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    機(jī)器人手術(shù)

    2015-11-01 02:49:40Teleroboticassistedlaparoscopicrightandsigmoidcolectomiesforbenigndisease
    關(guān)鍵詞:機(jī)器人

    Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease

    Weber,PA; Merola,S; Wasielewski,A; et al.

    Assessment of intraoperative safety in transoral robotic surgery

    Hockstein,NG; O'Malley,BW; Weinstein,GS; et al.

    Transoral robotic surgery

    Weinstein,GS; O'Malley,BW; Snyder,W; et al.

    外科手術(shù)機(jī)器人發(fā)展及其應(yīng)用*

    龔朱,楊愛華,趙惠康

    (同濟(jì)大學(xué)附屬同濟(jì)醫(yī)院,上海200065)

    醫(yī)療機(jī)器人發(fā)展概況綜述

    杜志江,孫立寧,富歷新

    熱點(diǎn)追蹤

    機(jī)器人手術(shù)

    ·編者按·

    機(jī)器人手術(shù)系統(tǒng)是集自動(dòng)機(jī)械技術(shù)、遠(yuǎn)程通訊和計(jì)算機(jī)技術(shù)等多項(xiàng)現(xiàn)代高科技手段于一體的綜合系統(tǒng),屬于涉及醫(yī)學(xué)、生物力學(xué)、機(jī)械力學(xué)、材料學(xué)、計(jì)算機(jī)圖形學(xué)、微電子學(xué)、數(shù)學(xué)分析等諸多學(xué)科的交叉研究領(lǐng)域,是當(dāng)前醫(yī)療器械信息化、程控化、智能化的一個(gè)重要發(fā)展方向,在臨床微創(chuàng)手術(shù)以及戰(zhàn)地救護(hù)、地震海嘯救災(zāi)等方面有著廣泛的應(yīng)用前景。尤其是以da Vinci(達(dá)芬奇)為代表的手術(shù)機(jī)器人,以其全新的理念和前所未有的技術(shù)優(yōu)勢(shì)將手術(shù)精確度和可行性提升到一個(gè)全新的高度,引領(lǐng)了外科發(fā)展史上的一次新革命。

    機(jī)器人首次協(xié)助手術(shù)治療始于1978年,Victor Scheinmann研制的基于工業(yè)機(jī)器人平臺(tái)的Puma560(Programmable Universal Manipulation Arm,PUMA)。到目前為止,獲得美國(guó)食品藥品監(jiān)督管理局認(rèn)證,并且比較有影響力的機(jī)器人手術(shù)系統(tǒng)主要有三代產(chǎn)品。第一代是美國(guó)Computer Motion公司1994年研制的持鏡機(jī)器人伊索(AESOP),包括AESOP-1000、AESOP-2000、AESOP-3000三個(gè)階段的產(chǎn)品;第二代是Computer Motion公司1995年研制的遙控機(jī)器人宙斯(ZEUS),分為Surgeonside系統(tǒng)和Patient-side系統(tǒng);第三代為美國(guó)Intuitive Surgical公司研制的達(dá)芬奇機(jī)器人手術(shù)系統(tǒng),達(dá)芬奇系統(tǒng)是現(xiàn)在最為先進(jìn)、成熟和應(yīng)用最廣泛的機(jī)器人手術(shù)系統(tǒng)。達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)由醫(yī)生操作系統(tǒng)、床旁機(jī)械臂系統(tǒng)、成像系統(tǒng)3部分組成。其中,醫(yī)生操作系統(tǒng)是達(dá)芬奇系統(tǒng)的控制核心,由計(jì)算機(jī)系統(tǒng)、監(jiān)視器、操作手柄及輸出設(shè)備等組成;床旁機(jī)械臂系統(tǒng)裝有一系列的內(nèi)置機(jī)械手腕裝置,每一個(gè)機(jī)械手腕裝置都有一個(gè)特定的手術(shù)功能,例如鉗夾、縫合或組織處理;影像系統(tǒng)裝配高清的3D內(nèi)鏡、圖像加工裝置和圖像監(jiān)視器。達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)具有微創(chuàng),術(shù)后恢復(fù)較快以及操作精細(xì)穩(wěn)定,可以在某種程度上降低手術(shù)風(fēng)險(xiǎn)的優(yōu)點(diǎn)。同時(shí),也存在著無(wú)觸覺,缺乏握力及壓力反饋系統(tǒng),無(wú)線通訊易受到干擾以及手術(shù)成本較高等不足之處,患者需要承擔(dān)一定的安全風(fēng)險(xiǎn)。盡管機(jī)器人手術(shù)存在問(wèn)題,但畢竟智能手術(shù)機(jī)器人正式應(yīng)用于臨床研究只不過(guò)十余年的時(shí)間,就已經(jīng)極大地提高了手術(shù)的精度和準(zhǔn)度,并且在實(shí)際應(yīng)用中取得了不小的成果。截至2014年底,達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)的全球裝機(jī)總量為3266臺(tái),其中,中國(guó)大陸地區(qū)為29臺(tái),應(yīng)用達(dá)芬奇機(jī)器人外科手術(shù)系統(tǒng)共完成手術(shù)11471例。有專家認(rèn)為,隨著醫(yī)學(xué)和科技的進(jìn)步,機(jī)器人手術(shù)中存在的問(wèn)題將得到逐步解決,未來(lái)外科領(lǐng)域中的各種手術(shù)操作都將可以通過(guò)手術(shù)機(jī)器人系統(tǒng)完成,機(jī)器人輔助手術(shù)、機(jī)器人遠(yuǎn)程手術(shù)將會(huì)像普通手術(shù)一樣平常。

    本專題得到了田利國(guó)編審(《中國(guó)實(shí)用外科雜志》編輯部)的大力支持。

    ·熱點(diǎn)數(shù)據(jù)排行·

    截至2015年6月15日,中國(guó)知網(wǎng)(CNKI)和Web of Science(WOS)的數(shù)據(jù)報(bào)告顯示,以機(jī)器人手術(shù)為詞條檢索到的期刊文獻(xiàn)分別為1506與4795條,本專題將相關(guān)數(shù)據(jù)按照:研究機(jī)構(gòu)發(fā)文數(shù)、作者發(fā)文數(shù)、期刊發(fā)文數(shù)、被引用頻次進(jìn)行排行,結(jié)果如下。

    研究機(jī)構(gòu)發(fā)文數(shù)量排名(CNKI)

    研究機(jī)構(gòu)發(fā)文數(shù)量排名(WOS)

    作者發(fā)文數(shù)量排名(CNKI)

    作者發(fā)文數(shù)量排名(WOS)

    期刊發(fā)文數(shù)量排名(CNKI)

    期刊發(fā)文數(shù)量排名(WOS)

    根據(jù)中國(guó)知網(wǎng)(CNKI)數(shù)據(jù)報(bào)告,以機(jī)器人手術(shù)為詞條檢索到的高被引論文排行結(jié)果如下。

    國(guó)內(nèi)數(shù)據(jù)庫(kù)高被引論文排行

    根據(jù)Web of Science統(tǒng)計(jì)數(shù)據(jù),以機(jī)器人手術(shù)為詞條檢索到的高被引論文排行結(jié)果如下。

    國(guó)外數(shù)據(jù)庫(kù)高被引論文排行

    ·經(jīng)典文獻(xiàn)推薦·

    基于Web of Science檢索結(jié)果,利用Histcite軟件選取LCS(Local Citation Score,本地引用次數(shù))TOP 50文獻(xiàn)作為節(jié)點(diǎn)進(jìn)行分析,并結(jié)合專家意見得到本領(lǐng)域推薦的經(jīng)典文獻(xiàn)如下。

    來(lái)源出版物:Journal of Urology,2001,165(6): 1964-1966

    Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease

    Weber,PA; Merola,S; Wasielewski,A; et al.

    Abstract: PURPOSE: Telerobotic surgical systems attempt to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. In this article,we present the first two reported cases of telerobotic-assisted laparoscopic colectomies performed on March 6 and 8,2001. METHODS: In the first patient we performed a telerobotic-assisted laparoscopic sigmoid colectomy for diverticulitis. In the second patient,we accomplished a telerobotic-assisted laparoscopic right hemicolectomy for cecal diverticulitis. The Da Vinci telerobotic surgical system was used in both cases to mobilize the bowel. The mesenteric division,bowel transection,and anastomoses were accomplished with standard laparoscopic-assisted techniques. Both operations were completed with a three-trocar technique. RESULTS:We found that the Da Vinci system adequately replaced the camera holder. The three-dimensional virtual operative field helped to maintain the surgeon's orientation during the operation. The combination of three-dimensional imaging and the hand-like motions of the telerobotic surgical instruments facilitated dissection. The Da Vinci console offered an ergonomically comfortable position for the surgeon. Operative times for the sigmoid colectomy was 340 minutes and for the right hemicolectomy 228 minutes. Telerobotic-assisted laparoscopic colectomy is feasible,but required a longer operative time than our standard laparoscopic-assisted technique. CONCLUSION:Telerobotic-assisted laparoscopic colectomy is feasible and warrants further investigations in controlled trials.

    Keywords: robots; telerobots; robotic surgery; telerobotic surgery; telepresence surgery; surgical technique; laparoscopic colectomy;diverticulitis

    來(lái)源出版物:Diseases of the Colon & Rectum,2002,45(12): 1689-1694

    Assessment of intraoperative safety in transoral robotic surgery

    Hockstein,NG; O'Malley,BW; Weinstein,GS; et al.

    Abstract: Introduction: Robotic technology has been safely integrated into thoracic and abdominopelvic surgery,and the early experience has been very promising with very rare complications related to robotic device failure. Recently,several reports have documented the technical feasibility of transoral robotic surgery(TORS)with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy,base-of-tongue resection,supraglottic laryngectomy,and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration,tooth injury,mucosal laceration,mandible fracture,cervical spine fracture,and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. Methods: To test this hypothesis,we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. Results: Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth,mandible,and cervical spine fracture could not be achieved. Conclusions: Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally,we discuss several strategies to increase patient safety in TORS.

    Keywords: robotic; endoscopic; minimally invasive surgery; microsurgery; larynx; partial laryngectomy; laryngeal cancer; DaVinci;transoral robotic surgery(TORS); complications

    來(lái)源出版物:Laryngoscope,2006,116(2): 165-168

    Transoral robotic surgery

    Weinstein,GS; O'Malley,BW; Snyder,W; et al.

    Abstract: Objective: To describe and show the feasibility of a new surgical technique for transoral robotic surgery(TORS)radical tonsillectomy. Design: A prospective,phase 1 clinical trial. Setting: Academic,tertiary referral center. Patients: A total of 27 participants were prospectively selected using a volunteer sample. All eligible patients agreed to participate in the study. Interventions: Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction,staged neck dissection,and adjuvant therapy. Main Outcome Measures: Outcome measures included final pathologic margin status,need for short-and long-term tracheotomy tube placement,and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up. The incidence of significant postoperative complications was recorded. Results: No mortality occurred. Final margins found to be negative for cancer were achieved in 25 of 27 patients(93%). Surgical complications included I case each of postoperative mucosal bleeding,delirium tremens,unplanned tracheotomy for temporary exacerbation of sleep apnea,and hypernasality and 2 cases of moderate trismus. Twenty-six of 27 patients(96%)were swallowing without the use of a gastrostomy. Conclusions: Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity. Future reports will focus on long-term oncologic and functional outcomes.

