Rogers Craig G, Laungani Rajesh, Bhandari Akshay, Krane Louis Spencer, Eun Daniel, Patel Manish N, Boris Ronald, Shrivastava Alok, Menon Mani
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
J Endourol. 2009 Jan;23(1):115-21. doi: 10.1089/end.2008.0416.
We describe multiple uses of the fourth robotic arm and TilePro on the da Vinci S surgical system to maximize console surgeon independence from the assistant during robot-assisted renal surgery.
We prospectively evaluated the use of the fourth robotic arm and TilePro on the da Vinci S during robot-assisted radical nephrectomy (RRN) and robot-assisted partial nephrectomy (RPN). The fourth robotic arm was used to provide kidney retraction, place the renal hilum on stretch, control vascular structures, apply and remove bulldog clamps during partial nephrectomy, and secure renal capsular stitches. TilePro was used to project intraoperative ultrasonography and preoperative CT images onto the console screen.
From January 2006 to June 2008, 90 robot-assisted kidney procedures were performed, of which the fourth robotic arm was used in 46 cases (RRN, 18; RPN, 24; nephroureterectomy, 4). The fourth robotic arm facilitated consistent kidney retraction for dissection of the renal hilum and mobilization of the kidney. The robotic Hem-o-Lok clip applier effectively controlled renal hilar vessels during eight RPN cases and secured renal capsular stitches during two RPN cases. Bulldog clamps were successfully applied to the renal artery during RPN using the fourth arm in two cases. TilePro was used during 22 RPN cases to project intraoperative ultrasonographic images and preoperative CT images onto the console screen as a picture-on-picture image to guide tumor resection.
Robotic instruments used with the fourth robotic arm may give the console surgeon greater independence from the assistant during robot-assisted kidney surgery by facilitating steps such as kidney retraction, hilar dissection, and vascular control. The TilePro feature of the da Vinci S can be used to project intraoperative ultrasonography and preoperative imaging onto the console screen, potentially guiding tumor localization and resection during RPN without the need to leave the console to view external images.
我们描述了达芬奇S手术系统上第四机械臂和TilePro的多种用途，以在机器人辅助肾手术期间最大限度地提高主刀医生不依赖助手的程度。
我们前瞻性地评估了在机器人辅助根治性肾切除术（RRN）和机器人辅助部分肾切除术（RPN）过程中，达芬奇S手术系统上第四机械臂和TilePro的使用情况。第四机械臂用于肾脏牵拉、拉伸肾门、控制血管结构、在部分肾切除术中应用和移除牛头夹以及固定肾包膜缝线。TilePro用于将术中超声图像和术前CT图像投射到控制台屏幕上。
2006年1月至2008年6月，共进行了90例机器人辅助肾脏手术，其中46例使用了第四机械臂（RRN 18例；RPN 24例；肾输尿管切除术4例）。第四机械臂有助于在肾门解剖和肾脏游离过程中持续牵拉肾脏。机器人Hem-o-Lok夹施器在8例RPN病例中有效控制了肾门血管，并在2例RPN病例中固定了肾包膜缝线。在2例RPN病例中，使用第四机械臂成功地将牛头夹应用于肾动脉。在22例RPN病例中使用TilePro将术中超声图像和术前CT图像作为画中画图像投射到控制台屏幕上，以指导肿瘤切除。
在机器人辅助肾脏手术中，与第四机械臂配合使用的机器人器械可通过便于肾脏牵拉、肾门解剖和血管控制等步骤，使主刀医生在很大程度上不依赖助手。达芬奇S手术系统的TilePro功能可用于将术中超声图像和术前影像投射到控制台屏幕上，有可能在RPN期间指导肿瘤定位和切除，而无需离开控制台查看外部图像。
