of-the-art, FDA-approved robotic surgery.

Minimally invasive surgeries are performed through small incisions rather than large ones. This results in potentially quicker recovery times, fewer complications, reduced hospitalization costs and less scarring.

One of the most common forms of minimally invasive surgery is performed with the da Vinci Surgical System. This technology provides surgeons an enhanced, high definition, magnified 3D view of the part of the body on which they are performing surgery.

The da Vinci robot translates the surgeons every hand movement into smaller, more precise movements for the tiny surgical instruments inside the patients body. Gwinnett Medical Center's board-certified surgeons use robotic surgery for the following procedures and conditions:

Gynecologic Procedures

Oncology/Cancer Conditions

Thoracic Procedures Bariatric Procedures

Want to learn more about robotic surgery? Download a FREE brochure now.

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Robotic Surgery

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Welcome to the CRSA Society Website Let's keep in touch to improve our robotic clinical practice

The CRSA is the new society devoted to minimally invasive robotic surgery.

Surgeons interested in the clinical applications of robotic surgery may now get full access to the world's largest library of minimally-invasive related media by applying for a free 15-day trial before becoming a member of the association.

No invitation codes required, no charges for the entire trial period. Sign up now:



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da Vinci Surgical System – Wikipedia, the free encyclopedia

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da Vinci Surgical System

Patient-side components of a da Vinci system, including the effector arms and endoscope.

The Da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate complex surgery using a minimally invasive approach, and is controlled by a surgeon from a console. The system is commonly used for prostatectomies, and increasingly for cardiac valve repair and gynecologic surgical procedures.[1][2] According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci's "study of human anatomy eventually led to the design of the first known robot in history."[3]

Da Vinci robots operate in hospitals worldwide, with an estimated 200,000 surgeries conducted in 2012, most commonly for hysterectomies and prostate removals.[4] As of June 30, 2014, there was an installed base of 3,102 units worldwide, up from 2,000 units at the same time the previous year. The location of these units are as follows: 2,153 in the United States, 499 in Europe, 183 in Japan, and 267 in the rest of the world.[5] The "Si" version of the system costs on average slightly under US$2 million, in addition to several hundred thousand dollars of annual maintenance fees.[6] The da Vinci system has been criticised for its cost and for a number of issues with its surgical performance.[2][7]

The da Vinci System consists of a surgeons console that is typically in the same room as the patient, and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, and can also act as scalpels, scissors, bovies, or unipolar or hi. The surgeon uses the consoles master controls to maneuver the patient-side carts three or four robotic arms (depending on the model). The instruments jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeons hand movements. The da Vinci System always requires a human operator, and incorporates multiple redundant safety features designed to minimize opportunities for human error when compared with traditional approaches.

The da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on a patient-side assistant to position the camera correctly. In contrast, the da Vinci Systems design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments and using controls at the console to move the instruments and camera.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.[8]

The Food and Drug Administration (FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The FDA also cleared the da Vinci System to be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.[9]

The da Vinci System has been successfully used in the following procedures:[9]

Although the general term "robotic surgery" is often used to refer to the technology, this term can give the impression that the da Vinci System is performing the surgery autonomously. In contrast, the current da Vinci Surgical System cannot in any manner function on its own, as it was not designed as an autonomous system and lacks decision making software. Instead, it relies on a human operator for all input; however, all operations including vision and motor functions are performed through remote human-computer interaction, and thus with the appropriate weak AI software, the system could in principle perform partially or completely autonomously. The difficulty with creating an autonomous system of this kind is not trivial; a major obstacle is that surgery per se is not an engineered process a requirement for weak AI. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeons direct input.

