Feasibility of Robotic Laparoscopic Surgery: 146 Cases
Tóm tắt
Theoretically, in laparoscopic surgery, a
computer interface in command of a mechanical system (robot) allows the
surgeon: (1) to recover a number a number of lost degrees of freedom,
thanks to intra-abdominal articulations; (2) to obtain better visual
control of instrument manipulation, thanks to three-dimensional vision;
(3) to modulate the amplitude of surgical motions by downscaling and
stabilization; (4) to work at a distance from the patient. These
advances improve the quality of surgical tasks in a perfect ergonomic
position. The purpose of this paper is to evaluate the feasibility of
utilizing a robot in laparoscopic surgery. The first robot-assisted
procedure in humans was performed in March 1997 by our team. One
hundred forty-six patients underwent robot-assisted laparoscopic
surgery. Between March 1997 and February 2001 a nonconsecutive
series was performed of 39 antireflux procedures, 48 cholecystectomies,
28 tubal reanastomoses, 10 gastroplasties for obesity, 3 inguinal
hernias, 3 intrarectal procedures, 2 hysterectomies, 2 cardiac
procedures, 2 prostactectomies, 2 arteriovenous fistulas, 1 lumbar
sympathectomy, 1 appendectomy, 1 laryngeal exploration, 1 varicocele
ligation, 1 endometriosis cure, 1 neosalpingostomy, 1 deferent canal.
The robot (Da Vinci system, Intuitive Surgical, Mountain View, CA),
consists of a console and a cart with three articulated robot arms. The
surgeon sits in front of the console, manipulating joysticklike handles
while observing the operative field through binoculars that provide a
three-dimensional picture. This computer is capable of modulating these
data by eliminating physiologic tremor and by downscaling the amplitude
of motions by a factor 5 or 3 to one. This study has demonstrated the
feasibility of several laparoscopic robotic procedures. There is no
morbidity related to the system. Operating time and the hospital stay
were within acceptable limits. The system seems most beneficial in
intra-abdominal microsurgery or for manipulations in a very small
space. Optimized ergonomics and increased mobility of the instrument
tips are beneficial in many steps of abdominal surgical procedures.