Bowersox J C, Cordts P R, LaPorta A J
Department of Surgery, Stanford University School of Medicine, CA, USA.
J Am Coll Surg. 1998 Jun;186(6):615-21. doi: 10.1016/s1072-7515(98)00105-7.
Death from battlefield trauma occurs rapidly. Potentially salvageable casualties generally exsanguinate from truncal hemorrhage before operative intervention is possible. An intuitive telemanipulator system that would allow distant surgeons to remotely treat injured patients could improve the outcome from severe injuries.
We evaluated a prototype, four-degree-of-freedom, telesurgery system that provides a surgeon with a stereoscopic video display of a remote operative field. Using dexterous robotic manipulators, surgical instruments at the remote site can be precisely controlled, enabling operative procedures to be performed remotely. Surgeons (n = 3) used the telesurgery system to perform organ excision, hemorrhage control, suturing, and knot tying on anesthetized swine. The ability to complete tasks, times required, technical quality, and subjective impressions were recorded.
Surgeons using the telesurgery system were able to close gastrotomies remotely, although times required were 2.7 times as long as those performed by conventional techniques (451 +/- 83 versus 1,235 +/- 165 seconds, p < 0.002). Cholecystectomies, hemorrhage control from liver lacerations, and enterotomy closures were successfully completed in all attempts. Force feedback and stereoscopic video display were important for achieving intuitive performance with the telesurgery system, although tasks were completed adequately in the absence of these sensory cues.
We demonstrated the feasibility of performing standard surgical procedures remotely, with the operating surgeon linked to the distant field only by electronic cabling. Complex manipulations were possible, although the times required were much longer. The capabilities of the system used would not support resuscitative surgery. Telesurgery is unlikely to play a role in early trauma management, but may be a unique research tool for acquiring basic knowledge of operative surgery.
战场创伤导致的死亡迅速发生。在进行手术干预之前，潜在可救治的伤员通常会因躯干出血而失血过多。一种直观的远程操作手术系统可让远程外科医生对受伤患者进行远程治疗，这可能会改善重伤的治疗效果。
我们评估了一种原型四自由度远程手术系统，该系统为外科医生提供远程手术区域的立体视频显示。通过灵活的机器人操纵器，可以精确控制远程部位的手术器械，从而能够远程进行手术操作。外科医生（n = 3）使用该远程手术系统对麻醉后的猪进行器官切除、止血、缝合和打结操作。记录完成任务的能力、所需时间、技术质量和主观感受。
使用远程手术系统的外科医生能够远程关闭胃切开术，尽管所需时间是传统技术的2.7倍（451±83秒对1235±165秒，p<0.002）。所有尝试均成功完成了胆囊切除术、肝裂伤止血和肠切开术闭合。力反馈和立体视频显示对于通过远程手术系统实现直观操作很重要，尽管在没有这些感官提示的情况下也能充分完成任务。
我们证明了仅通过电子线缆将手术医生与远程手术区域相连，远程执行标准外科手术的可行性。复杂操作是可能的，尽管所需时间长得多。所使用系统的能力不支持复苏手术。远程手术不太可能在早期创伤管理中发挥作用，但可能是获取手术基础理论知识的独特研究工具。
