Rassweiler J, Safi K C, Subotic S, Teber D, Frede T
Department of Urology, Klinikum Heilbronn, University of Heidelberg, Germany.
Minim Invasive Ther Allied Technol. 2005;14(2):109-22. doi: 10.1080/13645700510010908.
Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date, more than 3000 laparoscopic radical prostatectomies have been performed worldwide at 92 centres with this system. The main advantage of the system represents the translation of open surgical skills to laparoscopy. Despite recent development of basic tools (e.g. bipolar forceps) for the da Vinci robot, investment and maintenance costs still represent the major problem of the device. Additionally, the device does not provide any haptic sense (i.e. tactile feedback). Robotic surgery represents a turning point of surgical research. However, broad use of robotic systems is limited mainly because of the high investment and running costs. Interestingly, more than in the field of cardiac surgery, there seems to be a need for telemanipulators in urology, mainly to reduce the learning curve of standard laparoscopy. However, new training concepts used in combination with mono-tasking computerized robots (AESOP) have proved their efficacy associated with a significant cost reduction.
腹腔镜检查受到运动范围从六个自由度减少到仅四个自由度的限制。在复杂病例(如根治性前列腺切除术)中,外科医生和助手的手经常会交叉。最后,标准腹腔镜仅提供二维视野。这对技术难度较大的重建手术,如腹腔镜根治性前列腺切除术有重大影响。解决方案包括了解腹腔镜检查的几何结构,以及新开发的手术机器人。在过去五年中,泌尿外科机器人技术的发展和经验不断增加。本文回顾了实际结果,重点关注机器人技术在腹腔镜根治性前列腺切除术中的益处和问题。本人在机器人辅助手术方面的经验包括使用语音控制摄像头臂(AESOP)进行了1200多例腹腔镜根治性前列腺切除术,以及使用达芬奇系统进行了六次远程手术干预。已经进行了大量实验研究,重点关注腹腔镜检查的几何结构以及新的培训概念,如灌注盆腔训练器和尿道膀胱吻合术模拟模型。基于MEDLINE/PUBMED检索对泌尿外科机器人技术的最新文献进行了综述。腹腔镜检查的几何结构包括器械之间的角度,该角度必须在25度至45度范围内;器械与工作平面之间的角度不应超过55度;持针器轴与针之间的双平面角度必须根据解剖情况在90度至110度范围内进行调整。由于快门眼镜、视频头盔或亮度降低等操作问题,三维系统尚未证明有效。目前,临床使用的机器人手术系统只有两种(AESOP、达芬奇),其中只有达芬奇提供立体视觉和所有六个自由度(DOF)。迄今为止,全球92个中心使用该系统进行了超过3000例腹腔镜根治性前列腺切除术。该系统的主要优点是将开放手术技能转化为腹腔镜手术。尽管最近为达芬奇机器人开发了基本工具(如双极钳),但投资和维护成本仍然是该设备的主要问题。此外,该设备不提供任何触觉感知(即触觉反馈)。机器人手术代表了外科研究的一个转折点。然而,机器人系统的广泛使用主要受到高投资和运行成本的限制。有趣的是,与心脏外科领域相比,泌尿外科似乎更需要远程操作器,主要是为了缩短标准腹腔镜检查的学习曲线。然而,与单任务计算机化机器人(AESOP)结合使用的新培训概念已证明其有效性,并显著降低了成本。
Minim Invasive Ther Allied Technol. 2005
Urologe A. 2002-3
Can J Urol. 2007-6
Ont Health Technol Assess Ser. 2010
Can J Urol. 2007-4
Eur J Trauma Emerg Surg. 2011-6
Patient Prefer Adherence. 2015-1-13
Biomed Opt Express. 2014-7-10
Indian J Surg. 2012-6
Langenbecks Arch Surg. 2011-10-29