Concept design of robotic modules for needlescopic surgery

Background: Many minimally invasive surgical procedures and assisting robotic systems have been developed to further minimize the number and size of incisions in the body surface. This paper presents a new idea combining the advantages of modular robotic surgery, single incision laparoscopic surgery and needlescopic surgery.

Material and methods: In the proposed concept, modules carrying therapeutic or diagnostic tools are inserted in the abdominal cavity from the navel as in single incision laparoscopic surgery and assembled to 3-mm needle shafts penetrating the abdominal wall.

Results: A three degree-of-freedom robotic module measuring 16?mm in diameter and 51?mm in length was designed and prototyped. The performance of the three connected robotic modules was evaluated.

Conclusion: A new idea of modular robotic surgery was proposed, and demonstrated by prototyping a 3-DOF robotic module. The performance of the connected robotic modules was evaluated, and the challenges and future work were summarized.     

急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果比较

目的比较急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果。方法以2017年5月至2018年5月我院接收的68例肝胆外科损伤患者作为研究对象,根据治疗方法的不同将其分为参照组和控制性手术组,各34例。参照组采用常规急诊Ⅰ期手术治疗,控制性手术组采用控制性手术治疗。观察两组治疗前及治疗1周后的pH值、体温、血浆凝血酶原时间(PT)、手术时间、住院时间、治疗1周后的并发症发生情况及治疗2周后的死亡率。结果治疗1周后,两组pH值、体温明显高于治疗前,PT明显短于治疗前,且控制性手术组优于参照组(P<0.05)。控制性手术组的手术时间明显短于参照组,住院时间明显长于参照组(P<0.05)。治疗1周后,控制性手术组的并发症总发生率明显低于参照组(P<0.05)。治疗2周后,控制性手术组的死亡率明显低于参照组(P<0.05)。结论相比于常规急诊Ⅰ期手术,肝胆外科损伤患者通过控制性手术治疗的临床价值显著,值得在临床上推广应用。     

Automatic tracking of laparoscopic instruments for autonomous control of a cameraman robot

Background An automated instrument tracking procedure was designed and developed for autonomous control of a cameraman robot during laparoscopic surgery. Material and methods The procedure was based on an innovative marker-free segmentation algorithm for detecting the tip of the surgical instruments in laparoscopic images. A compound measure of Saturation and Value components of HSV color space was incorporated that was enhanced further using the Hue component and some essential characteristics of the instrument segment, e.g., crossing the image boundaries. The procedure was then integrated into the controlling system of the RoboLens cameraman robot, within a triple-thread parallel processing scheme, such that the tip is always kept at the center of the image. Results Assessment of the performance of the system on prerecorded real surgery movies revealed an accuracy rate of 97% for high quality images and about 80% for those suffering from poor lighting and/or blood, water and smoke noises. A reasonably satisfying performance was also observed when employing the system for autonomous control of the robot in a laparoscopic surgery phantom, with a mean time delay of 200ms. Conclusion It was concluded that with further developments, the proposed procedure can provide a practical solution for autonomous control of cameraman robots during laparoscopic surgery operations.     

Minimally invasive valve surgery: different techniques and approaches

Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery [111]. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.     

心房颤动外科治疗的研究进展

心房颤动是常见的心律失常之一,致残率和致死率较高,迷宫Ⅲ型手术是其外科治疗的金标准。以新型能源消融线路替代迷宫Ⅲ型手术"切与缝"线路的迷宫Ⅳ型手术,可降低手术对心脏造成的损伤,获得满意的窦性心律转复率,在临床应用日益广泛。近年来,随着医学技术的进步,改良迷宫手术、微创迷宫手术及杂交迷宫手术也在临床逐渐开展。本文就心房颤动外科治疗的研究进展综述如下。     

A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study

Purpose  The aim of this study was to create an access canal to the inner ear, by drilling, and perform the cochleostomy for cochlear implant surgery using robot guidance. Methods  A robot, a surgical drill and an Image-Guided Surgery (IGS) system were combined in a closed-loop setup. Ten temporal bones were scanned at the planning stages of the procedure. The robot guided the drill along the preplanned trajectory and created the approach. Postoperative scans were obtained. Results  The cochleostomy was performed completely in nine out of ten cases. This did not prove possible for one of the specimens, the target site selected being in too superficial a location in relation to the round window. No violation of the facial nerve took place, although the chorda tympani nerve was violated in one case and the stapes in two. It was obvious during preoperative planning that these structures would be violated, but this was accepted in order to maintain a safety margin from the facial nerve. No other unforeseen damage occurred. Conclusions  This preliminary study suggests that robot-guided drilling of a minimally invasive approach to the cochlea might be feasible, but further improvements are necessary before any clinical application becomes possible. Where the width of the facial recess is less than 2.5 mm, the chorda tympani nerve and the ossicles are at risk. Source of financial support or funding: Deutsche Forschungsgemeinschaft (DFG-German Research Foundation), Priority Program 1124 (Medical Robotics).     