    Keywords: squamous-cell carcinoma; selective neck dissection; locally advanced head; lateral oropharyngectomy; tonsillar region;chemotherapy; cancer

    來(lái)源出版物:Archives of Otolaryngology-Head & Neck Surgery,2007,133(12): 1220-1226

    ·推薦綜述·

    外科手術(shù)機(jī)器人發(fā)展及其應(yīng)用*

    龔朱,楊愛華,趙惠康

    (同濟(jì)大學(xué)附屬同濟(jì)醫(yī)院,上海200065)

    摘編自《海洋環(huán)境科學(xué)》2014年28卷3期:273-277頁(yè),圖、表、參考文獻(xiàn)已省略。

    外科手術(shù)機(jī)器人是集臨床醫(yī)學(xué)、生物力學(xué)、機(jī)械學(xué)、材料學(xué)、計(jì)算機(jī)科學(xué)、微電子學(xué)、機(jī)電一體化等諸多學(xué)科為一體的新型醫(yī)療器械,是當(dāng)前醫(yī)療器械信息化、程控化、智能化的一個(gè)重要發(fā)展方向,在臨床微創(chuàng)手術(shù)以及戰(zhàn)地救護(hù)、地震海嘯救災(zāi)等方面有著廣泛的應(yīng)用前景。

    進(jìn)入新世紀(jì)以來(lái),外科手術(shù)微創(chuàng)化,微創(chuàng)手術(shù)精細(xì)化、立體化,如同一股新浪潮席卷全球的外科學(xué)界,并滲透到普通外科、心臟外科、胸外科、泌尿外科、腦外科、骨科等各臨床??疲瑒?dòng)搖著并逐漸替代已沿用百余年之久的經(jīng)典的傳統(tǒng)外科手術(shù)方式。微創(chuàng)外科不僅引發(fā)了外科學(xué)領(lǐng)域的一場(chǎng)新技術(shù)革命,而且正在結(jié)合自動(dòng)機(jī)械技術(shù)、遠(yuǎn)程通訊和計(jì)算機(jī)技術(shù),開創(chuàng)一個(gè)機(jī)器人外科的新時(shí)代[1]!

    1外科手術(shù)機(jī)器人概況及其應(yīng)用

    1.1達(dá)芬奇機(jī)器人微創(chuàng)外科手術(shù)系統(tǒng)

    達(dá)芬奇機(jī)器人微創(chuàng)外科手術(shù)系統(tǒng)(da Vinci Si HDSurgical System)是目前世界范圍應(yīng)用廣泛的一種智能化手術(shù)平臺(tái),2000年獲得美國(guó)食品與藥品監(jiān)督管理局(FDA)批準(zhǔn),成為進(jìn)入臨床外科的智能內(nèi)窺鏡微創(chuàng)手術(shù)系統(tǒng)。適合普腹外科、泌尿外科、心血管外科、胸心外科、婦科、五官科、小兒外科等進(jìn)行遙控微創(chuàng)手術(shù)。該系統(tǒng)的手術(shù)操作部分已可完成7個(gè)自由度的操作,由外科醫(yī)師在遠(yuǎn)程工作站進(jìn)行遙控,具有整合三維成像、觸覺反饋和寬帶遠(yuǎn)距離控制等功能[2]。

    達(dá)芬奇微創(chuàng)外科手術(shù)機(jī)器人高達(dá)1.8米,重達(dá)500公斤,由醫(yī)師臥式操作控制臺(tái)、立式機(jī)械手術(shù)臂、輪式標(biāo)準(zhǔn)儀器柜三大部分組成(如圖1顯示)。這種外科手術(shù)系統(tǒng)的最大特點(diǎn)是:采用了醫(yī)師座式姿態(tài)(遠(yuǎn)程)遙控機(jī)器人系統(tǒng)進(jìn)行手術(shù),這樣的手術(shù)方式突破了傳統(tǒng)的手術(shù)方式,由“觸覺外科”向“視覺外科”轉(zhuǎn)變,標(biāo)志著人類微創(chuàng)外科技術(shù)的革命性飛躍。

    其核心技術(shù)是:

    1.1.1DHD 高清手術(shù)視野(視覺)

    該系統(tǒng)具有6-10倍的三維高清手術(shù)視野,可為醫(yī)師提供身臨其境的手術(shù)臨場(chǎng)沉浸感,提供清晰細(xì)致的解剖組織結(jié)構(gòu)圖像與自然的深度感覺空間,還提供了無(wú)與倫比的術(shù)野視覺感[3]。

    1.1.2EndoWrist 仿真機(jī)械手

    該系統(tǒng)可提供比人手自由度更廣泛的動(dòng)作。具有7個(gè)自由度,包括臂關(guān)節(jié)上下、前后、左右運(yùn)動(dòng)與機(jī)械手的左右、旋轉(zhuǎn)、開合、末端關(guān)節(jié)彎曲共7種動(dòng)作??勺餮卮怪陛S360°和水平軸270°旋轉(zhuǎn),且每個(gè)關(guān)節(jié)活動(dòng)度均大于90°。尤其在行深部操作時(shí),機(jī)械手由于動(dòng)作靈活,體積小巧,與開放手術(shù)的人手操作相比具有顯著優(yōu)勢(shì)。EndoWrist仿真機(jī)械手配置了各類型手術(shù)器械,可滿足抓持、鉗夾、縫合等各項(xiàng)手術(shù)操作要求,也可滿足胸心外科、普腹外科、泌尿外科、婦產(chǎn)科等各種手術(shù)的操作需求。各種類型手術(shù)器械手均有8 mm 和5 mm兩種規(guī)格[3]。

    1.1.3Intuitive 直覺運(yùn)動(dòng)控制技術(shù)

    Intuitive 是達(dá)芬奇機(jī)器人獨(dú)有的計(jì)算機(jī)輔助控制技術(shù)。眼—手協(xié)調(diào)、手—機(jī)械手端實(shí)時(shí)同步,使得醫(yī)師可以憑借本能進(jìn)行直覺式的操控機(jī)械手端。手術(shù)醫(yī)師手指動(dòng)作的運(yùn)動(dòng)行程與機(jī)械手端的運(yùn)動(dòng)行程比例可以調(diào)節(jié),現(xiàn)有3種縮小比例,即5∶1、3∶1和11∶ 。該技術(shù)將術(shù)者手指動(dòng)作的幅度自動(dòng)縮小,使手術(shù)操作更加穩(wěn)定精細(xì)。手術(shù)醫(yī)師的手部抖動(dòng)信號(hào)會(huì)被自動(dòng)過(guò)濾[3]。

    1.1.4達(dá)芬奇外科機(jī)器人手術(shù)系統(tǒng)臨床應(yīng)用

    達(dá)芬奇機(jī)器人外科微創(chuàng)手術(shù)系統(tǒng)是21世紀(jì)微創(chuàng)外科技術(shù)、遠(yuǎn)程遙控手術(shù)技術(shù)的革命性標(biāo)志,代表了當(dāng)今世界最先進(jìn)的外科醫(yī)療技術(shù)。

    目前,在美國(guó)泌尿外科領(lǐng)域,有50%的病人選擇達(dá)芬奇外科機(jī)器人手術(shù)。與常規(guī)泌尿外科腔鏡手術(shù)比較,達(dá)芬奇機(jī)器人外科微創(chuàng)手術(shù)系統(tǒng),提供3DHD高清晰度圖像,6-10倍的放大倍率,自然的深度感覺,使手術(shù)醫(yī)師能夠精細(xì)處理解剖組織,盡可能不碰傷手術(shù)周圍組織,如:在前列腺癌手術(shù)中不碰傷前列腺附近的神經(jīng)血管束、副交感神經(jīng),等,以保全患者性功能。美國(guó)85%以上的前列腺癌根治術(shù)已使用達(dá)芬奇手術(shù)機(jī)器人完成。

    另外,美國(guó)還采用達(dá)芬奇機(jī)器人打造新型戰(zhàn)地醫(yī)院。2005年3月28日,美國(guó)有關(guān)大學(xué)和斯坦福國(guó)際研究所(SRI International)與美國(guó)國(guó)防部簽訂了機(jī)器人醫(yī)師的研制協(xié)議[4]。這項(xiàng)名為“外傷豆莢”的計(jì)劃預(yù)計(jì)將耗資1200萬(wàn)美元、歷時(shí)兩年完成。機(jī)器人外傷救治體系是在達(dá)芬奇外科手術(shù)機(jī)器人系統(tǒng)基礎(chǔ)上更進(jìn)一步研究適用于戰(zhàn)場(chǎng)的機(jī)器人手術(shù)醫(yī)師。

    2009年美國(guó)斯坦福國(guó)際研究所開發(fā)出流動(dòng)“外傷救治艙”(Trauma Pod)[5],并將達(dá)芬奇機(jī)器人安裝在改裝的美軍“布拉德利”(Bradley)裝甲車上送往前線。醫(yī)師護(hù)士遠(yuǎn)離戰(zhàn)場(chǎng),通過(guò)衛(wèi)星聯(lián)網(wǎng),遙控達(dá)芬奇機(jī)械人給戰(zhàn)場(chǎng)傷員注射麻醉劑,實(shí)施手術(shù),挽救傷員生命,以減少美軍官兵在戰(zhàn)場(chǎng)上的傷亡人數(shù)。“外傷救治艙”遙控手術(shù)設(shè)計(jì)如圖2所示: ①遠(yuǎn)離戰(zhàn)場(chǎng)的外科醫(yī)師(人):用聲控監(jiān)視器和遙感通過(guò)衛(wèi)星連接遙控外傷救治艙(Trauma Pod)機(jī)器人;②機(jī)器人一個(gè)機(jī)械臂安置攝像機(jī)和內(nèi)窺鏡,另外兩個(gè)機(jī)械臂可以是手術(shù)刀或者是手術(shù)鉗和針;③手術(shù)床監(jiān)視傷兵的重要信息并控制生命維持系統(tǒng);④機(jī)器人器械柜放置各種手術(shù)用機(jī)械臂;⑤擦洗護(hù)士:聲控的機(jī)械臂,從器械柜抓取機(jī)械臂,并提供給操作的機(jī)器人。

    截止2013年3月31日,全球達(dá)芬奇外科手術(shù)機(jī)器人系統(tǒng)裝機(jī)總數(shù)為2710臺(tái)。其中,美國(guó):1957臺(tái)(占72.2%);歐洲:430臺(tái)(占15.9%);亞洲:220臺(tái),(其中中國(guó)香港8臺(tái))(8.1%);其他地區(qū):103臺(tái)(占3.8%)[6]。2011年,全球各國(guó)完成達(dá)芬奇機(jī)器人手術(shù)共計(jì)為36萬(wàn)例,2012年為45萬(wàn)例,年手術(shù)量同比增長(zhǎng)25%[3]。