The possibility of long-distance operations depends on the patient having access to a da Vinci System, but technically the system could allow a doctor to perform telesurgery on a patient in another country. In 2001, Dr. Marescaux and a team from IRCAD used a combination of high-speed fiber-optic connection with an average delay of 155ms with advanced asynchronous transfer mode (ATM) and a Zeus telemanipulator to successfully perform the first transatlantic surgical procedure, covering the distance between New York and Strasbourg. The event was considered a milestone of global telesurgery, and was dubbed Operation Lindbergh.[11]

Critics of robotic surgery assert that it is difficult for users to learn and that it has not been shown to be more effective than traditional laparoscopic surgery.[2] The da Vinci system uses proprietary software, which cannot be modified by physicians, thereby limiting the freedom to modify the operation system.[4] Furthermore, its $2 million cost places it beyond the reach of many institutions.[6]

The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as "premarket notification," which claims the product is similar to already-approved products. Intuitive has also been accused of providing inadequate training, and encouraging health care providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision.[12] There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive counters that the same type of stray currents can occur in non-robotic laparoscopic procedures.[13] A study published in the Journal of the American Medical Association found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system.[14][15] As of 2013, the FDA is investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits are also underway.[7]

From a social analysis, a disadvantage is the potential for this technology to dissolve the creative freedoms of the surgeon, once hailed by scholar Timothy Lenoir as one of the most professional individual autonomous occupations to exist. Lenoir claims that in the "heroic age of medicine," the surgeon was hailed as a hero for his intuitive knowledge of human anatomy and his well-crafted techniques in repairing vital body systems. Lenoir argues that the da Vinci's 3D console and robotic arms create a mediating form of action called medialization, in which internal knowledge of images and routes within the body become external knowledge mapped into simplistic computer coding.[16]

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Tracking the Rise of Robotic Surgery for Prostate Cancer …

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Drs. Peter Pinto and Gennady Bratslavsky of NCI's Urologic Oncology Branch prep a prostatectomy patient for surgery with the da Vinci Surgical System. (Photo by Bill Branson, NIH)

In the years since the Food and Drug Administration (FDA) approved the first robotic surgical system for conducting abdominal and pelvic surgeries, its use has skyrocketed. The da Vinci Surgical System is now used to perform as many as 4 out of 5 radical prostatectomies in the United States. The robotic system is also increasingly being used to treat other cancers, including gynecologic and head and neck cancers. According to da Vinci's manufacturer, Intuitive Surgical, Inc., more than 1,000 of the robotic systems are in hospitals across the country.

Several studies suggest that the ascendance of robotic prostatectomy has had numerous consequences, including a mass migration of prostate cancer patients to hospitals with robotic systems and an overall increase in the number of prostatectomies performed each year. The latter trend has raised some concern because it coincides with a period during which prostate cancer incidence has declined slightly.

How robotic prostatectomy proliferated so quickly, and what it means for patients and the health care system, is still a matter of study and debate. But the shift appears to have altered the surgical treatment of prostate cancer permanently, observed urologic surgeon Dr. Hugh Lavery of the Mount Sinai Medical Center in New York.

"I think that traditional open and laparoscopic prostatectomies have faded," Dr. Lavery said. The available data indicate that patients and surgeons "are pushing for the robots," he added, "and they're getting them."

Type "robotic surgery prostate cancer" into an Internet search engine, and the results will typically include glowing testimonials from patients who were treated with robotic surgery and videos of da Vinci's surgical instruments roaming about the peritoneal cavity suturing, cutting through tissue, removing fat. In these videos, the surgeon is on the other side of the room, head buried in a console, and hands at the robot's controls, maneuvering the instruments with the aid of a camera that offers a crisp, 3-dimensional image of the surgical field.

Dr. Peter Pinto sits at the da Vinci robot console to perform minimally invasive prostate surgery. (Photo by Bill Branson, NIH)

The Internet videos are just one component of the extensive marketing campaign behind da Vinci by individual hospitals and the system's manufacturer. A study of 400 hospital websites, published online in May 2011, found that 37 percent of the sites featured robotic surgery on the homepage, 61 percent used stock text provided by the robot's manufacturer, and nearly one in three sites had claims that robotic procedures led to improved cancer control.

"The tendency is to associate better technology with better care," explained the study's lead investigator, Dr. Marty Makary of the Johns Hopkins University School of Medicine.

Dr. Makary said he performs most operations, including complex pancreas surgery, laparoscopically because he believes the robot does not offer sufficient tactile feedback and takes more operative time. Traditional laparoscopy, however, is now rarely used for prostatectomies because the procedure is considered technically demanding, according to several researchers. One estimate put the number of laparoscopic prostatectomies each year in the United States at less than 1 percent of the total.