电子手术申请单与手术排班系统的改进与应用

目的完善电子手术申请单内涵,改进手术排班系统,满足手术需求,使手术室整体资源高效运转。方法重整电子手术申请及手术排班工作流程,规范了电子手术申请单内容的填写,完善了手术患者的信息,也设置了临床医师提交和取消手术申请单的权限,建立了急诊手术的绿色通道,为手术患者的术前准备工作提供依据和保障。结果运行3个月期间,特殊仪器设备与器械安排有误、手术信息取消、手术切口分类与手术安排有误等不良情况发生率明显下降。结论该系统为手术室整体资源共享,确保手术患者的安全,提高工作效率等方面提供了保障。     

腹腔镜下多脏器联合手术的临床体会

目的应用腹腔镜技术行腹腔内多脏器联合手术。方法分析10余年来由肝胆外科、妇产科、泌尿外科等联合完成腹腔镜下多脏器联合手术，其中行LC＋肠粘连松解术23例，LC＋阑尾切除术10例，LC＋肝囊肿开窗引流术12例，LC＋肝活检术13例，LC＋子宫附件手术6例，LC＋右肾囊肿去顶术2例，肝囊肿开窗引流＋肠粘连松解术3例。结果69例手术均顺利完成，无不可控制的出血，无中转开腹，无术后并发症发生。平均手术时间为100min，单病灶LC为45min；术后平均住院天数为5．2d，LC3．8d。所有患者均在术后36h内下床活动，术后第2天恢复饮食。结论腹腔镜下多脏器联合手术不增加患者痛苦，一次手术同时完成两个病灶，缩短了麻醉、手术和住院时间，从而减轻了患者的经济负担，兼有微创美容的效果。     

Unrecognized indication for robot-assisted cardiac surgery: Patients with acute psychotic disorders

Patients with acute psychotic disorders are often considered as inappropriate candidates for cardiac surgery as well as for other surgical interventions. Post-operative care and patient compliance, which are the main problems associated with such patients, are the most important issues for conventional cardiac surgery. Robot-assisted cardiac surgery may be a new solution in this respect. In this report we aimed to present our acute psychotic patient with serious mitral insufficiency secondary to huge atrial myxoma, treated with robotic cardiac surgery.     

生理性重睑术的临床应用

目的探讨符合重睑生理解剖结构的切开重睑成形术的临床应用。方法:自2018年10月到2019年4月我院收治的56例重睑术患者,随机分为观察组和对照组,观察组采用符合生理解剖结构的切开重睑成形术为研究对象,对照组运用传统切开重睑成形术为研究对象,观察患者术后伤口愈合情况,术后瘢痕以及患者满意度及并发症的情况。结果:所有患者术后随访18个月,观察组重睑形态满意度98%,无严重并发症发生。结论:生理性重睑术弧度自然流畅,无凹陷性疤痕形成,临床效果显著,是值得推广应用的手术方法。     

日间腹腔镜下腹膜透析置管术快速流程的临床应用研究

目的探讨腹腔镜腹膜透析置管术在日间手术快速流程的安全性、可行性。方法比较2011年3～7月我院51例日间腹腔镜腹膜透析置管术患者与50例住院的传统腹膜透析置管术患者,对两组病人的住院费、平均住院日、术后并发症进行统计分析。结果两组病人在住院费、平均住院日、术后并发症等方面比较差异有显著意义(P<0.05)。结论腹腔镜腹膜透析置管入术开展日间手术可以显著缩短患者住院时间,减少患者痛苦。     

机器人手术系统在早期肺癌治疗中的应用

机器人手术系统用于早期肺癌治疗是近10年发展起来的一项新的微创治疗技术。与传统的电视胸腔镜（ vide-o-assisted thoracoscopic surgery,VATS）比较,除具有VATS微创的基本优点外,其3D高清成像,高倍数放大,符合人体工程学的仿真机械臂及多自由度转腕功能（ Endowrist）等,通过人机交流还原了开放式手术中术者眼与器械、手与器械的同步运动,将微创外科技术提高到了一个新的境界。本文就机器人手术系统在早期肺癌治疗中的应用现状做一简述。     