    1.1.5達(dá)芬奇機(jī)器人微創(chuàng)外科手術(shù)系統(tǒng)在我國(guó)的應(yīng)用

    2007年1月25日,解放軍總醫(yī)院心血管外科高長(zhǎng)青運(yùn)用達(dá)芬奇外科手術(shù)機(jī)器人“da Vinci S”,為一名女患者成功實(shí)施不開胸的心臟手術(shù)。這是我國(guó)首例全部由機(jī)器人完成的心臟病手術(shù)。2008年,解放軍總醫(yī)院引進(jìn)中國(guó)第一臺(tái)達(dá)芬奇(da Vinci S)機(jī)器人外科手術(shù)系統(tǒng)。2010年以來(lái),以解放軍總醫(yī)院、第二炮兵總醫(yī)院、上海復(fù)旦大學(xué)附屬中山醫(yī)院、上海交通大學(xué)附屬瑞金醫(yī)院為代表,在心胸外科、肝膽胰腺等領(lǐng)域應(yīng)用達(dá)芬奇(da Vinci Si HD)機(jī)器人微創(chuàng)外科手術(shù)方面,已進(jìn)入世界前列。

    2010年1月20日,中國(guó)微創(chuàng)機(jī)器人心臟外科培訓(xùn)中心在解放軍總醫(yī)院正式成立。來(lái)自美、法等7個(gè)國(guó)家的200多名專家共同在該院觀摩“da Vinci SiHD”機(jī)器人心臟手術(shù)實(shí)況演示。截止2013年該中心已實(shí)施500例達(dá)芬奇機(jī)器人心臟手術(shù),手術(shù)種類世界第一[7]。

    截止2012年底,中國(guó)大陸(港澳臺(tái)除外)配置達(dá)芬奇手術(shù)機(jī)器人的有14家醫(yī)院,共安裝達(dá)芬奇機(jī)器人外科手術(shù)系統(tǒng)15臺(tái)。這些醫(yī)院在2011年完成各類達(dá)芬奇機(jī)器人手術(shù)808例,2012年完成1546例,年手術(shù)量同比增長(zhǎng)91.3%。截止2012年底,國(guó)內(nèi)歷年累計(jì)完成達(dá)芬奇機(jī)器人手術(shù)3551例[6]。

    1.2宙斯機(jī)器人手術(shù)系統(tǒng)

    宙斯機(jī)器人手術(shù)系統(tǒng)(zeus robotic surgical system)是由美籍華裔王友侖先生于1998年在美國(guó)摩星有限公司研發(fā)成功。1999年獲得歐洲市場(chǎng)認(rèn)證,標(biāo)志著真正的“手術(shù)機(jī)器人”進(jìn)入全球醫(yī)療市場(chǎng)領(lǐng)域。進(jìn)入中國(guó)市場(chǎng)的宙斯機(jī)器人手術(shù)系統(tǒng)包括:(aesop)聲控內(nèi)窺鏡定位器、赫米斯(hermes)聲控中心、宙斯(zeus)機(jī)器人手術(shù)系統(tǒng)(左右機(jī)械臂、術(shù)者操作控制臺(tái)、視訊控制臺(tái))、蘇格拉底(socrates)遠(yuǎn)程合作系統(tǒng)這幾部分組成。

    手術(shù)時(shí),宙斯機(jī)器人三條機(jī)械臂固定在手術(shù)床滑軌上,醫(yī)師坐在距離手術(shù)床2~5 m的控制臺(tái)前,實(shí)時(shí)監(jiān)視屏幕三維空間立體顯示的手術(shù)野情況,用語(yǔ)音指示Aesop聲控內(nèi)視鏡,另外兩條宙斯黃綠機(jī)械臂則在醫(yī)師遙控下執(zhí)行手術(shù)操作,醫(yī)師足部腳踏板控制超聲波手術(shù)刀完成手術(shù)的燒灼、切割、電凝等工作。

    宙斯機(jī)器人監(jiān)控屏上手術(shù)畫面能放大15~20倍,并可模擬醫(yī)師的手部動(dòng)作,宙斯手術(shù)抓持手是仿照人類手腕設(shè)計(jì)的機(jī)械手,能夠做拋擲、推動(dòng)、緊握等動(dòng)作,可以使醫(yī)師從5~8 mm的小切口進(jìn)入病人體內(nèi)進(jìn)行微創(chuàng)手術(shù)。這給許多本來(lái)需要傳統(tǒng)開放手術(shù)的患者無(wú)疑帶來(lái)很大的福音。

    1.2.1宙斯機(jī)器人手術(shù)系統(tǒng)應(yīng)用—一次橫跨大西洋的機(jī)器人輔助遠(yuǎn)程手術(shù)

    2001年9月7日,美法兩國(guó)醫(yī)師實(shí)施了一次橫跨大西洋的機(jī)器人輔助遠(yuǎn)程手術(shù),由法國(guó)醫(yī)師杰西奎·馬雷斯科(MD. Jacques Marescaux)在紐約西奈山醫(yī)院(Mount Sinai Hospital NY.)操縱著宙斯(Zeus)機(jī)器人(如圖3所示),法國(guó)電信公司開通一條基于(asynchronous transfer mode,ATM)高速光纖專線(10 Mb/s),通過(guò)大西洋海底光纜鏈接到法國(guó)東部斯特拉斯堡大學(xué)醫(yī)院遠(yuǎn)程遙控宙斯機(jī)器人3條機(jī)械臂,為一位68歲法國(guó)婦女作膽囊切除術(shù)(如圖4所示)。這次手術(shù)用了54分鐘,術(shù)后病人情況良好,48小時(shí)之后病人出院[8]。

    越洋手術(shù)成功的一個(gè)關(guān)鍵是解決延時(shí)信號(hào)(Keyto oversea surgery-solution to signal delay)問(wèn)題。紐約至法國(guó)斯特拉斯堡遠(yuǎn)程遙控手術(shù)視頻圖像信號(hào)傳輸相距14000公里,并且,穿越大西洋海底,法國(guó)電信公司開通一條基于ATM高速光纖專線(10 Mb/s),手術(shù)圖像往返的傳輸幾乎是瞬間完成的。也就是說(shuō),馬雷斯科醫(yī)師在紐約遙控斯特拉斯堡手術(shù)臺(tái)上的3條宙斯機(jī)械臂的手術(shù)動(dòng)作,幾乎是即刻反饋在紐約的監(jiān)控屏幕上,僅有約155毫秒的延遲,遠(yuǎn)遠(yuǎn)低于原來(lái)估計(jì)的330毫秒的安全延遲時(shí)限范圍之內(nèi)[8]。

    為了此次越洋手術(shù),醫(yī)療小組前后共進(jìn)行了兩年的時(shí)間準(zhǔn)備,歷經(jīng)無(wú)數(shù)次的各種試驗(yàn)考驗(yàn)[8]。

    1.2.2宙斯機(jī)器人手術(shù)系統(tǒng)在我國(guó)的應(yīng)用

    2004年4月,深圳市人民醫(yī)院引進(jìn)宙斯機(jī)器人手術(shù)系統(tǒng),周漢新團(tuán)隊(duì)完成國(guó)內(nèi)第一臺(tái)宙斯機(jī)器人輔助膽囊切除術(shù)。該院溫定國(guó)團(tuán)隊(duì)完成國(guó)內(nèi)首例宙斯機(jī)器人輔助心臟搭橋術(shù)[9]。

    1.3伊索機(jī)器人手術(shù)輔助系統(tǒng)

    伊索聲控機(jī)器人手術(shù)輔助系統(tǒng)Aesop 1000也是由王友侖先生所在的美國(guó)摩星公司于1994年10月研發(fā)成功,1996年11月第二代Aesop 2000研發(fā)成功。目前,在中國(guó)各大醫(yī)院仍在使用的多為第四代Aesop 3000,重約17公斤。主要由機(jī)械手掌、機(jī)械臂、機(jī)械軀體和電腦語(yǔ)音識(shí)別系統(tǒng)幾部分組成。Aesop實(shí)際上只是一種具有語(yǔ)言識(shí)別能力的內(nèi)窺鏡定位器聲控自動(dòng)裝置。醫(yī)師在手術(shù)前把各種指令記錄在一張聲卡上,手術(shù)時(shí)只需將這張聲卡插入Aesop機(jī)器人的控制盒內(nèi),手術(shù)醫(yī)師就能用聲音直接控制Aesop內(nèi)窺鏡的各種動(dòng)作。如:“move in(前進(jìn))、move back(后退)、move left(左移)、move right(右移),等,它能聽懂幾百條指令,常用指令約30條”。

    1.4伊索機(jī)器人手術(shù)輔助系統(tǒng)在我國(guó)的應(yīng)用

    2001年起,Aesip 2000及Aesop 3000先后進(jìn)入中國(guó)醫(yī)療領(lǐng)域,并先后完成以下手術(shù),如:2001年6月,無(wú)錫四院子宮切除術(shù)和膽囊切除術(shù);2002年3月,山東省胸科醫(yī)院冠狀動(dòng)脈搭橋術(shù);4月,復(fù)旦大學(xué)附屬兒科醫(yī)院3歲兒童的先天性室間隔缺損修復(fù)術(shù);2003年6月,上海市第一人民醫(yī)院心臟二尖瓣膜置換術(shù);2005年7月,復(fù)旦大學(xué)附屬中山醫(yī)院的第10例7歲兒童房缺封堵術(shù);2008年,湖南省兒童醫(yī)院小兒巨結(jié)腸術(shù)。該院自投入300多萬(wàn)元從美國(guó)引進(jìn)Aesop 3000運(yùn)用,至今已行各種手術(shù)近千例[10]。2012年中國(guó)煤炭神馬醫(yī)療集團(tuán)總醫(yī)院應(yīng)用Aesop 3000機(jī)器人施行各種膽囊疾病微創(chuàng)手術(shù)418例的報(bào)道。Aesop聲控機(jī)器人彌補(bǔ)了常規(guī)腹腔鏡、胸腔鏡光學(xué)內(nèi)鏡視角狹小、手持晃動(dòng)引起頭暈眼晃等不足,提高了微創(chuàng)手術(shù)的療效。

    2中國(guó)遠(yuǎn)程遙控機(jī)器人概況

    2.1中國(guó)遠(yuǎn)程遙控機(jī)器人—“黎元BH-600”聲控機(jī)器人

    2001年,解放軍海軍總醫(yī)院田增民神經(jīng)外科團(tuán)隊(duì)與北京航空航天大學(xué)中國(guó)航天技術(shù)研究所合作,研發(fā)成功“黎元BH-600”聲控機(jī)器人。并于2003年9月10日,在北京海軍總醫(yī)院通過(guò)互聯(lián)網(wǎng)鏈接到相距600公里外的沈陽(yáng)醫(yī)學(xué)院附屬中心醫(yī)院手術(shù)室,為一位52歲的腦溢血患者實(shí)施微創(chuàng)手術(shù),成功實(shí)施了國(guó)內(nèi)第一例腦外科立體定向遠(yuǎn)程遙控手術(shù)(如圖5所示)。

    上午10點(diǎn)整,手術(shù)正式開始,田增民醫(yī)師在北京手持鼠標(biāo)發(fā)出指令,沈陽(yáng)手術(shù)室里“黎元”機(jī)器人在一位腦溢血患者頭部行校正、靶點(diǎn)定位后,鉆出一個(gè)3 mm的小孔,將一根針管從小孔插到淤血里回抽出淤血。10點(diǎn)55分,手術(shù)圓滿成功,病人的患肢肌力從二級(jí)提高到三級(jí)[11]。