Patients often arrive for an office visit knowing that they want a prostatectomy performed with the robot, said Dr. William Lowrance, a urologic oncologist at the Huntsman Cancer Institute at the University of Utah. "It may be based on something they saw on the Internet or because of a friend or relative who had a good experience" with robotic surgery, he explained. Approximately 70 percent of the prostatectomies he performs are done with da Vinci.

Patient-to-patient referrals and the fact that the robotic procedure is minimally invasive have been two key drivers of the robot's popularity, said Dr. Ash Tewari, director of the Prostate Cancer Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center, who performs nearly 600 robotic prostatectomies a year.

Several studies have documented that there can be a fairly steep learning curve before surgeons achieve proficiency with the robot. But according to Dr. Warner K. Huh, a gynecologic oncologist and surgeon at the University of Alabama Birmingham Comprehensive Cancer Center, the robot makes it easier to perform many minimally invasive procedures.

"For many surgeons, they feel they can do a minimally invasive procedure more effectively and safely robotically, and I think that's a big reason that it's taken off," Dr. Huh said.

The growth of robotic surgery is more than just a marketing phenomenon, agreed Dr. Tewari. "It has been supported with a lot of good science," he continued. "We want to make this field better and beyond the hype of robotics."

Based on studies to date, there seems to be agreement that robotic surgery is comparable to traditional laparoscopic surgery in terms of blood loss and is superior to open surgery in terms of blood loss and length of hospital stay. Recovery time may also beshorter following robotic surgery than open surgery.

But for the big three outcomescancer control, urinary control, and sexual functionthere is still no clear answer as to whether one approach is superior to another, Dr. Lowrance noted.

A large, randomized clinical trial comparing any of the approaches seems out of the realm of possibility at this point. At Weill Cornell, Dr. Tewari has approval to conduct a trial comparing robotic prostatectomy with open surgery. But the trial never got off the ground because there are not enough patients willing to be randomly assigned to surgery without the robot, he said.

A randomized trial may not even be that informative. "Many open surgeons have excellent outcomes, which may be hard to improve upon," said Dr. Lavery. "I think that if you have an expert surgeon doing either procedure, you're likely to have an excellent outcome."

The remarkably swift proliferation of the da Vinci system in surgery suites across the United States appears to have had population-wide effects. In a study Dr. Lavery presented at the American Urological Association annual meeting in March, he showed that, from 1997 to 2004, the number of prostatectomies performed in the United States was fairly stable, around 60,000 per year.

From 2005 to 2008, howeverwhat Dr. Lavery and his colleagues called the first true years of the "robotic era"the number of prostatectomies and robotic procedures spiked. The number of prostatectomies rose to roughly 88,000 in 2008, and the number of robotic procedures jumped from approximately 9,000 in 2004 to 58,000 in 2008.

The number of prostatectomies rose to roughly 88,000 in 2008, and the number of robotic procedures jumped from approximately 9,000 in 2004 to 58,000 in 2008.

Two other analyses that looked at smaller geographic regionsNew York, New Jersey, and Pennsylvania in one study and Wisconsin in the otheryielded similar results. But they also showed something else: Hospitals that acquired robots saw a significant increase in the number of radical prostatectomies they performed. At the same time, the number of procedures at hospitals that did not acquire a robot fell.

"The overall result has been a sudden, population-wide, technology-driven centralization of procedures that is without precedent," wrote Dr. Karyn Stitzenberg of the University of North Carolina Division of Surgical Oncology and her colleagues, who conducted the study in New York, New Jersey, and Pennsylvania.

Whether the rise in the number of procedures has meant that patients who might have been strong candidates for a different treatment, including active surveillance, instead opted for surgery is "speculative," Dr. Lowrance said.

"My own feeling is that radical prostatectomy rates in general have probably peaked and are on their way down," he said, in part because of the increased emphasis on active surveillance in men with localized, low-risk prostate cancer.

