机器人手术、远程机器人手术、远程临场感及远程指导。早期临床结果综述。

Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results.

作者信息

Ballantyne G H

机构信息

Minimally Invasive & Telerobotic Surgery Institute, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, USA.

出版信息

Surg Endosc. 2002 Oct;16(10):1389-402. doi: 10.1007/s00464-001-8283-7. Epub 2002 Jul 29.

Abstract

Although laparoscopic cholecystectomy rapidly became the standard of care for the surgical treatment of cholelithiasis, very few other abdominal or cardiac operations are currently performed using minimally invasive surgical techniques. The inherent limitations of traditional laparoscopic surgery make it difficult to perform these operations. We, and others, have attempted to use robotic technology to (a) provide a stable camera platform, (b) replace two-dimensional with three-dimensional (3-D) imaging, (c) simulate the fluid motions of a surgeon's wrist to overcome the motion limitations of straight laparoscopic instruments, and (d) offer the surgeon a comfortable, ergonomically optimal operating position. In this article, we review the early published clinical experience with surgical robotic and telerobotic systems and assess their current limitations. The voice-controlled AESOP robot replaces the cameraperson and facilitates the performance of solo-surgeon laparoscopic operations. AESOP provides a stable camera platform and avoids motion sickness in the operative team. The telerobotic Zeus and da Vinci surgical systems permit solo surgery by a surgeon from a remote sight. These telerobots hold the camera, replace the surgeon's two hands with robotic instruments, and serve in a master-slave relationship for the surgeon. Their robotic instruments simulate the motions of the surgeon's wrist, facilitating dissection. Both telerobots use 3-D imaging to immerse the surgeon in a three-dimensional video operating field. These robots also provide operating positions for the surgeon console that are ergonomically superior to those required by traditional laparoscopy. The technological advances of these telerobots now permit telepresence surgery from remote locations, even locations thousands of miles away. In addition, telepresence permits the telementoring of novice surgeons who are performing new procedures by expert surgeons in remote locations. The studies reviewed here indicate that robotics and telerobotics offer potential solutions to the inherent problems of traditional laparoscopic surgery, as well as new possibilities for telesurgery and telementoring. Nonetheless, these technologies are still in an early stage of development, and each device entails its own set of challenges and limitations for actual use in clinical settings.

摘要

尽管腹腔镜胆囊切除术迅速成为胆结石手术治疗的标准术式,但目前很少有其他腹部或心脏手术采用微创外科技术进行。传统腹腔镜手术的固有局限性使得这些手术难以开展。我们和其他一些人尝试使用机器人技术来:(a)提供一个稳定的摄像平台;(b)用三维(3-D)成像取代二维成像;(c)模拟外科医生手腕的流体运动,以克服直筒腹腔镜器械的运动限制;(d)为外科医生提供一个舒适、符合人体工程学的最佳操作位置。在本文中,我们回顾了已发表的关于手术机器人和远程机器人系统的早期临床经验,并评估了它们目前的局限性。语音控制的AESOP机器人取代了摄像师,便于单人外科医生进行腹腔镜手术。AESOP提供了一个稳定的摄像平台,并避免了手术团队中的晕动症。远程机器人宙斯和达芬奇手术系统允许外科医生在远程进行单人手术。这些远程机器人手持摄像头,用机器人器械取代外科医生的双手,并以主从关系为外科医生服务。它们的机器人器械模拟外科医生手腕的运动,便于解剖操作。两种远程机器人都使用3-D成像,使外科医生沉浸在三维视频手术视野中。这些机器人还为外科医生控制台提供了符合人体工程学的操作位置,优于传统腹腔镜手术所需的位置。这些远程机器人的技术进步现在允许从远程地点进行远程临场手术,甚至是数千英里外的地点。此外,远程临场还允许由远程地点的专家外科医生对正在进行新手术的新手外科医生进行远程指导。这里回顾的研究表明,机器人技术和远程机器人技术为传统腹腔镜手术的固有问题提供了潜在的解决方案,也为远程手术和远程指导带来了新的可能性。尽管如此,这些技术仍处于发展的早期阶段,每种设备在实际临床应用中都有其自身的一系列挑战和局限性。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索