    2.2國(guó)內(nèi)第一例長(zhǎng)骨骨折髓內(nèi)釘內(nèi)固定遠(yuǎn)程遙控操作手術(shù)

    2006年3月,北京積水潭醫(yī)院與北京航空航天大學(xué)合作,利用小型模塊化機(jī)器人,在北京和延安之間完成了國(guó)內(nèi)第一例長(zhǎng)骨骨折髓內(nèi)釘內(nèi)固定遠(yuǎn)程遙控操作手術(shù),提出并實(shí)現(xiàn)了基于窄帶網(wǎng)絡(luò)的遠(yuǎn)程規(guī)劃理念,從而在一定程度上降低了遠(yuǎn)程遙控外科對(duì)網(wǎng)絡(luò)配置的要求[12]。

    2.3我國(guó)自主研制成功首臺(tái)微創(chuàng)外科手術(shù)機(jī)器人“妙手A”

    “妙手A”系統(tǒng)是由天津大學(xué)、南開大學(xué)和天津醫(yī)科大學(xué)總醫(yī)院聯(lián)合研制,是國(guó)家863計(jì)劃和國(guó)家杰出青年科學(xué)基金重點(diǎn)支持項(xiàng)目。該系統(tǒng)主要用于腹腔微創(chuàng)手術(shù),擁有多項(xiàng)技術(shù)創(chuàng)新和發(fā)明。如首次設(shè)計(jì)完成四自由度小型手術(shù)工具,可適應(yīng)微創(chuàng)手術(shù)需求,并可完成復(fù)雜的縫合打結(jié)運(yùn)動(dòng)操作;采用多自由度絲傳動(dòng)技術(shù),實(shí)現(xiàn)主、從操作手本體輕量化設(shè)計(jì);基于異構(gòu)空間映射模型,實(shí)現(xiàn)主、從遙操作控制;設(shè)計(jì)機(jī)器人系統(tǒng)與人體軟組織變形仿真環(huán)境,實(shí)現(xiàn)主、從操作虛擬力反饋與手術(shù)規(guī)劃;采用雙路平面正交偏振影像分光法,研制成功微創(chuàng)外科手術(shù)機(jī)器人三維立體視覺系統(tǒng)[13]。

    3外科手術(shù)機(jī)器人應(yīng)用前景與啟示

    醫(yī)用機(jī)器人是當(dāng)今世界各國(guó)的研究熱點(diǎn)。國(guó)際先進(jìn)機(jī)器人計(jì)劃(international advanced robotics program,IARP)在歐美、日本等國(guó)已召開過(guò)多屆醫(yī)用外科機(jī)器人研討會(huì)。像IEEE robotics and automation,IEEE Eng,in medicine and biology society,IEEE system,man andcybernetics 等許多著名的國(guó)際會(huì)議,都將醫(yī)用機(jī)器人與計(jì)算機(jī)輔助外科單獨(dú)列為一個(gè)專題。

    近年來(lái),歐美諸國(guó)都進(jìn)行專門立項(xiàng)投資,積極開展醫(yī)用機(jī)器人方面的研究。2008年,美軍在華爾特里德陸軍醫(yī)學(xué)中心(water reed army medical center,WRAMC)和約翰·霍普金斯醫(yī)院(johns hopkins hospital,JHH)之間,兩地相距64公里,采用達(dá)芬奇外科手術(shù)機(jī)器人系統(tǒng),開展微創(chuàng)手術(shù)機(jī)器人遠(yuǎn)程外科項(xiàng)目。

    目前,醫(yī)用機(jī)器人技術(shù)在微創(chuàng)外科手術(shù)治療、病人安全救援、無(wú)痛轉(zhuǎn)運(yùn)、康復(fù)護(hù)理、功能輔助及醫(yī)院自動(dòng)化服務(wù)等方面得到了廣泛的應(yīng)用,這不僅促進(jìn)了傳統(tǒng)醫(yī)學(xué)的革命,也帶動(dòng)了新技術(shù)、新理論的發(fā)展。

    如何將信息技術(shù)與數(shù)字化醫(yī)學(xué)、3DHD和3D打印有機(jī)融入到自身的醫(yī)學(xué)信息教育技術(shù)工作實(shí)踐中去,將是當(dāng)今每一位從事醫(yī)學(xué)信息教育技術(shù)者所面臨的新課題。

    3D高清手術(shù)當(dāng)前如火如荼地在全球醫(yī)療領(lǐng)域進(jìn)行著,中國(guó)各大醫(yī)院3D高清手術(shù)同樣也是遍地開花。同濟(jì)大學(xué)附屬同濟(jì)醫(yī)院(臨床醫(yī)學(xué)院)從2009年起,至今已經(jīng)連續(xù)舉辦了4屆國(guó)家級(jí)3DHD高清手術(shù)轉(zhuǎn)播系統(tǒng)學(xué)習(xí)班(2014年將舉辦第5屆),2013年投入500萬(wàn)專項(xiàng)資金建設(shè)一套3DHD高清手術(shù)轉(zhuǎn)播系統(tǒng)和3DHD遠(yuǎn)程醫(yī)療示教系統(tǒng),用于3DHD高清手術(shù)臨床實(shí)踐與醫(yī)學(xué)信息教育技術(shù)專業(yè)人才培養(yǎng),并與松下電器(中國(guó))有限公司合作,正式簽署協(xié)議,建立上海乃至全國(guó)臨床醫(yī)療領(lǐng)域第一家“3DHD高清手術(shù)轉(zhuǎn)播系統(tǒng)和3DHD遠(yuǎn)程醫(yī)療示教系統(tǒng)上海基地”。

    ·高被引論文摘要·

    被引頻次:157

    醫(yī)療機(jī)器人發(fā)展概況綜述

    杜志江,孫立寧,富歷新

    近年來(lái),醫(yī)療機(jī)器人成為機(jī)器人領(lǐng)域研究熱點(diǎn)之一。本文詳細(xì)介紹了外科手術(shù)機(jī)器人、康復(fù)機(jī)器人、醫(yī)院服務(wù)機(jī)器人等在國(guó)內(nèi)外的研究及應(yīng)用現(xiàn)狀,并探討了今后的發(fā)展方向。

    外科手術(shù)機(jī)器人;康復(fù)機(jī)器人;醫(yī)院服務(wù)機(jī)器人;生物機(jī)器人;納米機(jī)器人

    來(lái)源出版物:機(jī)器人,2003,25(2): 182-187

    被引頻次:83

    微操作機(jī)器人系統(tǒng)的研究開發(fā)

    畢樹生,宗光華

    摘要:介紹了國(guó)家自然科學(xué)基金資助課題“微動(dòng)并聯(lián)機(jī)器人的研制”、“面向生物工程及顯微手術(shù)的微操作機(jī)器人系統(tǒng)”的部分研究成果,討論了微操作機(jī)器人系統(tǒng)亟待解決的一些問(wèn)題,闡述了在構(gòu)筑微操作機(jī)器人過(guò)程中應(yīng)特別注意的一些關(guān)鍵技術(shù)及理論。

    關(guān)鍵詞:微機(jī)械電氣系統(tǒng);微操作系統(tǒng);機(jī)器人

    來(lái)源出版物:中國(guó)機(jī)械工程,1999,10(9): 1024-1027

    被引頻次:81

    基于虛擬現(xiàn)實(shí)的計(jì)算機(jī)輔助立體定向神經(jīng)外科手術(shù)系統(tǒng)

    王子罡,唐澤圣,王田苗,等

    摘要:介紹了一個(gè)計(jì)算機(jī)輔助立體定向神經(jīng)外科手術(shù)系統(tǒng),該系統(tǒng)基于實(shí)時(shí)可視化繪制、機(jī)器人和虛擬現(xiàn)實(shí)技術(shù),輔助醫(yī)生完成立體定向神經(jīng)外科手術(shù)系統(tǒng)首先利用患者腦部的掃描數(shù)據(jù)重構(gòu)并繪制出患者腦部的三維組織結(jié)構(gòu),為醫(yī)生調(diào)整和確定手術(shù)規(guī)劃提供參照,系統(tǒng)采用了標(biāo)記點(diǎn)的校準(zhǔn)方法,在手術(shù)前和手術(shù)中分別進(jìn)行腦部模型和患者的坐標(biāo)校準(zhǔn)。通過(guò)機(jī)械臂的導(dǎo)航,使機(jī)械臂達(dá)到手術(shù)規(guī)劃規(guī)定的位置和姿態(tài),醫(yī)生利用安裝在機(jī)械臂上的手術(shù)器械完成立體定向神經(jīng)外科手術(shù)。通過(guò)虛擬現(xiàn)實(shí)設(shè)備,系統(tǒng)可以創(chuàng)造一個(gè)虛擬手術(shù)環(huán)境和虛擬病人。在這個(gè)虛擬環(huán)境中,醫(yī)生可以進(jìn)行虛擬手術(shù),對(duì)醫(yī)生以后的診斷和手術(shù)起到培訓(xùn)和教學(xué)的作用。

    關(guān)鍵詞:三維數(shù)據(jù)可視化;計(jì)算機(jī)輔助手術(shù);立體定向神經(jīng)外科手術(shù);虛擬現(xiàn)實(shí)

    來(lái)源出版物:計(jì)算機(jī)學(xué)報(bào),2000,23(9): 931-937

    被引頻次:67

    全方向蠕動(dòng)機(jī)器人驅(qū)動(dòng)內(nèi)窺鏡系統(tǒng)的研究

    高立明,林良明,顏國(guó)正,等

    摘要:微創(chuàng)外科手術(shù)是當(dāng)前生物醫(yī)學(xué)工程領(lǐng)域研究的一個(gè)主要目標(biāo)和熱點(diǎn)問(wèn)題,而醫(yī)用內(nèi)窺鏡是符合微創(chuàng)外科手術(shù)要求的一種典型醫(yī)療儀器。本文首先對(duì)醫(yī)用內(nèi)窺鏡的現(xiàn)狀和發(fā)展作了簡(jiǎn)短的評(píng)述,指出了傳統(tǒng)內(nèi)窺鏡人為插入的不足之處;然后結(jié)合微型機(jī)電系統(tǒng)MEMS(micro Electro Me-chanical System)技術(shù)提出了新型全方向蠕動(dòng)機(jī)器人驅(qū)動(dòng)內(nèi)窺鏡系統(tǒng)的方案;最后就該系統(tǒng)的技術(shù)難點(diǎn)和應(yīng)用前景提出了展望。

    關(guān)鍵詞:醫(yī)用內(nèi)窺鏡;蠕動(dòng)式機(jī)器人;微創(chuàng)外科手術(shù)

    來(lái)源出版物:中國(guó)生物醫(yī)學(xué)工程學(xué)報(bào),1998,17(1): 36-41

    被引頻次:64

    醫(yī)療機(jī)器人的研究與進(jìn)展

    張西正,侍才洪,李瑞欣,等

    摘要:醫(yī)療機(jī)器人主要用于傷病員的救援、轉(zhuǎn)運(yùn)、手術(shù)和康復(fù),是醫(yī)療衛(wèi)生裝備信息化、智能化的重要發(fā)展方向之一。通過(guò)對(duì)救援機(jī)器人、手術(shù)機(jī)器人和康復(fù)機(jī)器人等醫(yī)療機(jī)器人的研究現(xiàn)狀及進(jìn)展介紹,表明醫(yī)療機(jī)器人在軍用和民用上有著廣泛的應(yīng)用前景,是目前機(jī)器人領(lǐng)域的一個(gè)研究熱點(diǎn)。

