Klein Michael D, Langenburg Scott E, Kabeer Mustafa, Lorincz Attila, Knight Colin G
Wayne State University School of Medicine and the Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children's Hospital of Michigan, Detroit, MI 48201, USA.
J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):265-71. doi: 10.1089/lap.2006.0034.
Robotic surgery may improve minimally invasive surgery at high magnification by tremor filtration, motion-scaling, and improved dexterity with the provision of a wrist at the end of the robotic instrument.
We chose the Zeus Microwrist robotic surgical system as more applicable to small children than the competing da Vinci surgical system. We attempted 57 surgical procedures and completed 54.
Completed procedures included Nissen fundoplication (n = 25), cholecystectomy (n = 18), Heller myotomy (n = 2), splenectomy (n = 2), Morgagni hernia repair (n = 2), and single cases of complex pyloroplasty in the chest, bowel resection, left Bochdalek congenital diaphragmatic hernia repair, esophageal atresia and tracheoesophageal fistula repair, and choledochal cyst excision. There were no complications related to the use of the robot. The mean time for the surgeon at the console using the robot was 117 +/- 39 minutes for Nissen fundoplication, and the total operating room time was 250 +/- 60 minutes. Surgeons found dissection, suturing, and knot tying easier than with conventional laparoscopy. None of the surgeons thought the lack of touch feedback (haptics) was crucial.
Robotic surgery offers increased dexterity to the pediatric minimally invasive surgeon, but procedures require more time, and there is no defined patient benefit. The fact that robotic surgery digitalizes minimally invasive surgery creates exciting possibilities for training surgeons, planning operations, and performing surgery at great distances from the operator.
机器人手术可通过震颤过滤、动作缩放以及在机器人器械末端配备腕部以提高灵活性，从而在高放大倍数下改善微创手术。
我们选择宙斯微腕部机器人手术系统，因为它比竞争的达芬奇手术系统更适用于小儿患者。我们尝试了57例手术，完成了54例。
完成的手术包括nissen胃底折叠术（n = 25）、胆囊切除术（n = 18）、海勒肌切开术（n = 2）、脾切除术（n = 2）、莫尔加尼疝修补术（n = 2），以及胸部复杂幽门成形术、肠切除术、左侧博赫dalek先天性膈疝修补术、食管闭锁和气管食管瘘修补术、胆总管囊肿切除术各1例。没有与机器人使用相关的并发症。对于nissen胃底折叠术，外科医生在控制台使用机器人的平均时间为117±39分钟，总手术室时间为250±60分钟。外科医生发现解剖、缝合和打结比传统腹腔镜手术更容易。没有外科医生认为缺乏触觉反馈（力反馈）至关重要。
机器人手术为小儿微创外科医生提供了更高的灵活性，但手术需要更多时间，且对患者没有明确的益处。机器人手术将微创手术数字化这一事实为培训外科医生、规划手术以及在远离操作者的地方进行手术创造了令人兴奋的可能性。
