Bowersox J C, Shah A, Jensen J, Hill J, Cordts P R, Green P S
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
J Vasc Surg. 1996 Feb;23(2):281-7. doi: 10.1016/s0741-5214(96)70272-0.
Telepresence surgery is a novel technology that will allow procedures to be performed on a patient at locations that are physically remote from the operating surgeon. This new method provides the sensory illusion that the surgeon's hands are in direct contact with the patient. We studied the feasibility of the use of telepresence surgery to perform basic operations in vascular surgery, including tissue dissection, vessel manipulation, and suturing.
A prototype telepresence surgery system with bimanual force-reflective manipulators, interchangeable surgical instruments, and stereoscopic video input was used. Arteriotomies created ex vivo in segments of bovine aortae or in vivo in femoral arteries of anesthetized swine were closed with telepresence surgery or by conventional techniques. Time required, technical quality (patency, integrity of suture line), and subjective difficulty were compared for the two methods.
All attempted procedures were successfully completed with telepresence surgery. Arteriotomy closures were completed in 192+/-24 sec with conventional techniques and 483+/-118 sec with telepresence surgery, but the precision attained with telepresence surgery was equal to that of conventional techniques. Telepresence surgery was described as intuitive and natural by the surgeons who used the system.
Blood-vessel manipulation and suturing with telepresence surgery are feasible. Further instrument development (to increase degrees of freedom) is required to achieve operating times comparable to conventional open surgery, but the system has great potential to extend the expertise of vascular surgeons to locations where specialty care is currently unavailable.
远程临场手术是一项新技术，它能使手术在与主刀医生实际相隔较远的地点对患者进行操作。这种新方法能提供一种感觉错觉，让外科医生觉得自己的双手直接接触到了患者。我们研究了使用远程临场手术进行血管外科基本手术（包括组织解剖、血管操作和缝合）的可行性。
使用了一个带有双手力反馈操纵器、可互换手术器械和立体视频输入的远程临场手术系统原型。通过远程临场手术或传统技术对在牛主动脉段离体创建或在麻醉猪的股动脉体内创建的动脉切开进行闭合。比较了两种方法所需的时间、技术质量（通畅性、缝线完整性）和主观难度。
所有尝试的手术均通过远程临场手术成功完成。传统技术完成动脉切开闭合的时间为192±24秒，远程临场手术为483±118秒，但远程临场手术达到的精度与传统技术相当。使用该系统的外科医生将远程临场手术描述为直观且自然。
远程临场手术进行血管操作和缝合是可行的。需要进一步开发器械（以增加自由度），以实现与传统开放手术相当的手术时间，但该系统有很大潜力将血管外科医生的专业技能扩展到目前无法获得专科护理的地点。