    關(guān)鍵詞:醫(yī)療機(jī)器人;傷病員;救援;手術(shù);康復(fù)

    來(lái)源出版物:中國(guó)醫(yī)學(xué)裝備,2009,6(1): 7-12

    被引頻次:63

    21世紀(jì)骨科領(lǐng)域新技術(shù)——微創(chuàng)外科

    裴國(guó)獻(xiàn),任高宏

    摘要:近年來(lái),微創(chuàng)技術(shù)在骨科領(lǐng)域的應(yīng)用日益廣泛。骨折治療的觀念正在由生物力學(xué)向生物學(xué)微創(chuàng)固定轉(zhuǎn)變,關(guān)節(jié)鏡介導(dǎo)的微創(chuàng)技術(shù)在臨床上的應(yīng)用取得了驚人的發(fā)展,內(nèi)鏡介導(dǎo)的微創(chuàng)脊柱外科治療技術(shù)顯示了良好的發(fā)展前景,四肢和脊柱疾患的經(jīng)皮微創(chuàng)技術(shù)取得了長(zhǎng)足進(jìn)步,計(jì)算機(jī)輔助的手術(shù)導(dǎo)航系統(tǒng)、手術(shù)模擬系統(tǒng)、遠(yuǎn)程會(huì)診和遠(yuǎn)程機(jī)器人遙控手術(shù)等微創(chuàng)技術(shù)受到了廣泛的關(guān)注,將微創(chuàng)技術(shù)應(yīng)用于顯微外科,已成為減少供區(qū)破壞、保存美觀的有效手段。新的影像技術(shù)和介入放射技術(shù)的發(fā)展,為微創(chuàng)技術(shù)在骨科領(lǐng)域的應(yīng)用提供了強(qiáng)有力的手段,激光、射頻消融、微波、冷凍、聚焦超聲等新的治療手段和納米技術(shù)、基因治療的發(fā)展及組織工程研究的深入為骨科疾患的微創(chuàng)治療拓展了更為廣闊的發(fā)展空間。因此,21世紀(jì)的微創(chuàng)外科具有誘人的前景,可望成為骨科領(lǐng)域新的生長(zhǎng)點(diǎn)。

    關(guān)鍵詞:微創(chuàng);骨折;治療;內(nèi)鏡;外科操作

    來(lái)源出版物:中華創(chuàng)傷骨科雜志,2002,4(2): 89-95

    被引頻次:57

    顯微外科手術(shù)機(jī)器人——“妙手”系統(tǒng)的研究

    王樹新,丁杰男,贠今天,等

    摘要:描述了一套顯微外科手術(shù)機(jī)器人系統(tǒng)——“妙手(MicroHand)”。該系統(tǒng)采用主從遙操作方式,主從手為同構(gòu)異型模式:主手是具有三維力感覺功能的PHANToM Desktop,從手是針對(duì)顯微外科手術(shù)特點(diǎn)而設(shè)計(jì)的高精度關(guān)節(jié)型機(jī)器人。從手末端安裝有六維力傳感器Mini40,將檢測(cè)到手術(shù)環(huán)境的力信息反饋給主手,從而使手術(shù)醫(yī)生通過(guò)PHANToM,感受手術(shù)環(huán)境的三維力信息。本系統(tǒng)成功地對(duì)兔子頸部和腿部1毫米動(dòng)脈進(jìn)行了血管吻合手術(shù)操作,證明了它的有效性。

    關(guān)鍵詞:顯微外科;手術(shù)機(jī)器人;血管吻合;主從操作;異構(gòu);力感覺

    來(lái)源出版物:機(jī)器人,2006,28(2): 130-135

    被引頻次:51

    面向腦外科微創(chuàng)手術(shù)的醫(yī)療機(jī)器人系統(tǒng)

    丑武勝,王田苗

    摘要:機(jī)器人為微創(chuàng)外科手術(shù)的實(shí)施提供了有利的技術(shù)支持。本文針對(duì)傳統(tǒng)腦外科手術(shù)的不足,開發(fā)研制了一套機(jī)器人輔助腦外科微創(chuàng)手術(shù)系統(tǒng),主要由5自由度機(jī)器人、手術(shù)規(guī)劃和導(dǎo)航軟件及基于標(biāo)志點(diǎn)的標(biāo)定模塊組成,其中機(jī)器人系統(tǒng)不僅可用于系統(tǒng)標(biāo)定和導(dǎo)航,而且可作為手術(shù)的支撐平臺(tái)。該系統(tǒng)已應(yīng)用到臨床中,成功完成了大量的微創(chuàng)腦外科手術(shù)。

    關(guān)鍵詞:微創(chuàng)手術(shù);醫(yī)療機(jī)器人

    來(lái)源出版物:機(jī)器人技術(shù)與應(yīng)用,2003(4): 18-21

    被引頻次:49

    面向微創(chuàng)手術(shù)的醫(yī)療外科機(jī)器人構(gòu)型綜合

    劉達(dá),王田苗,張玉茹,等

    摘要:在微創(chuàng)手術(shù)中醫(yī)療外科機(jī)器人可以輔助醫(yī)生精確定位和提供穩(wěn)定的手術(shù)平臺(tái),本文結(jié)合醫(yī)療外科機(jī)器人結(jié)構(gòu)特點(diǎn)和手術(shù)適用范圍,對(duì)適合微創(chuàng)手術(shù)的機(jī)器人結(jié)構(gòu)進(jìn)行了構(gòu)型綜合分析,并以此為依據(jù),設(shè)計(jì)出一種適用于神經(jīng)外科立體定向手術(shù)的機(jī)器人,系統(tǒng)已經(jīng)應(yīng)用于臨床,取得了滿意的效果。

    關(guān)鍵詞:醫(yī)療外科機(jī)器人;構(gòu)型綜合;微創(chuàng)手術(shù)

    來(lái)源出版物:機(jī)器人,2003,25(2): 132-135

    被引頻次:47

    全機(jī)器人不開胸房間隔缺損修補(bǔ)術(shù)

    高長(zhǎng),楊明,王剛,等

    摘要:以內(nèi)腔鏡與遙控技術(shù)為特征的機(jī)器人施行心臟手術(shù)始于上個(gè)世紀(jì)末期,旨在減輕手術(shù)創(chuàng)傷、提高治療效果,是生物醫(yī)學(xué)工程的重大成果。現(xiàn)在此項(xiàng)技術(shù)已由我國(guó)少數(shù)醫(yī)院引進(jìn)用于臨床,這是一件可喜的事物,有利于對(duì)機(jī)器人心臟手術(shù)進(jìn)一步探索發(fā)展。但到目前為止,機(jī)器人心臟手術(shù)技術(shù)不僅僅是花費(fèi)昂貴,更重要的是此技術(shù)尚不十分完善,它的適應(yīng)范圍尚有一定局限性,其微創(chuàng)水平尚待不斷提高,以房間隔缺損治療為例已有多種微創(chuàng)方法可以選擇。隨著高科技發(fā)展,機(jī)器人技術(shù)必然會(huì)取得巨大進(jìn)步。我國(guó)作為一個(gè)發(fā)展中國(guó)家,在醫(yī)療保健的投入尚不寬裕的情況下,少數(shù)有條件的單位開展機(jī)器人心臟手術(shù)的實(shí)踐和研究是很有必要的,但在國(guó)內(nèi)推廣普及此技術(shù)還需慎重穩(wěn)妥。心臟外科的微創(chuàng)技術(shù)是今后發(fā)展的大方向,但機(jī)器人能否代表這個(gè)大方向,目前下結(jié)論為時(shí)尚早,還需要今后不斷的實(shí)踐和研究。

    關(guān)鍵詞:房間隔缺損;心臟外科手術(shù);機(jī)器人;達(dá)芬奇S系統(tǒng)

    來(lái)源出版物:計(jì)算機(jī)學(xué)報(bào),2002,25(11):1250-1256

    被引頻次:285

    Alignment in total knee arthroplasty - A comparison of computer-assisted surgery with the conventional technique

    Bathis,H; Perlick,L; Tingart,M; et al.

    Abstract: Restoration of neutral alignment of the leg is an important factor affecting the long-term results of total knee arthroplasty(TKA). Recent developments in computer-assisted surgery have focused on systems for improving TKA. In a prospective study two groups of 80 patients undergoing TKA had operations using either a computer-assisted navigation system or a conventional technique. Alignment of the leg and the orientation of components were determined on post-operative long-leg coronal and lateral films. The mechanical axis of the leg was significantly better in the computer-assisted group(96%,within +/-3degrees varus/valgus)compared with the conventional group(78%,within +/-3degrees varus/valgus). The coronal alignment of the femoral component was also more accurate in the computer-assisted group. Computer-assisted TKA gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique. Potential benefits in the long-term outcome and functional improvement require further investigation.

    Keywords: femoral intramedullary guides; replacement; prosthesis; experience

    來(lái)源出版物:Journal of Bone & Joint Surgery,British Volume,2004,86(5): 682-687

    被引頻次:282

    Synthetic gecko foot-hair micro/nano-structures as dry adhesives

    Sitti,M; Fearing,RS

    Abstract: This paper proposes techniques to fabricate synthetic gecko foot-hairs as dry adhesives for future wall-climbing and surgical robots,and models for understanding the synthetic hair design issues. Two nanomolding fabrication techniques are proposed: the first method uses nanoprobe indented flat wax surface and the second one uses a nano-pore membrane as a template. These templates are molded with silicone rubber,polyimide,etc. type of polymers under vacuum. Next,design parameters such as length,diameter,stiffness,density,and orientation of hairs are determined for non-matting and rough surface adaptability. Preliminary micro/nano-hair prototypes showed adhesion close to the predicted values for natural specimens(around 100 nN each).

    Keywords: biomimetic adhesives; pressure controlled dry adhesives; adhesion forces; polymer micro/nano-fabrication;micro/nano-robotics; nanoindentation; and nanomolding

    來(lái)源出版物:Journal of Adhesion Science and Technology,2003,17(8): 1055-1073

    被引頻次:271

    Image guided navigation system to measure intraoperatively acetabular implant alignment

    DiGioia,AM; Jaramaz,B; Blackwell,M; et al.

    Abstract: There has been little clinical research to examine the effects of patient positioning and pelvic motion on the alignment of the acetabular implant during total hip replacement surgery. Until now,no tools were capable of accurately measuring these variables during the actual procedure. As part of a broader program in medical robotics and computer assisted surgery,a clinical system has been developed that includes several enabling technologies. The hip navigation system(HipNav)continuously and precisely measures pelvic location and tracks relative implant alignment intraoperatively. HipNav technology is used to gauge current clinical practice and provide intraoperative feedback to surgeons with the goal of improving the precision and accuracy of acetabular alignment during total hip replacement. Thissystem provides surgeons with a new class of image guided measurement tools and assist devices. These tools successfully were introduced into the clinical practice of surgery with results showing the following:(1)There exist unpredictable and large variations in the initial position of patients' pelves on the operating room table and significant pelvic movement during surgery and during intraoperative range of motion testing;(2)current mechanical acetabular alignment guides do not account for these variations,and result in variable and in the majority of cases unacceptable acetabular alignment; and(3)press fitting oversized acetabular components influences the final cup orientation.

