Department of Colorectal Surgery, EndoSurgical Center of Florida, Florida Hospital, 100 N. Dean Road, Orlando, FL, 32825, USA.
Department of Surgery, Good Samaritan Hospital, West Palm Beach, FL, 33401, USA.
Tech Coloproctol. 2019 Jan;23(1):53-63. doi: 10.1007/s10151-018-1914-y. Epub 2019 Jan 17.
Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics has not been previously explored in a clinical setting.
After pre-clinical assessment, and configuration of a robotic-assisted navigational system, two patients with locally advanced rectal cancer were selected for enrollment into a pilot study designed to assess the feasibility of navigation coupled with the robotic da Vinci Xi platform via TilePro interface. In one case, fluorescence-guided surgery was also used as an adjunct for structure localization, with local administration of indocyanine green into the ureters and at the tumor site.
Each operation was successfully completed with a robotic-assisted approach; image-guided navigation provided computed accuracy of ± 4.5 to 4.6 mm. The principle limitation encountered was navigation signal dropout due to temporary loss of direct line-of-sight with the navigational system's infrared camera. Subjectively, the aid of navigation assisted the operating surgeon in identifying critical anatomical planes. The combination of fluorescence with image-guided surgery further augmented the surgeon's perception of the operative field.
The combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery.
在使用腹腔镜技术的小型试点系列研究中，已经证明实时立体定向导航用于经肛门全直肠系膜切除术是可行的。实时立体定向导航与机器人技术相结合的可能性尚未在临床环境中进行过探索。
在临床前评估和机器人辅助导航系统配置之后，选择了两名局部晚期直肠癌患者参加一项试点研究，该研究旨在评估通过 TilePro 接口与机器人达芬奇 Xi 平台结合导航的可行性。在其中一个病例中，荧光引导手术也被用作结构定位的辅助手段，将吲哚菁绿局部注入输尿管和肿瘤部位。
每个手术都成功地完成了机器人辅助操作；图像引导导航提供了计算出的 ±4.5 到 4.6 毫米的准确性。遇到的主要限制是由于与导航系统红外摄像机的直接视线暂时丢失，导致导航信号丢失。从主观上讲，导航辅助操作医生识别关键的解剖平面。荧光与图像引导手术的结合进一步增强了外科医生对手术区域的感知。
立体定向导航和机器人手术的结合是可行的，尽管观察到了一些限制和技术挑战。对于复杂的手术，导航添加到机器人手术中可以提高手术精度。这可能代表着机器人技术和数字化手术发展的下一步。
