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单孔腹腔镜手术器械形成及操作空间的力学分析

Mechanical analysis of the formation of forceps and scope for single-port laparoscopic surgery.

作者信息

Kawamura Hideki, Ishii Chiharu

机构信息

Department of Surgery, JA Sapporo Kosei Hospital, Sapporo, Japan.

出版信息

Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):e168-75. doi: 10.1097/SLE.0b013e31825502a3.

Abstract

BACKGROUND

The aim of this study is to demonstrate a shaft formation of forceps and scope which provides higher degree of freedom of motion for single-port laparoscopic surgery (SPLS). The key to smoothly performing SPLS lies in understanding the formation in which the shaft conflict is minimized. However, there have been no reported studies on conflict reduction in SPLS from a shaft formation perspective.

METHODS

When performing SPLS, 3 instruments are passed into a narrow space, only 2 patterns of shaft formation can be obtained: a formation in which the 3 instruments rotate clockwise or counterclockwise (rotation formation) or a formation in which 1 instrument passes between the other 2 (cross formation). So motion spaces of the instruments in rotation formation compared with that in cross formation were tested using engineering methods. The range of the forceps' motion was assumed to be the space covered by the forceps till collision occurred between the moving forceps and either the other fixed forceps or the fixed scope. Examination of the range of movement of the scope was conducted in the same manner. The motion space with the area on the x-y horizontal is evaluated, as viewed from the peritoneal umbilicus port entry area.

RESULTS

The motion area of each instrument in rotation formation is 1.9 to 2.6 times wider than that in cross formation.

CONCLUSIONS

Rotation formation provides high degree of freedom of motion for SPLS.

摘要

背景

本研究的目的是展示一种用于单孔腹腔镜手术(SPLS)的钳夹和内镜杆身构造,该构造能提供更高的运动自由度。顺利实施单孔腹腔镜手术的关键在于理解能将杆身冲突降至最低的构造形式。然而,从杆身构造角度减少单孔腹腔镜手术中冲突的相关研究尚无报道。

方法

在进行单孔腹腔镜手术时,3 种器械被置入一个狭窄空间,仅能获得 2 种杆身构造形式:3 种器械顺时针或逆时针旋转的构造形式(旋转构造),或 1 种器械从另外 2 种器械之间穿过的构造形式(交叉构造)。因此,使用工程方法测试了旋转构造形式下器械的运动空间,并与交叉构造形式下的运动空间进行比较。钳夹的运动范围被假定为移动的钳夹与其他固定钳夹或固定内镜发生碰撞之前钳夹所覆盖的空间。以同样方式对内镜的移动范围进行了检测。从腹膜脐部端口进入区域观察,评估 x - y 水平面上具有该区域的运动空间。

结果

旋转构造形式下每种器械的运动面积比交叉构造形式下宽 1.9 至 2.6 倍。

结论

旋转构造为单孔腹腔镜手术提供了高度的运动自由度。

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