    Keywords: total hip-arthroplasty; dislocation; replacement; reoperation

    來(lái)源出版物:Clinical Orthopaedics and Related Research,1998,355: 8-22

    被引頻次:268

    A prospective comparison of radical retropubic and robot-assisted

    Tewari,A; Srivasatava,A; Menon,M

    Abstract: To prospectively compare standard radical retropubic prostatectomy(RRP)and the robotically assisted Vattikuti Institute prostatectomy(VIP)in the management of localized prostate cancer. The study was a single-institution,prospective,unrandomized comparison of histopathological,and functional outcomes,at baseline and during and after surgery,in 100 patients undergoing RRP and 200 undergoing VIP. While the variables before surgery,the operative duration(163 vs 160 min)and pathological stages were comparable,there were significant differences in the measured outcomes. The blood loss was 910 and 150 mL for RRP and VIP,respectively,and transfusion was greater after RRP(67% vs none; both P < 0.001). There were four times as many complications after RRP(20% vs 5%,P <0.05),the haemoglobin level at discharge was lower(100 vs 130 g/L,P < 0.005)and the hospital stay longer(3.5 vs 1.2 days; P < 0.05). Most(93%)of VIP and none of the RRP patients were discharged within 24 h(P < 0.001); the duration of catheterization was twice as long after RRP(15.8 vs 7 days; P < 0.05). Positive margin was more frequent after RRP(23% vs 9%,P < 0.05). After VIP,patients achieved continence and return of erections more quickly than after RRP(160 vs 44,and 180 vs 440 days,both P < 0.5). The median return to intercourse was 340 days after VIP but after RRP half the patients have as yet not resumed intercourse at 700 days(P < 0.05). The VIP procedure appears to be safer,less bloody and requires shorter hospitalization and catheterization. The oncological and functional results were favourable in patients undergoing VIP.

    Keywords: robotic surgery; prostate cancer; prostatectomy; outcome

    來(lái)源出版物:BJU international,2003,92(3): 205-210

    被引頻次:265

    Computer-assisted knee arthroplasty versus a conventional jig-based technique - A randomised,prospective trial

    Chauhan,SK; Scott,RG; Breidahl,W; et al.

    Abstract: We have compared a new technique of computer-assisted knee arthroplasty with the current conventional jig-based technique in 70 patients randomly allocated to receive either of the methods. Post-operative CT was performed according to the Perth CT Knee Arthroplasty protocol and pre- and post-operative Maquet views of the limb were taken. Intra-operative and peri-operative morbidity data were collected and blood loss measured. Post-operative CT showed a significant improvement in the alignment of the components using computer-assisted surgery in regard to femoral varus/valgus(p = 0.032),femoral rotation(p = 0.001),tibial varus/valgus(p = 0.047)tibial posterior slope(p = 0.0001),tibial rotation(p 0.011)and femorotibial mismatch(p = 0.037). Standing alignment was also improved(p 0.004)and blood loss was less(p = 0.0001). Computer-assisted surgery took longer with a mean increase of 13 minutes(p = 0.0001).

    Keywords: replacement; alignment; prosthesis

    來(lái)源出版物:Journal of Bone & Joint Surgery,British Volume,2004,86(3): 372-377

    被引頻次:263

    Intraoperative brain shift and deformation: A quantitative analysis of cortical displacement in 28 cases

    Roberts,DW; Hartov,A; Kennedy,F(xiàn)E; et al.

    Abstract: OBJECTIVE: A quantitative analysis of intraoperative cortical shift and deformation was performed to gain a better understanding of the nature and extent of this problem and the resultant loss of spatial accuracy in surgical procedures coregistered to preoperative imaging studies. METHODS: Three-dimensional feature tracking and two-dimensional image analysis of the cortical surface were used to quantify the observed motion. Data acquisition was facilitated by a ceiling-mounted robotic platform,which provided a number of precision tracking capabilities. The patient's head position and the size and orientation of the craniotomy were recorded at the start of surgery. Error analysis demonstrated that the surface displacement measuring methodology was accurate to 1 to 2 mm. Statistical tests were performed to examine correlations between the amount of displacement and the type of surgery,the nature of the cranial opening,the region of the brain involved,the duration of surgery,and the degree of invasiveness. RESULTS: The results showed that a displacement of an average of 1 cm occurred,with the dominant directional component being associated with gravity. The mean displacement was determined to be independent of the size and orientation of the cranial opening. CONCLUSION: These data suggest that loss of spatial registration with preoperative images is gravity-dominated and of sufficient extent that attention to errors resulting from misregistration during the course of surgery is warranted.

    Keywords: brain shift; computer-assisted surgery; image-guided surgery; stereotaxy

    來(lái)源出版物:Neurosurgery,1998,43(4): 749-758

    被引頻次:254

    Robotics in general surgery - Personal experience in a large community hospital

    Giulianotti,PC ; Coratti,A; Angelini,M; et al.

    Abstract: Hypothesis: Robotic technology is the most advanced development of minimally invasive surgery,but there are still some unresolved issues concerning its use in a clinical setting. Design: The study describes the clinical experience of the Department of General Surgery,Misericordia Hospital,Grosseto,Italy,in robot-assisted surgery using the da Vinci Surgical System. Results: Between October 2000 and November 2002,193 patients under-went a minimally invasive robotic procedure(74 men and 119 women; mean age,55.9 years[range,16-91 years]). A total of 207 robotic surgical operations,including abdominal,thoracic and vascular procedures,were performed;179 were single procedures,and 14 were double(2 operations on the same patient). There were 4 conversions to open surgery and 3 to conventional laparoscopy(conversion rate,3.6%; 7 of 193 patients). The perioperative morbidity rate was 9.3%(18 of 193 patients),and 6 patients(3.1%)required a reoperation. The postoperative mortality rate was 1.5%(3 of 193 patients). Conclusions: Our preliminary experience at a large community hospital suggests that robotic surgery is feasible in a clinical setting. Its daily use is safe and easily managed,and it expands the applications of minimally invasive surgery. However,the best indications still have to be defined,and the cost-benefit ratio must be evaluated. This report could serve as a basis for a future prospective,randomized trial.

    Keywords: laparoscopic cholecystectomy; nissen fundoplication; feasibility; nephrectomy

    來(lái)源出版物:Archives of Surgery,2003,138(7): 777-784

    被引頻次:253

    Measurement of intraoperative brain surface deformation under a craniotomy

    Hill,DLG; Maurer,CR; Maciunas,RJ; et al.

    Abstract: OBJECTIVE: Several causes of spatial inaccuracies in image-guided surgery have been carefully studied and documented for several systems. These include error in identifying the external features used for registration,geometrical distortion in the preoperative images,and error in tracking the surgical instruments. Another potentially important source of error is brain deformation between the time of imaging and the time of surgery or during surgery. In this study,we measured the deformation of the dura and brain surfaces between the time of imaging and the start of surgical resection for 21 patients. METHODS: All patients underwent intraoperative functional mapping,allowing us to measure brain surface motion at two times that were separated by nearly an hour after opening the dura but before performing resection. The positions of the dura and brain surfaces were recorded and transformed to the coordinate space of a preoperative magnetic resonance image,using the Acustar surgical navigation system(manufactured by Johnson & Johnson Professional,Inc.,Randolph,MA)(the Acustar trademark and associated intellectual property rights are now owned by Picker International,Highland Heights,OH). This system performs image registration with bone-implanted markers and tracks a surgical probe by optical triangulation. RESULTS: The mean displacements of the dura and the first and second brain surfaces were 1.2,4.4,and 5.6 mm,respectively,with corresponding mean volume reductions under the craniotomy of 6,22,and 29 cc. The maximum displacement was greater than 10 mm in approximately one-third of the patients for the first brain surface measurement and one-half of the patients for the second. In all cases,the direction of brain shift corresponded to a "sinking" of the brain intraoperatively,compared with its preoperative position. Analysis of the measurement error revealed that its magnitude was approximately 1 to 2 mm. We observed two different patterns of the brain surface deformation field,depending on the inclination of the craniotomy with respect to gravity. Separate measurements of brain deformation within the closed cranium caused by changes in patient head orientation with respect to gravity suggested that less than 1 mm of the brain shift recorded intraoperatively could have resulted from the change in patient orientation between the time of imaging and the time of surgery. CONCLUSION: These results suggest that intraoperative brain deformation is an important source of error that needs to be considered when using surgical navigation systems.

    Keywords: brain deformation; computer-assisted surgery; image-guided surgery; image registration; registration accuracy; stereotactic surgery

    來(lái)源出版物:Neurosurgery,1998,43(3): 514-526

    被引頻次:249

    Constitutive modelling of brain tissue: Experiment and theory

    Miller,K; Chinzei,K

    Abstract: Recent developments in computer-integrated and robot-aided surgery-in particular,the emergence of automatic surgical tools and robots-as well as advances in virtual reality techniques,call for closer examination of the mechanical properties of very soft tissues(such as brain,liver,kidney,etc.). The ultimate goal of our research into the biomechanics of these tissues is the development of corresponding,realistic mathematical models. This paper contains experimental results of in vitro,uniaxial,unconfined compression of swine brain tissue and discusses a single-phase,non-linear,viscoelastic tissue model. The experimental results obtained for three loading velocities,ranging over five orders of magnitude,are presented. The applied strain rates have been much lower than those applied in previous studies,focused on injury modelling. The stress-strain curves are concave upward for all compression rates containing no linear portion from which a meaningful elastic modulus might be determined. The tissue response stiffened as the loading speed increased,indicating a strong stress-strain rate dependence. The use of the single-phase model is recommended for applications in registration,surgical operation planning and training systems as well as a control system of an image-guided surgical robot. The material constants for the brain tissue are evaluated. Agreement between the proposed theoretical model and experiment is good for compression levels reaching 30% and for loading velocities varying over five orders of magnitude.

    Keywords: brain tissue; mechanical properties; mathematical modelling; compression experiment

    來(lái)源出版物:Journal of Biomechanics,1997,30(11): 1115-1121

    被引頻次:239

    Radiosurgery for spinal metastases - Clinical experience in 500 cases from a single institution

    Gerszten,PC; Burton,SA; Ozhasoglu,C; et al.

    Abstract: Study Design: A prospective nonrandomized,longitudinal cohort study. Objective: To evaluate the clinical outcomes of single-fraction radiosurgery as part of the management of metastatic spine tumors. Summary of Background Data. The role of stereotactic radiosurgery for the treatment of spinal lesions has previously been limited by the availability of effective target immobilization and target tracking devices. Large clinical experience with spinal radiosurgery to properly assess clinical experience has previously been limited. Methods: A cohort of 500 cases of spinal metastases underwent radiosurgery. Ages ranged from 18 to 85 years(mean 56). Lesion location included 73 cervical,212 thoracic,112 lumbar,and 103 sacral. Results: The maximum intratumoral dose ranged from 12.5 to 25 Gy(mean 20). Tumor volume ranged from 0.20 to 264 mL(mean 46). Long-term pain improvement occurred in 290 of 336 cases(86%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Twenty-seven of 32 cases(84%)with a progressive neurologic deficit before treatment experienced at least some clinical improvement. Conclusions: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases,especially those with solitary sites of spine involvement,to improve long-term palliation.