Another uncertain aspect centers on whether there has been any economic fallout from the increased use of this fairly expensive technology. Hospitals are not paid more for procedures using the robot, despite the fact that its use carries significant extra costs.

The robot itself runs anywhere from $1.2 million to $1.7 million (and many hospitals have several), a required annual maintenance contract is approximately $150,000, and about $2,000 in disposable equipment is required each time the robot is used. Studies have suggested that using the robot may add as much as $4,800 to the cost of each surgery.

Shorter hospital stays and less need for blood transfusions may offset some of these costs, however. In fact, data from a study that Dr. Lowrance and his colleagues have in press indicate that, after adjusting for various factors and excluding the fixed cost of the robot, the cost of robotic prostatectomy and the medical care needed for the ensuing year is comparable to the cost of open surgery and the ensuing year of care in a group of Medicare patients.

Although no other surgical robots have been approved by the FDA, at least two companies are developing similar robotic systems that could, eventually, compete with da Vinci, Dr. Lavery noted, which could reduce costs further.

The dramatic centralization of robotic prostatectomy procedures could be a double-edged sword, Dr. Stitzenberg and her colleagues concluded. A multitude of studies have demonstrated that higher volume is linked to better outcomes, suggesting that having fewer centers performing prostatectomies could improve the overall quality of care. But centralization also raises the specter that access to care could be impaired, particularly in rural areas where market forces could limit the availability of surgeons who can perform the procedure.

The rapid growth of robotic prostatectomy is a proxy for the larger debate about the role of technology in medicine, Dr. Lowrance believes. For example, intensity-modulated radiation therapy and proton-beam therapywhich cost tens of thousands of dollars more than robotic surgeryare also gaining popularity as treatments for localized prostate cancer, even though neither has been shown to produce better outcomes than standard radiation therapy.

"The big question is: How do we balance the uptake of new technology and its cost with the additional [clinical] value it may provide?" he continued. "It's hard to do those types of studies, but we have to continue to ask whether [a new technology] is always worthwhile."

The meteoric growth of robotic surgery to treat prostate cancer over the past decade has been mirrored by a similar growth in the treatment of gynecologic cancers, such as cervical and endometrial cancer. (Robotic surgery for gynecologic cancers typically involve a hysterectomy, which may be accompanied by lymph node dissection.)

Minimally invasive surgery with traditional laparoscopy has been a common treatment for gynecologic cancers for two decades, said Dr. Warner Huh of the University of Alabama Birmingham Comprehensive Cancer Center. But many surgeons have switched to the robotic procedure. In particular, the robotic procedure has given surgeons an important new option for treating obese women, Dr. Huh said. Traditional laparoscopy often cannot be performed on obese women, so before robotic surgery these patients typically had to have open surgery.

"An open surgery in these patients is extremely difficult to do," he said. "Some of these women had horrific complications related to their incision."

Obesity rates in Alabama are among the highest in the nation, so robotic surgery has provided an important new clinical option for many women in the state. The average hospital stay following open surgery in obese patients was 4 to 5 days, he said. Now, with the robotic procedure, the average stay is often 24 hours or less. Complication rates have dropped from anywhere between 5 to 10 percent with open surgery to 1 to 2 percent with robotic surgery.

"It's completely changed how we manage these diseases in morbidly obese women," Dr. Huh said.

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Robotic Surgery: The da Vinci Surgical System

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Robotic Surgery Institute

The da VinciTM Surgical System

The da VinciTM Surgical System consists of a surgeon's console, a patient-side cart, a high performance vision system and proprietary instruments from Intuitive Surgical, Inc.

Using the da VinciTM Surgical System, the surgeon operates while seated comfortably at a console viewing a 3-D image of the surgical field. The surgeon's fingers grasp the instrument controls below the display with wrists naturally positioned relative to his or her eyes. The da VinciTM Surgical System's technology seamlessly translates the surgeon's movements into precise, real-time movements of surgical instruments inside the patient.

The da VinciTM Surgical System is the only commercially available technology that can provide the surgeon with the intuitive control, range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through small ports of minimally invasive surgery.

The da VinciTM Surgical System has the potential to change surgical procedures in three basic ways:

More information can be found at Intuitive Surgical's web site.

