Ballantyne Garth H, Hourmont Katherine, Wasielewski Annette
Minimally Invasive & Telerobotic Surgery Institute, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA.
JSLS. 2003 Jan-Mar;7(1):7-14.
Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure.
腹腔镜腹疝修补术可缩短住院时间，并降低疝复发率。然而，进行高级腹腔镜手术存在的固有困难限制了许多外科医生采用该技术。我们推测，远程机器人手术系统的虚拟手术视野和类似手的器械可以克服这些限制。我们在此报告首例2例采用网片的远程机器人腹腔镜腹疝修补术。手术通过达芬奇远程机器人手术系统完成。疝缺损用双面膨体聚四氟乙烯（ePTFE）网片修复。网片通过8根穿过腹壁的缝线固定到位，并在网片周边放置5毫米的手术钉。这2例手术的总手术时间分别为120分钟和135分钟，总手术室时间分别为166分钟和180分钟。患者分别在术后第1天和第4天出院回家。外科医生坐在远离患者的电脑控制台前，处于符合人体工程学的舒适位置。外科医生沉浸在三维虚拟手术视野中加快了这些手术的每个阶段。带腕部的远程机器人器械的关节活动极大地便于到达腹壁附近的前腹腔。本报告表明远程机器人腹腔镜腹疝修补术是可行的，并表明远程临场技术有助于该手术。
