Manipulators and integrated OR systems - requirements and solutions.

Videoendoscopic (laparoscopic and thoracoscopic) surgery is characterized by challenges for the whole OR team. Additional equipment must be monitored and managed by the surgeon and the nurses in a rather dark environment. The surgeon is using long-shafted instruments that reduce the degrees of freedom of the possible instrument movements, thus limiting the dexterity for the surgeon. The use of trocars results in a pivot point effect when moving the instruments, which needs some experience on the surgeon's side to move the instruments adequately and into the right direction. Finally the hand-eye-coordination is dependent on the camera position relative to the instruments and a stable image of the situs shown at the monitor. To overcome these challenges, several new technologies have been developed and introduced into the OR by the industry, also using robotics to help the surgeon perform the procedure. Integrated OR systems enable the OR team to control virtually all devices in the OR from a centralized panel; scope-positioning systems provide the surgeon with a stable image under his own control and manipulators for the instruments allow fine movements with additional degrees of freedom. This article gives a short overview of currently available technologies, describing the design requirements and the functionality of the different systems.