Department of General, Abdominal and Transplant Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Langenbecks Arch Surg. 2012 Mar;397(3):333-41. doi: 10.1007/s00423-011-0859-7. Epub 2011 Oct 29.
Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact.
The Medline database was searched for the terms "robot, telemanipulat, and laparoscop." A total of 2,573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work.
In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers.
Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.
在过去十年的腹部外科手术中，机器人辅助被认为是一项创新技术，它有可能弥补传统腹腔镜手术的一些缺点，如自由度有限、二维视觉、支点和枢轴效应。机器人系统提供了相应的解决方案，如 3D 视图、直观的运动和额外的自由度。本文综述了医疗机器人的历史、实验研究、临床现状和经济影响。
在 Medline 数据库中搜索了“机器人、远程操作和腹腔镜”这三个术语。共发现 2573 篇参考文献。所有参考文献都被认为是关于高级腹腔镜中机器人辅助的信息来源。通过交叉引用每篇文献中引用的参考文献，进一步获得了其他参考文献。
在实验研究中，与传统腹腔镜技术相比，当前的机器人系统具有更好的操作和人机工程学性能。在妇科，特别是子宫切除术，和泌尿科，特别是前列腺切除术，这两个以前需要开放手术的程序，机器人使腹腔镜手术成为可能。这导致对止痛药的需求减少、出血量减少和住院时间缩短。在腹部外科手术中，临床研究通常无法证明机器人的益处。虽然机器人的益处仍有待讨论，但机器人系统正在全球范围内的三级中心广泛应用。
由于大多数手术的临床益处尚未得到证实，机器人辅助仍将是一个备受争议的话题。最有前途的手术是那些机器人可以使腹腔镜手术成为可能的手术，而这些手术通常需要开放手术。
