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13 Νοε 2013 (πριν από 3 χρόνια και 10 μήνες)

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Telerobotic surgery




in US alone, over 300,000 heart surgeries
performed annually, over 600,000 performed
worldwide



previous difficulties in telerobotics due to
complexity of heart surgery



telerobotics now evaluated for use in
minimally invasive heart surgery, endoscopic
coronary artery bypass surgery


Telerobotic surgery:

ready for primetime?

Intuitive Surgical


da Vinci


Surgical System




original system designed to mobilize internal
thoracic artery endoscopically with robotic
assistance



surgeon sits at a console and manipulates
hands as if in chest cavity




motions are transmitted through computer to
instruments within patient’s chest

Telerobotic surgery:

ready for primetime?


Telerobotic surgery



current study of single bypass surgery,
performed by telerobotics, is more than 3/4
complete



average back to work time
-

10.4 days



no sternotomy, no heart
-
lung machine



anastomosis is under direct vision through a
small incision,minimally invasive

Telerobotic surgery:

ready for primetime?

Investigators

Reported
attempts

Successes

Reversions to
manual
anastomosis via
minithoracotomy

Adverse
effects

Mohr, Falk et al

4 patients
with single
-
vessel
disease

2 with port
access only

2 to correct
suboptimal
robotic
anastomoses

None

Reichenspurner
et al

12 patients
with single
-
vessel
disease

7 with port
access

2 due to small
LAD

None

Boyd et al

15 patients
with single
-
vessel
disease*

6 with port
access only;
6 with
incisions
=2
-
3 cm

3 to correct
suboptimal
robotic
anastomoses or
in response to
arrhythmia

1
arrhythmia

* Boyd has also carried 3 planned hybrid procedures in multivessel disease

Results of robotic beating
-
heart endoscopic
CABG in human patients

heart
wire

/ Feb 10, 2000 / Robotic systems make major headway in
minimally invasive beating
-
heart CABG



If you look at the car manufacturing
industry, after 100 years the tools are more
precise and almost everything is automatic.
In surgery, though the technology is
available, we still use the same tools as 100
years ago."



Dr Friedrich Mohr


University of Leipzig

Telerobotic surgery:

ready for primetime?

theheart.org

/ Views / February 28, 2000 / Robotic surgery (2): rival
robots wrestle for hearts and minds of surgeons

Cost
-
benefit ratio




not entirely clear from current study, limited
to single vessel bypass



ideally would like data for total endoscopic
coronary artery bypass on a beating heart



cost of technology analogous to introduction
of heart/lung machines 40 years ago, and
not out of line with major expenses incurred
in a heart surgery program

Telerobotic surgery:

ready for primetime?

Cost
-
benefit ratio




mediastinal sepsis present in 1.5% of
patients with current operative techniques



robotic surgery eliminates possibility of
mediastinal sepsis



robotic operation typically uses only 3
-
4
small ports in side of chest

Telerobotic surgery:

ready for primetime?



If we can avoid opening the breastbone, if
we can decrease the trauma, and do the
same operation, this is going to be of benefit
to our patients. I think that's the bottom
line.”



Randall K Wolf MD



Associate Professor and Director


Minimally Invasive Cardiac Surgery and Robotics


Ohio State University Medical Center


Telerobotic surgery:

ready for primetime?

Manufacturer

ZEUS


Computer Motion

(Santa Barbara, CA)

da Vinci


Intuitive Surgical

(Mountain View, CA)

Cost

$750 000

$1 000 000

Advantage

modularity allows
custom device options


voice
-
activated scope
holder available

EndoWrist


provides 6
degrees of freedom


integrated 3D visual
system

CE
-
mark approval

yes

yes

Phase I FDA trials

yes

yes

Closed
-
chest, beating
heart CABG

October, 1999

January, 2000

Comparison of commercially available
telerobotic systems used in endoscopic CABG

adapted from

theheart.org

/ Views / February 28, 2000 / Robotic
surgery (2): rival robots wrestle for hearts and minds of surgeons

Future technology




additional miniaturization



devices that aid in vessel anastomoses



navigational systems



novel sealants and sutures in association
with robotic techniques




Telerobotic surgery:

ready for primetime?



This is a major change…we're transcending
the framework of conventional cardiac
surgery and we're just now seeing that
maybe we can enter the information age.”



Randall K Wolf MD



Associate Professor and Director


Minimally Invasive Cardiac Surgery and Robotics


Ohio State University Medical Center

Telerobotic surgery:

ready for primetime?