Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan.
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Langenbecks Arch Surg. 2022 Dec;407(8):3783-3791. doi: 10.1007/s00423-022-02710-6. Epub 2022 Oct 14.
AIM: The recent development of new surgical robots and network telecommunication technology has opened new avenues for robotic telesurgery. Although a few gastroenterological surgeries have been performed in the telesurgery setting, more technically demanding procedures including gastrectomy with D2 lymphadenectomy and intracorporeal anastomosis have never been reported. We examined the feasibility of telesurgical robotic gastrectomy using the hinotori™ Surgical Robot System in a preclinical setting. METHODS: First, the suturing time in the dry model was measured in the virtual telesurgery setting to determine the latency time threshold. Second, a surgeon cockpit and a patient unit were installed at Okazaki Medical Center and Fujita Health University, respectively (approximately 30 km apart), and connected using a 10-Gbps leased optic-fiber network. After evaluating the feasibility in the dry gastrectomy model, robotic distal gastrectomies with D2 lymphadenectomy and intracorporeal B-I anastomosis were performed in two porcine models. RESULTS: The virtual telesurgery study identified a latency time threshold of 125 ms. In the actual telesurgery setting, the latency time was 27 ms, including a 2-ms telecommunication network delay and a 25-ms local information process delay. After verifying the feasibility of the operative procedures using a gastrectomy model, two telesurgical gastrectomies were successfully completed without any unexpected events. No fluctuation was observed across the actual telesurgeries. CONCLUSION: Short-distance telesurgical robotic surgery for technically more demanding procedure may be safely conducted using the hinotori Surgical Robot System connected by high-speed optic-fiber communication.
目的:新的手术机器人和网络远程通信技术的发展为远程机器人手术开辟了新途径。虽然已经在远程手术环境中进行了一些胃肠手术,但从未报道过包括 D2 淋巴结清扫和体内吻合在内的技术要求更高的手术。我们在临床前环境中使用 hinotori™手术机器人系统检查了远程机器人胃切除术的可行性。
方法:首先,在虚拟远程手术环境中测量干模型中的缝合时间,以确定潜伏期时间阈值。其次,在冈崎医疗中心和藤田保健大学分别安装了一个外科医生驾驶舱和一个患者单元(相距约 30 公里),并使用 10Gbps 租用光纤网络连接。在干胃切除术模型中评估可行性后,在两个猪模型中进行了机器人远端胃切除术和 D2 淋巴结清扫以及体内 B-I 吻合术。
结果:虚拟远程手术研究确定了 125ms 的潜伏期时间阈值。在实际远程手术环境中,潜伏期时间为 27ms,包括 2ms 的远程通信网络延迟和 25ms 的本地信息处理延迟。使用胃切除术模型验证了手术程序的可行性后,成功完成了两次远程机器人胃切除术,没有发生任何意外事件。实际远程手术中没有观察到波动。
结论:使用高速光纤通信连接的 hinotori 手术机器人系统,可安全进行技术要求更高的短距离远程机器人手术。
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