腹部手术患者术前心理需求的调查分析

目的了解胃肠、胆囊手术患者术前心理需求,为制定更加个性化的护理措施提供依据。方法选择2008年11月~2009年3月在本院普外科实施胆囊胃肠择期手术患者共148例,其中腹腔镜胆囊切除手术患者73例,其他经腹手术患者75例,采用自行设计调查问卷对患者进行心理需求的调查,并对调查结果进行分析。结果共同心理需求为:①手术的安全性;②术后的恢复及手术对自己的影响;③术后放置引流管及引起的并发症;④胃肠功能恢复的时间;⑤患者对主刀医生的期望主要为经验丰富、技术好。个体差异心理需求为:疼痛及术后护理方法。结论择期手术患者的心理需求存在其共性特点和个体差异,对于护理措施的制定具有指导意义。     

眼内激光在玻璃体和手术中的应用

目的：观察眼内激光在玻璃体切除术中治疗视网膜病变，封闭视网膜裂孔的作用。方法：回顾性分析56例（56眼）玻璃体切除手术，病种有增殖性糖尿病性视网膜病变，视网膜静脉周围炎，视网膜静脉阻塞，外伤性玻璃体出血（共33例）以及复杂性视网膜脱离（23例），在术中施行了眼内光凝，封闭裂孔或光凝视网膜新生血管区及无灌注区。结果：复杂性视网膜脱离23例，视网膜复位19例，其余33例均手术成功。结论：眼内激光是治疗多种视网膜病变的有效方法，是玻璃体切除手术中一个重要步骤。     

腹腔镜胆囊切除术治疗胆结石的效果及对患者胃肠功能的影响

目的研究腹腔镜胆囊切除术治疗胆结石的效果及对患者胃肠功能的影响。方法选取我院2016年1月至2019年1月收治的156例胆结石患者作为研究对象,按手术方式的不同将其分为对照组(63例,开腹手术)和观察组(93例,腹腔镜胆囊切除术)。比较两组的治疗效果。结果观察组的治疗总有效率与结石清除率显著高于对照组,差异具有统计学意义(P<0.05)。观察组的肛门首次排气时间、肠鸣音恢复时间、正常排便时间及正常进食时间均短于对照组,差异具有统计学意义(P<0.05)。术后,两组的血清GAS、MTL、SS水平均降低,但观察组均优于对照组,差异具有统计学意义(P<0.05)。术后1 d,两组的GGT、TBIL、AST及ALT水平均升高,但观察组低于对照组(P<0.05);术后5 d,观察组的GGT、TBIL、AST及ALT水平均低于对照组,差异具有统计学意义(P<0.05)。结论相较于传统开腹手术,腹腔镜手术治疗胆结石对患者胃肠功能及肝功能影响小,治疗有效率高,值得临床进一步推广和应用。     

The past,present and future of minimally invasive spine surgery: A review and speculative outlook

Abstract

In the last 25 years of spinal surgery, tremendous improvements have been made. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, endoscopy and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer- and robot-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. The promise of the continuing evolution of spinal surgery, the era of restoring spinal function, already appears on the horizon. The current state of minimally invasive spine surgery is the result of a long-lasting and consecutive development of smart technologies, along with stringent surgical training practices and the improvement of instruments and techniques. However, much effort in research and development is still mandatory to establish, maintain and evolve minimally invasive spine surgery. The education and training of the next generation of highly specialized spine surgeons is another key point. This paper will give an overview of surgical techniques and methods of the past 25 years, examine what is in place today, and suggest a projection for spine surgery in the coming 25 years by drawing a connection from the past to the future.     

Combined thoraco-laparoscopic hepatectomy concomitant with resection of the diaphragm for solitary peritoneal seeding from cervical cancer: A case report

Combined thoraco-laparoscopic resection can aid in precise resection of an invasive tumor of the diaphragm. A 44-year-old woman was referred to our department for resection of solitary peritoneal seeding from cervical cancer following systemic chemotherapy. The tumor was located in the right diaphragm with an ill-defined border of the liver. Combined thoraco-laparoscopic resection was proposed. Laparoscopy portrayed that the right diaphragm was partially attached to the liver, and the depth of tumor invasion to the diaphragm was ambiguous. Observation from the thoracic cavity indicated a white-colored distortion following the location of peritoneal seeding. Partial resection and repair of the diaphragm were made using the thoracoscopic-assisted approach, followed by laparoscopic hepatectomy. The postoperative course was uneventful, and pathological findings revealed that peritoneal metastases of the diaphragm and surgical margin was negative for cancer. Combined thoraco-laparoscopic resection can cover the drawbacks of each approach and is among the options for minimally invasive surgery for invasive tumor of the diaphragm.