Howe R D, Matsuoka Y
Division of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA.
Annu Rev Biomed Eng. 1999;1:211-40. doi: 10.1146/annurev.bioeng.1.1.211.
Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.
机器人技术正通过提高精准度、稳定性和灵活性来提升手术效果。在图像引导手术中，机器人利用磁共振成像和计算机断层扫描图像数据将器械引导至治疗部位。这需要用于手术规划的新算法和用户界面；还需要用于将患者解剖结构与术前图像数据进行配准的传感器。微创手术使用遥控机器人，使外科医生无需做大切口就能在患者体内进行操作。需要专门的机械设计和传感技术，以在这些操作限制条件下最大限度地提高灵活性。机器人在许多外科专科领域都有应用。在神经外科手术中，图像引导机器人能够对脑损伤进行活检，同时对相邻组织的损伤最小。在骨科手术中，机器人常被用于塑造股骨，使其精确适配人工髋关节置换。用于闭式心脏搭桥手术、眼科显微手术以及手术培训和模拟的机器人系统也在研发之中。尽管初步临床经验的结果是积极的，但临床医生的接受度、高昂的资金成本、性能验证和安全性等问题仍有待解决。
