Zeltser Ilia S, Bergs Richard, Fernandez Raul, Baker Linda, Eberhart Robert, Cadeddu Jeffrey A
Clinical Center for Minimally Invasive Urologic Cancer Treatment, Department of Urology, Dallas, Texas 75390-9110, USA.
J Urol. 2007 Jul;178(1):288-91. doi: 10.1016/j.juro.2007.03.001. Epub 2007 May 17.
We assessed the feasibility of single keyhole laparoscopic surgery using a novel transabdominal magnetic anchoring and guidance system platform in the porcine model.
A collaborative research group was formed to build a prototype system of magnetically anchored instruments for trocar-free laparoscopy. The design mandate was that the developed technology should be able to deploy into the insufflated abdomen through an existing 12 mm diameter trocar and then be moved into position in the peritoneum by manipulating external magnets. The magnetic anchoring and guidance system concept was advanced to a working prototype with a system of external magnetic anchors, an internal camera system and a hook cautery supported by an intra-abdominal robotic arm. This prototype system was then evaluated in vivo in a porcine laparoscopic nephrectomy model.
Two nonsurvival porcine laparoscopic nephrectomies were successfully completed without complications via a single 15 mm transumbilical trocar using the prototype magnetic anchoring and guidance system camera and the magnetically anchored robotic arm cauterizer. A conventional laparoscopic grasper was used for retraction through the 15 mm trocar after magnetic anchoring and guidance system deployment. The renal artery and vein were transected with a conventional Endo-GIA stapler introduced through the 15 mm trocar. Procedure time was not recorded and blood loss was minimal.
Single trocar laparoscopic nephrectomy using magnetically anchored instrumentation is technically feasible, demonstrating that intracorporeal instrument manipulation may overcome the limitations of current laparoscopic and robotic surgery by allowing unhindered intra-abdominal movement. This single access technique may be used with natural orifice surgery approaches and it has the potential to realize incision-free intra-abdominal surgery.
我们在猪模型中评估了使用新型经腹磁锚定与引导系统平台进行单孔腹腔镜手术的可行性。
成立了一个合作研究小组，以构建用于免套管腹腔镜手术的磁锚定器械原型系统。设计要求是，所开发的技术应能够通过现有的直径12毫米的套管针部署到充气的腹腔中，然后通过操作外部磁体将其移动到腹膜内的指定位置。磁锚定与引导系统概念发展为一个工作原型，该原型包括外部磁锚系统、内部摄像系统以及由腹腔内机器人手臂支撑的钩形电灼器。然后在猪腹腔镜肾切除术模型中对该原型系统进行体内评估。
使用原型磁锚定与引导系统摄像头和磁锚定机器人手臂电灼器，通过单个15毫米经脐套管针成功完成了两台非存活猪的腹腔镜肾切除术，且无并发症。在部署磁锚定与引导系统后，使用传统的腹腔镜抓钳通过15毫米套管针进行牵开。通过15毫米套管针引入传统的Endo - GIA吻合器切断肾动脉和静脉。未记录手术时间，失血极少。
使用磁锚定器械进行单孔腹腔镜肾切除术在技术上是可行的，这表明体内器械操作通过实现腹腔内不受阻碍的移动，可能克服当前腹腔镜手术和机器人手术的局限性。这种单通道技术可与自然腔道手术方法结合使用，并且有潜力实现无切口腹腔内手术。
