Gueli Alletti Salvatore, Chiantera Vito, Arcuri Giovanni, Gioè Alessandro, Oliva Riccardo, Monterossi Giorgia, Fanfani Francesco, Fagotti Anna, Scambia Giovanni
Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
Front Oncol. 2022 Jun 9;12:898060. doi: 10.3389/fonc.2022.898060. eCollection 2022.
This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an "open" surgical console with an HD-3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called "straight" and "bridge"; instead, the so-called "compact" and "butterfly" configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer's point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.
本研究详细描述了新型HUGO™机器人辅助手术系统，并提出了妇科手术的对接设置。该系统由一个带有高清3D被动显示器的“开放式”手术控制台、一个系统塔和四个臂架推车组成。由于关节众多，每个臂架具有极广泛的适应性。人体尸体实验于2021年8月至12月在ORSI学院进行。所有手术均由两个手术团队进行，每个团队由一名在机器人手术、妇科肿瘤学和盆腔侧壁手术方面经验丰富的高年资外科医生以及一名床边助手组成。确定了三种主要的妇科手术场景：标准盆腔手术、盆腔侧壁手术和腹主动脉旁/上腹部手术。关于端口放置，选择的方案称为“直线型”和“桥接型”；相反，臂架推车定位确定了所谓的“紧凑型”和“蝴蝶型”配置。使用四具尸体进行了全子宫切除术、根治性子宫切除术、盆腔脏器清扫术、盆腔和腹主动脉旁淋巴结清扫术以及大网膜切除术。我们进行了多项测试，确定了最佳系统配置，以便在所有妇科手术场景中从系统的灵活性中获得适当的效率。直线型端口放置似乎适用于标准盆腔手术。桥接套管针位置最适合到达女性盆腔更深和更外侧的解剖区域。紧凑型和蝴蝶型臂架推车配置适用于直线型和桥接型端口放置。在进行深部盆腔手术时，床边助手通过使用放置在左髂窝辅助端口的标准腹腔镜器械操作变得更加熟练。臂架推车需要以开放的方式移动，就像所提议的蝴蝶型配置那样。相反，紧凑型配置在帕尔默点端口处留出了足够的空间进行辅助。成功进行并完成了多项基本和高级妇科手术，未遇到任何技术或手术问题，所获得的结果被认为足以在日常实践中开展临床经验。HUGO™机器人辅助手术系统在各种手术场景中具有灵活性和高性能。
