5G远程机器人手术动物实验研究

目的通过动物实验进行5G网络下远程机器人手术可行性分析。 方法将国产康多机器人主、从系统分开,物理空间隔离50 km,借助华为技术有限公司和中国联通共同研发的5G网络互联,主刀医师远程无线控制床旁操作系统进行动物实验,测试远程手术稳定性和安全性相关指标。 结果2018年12月18日,动物实验在福建省福州市顺利完成。主刀医师远程控制2个机械臂(双极电凝和电凝钩)和镜头臂,顺利完成猪的肝脏楔形切除,切除范围约2 cm×2 cm×3 cm。整个动物实验耗时约60 min,出血约5 ml,术中高清3D影像及声音传输即时、稳定,床旁机械臂操作平顺、灵活,主、从跟踪性好,无误操作产生,主、从映射模型正确。移动执行器末端运动指令到机器人臂末端运动平均延误时间<150 ms。整个实验过程机器人系统未出现软件、硬件不良状况。 结论本次动物实验是国际上5G远程手术的首次尝试,结果初步验证了5G远程国产机器人手术技术可行,远程手术的应用将有效解决目前医疗资源供需不平衡的矛盾,实现优质医疗资源下沉,缩小分级诊疗差距,有效降低医疗开支,减轻患者的经济负担,对战时医疗救援更有十分重要的意义。     

机器人远程手术在泌尿外科中的应用

腹腔镜、机器人等微创技术,逐渐成为泌尿外科主流的手术方式。由于各地区医生技术水平参差不齐、医疗资源配置不均衡,无法使其优势充分展现。机器人远程手术秉承机器人系统灵活、精确、稳定、安全、舒适等特点,可远距离或在极端环境进行手术操作,实现及时、有效、合理的医疗救治,为上述一系列的问题提供了解决方案。机器人远程手术系统还是良...     

机器人手术系统在肝脏外科中的应用

机器人手术系统具有稳定、清晰及放大的3D视野,可滤过术者手部震颤,具有多个自由度的灵活稳定操作,克服了传统腹腔镜的不足。尽管机器人手术系统在泌尿外科、妇产科等外科领域得到广泛应用,但在肝脏外科中的作用仍未得到充分认识。笔者综合国内外相关文献,结合团队经验,针对机器人手术系统在肝脏外科应用中的适应证、机器人手术系统肝切除...     

遥控手术机器人动物实验模型的建立

目的 建立机器人外科手术动物模型,掌握遥控外科机器人(Zeus)的基本性能和手术方法,建立手术操作常规。方法 应用Zeus外科机器人系统完成3例腹腔镜猪胆囊切除术,观察术前准备时间、手术时间、出血量、手术并发症及术后生存情况。结果 3只接受胆囊切除术后的猪均恢复顺利,随着手术经验的积累,术前准备时间由120min缩短为60min,手术时间由60min缩短到15 min,出血量由20 ml减少到5 ml,除1只猪在术中有胆囊破裂、胆汁泄漏外,其余2只无任何并发症的发生。结论 Zeus手术机器人具有术野图像更清晰稳定、操作更精确、轻柔和可实施远程手术优势,可安全应用于临床。     

机器人系统辅助微创心脏外科手术进展

机器人系统辅助微创心脏外科手术 ,是在机器人系统辅助下将内镜及细长的手术器械通过小切口置入病人体内 ,通过ＨＥＡＲＴ ＰＯＲＴ公司体外循环管道进行股动、静脉插管建立体外循环进行的手术 ,手术切口根据手术目的和方式而定。目前常用的手术室辅助机器人系统是美国ＣｏｍｐｕｔｅｒＭｏｔｉｏｎ公司的手术室智能机器人系统 ,包括ＡＥＳＯＰ30 0 0系统 ,即声控内镜定位机器人 ;ＨＥＲＭＥＳ控制中心 ,为声控一系列智能化医械的中央控制系统 ;ＺＥＵＳ微创外科手术机器人系统 3部分。此外 ,还有建立在ＡＥＳＯＰ30 0 0基础上的ＡＥＳＯＰ…     