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Robotic Surgery – Ohio State University Wexner Medical Center

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Robotic surgery allows for incredible precision, while reducing blood loss, pain and recovery time.

Ohio State has always been at the forefront of pioneering new ways to perform traditional surgeries in less invasive ways using robotic technology. With surgeries offered at both The Ohio State University Wexner Medical Center and the OSUCCC - James, the Center for Advanced Robotic Surgery is a unique program that combines:

Robotic surgery is an advanced method of surgery using leading-edge technology called theda Vincisystem to perform minimally invasive procedures. The robot is a sophisticated medical device that allows surgeons to operate through tiny incisions using enhanced imagery and precise movements.

Robotic surgery allows for incredible precision and has the potential to provide benefits to the patient:

Schedule an appointment


Search for active research studies for robotic surgery.

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Equipped with unparalleled robotic expertise and advanced technology, our Center is the most comprehensive robotics program in the country.

Advancing the future of robotic surgery by researching ways to improve current techniques and developing new robotic procedures

Among the goals of our multispecialty robotics program is training the next generation of surgeons.

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Robotic surgery | North Shore-LIJ Health System

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Robot-Assisted Surgery: da Vinci – Brown University

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With already over 210 devices in use throughout the United States, Europe, and Japan, Intuitive Surgical is the leading company in the field of digital surgery with its da Vinci? Surgical System. Approved in July 2000 to perform advanced surgical techniques such as cutting and suturing, this system is the first operative surgical robotic system to be cleared by the FDA, giving it a first-mover advantage over its competitors. Though Intuitive Surgical has had to overcome many obstacles in order to dominate the digital surgery field, it is now a multimillion-dollar business that continues to grow1.

System Overview


Making a one-centimeter keyhole incision to perform the operation, the surgeon is able to engage in minimally invasive surgery through this system. According to Ben Gong, Intuitive Surgical's vice president of finance, da Vinci reduces the average 2-3% infection probability to nearly zero2. There are four main components to da Vinci: the surgeon console, patient-side cart, EndoWrist Instruments, and Insite Vision System with high resolution 3D Endoscope and Image Processing Equipment.

1. Surgeon Console

The surgeon is situated at this console several feet away from the patient operating table. The surgeon has his head tilted forward and his hands inside the systems master interface. The surgeon sits viewing a magnified three- dimensional image of the surgical field with a real-time progression of the instruments as he operates. The instrument controls enable the surgeon to move within a one cubic foot area of workspace.

2. Patient-side Cart

This component of the system contains the robotic arms that directly contact the patient. It consists of two or three instrument arms and one endoscope arm. The feedback as of today is limited to sensing tool-on-tool collision, so the surgeon needs to rely almost solely on the visual field when suturing or contacting soft tissue. As of 2003, Intuitive launched a fourth arm, costing $175,000, as a part of a new system installation or as an upgrade to an existing unit2. It provides the advantages of being able to manipulate another instrument for complex procedures and removes the need for one operating room nurse3.

3. Detachable Instruments (Endowrist Instruments and Intuitive Masters)

The Endowrist detachable instruments allow the robotic arms to maneuver in ways that simulate fine human movements. Each instrument has its own function from suturing to clamping, and is switched from one to the other using quick-release levers on each robotic arm. The device memorizes the position of the robotic arm before the instrument is replaced so that the second one can be reset to the exact same position as the first. The instruments abilities to rotate in full circles provide an advantage over non-robotic arms. The seven degrees of freedom (meaning the number of independent movements the robot can perform) offers considerable choice in rotation and pivoting4. Moreover, the surgeon is also able to control the amount of force applied, which varies from a fraction of an ounce to several pounds. The Intuitive Masters technology also has the ability to filter out hand tremors and scale movements. As a result, the surgeons large hand movements can be translated into smaller ones by the robotic device5. Carbon dioxide is usually pumped into the body cavity to make more room for the robotic arms to maneuver.

