共查询到20条相似文献,搜索用时 296 毫秒
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Winter JM Talamini MA Stanfield CL Chang DC Hundt JD Dackiw AP Campbell KA Schulick RD 《Surgical endoscopy》2006,20(1):119-124
Background Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports
and small series of robotic adrenalectomies have been reported. This study presents a single institution’s series of 30 robotic
adrenalectomies, and evaluates the procedure’s safety, efficacy, and cost.
Methods Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient
morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented.
Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional
laparoscopic and open adrenalectomies performed during the same time period.
Results Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open
surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital
charges for robotic adrenalectomy ($12,977) were not significantly different than charges for traditional laparoscopic ($11,599)
or open adrenalectomy ($14,600).
Conclusions Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy. 相似文献
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AESOP robotic arm 总被引:2,自引:0,他引:2
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Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery. 相似文献
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Computer-enhanced robotic telesurgery 总被引:8,自引:0,他引:8
Melvin WS Needleman BJ Krause KR Schneider C Wolf RK Michler RE Ellison EC 《Surgical endoscopy》2002,16(12):1790-1792
BACKGROUND: A new type of computer-enhanced telemanipulator device for "robotic" laparoscopic surgery was recently approved. We prospectively evaluated the initial patients undergoing procedures with this new device at our institution. METHODS: Patient demographics, operative indications, port placement, operative time, robot time, complications, and hospital stay were recorded. Follow-up evaluation was appropriate for the individual procedure. RESULTS: Initially, 35 cases were managed. There were 22 anti-reflux procedures, 9 Heller myotomies, 1 pyloroplasty, 1 distal pancreatectomy with splenectomy, 1 esophagectomy with intrathoracic anastomosis, and 1 diagnostic laparoscopy. The operative times ranged from 88 to 458 min. The robot use times were between 16 and 185 min. There were no device-related complications. CONCLUSIONS: Computer-enhanced robotic telesurgery is a safe and effective treatment method for a variety of diseases of the proximal gastrointestinal tract. Further study is needed to determine the benefits of this approach as compared with current technology. 相似文献
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Desai MM Aron M Berger A Canes D Stein R Haber GP Kamoi K Crouzet S Sotelo R Gill IS 《BJU international》2008,102(11):1666-1669
OBJECTIVE
To report the technical feasibility of performing transvesical robotic radical prostatectomy (TRRP) in a cadaver.MATERIALS AND METHODS
TRRP was performed in two fresh male cadavers (prostate volume 46 and 30 mL). In the first procedure we used four laparoscopic transvesical trocars and in the second a single‐port device was placed percutaneously into the bladder. Pneumovesicum was established in both cases and the da Vinci‐S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the TRRP. All steps of the procedure, including dissection of the seminal vesicles and vas deferens, ligation of prostatic pedicles, release of neurovascular bundles, apical dissection, urethral transection, and urethro‐vesical anastomosis, were done transvesically and robotically. Real time transrectal ultrasonography monitoring was used in the first cadaver.RESULTS
Both procedures were technically successful transvesically with no need for additional ports or conversion to standard laparoscopy. The operative duration for the multi‐port procedure was 3 h and for the single‐port procedure was 4.2 h. Clashing of the da Vinci arms was the primary technical difficulty with the single‐port procedure, but did not occur in the multi‐port procedure.CONCLUSIONS
TRRP under pneumovesicum is technically feasible using multiple‐port or a single‐port approach in the cadaver. The clinical application of this novel approach is imminent. Further refinement of technique and instruments might lead to an increasing role of percutaneous intraluminal surgery in various surgical disciplines. 相似文献11.
