Cadière G B, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J
Departement de Chirurgie Digestive, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
World J Surg. 2001 Nov;25(11):1467-77. doi: 10.1007/s00268-001-0132-2.
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 intraabdominal 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.
从理论上讲，在腹腔镜手术中，一个控制机械系统（机器人）的计算机接口可使外科医生：（1）借助腹腔内关节恢复一些丧失的自由度；（2）借助三维视觉更好地视觉控制器械操作；（3）通过缩小比例和稳定化来调节手术动作的幅度；（4）在远离患者的位置进行手术。这些进展在完美的人体工程学位置上提高了手术任务的质量。本文的目的是评估在腹腔镜手术中使用机器人的可行性。1997年3月，我们团队进行了首例人类机器人辅助手术。146例患者接受了机器人辅助腹腔镜手术。在1997年3月至2001年2月期间，进行了一系列非连续性手术，包括39例抗反流手术、48例胆囊切除术、28例输卵管再吻合术、10例肥胖症胃成形术、3例腹股沟疝修补术、3例直肠内手术、2例子宫切除术、2例心脏手术、2例前列腺切除术、2例动静脉瘘手术、1例腰交感神经切除术、1例阑尾切除术、1例喉部探查术、1例精索静脉曲张结扎术、1例子宫内膜异位症治疗术、1例输卵管造口术、1例输精管手术。该机器人（达芬奇系统，直观外科公司，加利福尼亚州山景城）由一个控制台和一个带有三个关节式机器人手臂的推车组成。外科医生坐在控制台前，操作类似操纵杆的手柄，同时通过提供三维图像的双目镜观察手术区域。该计算机能够通过消除生理震颤并将动作幅度缩小5倍或3倍来调节这些数据。这项研究证明了几种腹腔镜机器人手术的可行性。与该系统无关的发病率。手术时间和住院时间在可接受范围内。该系统在腹腔内显微手术或在非常小的空间内进行操作时似乎最有益。优化的人体工程学和器械尖端增加的灵活性在腹部外科手术的许多步骤中都很有益。
