A technical challenge for robot-assisted minimally invasive surgery: precision surgery on soft tissue

In minimally invasive surgery, a higher degree of accuracy is required by surgeons both for current and for future applications. This could be achieved using either a manipulator or a robot which would undertake selected tasks during surgery. However, a manually-controlled manipulator cannot fully exploit the maximum accuracy and feasibility of three-dimensional motion sequences. Therefore, apart from being used to perform simple positioning tasks, manipulators will probably be replaced by robot systems more and more in the future. However, in order to use a robot, accurate, up-to-date and extensive data is required which cannot yet be acquired by typical sensors such as CT, MRI, US or common x-ray machines. This paper deals with a new sensor and a concept for its application in robot-assisted minimally invasive surgery on soft tissue which could be a solution for data acquisition in future.     

Development of a new 3‐DOF parallel manipulator for minimally invasive surgery

This article proposes a novel dexterous endoscopic parallel manipulator for minimally invasive surgery. The proposed manipulator has 3 degrees of freedom (3‐DOF), which consist of two rotational DOFs and one translational DOF (2R1T DOFs). The manipulator consists of 3 limbs exhibiting identical kinematic structure. Each limb contains an active prismatic joint followed by 2 consecutive passive universal joints. The proposed manipulator has a unique arrangement of its joints' axes. This unique arrangement permits large bending angles, ±90° in any direction, and a workspace almost free from interior singularities. These advantages allow the proposed manipulator to outperforms existing surgical manipulators. However, this unique arrangement makes the analysis of the robot extremely difficult. Therefore, a geometrical/analytical approach is used to facilitate its singularity analysis. Construction of the virtual prototype is accomplished using ADAMS software to validate the proposed manipulator and its bending capability. A closed‐form solution for inverse kinematics is obtained analytically. Also, the forward kinematics solution is obtained numerically. Moreover, evaluation of the workspace is achieved using motion/force transmissibility indices. A practical experiment has been performed using a scaling technique and PID controller. The experimental results show the feasibility of the teleoperated surgical system using the proposed parallel manipulator as the slave.     

微创外科时代的胆道外科——胆囊切除术尚非平安无事

自从首例在腹腔镜下施行胆囊切除术之后,胆道外科技术经历了革命性的改变。当前,已经有越来越多的传统外科手术方法被腹腔镜外科所取代。然而,腹腔镜胆囊切除术并非平安无事。当前,由于影像学技术的发展,例如对肝内、外胆道的虚拟现实、三维重建等,可以有助于对复杂胆道外科问题如肝内胆管结石和其他肝内病变的手术前评估和手术设计。约占原发性肝癌5%～10%的肝内胆管癌由于其与肝细胞癌有不同的病理-生物学特点,故在治疗措施选择上应得到特殊的关注,一般应该施行广泛的肝切除手术而不是局部切除或消融。关于肝门部胆管癌的治疗,扩大的肝切除术可以改进早期的、无淋巴结转移病变治疗结果。当前,在微创外科时代,许多传统的外科手术将在微创外科理念下重新受到检验。     

内镜辅助下甲状腺手术12例报告

目的　探讨微创内镜辅助下甲状腺手术可行性及优点。方法　自 2 0 0 3年 9月至2 0 0 3年 12月进行微创内镜辅助下甲状腺手术 12例。其中结节性甲状腺肿 7例 ,甲状腺腺瘤 5例。结果　 12例病人均完成手术 ,无一例中转为常规手术 ,无明显术后并发症。手术时间 3 8～ 110min ,平均约 65min。所有病人经过 1～ 3个月的随访 ,对切口的美容效果感到满意。结论　微创内镜辅助下甲状腺手术安全 ,切实可行 ,具有良好的切口美容效果。     

微创手术治疗单纯内踝撕脱骨折

2002年1月～2005年1月,我们应用闭合复位、经皮导针定位、2枚空心螺纹钉内固定的方法治疗单纯内踝撕脱骨折22例,效果满意,报道如下。     

Superior trans‐septal approach for minimally invasive mitral valve surgery via right small thoracotomy

Minimally invasive mitral valve surgery (MIMVS), despite its challenges, is not a rare procedure. However, MIMVS via a right small thoracotomy must be performed using long‐shafted surgical instruments and thoracotomy instruments specialized for minimally invasive cardiac surgeries. We have performed 12 cases of MIMVS via right small thoracotomy using the superior trans‐septal approach and secured a surgical visual field that easily allows a finger to reach the mitral valve annulus without using special instruments for minimally invasive cardiac surgery. We named this technique the “drawer‐case technique.” In conclusion, MIMVS via right thoracotomy using the superior trans‐septal approach can be performed easily and safely, similar to mitral valve surgery performed via median sternotomy.     

The efficiency of absorbable clips in minimally invasive surgery

This study was conducted to evaluate the efficiency of polymeric clips in minimally invasive surgery. Absorbable polymeric clips were applied to the cystic duct, appendicular stump, and blood vessels in 35 patients undergoing laparoscopic or thoracoscopic procedures. All patients were reviewed 3 months after their operations, and no complications related to the clips were observed. These findings indicate that absorbable clips have more advantages than metallic clips. We believe that as this clip is easy to operate with safety, it should be used in the majority of minimally invasive surgical procedures.