4. 3-D Vision System (Insite Vision and Navigator Camera Control)

The camera unit or endoscope arm provides enhanced three-dimensional images. This high-resolution real-time magnification showing the inside the patient allows the surgeon to have a considerable advantage over regular surgery. The system provides over a thousand frames of the instrument position per second and filters each image through a video processor that eliminates background noise. The endoscope is programmed to regulate the temperature of the endoscope tip automatically to prevent fogging during the operation3. Unlike The Navigator Control, it also enables the surgeon to quickly switch views through the use of a simple foot pedal.


Just a few years ago, Intuitive Surgical was in the midst of a fierce legal battle with its competitor, Computer Motion. The series of events was offset by a lawsuit filed by Computer Motion for nine patent infringements. Intuitive Surgical then filed three lawsuits of its own and made a final blow by teaming with IBM to sue its competitor for infringing on its voice-recognition technology. Computer Motion lost the case for this integral component of all its devices including Zeus, its version of da Vinci. It faced a major problem since it would have to stop selling in the event that it could not receive a proper license from its competitor. On March 7, 2003, Intuitive Surgical merged with its main competitor6, ending a four-year legal power struggle that detracted from product advancement and funds7. Intuitive Surgical paid $150 million for Computer Motions and laid off around 90% of its employees following the merger2. Intuitive now owns and will market Computer Motion's products (Zeus Surgical System, Hermes Control Center, Aesop Robotic Endoscope Positioner, and Socrates Telecollaboration System)8.

Market Information of the Robot Surgical Systems

Advantages and Disadvantages:

The da Vinci Surgical System reduces hospital stays by about half, reducing hospital cost by about 33%9. These fewer days in the intensive care unit are a result of less pain and quicker recovery. Though the size of the device is still not small enough for heart procedures in children, the minimally invasive nature of da Vinci does not leave a large surgical scar and still has some limited applications in children for the time being. Moreover, according to Intuitive Surgical, only 80,000 out of 230,000 new cases of prostate cancer undergo surgery because of the high risk invasive surgery carries, implying that more people may undergo surgery with this evolving technology2. The main drawbacks to this technology are the steep learning curve and high cost of the device. Though Intuitive Surgical does provide a training program, it took surgeons about 12-18 patients before they felt comfortable performing the procedure10. One of the greatest challenges facing surgeons who were training on this device was that they felt hindered by the loss of tactile, or haptic, sensation (ability to feel the tissue). The large floor-mounted patient-side cart limits the assistant surgeons access to the patient. However, there are also many who are unable to access the da Vinci based on the steep price. In a paper published by The American Journal of Surgery, 75% of surgeons claimed that they felt financially limited by any system that cost more than $500,00011. As of now, surgery with the da Vinci Surgical System takes 40-50 minutes longer, but the FDA considered this a learning curve variable and expects time to improve with more use of the system12.

Estimate of Initial Investment and Cost Savings per Heart-Valve Surgery for da Vinci Market Price


Though Intuitive Surgical has faced some setbacks during its legal battles with Computer Motion, it has recovered quickly and has been growing at an unprecedented rate since the merger. The total sale for the first year of 2004 was $138.8 million (a 51% increase from the previous year) with a total of $60 million in revenue. This includes recurring revenue from instruments, disposable accessories, and services, which have also increased accordingly in response to the larger number of systems installed and greater usage in hospitals. In 2004 alone, 76 da Vinci Systems, each costing about $1.5 million, were sold13.


Medical reimbursement by insurance companies is specific to each respective company. However, Medicare reimbursement is available for laparoscopic and thoracoscopic procedures since the da Vinci Surgical System has been FDA approved for commercial distribution in the United States14.

FDA Approval:

Fail Safe Mechanisms

Safety concerns remain the center of focus for Intuitive Surgical. To start the procedure, the surgeons head must be placed in the viewer. Otherwise, the system will lock and remain motionless until it detects the presence of the surgeons head once again. During the procedure, a zero-point movement system prevents the robotic arms from pivoting above or at the one-inch entry incision, which could otherwise be unintentionally torn. Included in the power source is a backup battery that allows the system to run for twenty minutes, giving the hospital enough time to reestablish power. Each instrument contains a chip that prevents the use of any instrument other than those made by Intuitive Surgical. These chips also store information about each instrument for more precise control and keep track of instrument usage to determine when it must be replaced.