Binder N Matthäus L Burgkart R Schweikard A 《The international journal of medical robotics + computer assisted surgery : MRCAS》2005,1(3):108-116
Fluoroscopic C-arms are common devices for acquiring images during surgery. Manual positioning is time consuming and requires considerable experience. Trained users must often take several images to find the best viewing direction. If a second image must be taken from the same position, e.g. for postoperative control, the C-arm must be moved to the exact same position. Without guidance, this is often difficult to accomplish. We developed the idea to completely "robotize" a standard C-arm, i.e. to equip all joints with motors and encoders. A software environment provides for intelligent control. To archive this goal a complete kinematic analysis of the fluoroscope was necessary. On the basis of this analysis a number of clinical applications have been developed: (1) simplified positioning via cartesian control; (2) automatic acquisition of panoramic images; (3) 3D CT with arbitrary viewing angles; (4) 4D intraoperative CT with/without respiration triggering; (5) automated anatomy-oriented positioning. The goal of this research is thus three-fold: minimise radiation exposure of the OR staff, reduce positioning time and offer enhanced imaging capability. 相似文献
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Cepolina F Challacombe B Michelini RC 《Journal of endourology / Endourological Society》2005,19(8):940-951
Robotic surgery began as a technology-driven innovation but is now becoming a genuine method of improving healthcare effectiveness worldwide. This comprehensive review introduces the current trends, using examples of specific systems to distinguish the various types of robotic surgical devices, from remote handling machines to those performing delicate local interventions. We end by commenting on how to extend existing systems and provide an account of the rapid developments in minimally invasive robotic surgery. 相似文献
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Advances in robotic prostatectomy 总被引:2,自引:0,他引:2
Robotic-assisted laparoscopic prostatectomy (RALP) has emerged as an important treatment option for localized prostate cancer.
As such, methods to improve instrumentation, technique, outcomes, and cost require continued investigation. For example, a
recently introduced four-armed robotic system has limited the need for bedside assistants, while an enhanced understanding
of pelvic anatomy as visualized robotically has led to valuable modifications in operative technique. Increased surgeon experience
has decreased perioperative morbidity, and has resulted in short-term pathologic and functional outcomes that compare favorably
with open radical prostatectomy. Meanwhile, quality-of-life studies using validated instruments are helping to define the
time course of patient recovery. Nevertheless, costs associated with robotic surgery remain daunting. As the follow-up of
patients treated with RALP matures, future studies, ideally with a prospective, randomized design, will be needed to establish
the long-term oncologic efficacy of the procedure and to evaluate the overall advantages of RALP compared with open surgery. 相似文献
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Laparoscopic colectomy has been a challenge for surgeons due to steep learning curves, limited dexterity of instruments and
non-depth perception with visualization. Robotics for left colectomy has been described in the past years using mostly single
docking or hybrid techniques. With the advantages of the robotic technology including the use of 3D visualization, increase
dexterity with 360-degree motion of the instruments, surgeons may see an increase in the adoption of minimally invasive surgery
for colectomies. Surgeons know that multi-quadrant dissection can be difficult at best with the current platforms available
due to the approach of the angles with the robotic arms and collisions. The use of a single docking technique can be challenging
especially for the dissection of the splenic flexure especially in obese patients. We describe a double docking technique
for the approach of the left colectomy that may help surgeons in the approach of multi-quadrant colorectal surgery. 相似文献
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达芬奇机器人甲状腺手术 总被引:2,自引:0,他引:2
达芬奇机器人手术系统是目前微创手术的新趋势,该系统在甲状腺手术上的应用目前也正在开展过程中.笔者对达芬奇机器人甲状腺手术的器械、操作进行介绍,并且与传统手术及腔镜手术进行比较,希望提供甲状腺手术的新思路. 相似文献
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Michael E. Moran 《Journal of robotic surgery》2007,1(2):103-111
The foundation of surgical robotics is in the development of the robotic arm. This is a thorough review of the literature
on the nature and development of this device with emphasis on surgical applications. We have reviewed the published literature
and classified robotic arms by their application: show, industrial application, medical application, etc. There is a definite
trend in the manufacture of robotic arms toward more dextrous devices, more degrees-of-freedom, and capabilities beyond the
human arm. da Vinci designed the first sophisticated robotic arm in 1495 with four degrees-of-freedom and an analog on-board
controller supplying power and programmability. von Kemplen’s chess-playing automaton left arm was quite sophisticated. Unimate
introduced the first industrial robotic arm in 1961, it has subsequently evolved into the PUMA arm. In 1963 the Rancho arm
was designed; Minsky’s Tentacle arm appeared in 1968, Scheinman’s Stanford arm in 1969, and MIT’s Silver arm in 1974. Aird
became the first cyborg human with a robotic arm in 1993. In 2000 Miguel Nicolalis redefined possible man–machine capacity
in his work on cerebral implantation in owl-monkeys directly interfacing with robotic arms both locally and at a distance.
The robotic arm is the end-effector of robotic systems and currently is the hallmark feature of the da Vinci Surgical System
making its entrance into surgical application. But, despite the potential advantages of this computer-controlled master–slave
system, robotic arms have definite limitations. Ongoing work in robotics has many potential solutions to the drawbacks of
current robotic surgical systems. 相似文献
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