    Keywords: CyberKnife(R); image-guided surgery; robotic surgery; spine metastases; spine tumors; stereotactic radiosurgery

    來(lái)源出版物:Spine,2007,32(2): 193-199

    ·推薦論文摘要·

    機(jī)器人手術(shù)系統(tǒng)在胃癌治療中的應(yīng)用研究進(jìn)展

    湯玉成,王子衛(wèi)

    摘要:自1994年日本Kitano等首次報(bào)道腹腔鏡輔助早期胃癌根治術(shù)以來(lái),腹腔鏡技術(shù)在胃癌中應(yīng)用得到廣泛普及和推廣。與傳統(tǒng)開腹手術(shù)相比,腹腔鏡手術(shù)具有切口小、并發(fā)癥少、術(shù)后恢復(fù)快、住院時(shí)間少等優(yōu)點(diǎn)。但仍然存在二維圖形、反向操作、醫(yī)生體位不適等不足之處。因此,2000年機(jī)器人手術(shù)系統(tǒng)被引進(jìn)用于克服傳統(tǒng)微創(chuàng)外科的技術(shù)缺點(diǎn)。

    關(guān)鍵詞:機(jī)器人;胃腫瘤;外科手術(shù);微創(chuàng)性;淋巴結(jié)切除術(shù)

    來(lái)源出版物:重慶醫(yī)學(xué),2015,44(1): 120-122聯(lián)系郵箱:王子衛(wèi),wangziwei571@sina.com

    機(jī)器人手術(shù)系統(tǒng)行胰腺鉤突腫瘤切除術(shù)療效評(píng)價(jià)(附6例報(bào)告)

    施昱晟,彭承宏,詹茜,等

    摘要:目的:探討機(jī)器人手術(shù)系統(tǒng)行胰腺鉤突腫瘤切除術(shù)的臨床療效。方法:回顧性分析自2010年12月至2013年12月上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院完成的6例機(jī)器人手術(shù)系統(tǒng)輔助胰腺鉤突腫瘤切除術(shù)的臨床資料。結(jié)果:6例手術(shù)均順利完成,無(wú)中轉(zhuǎn)開腹。病人平均年齡51.7(40~64)歲,男性3例,女性3例。平均手術(shù)時(shí)間143.3(100~200)min;平均術(shù)中出血80(30~150)mL;平均術(shù)后住院天數(shù)23.8(13~44)d;術(shù)后2例出現(xiàn)B級(jí)胰瘺,1例出現(xiàn)C級(jí)胰瘺及肺部感染;無(wú)死亡病例。術(shù)后病理檢查報(bào)告:4例為導(dǎo)管內(nèi)乳頭狀黏液性腫瘤(IPMT),1例為胰島素瘤,1例為實(shí)性假乳頭狀瘤(SPT)。術(shù)后常規(guī)隨訪:根據(jù)手術(shù)時(shí)間分別隨訪2個(gè)月至2年,術(shù)后均未因相關(guān)并發(fā)癥再次入院,均未發(fā)現(xiàn)腫瘤復(fù)發(fā)。結(jié)論:機(jī)器人手術(shù)系統(tǒng)輔助胰腺鉤突腫瘤切除術(shù)安全可行,成功率高,較傳統(tǒng)開腹手術(shù)及腹腔鏡手術(shù),具有一定優(yōu)勢(shì),但術(shù)后出現(xiàn)胰瘺等并發(fā)癥概率仍較高。

    關(guān)鍵詞:胰腺鉤突腫瘤;達(dá)芬奇機(jī)器人手術(shù)系統(tǒng);局部切除術(shù)

    來(lái)源出版物:中國(guó)實(shí)用外科雜志,2015,35(3): 308-312聯(lián)系郵箱:彭承宏,chhpeng@188.com

    中國(guó)達(dá)芬奇手術(shù)機(jī)器人臨床應(yīng)用

    金振宇

    摘要:達(dá)芬奇手術(shù)機(jī)器人引領(lǐng)著微創(chuàng)外科技術(shù)的發(fā)展,使用達(dá)芬奇手術(shù)機(jī)器人進(jìn)行微創(chuàng)手術(shù)給醫(yī)生帶來(lái)諸多優(yōu)勢(shì)。我國(guó)自2008年起,先后由北京、上海等地14家醫(yī)院逐步開展達(dá)芬奇機(jī)器人手術(shù),至2012年底已經(jīng)累計(jì)完成達(dá)芬奇機(jī)器人手術(shù)3551例,涵蓋普外科、泌尿外科、心血管外科、胸外科、婦產(chǎn)科、五官科等各學(xué)科多種手術(shù)術(shù)式,取得了矚目的成就。

    關(guān)鍵詞:達(dá)芬奇手術(shù)系統(tǒng);外科手術(shù);微創(chuàng)性;機(jī)器人

    來(lái)源出版物:中國(guó)醫(yī)療器械雜志,2014,38(1): 47-49聯(lián)系郵箱:金振宇,satyraga@sina.com

    達(dá)芬奇機(jī)器人直腸癌根治術(shù)的學(xué)習(xí)曲線

    蘭遠(yuǎn)志,曾冬竹,張超,等

    摘要:目的:探討達(dá)芬奇機(jī)器人直腸癌根治術(shù)的學(xué)習(xí)曲線。方法:回顧分析我院微創(chuàng)胃腸外科中心2010年3月—2012年5月完成的60例達(dá)芬奇機(jī)器人直腸癌根治術(shù)的臨床資料,按手術(shù)先后順序分成A、B、C 3組,每組20例,比較各組機(jī)器人安裝時(shí)間、手術(shù)時(shí)間、出血量、淋巴結(jié)清掃數(shù)目、并發(fā)癥、術(shù)后住院時(shí)間。結(jié)果:A組機(jī)器人安裝時(shí)間(66±6)min,顯著長(zhǎng)于B組(35±5)min和C組(32±4)min(q=27.365,P<0.05;q=30.013,P<0.05),B、C 2組無(wú)統(tǒng)計(jì)學(xué)差異(q=2.648,P>0.05)。3組手術(shù)時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異(F=1.28,P=0.286),總手術(shù)時(shí)間差異(F=8.82,P=0.000)主要由于機(jī)器人安裝時(shí)間差異,機(jī)器人直腸癌根治術(shù)學(xué)習(xí)曲線為20例。3組出血量、淋巴結(jié)清掃數(shù)目、并發(fā)癥、術(shù)后住院時(shí)間無(wú)顯著性差異(P>0.05)。結(jié)論:對(duì)于熟練掌握腹腔鏡直腸癌根治術(shù)的外科醫(yī)生,達(dá)芬奇機(jī)器人直腸癌根治術(shù)學(xué)習(xí)曲線約為20例。

    關(guān)鍵詞:直腸癌;達(dá)芬奇機(jī)器人手術(shù)系統(tǒng);學(xué)習(xí)曲線

    來(lái)源出版物:中國(guó)微創(chuàng)外科雜志,2014,14(6): 490-493聯(lián)系郵箱:余佩武,yupeiwu01@sina.com

    達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)與電視胸腔鏡在胸內(nèi)縱隔疾病手術(shù)治療中的對(duì)比研究

    丁仁泉,童向東,許世廣,等

    摘要:背景與目的:近年來(lái)達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)(da Vinci robot system)應(yīng)用于治療胸內(nèi)縱隔疾病日趨成熟。本研究通過(guò)總結(jié)沈陽(yáng)軍區(qū)總醫(yī)院近3年來(lái)在縱隔疾病中行手術(shù)治療的臨床病例資料,探討達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在手術(shù)中的療效;并比較其與電視胸腔鏡在縱隔手術(shù)中的優(yōu)缺點(diǎn),展望達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在縱隔手術(shù)中的應(yīng)用前景。方法:選擇2010年1月—2013年11月沈陽(yáng)軍區(qū)總醫(yī)院行達(dá)芬奇機(jī)器人手術(shù)及電視胸腔鏡下(含胸腔鏡輔助小切口)手術(shù)的胸內(nèi)縱隔疾病患者共203例。對(duì)兩組的手術(shù)時(shí)間、術(shù)中失血量、術(shù)后3天內(nèi)引流總量、術(shù)后拔管時(shí)間、術(shù)后住院時(shí)間、手術(shù)費(fèi)用進(jìn)行比較,結(jié)果:應(yīng)用SPSS 19.0進(jìn)行相關(guān)分析。結(jié)果:兩組共203例患者均順利完成手術(shù)。術(shù)后恢復(fù)良好,無(wú)圍手術(shù)期死亡病例。手術(shù)時(shí)間機(jī)器人組為82(20-320)min,電視胸腔鏡組89(35-360)min,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。術(shù)中出血量:機(jī)器人組為10(1-100)mL,電視胸腔鏡組50(3-1,500)mL;術(shù)后72 h引流量:機(jī)器人組215(0-2,220)mL,電視胸腔鏡組350(50-1,810)mL;術(shù)后拔管時(shí)間:機(jī)器人組3(0-10)d,電視胸腔鏡組5(1-18)d;術(shù)后住院天數(shù):機(jī)器人組7(2-15)d,電視胸腔鏡組9(2-50)d;手術(shù)費(fèi)用:機(jī)器人組(18,983.6±4,461.2)元,電視胸腔鏡組(9,351.9±2,076.3)元,以上指標(biāo)兩組比較差異均具有統(tǒng)計(jì)學(xué)意義(P<0.001)。結(jié)論:達(dá)芬奇機(jī)器人手術(shù)與電視胸腔鏡手術(shù)在胸內(nèi)縱隔疾病的手術(shù)時(shí)間相當(dāng),在手術(shù)安全性以及術(shù)后快速恢復(fù)上均優(yōu)于胸腔鏡手術(shù),但手術(shù)費(fèi)用也比胸腔鏡手術(shù)明顯增加。

    關(guān)鍵詞:達(dá)芬奇機(jī)器人手術(shù)系統(tǒng);縱隔疾??;微創(chuàng)手術(shù)

    來(lái)源出版物:中國(guó)肺癌雜志,2014,17(7): 557-562聯(lián)系郵箱:王述民,sureman2003congo@163.com

    達(dá)芬奇機(jī)器人在小兒外科手術(shù)中的應(yīng)用(附20例報(bào)告)

    黃格元,藍(lán)傳亮,劉雪來(lái),等

    摘要:目的:達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)具有獨(dú)特的優(yōu)勢(shì),是當(dāng)前微創(chuàng)外科手術(shù)的前沿領(lǐng)域。本文通過(guò)回顧分析和總結(jié)我中心在機(jī)器人輔助下完成小兒外科手術(shù)資料,為今后深入開展機(jī)器人小兒外科手術(shù)提供經(jīng)驗(yàn)和參考。方法:2007—2012年,我中心累積采用機(jī)器人輔助完成小兒外科手術(shù)20例(男女各10例;平均年齡10.7歲)。手術(shù)包括9例胃底折疊術(shù)、5例腎盂成形術(shù)、2例膽總管囊腫切除術(shù)、2例食管部分切除術(shù)、1例輸尿管膀胱再植術(shù)和1例可控性尿流改道術(shù)。結(jié)果:9例胃底折疊平均手術(shù)時(shí)間為220.1 min,5例腎盂成形平均手術(shù)時(shí)間為204.2 min。1例膽總管囊腫術(shù)中因組織分離困難而中轉(zhuǎn)開腹。1例先天性食管狹窄伴食管氣管瘺行食管部分切除術(shù)后2周復(fù)發(fā),經(jīng)二次手術(shù)治愈。結(jié)論:機(jī)器人手術(shù)是小兒微創(chuàng)外科治療的有效手段。仍需對(duì)患兒長(zhǎng)期隨訪,以進(jìn)一步評(píng)估機(jī)器人手術(shù)的遠(yuǎn)期效果。