Future Outlook

Besides the cost, the da Vinci Surgical System still has many obstacles that it must overcome before it can be fully integrated into the existing healthcare system. From the lack of tactile feedback to the large size, the current da Vinci Surgical System is merely a rough preview of what is to come. Spending around $16.2 million in 2003 alone, Intuitive Surgical has a first-mover advantage over its competitors and continues to lead on as it receives more and more FDA approvals. More improvements in size, tactile sensation, cost, and telesurgery are expected for the future15.

* = All pictures taken from

Robot-Assisted Surgery: da Vinci - Brown University

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How Robotic Surgery Will Work – HowStuffWorks

§ September 8th, 2015 § Filed under Nano Medicine Comments Off on How Robotic Surgery Will Work – HowStuffWorks

Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other consumer goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean.

In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMO robot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients.

Not all surgical robots are equal. There are three different kinds of robotic surgery systems: supervisory-controlled systems, telesurgical systems and shared-control systems. The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. On one end of the spectrum, robots perform surgical techniques without the direct intervention of a surgeon. On the other end, doctors perform surgery with the assistance of a robot, but the doctor is doing most of the work [source: Brown University].

While robotic surgery systems are still relatively uncommon, several hospitals around the world have bought robotic surgical systems. These systems have the potential to improve the safety and effectiveness of surgeries. But the systems also have some drawbacks. It's still a relatively young science and it's very expensive. Some hospitals may be holding back on adopting the technology.

Why would a hospital consider a robotic surgery system in the first place? Find out in the next section.

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How Robotic Surgery Will Work - HowStuffWorks

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da Vinci Prostatectomy

§ September 8th, 2015 § Filed under Nano Medicine Comments Off on da Vinci Prostatectomy

Prostate cancer is a disease in which cancerous cells form in the tissues of the prostate. The prostate is a gland in the male reproductive system located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (tube that empties urine from the bladder). The prostate gland produces fluid that is one of the components of semen.

When prostate cancer is found early, there are typically many treatment and surgical options available to patients. That's why it is important for men to get regular exams and talk to their doctors about any unusual symptoms.

When facing a diagnosis of prostate cancer, it is important to learn about all treatments and surgical options.

Serious complications may occur in any surgery, including da Vinci Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.

Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.

Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci Surgery. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to and Unless otherwise noted, all people depicted are models.

2015 Intuitive Surgical. All rights reserved. All product names are trademarks or registered trademarks of their respective holders.

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da Vinci Prostatectomy

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Robotic Surgery Program | UC Health

§ September 8th, 2015 § Filed under Nano Medicine Comments Off on Robotic Surgery Program | UC Health

The UC Health Robotic Surgery Program offers a wide-range of procedures that combines more than 25 robotically-skilled surgeons working across eight different specialties, supported by multidisciplinary teams with specialists in each area. Our teams have expertise in 52 robotic procedures, including 15 cancer-related surgeries and several of the most complex types of cases within gynecology, urology and cardiology. Using the da Vinci Surgical System, or robot, enables surgeons to perform delicate and complex operations through a few tiny incisions with increased vision, precision, dexterity and control. The robot consists of several key components, including an ergonomically designed console where the surgeon sits while operating, a side cart where the patient lies during surgery, four interactive robotic arms, a high-definition 3D vision system, and proprietary EndoWrist instruments. da Vinci is powered by state-of-the-art robotic technology that allows the surgeons hand movements to be scaled, filtered and translated into precise movements of the EndoWrist instruments working inside the patients body.

Robotic surgery is the most advanced form of minimally invasive surgery available today and UC Health has one of the most advanced and comprehensive programs in the nation. Our expertise in cardiac, urologic and gynecologic robotic procedures is unsurpassed and we were the first in Ohio to perform gastric banding surgery using this technology. We are also one of the few programs in the area offering single site cholecystectomy. Robotic surgery is particularly effective over traditional surgery when performing more challenging procedures like radical hysterectomy or prostatectomy, but is currently FDA-approved for over 50 procedures in:

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Robotic Surgery Program | UC Health

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