12-10-2010, 03:32 PM
This article is presented by:
A. Lobontiu, D. Loisance
Department of Cardio-Thoracic Surgery
Henri Mondor Hospital, University Paris 12, France
ROBOTIC SURGERY AND TELE-SURGERY:
BASIC PRINCIPLES AND DESCRIPTION OF A NOVEL CONCEPT
BASIC PRINCIPLES AND DESCRIPTION OF A NOVEL CONCEPT
ROBOTIC SURGERY AND TELE-SURGERY: BASIC PRINCIPLES AND DESCRIPTION OF A NOVEL
CONCEPT (Abstract): One of the most important advances in surgical technology in the last two decades of the twentieth century is represented by the introduction of the laparoscopic technique. Using the laparoscopic approach the patient is operated through keyhole incisions as opposed to long, traumatic incisions over the thoracic or abdominal cavity. Many open procedures, such as those for gallbladder disorders, groin hernia repair and anti-reflux surgery of the stomach have been replaced by minimally-invasive procedures, whose advantages include shorter postoperative hospitalization, less pain, and a faster return to normal activity. Although improvements continue to be made in laparoscopic surgery, surgeons are generally still faced with particular drawbacks of this technique. Robotic surgery and computer-enhanced surgery may revolutionize these techniques by restoring most of the advantages of open surgery but in the context of minimally-invasive procedures. For example, cardiac surgery has entered a new era since robotic surgery appeared a part of certain by-pass and valve surgery. This work describes the da Vinci Surgical Robot™ which represents the current stateof- the art of this technology. New developments in system accuracy, planning and simulation of the surgical act are highlighted.
INTRODUCTION
Robots are being used in increasingly complex surgical procedures. However these robots are not autonomous machines that carry out simple, pre-programmed instructions. Operating theatre robots are designed to supplement a surgeon's abilities, translating human movements into incredibly steady and accurate robotic movements, which, in turn, manipulate instruments to aid delicate operations. Keyhole surgery has been in use since the late 1970s for surgical procedures in a number of areas - for example gastrointestinal, gynaecological and even cardiac. The benefits include the reduction of patient pain and trauma, as well as a decline in the chance of infection and a quicker recovery time. But minimally invasive procedures, using instruments controlled by humans, have their limitations. For one, instruments are not in the surgeon's direct control, being manipulated by assistants. And the instruments' positioning within the body is subject to human tremors and fatigue, which makes working on minute structures difficult and dangerous [1]. Keyhole surgery has hitherto been best used where there is a maximum of space - for instance, in the abdominal cavity, into which CO2 can be blown. While it is possible to carry out minimally invasive heart surgery, it can entail the surgeon having to adopt awkward physical positions for prolonged periods of time. By handing control of the surgical instruments over to a robot - and positioning the surgeon at a comfortable console with a 3D or and high- resolution display at 10 to 20 times magnification - surgery is easier and more accurate
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