    關(guān)鍵詞:機(jī)器人系統(tǒng);小兒外科;手術(shù)

    來(lái)源出版物:中國(guó)微創(chuàng)外科雜志,2013,13(1): 4-8聯(lián)系郵箱:黃格元,kkywong@hku.hk

    達(dá)芬奇手術(shù)機(jī)器人與腹腔鏡行遠(yuǎn)端胃癌根治術(shù)近期療效對(duì)照研究

    趙坤,潘華峰,王剛,等

    摘要:目的:對(duì)比分析達(dá)芬奇手術(shù)機(jī)器人系統(tǒng)(以下簡(jiǎn)稱機(jī)器人)和腹腔鏡行胃癌根治術(shù)遠(yuǎn)端胃大部切除病人術(shù)中、術(shù)后恢復(fù)情況。方法:選取2012年1月至2012年5月南京軍區(qū)南京總醫(yī)院普外科60例遠(yuǎn)端胃癌根治術(shù)的病人,隨機(jī)分為機(jī)器人組和腹腔鏡組行遠(yuǎn)端胃癌根治術(shù),每組各30例,比較兩組病人手術(shù)時(shí)間、術(shù)中出血、術(shù)后恢復(fù)情況、術(shù)后并發(fā)癥情況。結(jié)果:機(jī)器人組術(shù)中出血、手術(shù)切口長(zhǎng)度、術(shù)后3 d切口疼痛及術(shù)后首次進(jìn)食時(shí)間優(yōu)于腹腔鏡組(P<0.05),但在淋巴結(jié)清掃及術(shù)后并發(fā)癥方面兩者差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:機(jī)器人組除價(jià)格昂貴外較腹腔鏡遠(yuǎn)端胃癌根治術(shù)病人手術(shù)創(chuàng)傷更小,術(shù)后恢復(fù)快,值得推廣和應(yīng)用。

    關(guān)鍵詞:達(dá)芬奇機(jī)器人;腹腔鏡;遠(yuǎn)端胃癌

    來(lái)源出版物:中國(guó)實(shí)用外科雜志,2013,33(4): 325-327聯(lián)系郵箱:江志偉,surgery34@163.com

    Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi-institutional report of outcomes

    Gellhaus,PT; Bhandari,A; Monn,MF; et al.

    Abstract: Objective: To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological(OBGYN)surgery. Patients and Methods: A retrospective review of all patients from four different high-volume institutions between 2002 and 2013 that had a robot-assisted(RA)repair by a urologist after an OBGYN genitourinary injury. Results: Of the 43 OBGYN operations,34 were hysterectomies: 10 open,10 RA,nine vaginally,and five pure laparoscopic. Nine patients had alternative OBGYN operations:three caesarean sections,three oophorectomies(one open,two laparoscopic),one RA colpopexy,one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all,49 genitourinary(GU)injuries were sustained: ureteric ligation(26),ureterovaginal fistula(10),ureterocutaneous fistula(one),vesicovaginal fistula(VVF; 10)and cystotomy alone(two). In all,10 patients(23.3%)underwent immediate urological repair at the time of their OBGYN RA surgery. The mean(range)time between OBGYN injury and definitive delayed repair was 23.5(1-297)months. Four patients had undergone prior failed repair: two open VVF repairs and twoballoon ureteric dilatations with stent placement. In all,22 ureteric re-implants(11 with ipsilateral psoas hitch)and 15 ureteroureterostomies were performed. Stents were placed in all ureteric cases for a mean(range)of 32(1-63)days. In all,10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases(57.1%)for a mean(range)of 4.1(1-26)days. No case required open conversion. Two patients(4.1%)developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean(range)follow-up of the entire cohort was 16.6(1-63)months. Conclusions: RA repair of GU injuries during OBGYN surgery is associated with good outcomes,appears safe and feasible,and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.

    Keywords: robotic surgery; gynaecology injury; ureteroneocystostomy; vesicovaginal fistula; ureterovaginal fistula

    來(lái)源出版物:BJU International,2015,115(3): 430-436聯(lián)系郵箱:Boris,RS; rboris@IUHealth.org

    Randomised Controlled Trial Comparing Laparoscopic and Robot-assisted Radical Prostatectomy

    Porpiglia,F(xiàn); Morra,I; Chiarissi,ML; et al.

    Abstract: Background: The advantages of robot-assisted radical prostatectomy(RARP)over laparoscopic radical prostatectomy(LRP)have rarely been investigated in randomised controlled trials. Objective: To compare RARP and LRP in terms of the functional,perioperative,and oncologic outcomes. The main end point of the study was changes in continence 3 mo after surgery. Design,setting,and participants: From January 2010 to January 2011,120 patients with organ-confined prostate cancer were enrolled and randomly assigned(using a randomisation plan)to one of two groups based on surgical approach: the RARP group and the LRP group. Intervention: All RARP and LRP interventions were performed with the same technique by the same single surgeon. Outcome measurements and statistical analysis:The demographic,perioperative,and pathologic results,such as the complications and prostate-specific antigen(PSA)measurements,were recorded and compared. Continence was evaluated at the time of catheter removal and 48 h later,and continence and potency were evaluated after 1,3,6,and 12 mo. The student t test,Mann-Whitney test,chi(2)test,Pearson chi(2)test,and multiple regression analysis were used for statistics. Results and limitations: The two groups(RARP: n = 60; LRP: n = 60)were comparable in terms of demographic data. No differences were recorded in terms of perioperative and pathologic results,complication rate,or PSA measurements. The continence rate was higher in the RARP group at every time point: Continence after 3 mo was 80% in the RARP group and 61.6% in the LRP group(p = 0.044),and after 1 yr,the continence rate was 95.0% and 83.3%,respectively(p = 0.042). Among preoperative potent patients treated with nerve-sparing techniques,the rate of erection recovery was 80.0% and 54.2%,respectively(p = 0.020). The limitations included the small number of patients. Conclusions: RARP provided better functional results in terms of the recovery of continence and potency. Further studies are needed to confirm our results.

    Keywords: prostate cancer; laparoscopy; robotic surgery; continence; potency

    來(lái)源出版物:European Urology,2013,63(4): 606-614聯(lián)系郵箱:Porpiglia,F(xiàn); porpiglia@libero.it

    250 Robotic Pancreatic Resections Safety and Feasibility

    Zureikat,AH; Moser,AJ; Boone,BA; et al.

    Abstract: Background and Objectives: Computer-assisted robotic surgery allows complex resections and anastomotic reconstructions to be performed with nearly identical standards to open surgery. We applied this technology to a variety of pancreatic resections to assess the safety,feasibility,versatility,and reliability of this technology. Methods: A retrospective review of a prospective database of robotic pancreatic resections at a single institution between August 2008 and November 2012 was performed. Perioperative outcomes were analyzed. Results: A total of 250 consecutive robotic pancreatic resections were analyzed; pancreaticoduodenectomy(132),distal pancreatectomy(83),central pancreatectomy(13),pancreatic enucleation(10),total pancreatectomy(5),Appleby resection(4),and Frey procedure(3). Thirty-day and 90-day mortality was 0.8% and 2.0%. Rate of Clavien 3 and 4 complications was 14% and 6%. The International Study Group on Pancreatic Fistula grade C fistula rate was 4%. Mean operative time for the 2 most common procedures was 529 +/- 103 minutes for pancreaticoduodenectomy and 257 +/- 93 minutes for distal pancreatectomy. Continuous improvement in operative times was observed over the course of the experience. Conversion to open procedure was required in 16 patients(6%)(11 with pancreaticoduodenectomy,2 with distal pancreatectomy,2 with central pancreatectomy,1 with total pancreatectomy)for failure to progress(14)and bleeding(2). Conclusions: This represents to our knowledge the largest series of robotic pancreatic resections. Safety and feasibility metrics including the low incidence of conversion support the robustness of this platform and suggest no unanticipated risks inherent to this new technology. By defining these early outcome metrics,this report begins to establish a framework for comparative effectiveness studies of this platform.

    Keywords: minimally invasive surgery; pancreatic cancer; pancreatic; pancreaticoduodenectomy; robotic surgery

    來(lái)源出版物:Annals of Surgery,2013,258(4): 554-562聯(lián)系郵箱:Zeh,HJ; zehxhx@upmc.edu

    編輯:王微

    Purpose: Robotics in surgery is a recent innovation. This technology offers a number of attractive features in laparoscopy. It overcomes the difficulties with fixed port sites by restoring all 6 degrees of freedom at the instrument tips,provides new possibilities for miniaturization of surgical tasks and allows remote controlled surgery. We investigated the applicability of remote controlled robotic surgery to laparoscopic radical prostatectomy. Materials and Methods: Our previous experience with laparoscopic prostatectomy served as a basis for adapting robotic surgery to this procedure. A surgeon at a different location who activated the tele-manipulators of the da Vinci* robotic system performed all steps of the intervention. A scrub nurse and second surgeon who stood at patient side had limited roles to port;and instrument placement,exposure of the operative field,assistance in hemostasis and removal of the operative specimen. Our patient was a 63-year-old man presenting with a T1c tumor discovered on 1 positive sextant biopsy with a 3+3 Gleason score and 7 ng./ml. preoperative serum prostate specific antigen. Results: The robot provided an ergonomic surgical environment and remarkable dexterity enhancement. Operating time was 420 minutes,and the hospital stay lasted 4 days. The bladder catheter was removed 3 days postoperatively,and 1 week later the patient was fully continent. Pathological examination showed a pT3a tumor with negative margins. Conclusions: Robotically assisted laparoscopic radical prostatectomy is feasible. This new technology enhances surgical dexterity. Further developments in this field may have new applications in laparoscopic tele-surgery.

    robotics; feasibility studies; laparoscopy; prostatectomy; prostatic neoplasms

    文章題目第一作者來(lái)源出版物1Laparoscopic radical prostatectomy with a remote controlled robot Abbou,CCJournal of Urology,2001,165(6):1964-1966 2(12): 1689-1694 3Assessment of intraoperative safety in transoral robotic surgery Telerobotic-assisted laparoscopic right and sigmoid Weber,PA Diseases of the Colon & Rectum,2002,45 colectomies for benign disease Hockstein,NGLaryngoscope,2006,116(2): 165-168 4 Transoral robotic surgery Weinstein,GS Archives of Otolaryngology-Head & Neck Surgery,2007,133(12): 1220-1226

    Laparoscopic radical prostatectomy with a remote controlled robot

    Abbou,CC; Hoznek,A; Salomon,L; et al.

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