微创外科将进入手术机器人的新时代

1987年,腹腔镜胆囊切除术成功开展,标志着微创外科时代的到来。本世纪初,以daVinci为代表的手术机器人进入外科领域。经过10年的不断发展,手术机器人的性能不断提高,适应证的范围扩大,其临床应用的优势日益显现。在不久的将来,手术机器人可能进一步发展成为微创外科的新标准,微创外科将迎来手术机器人的新时代。     

机器人手术系统行胰腺中段切除的临床应用

目的初步研究利用机器人手术系统行胰腺中段切除术的临床应用价值。方法回顾性分析解放军总医院2015年3月至2016年6月期间行机器人胰腺中段切除术的病人的临床资料。结果共开展8例机器人胰腺中段切除术,均顺利完成,达到R0切除,无中转开腹,其中行胰胃吻合术3例,胰肠吻合术5例。手术平均时长为(283±43)min,术中平均出血量为(94±27)ml。实性假乳头状瘤4例,神经内分泌肿瘤2例,导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)1例,囊腺瘤1例。术后平均住院时间为(9.3±0.7)d,所有病人均康复出院,无病人死亡。结论机器人胰腺中段切除术技术上安全、可行,具有一定的临床应用价值。     

手术机器人：工具还是玩具

腔镜外科是21世纪外科领域的革命性进步。由此而派生的微创外科理念已经被广泛接受。目前商品化机器人辅助腔镜器械操作系统,俗称“手术机器人”尚不具备真正机器人的属性,仍需要进一步优化。我们与声称的“外科机器人时代”仍相距甚远。具有更完善人工智能模拟功能的新一代手术机器人值得期待。“微创入路”并不一定等同于“微创外科”,患者...     

手术机器人及虚拟、远程技术在微创胆道外科的应用

微创外科(mininally invasive surgery)是以传统外科学为基础，融合信息科学、材料科学和机械工程科学等，使外科诊断与治疗达到了微创化、微型化、智能化和数字化。由于胆道的特殊解剖结构使得其非常适宜微创的开展，故微创技术在胆道外科诊断、治疗中的应用日益广泛、成熟，正如黄志强教授^[1]所言：“2l世纪的胆道外科是微创的时     

全机器人心脏不停跳下房间隔缺损修补术

目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5～3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.

Abstract：

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After "da Vinci S" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.     

Robotic spine surgery: Ushering in a new era

The endeavour to make spine surgery safe with reproducible, consistent outcomes has led to growing interest and research in the field of intraoperative imaging, navigation and robotics. The advent of surgical robot systems in spine surgery is relatively recent – with only a few systems approved for commercial use. At present, pedicle screw insertion remains the primary application of robotic systems in spine surgery. The purported advantages of robot-assisted pedicle screw insertion over other conventional techniques are its increased accuracy, reproducible consistency and reduced radiation exposure. Many of these claims have been supported or refuted by individual studies – and high quality evidence for the same is lacking. Robotic spine surgery also has its share of limitations which include increased operative time, considerable learning curve and technical pitfalls unique to the robotic systems. The applications of robotic spine surgery are evolving and expanding to spinal deformity, spine oncology and needle-based interventional treatments. This review provides an overview of the evolution and current status of robotic spine surgery along with an evidence-based discussion of its current applications in spine surgery.     

Robotic correction of Östling folds as a rare cause of ureteropelvic junction obstruction in children

?stling folds are considered to be normal variants of ureteral growth at a quicker rate than body lengthening and, therefore, have been reported to be of no clinical significance. We report a robotic correction of the first documented cases of ?stling folds causing a persistent ureteroplevic junction obstruction in children.     

Robotic liver surgery

Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented.     

Current Status of Robotic Surgery

Surgery has increasingly become a technology-driven specialty. Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy. The dramatic evolution of robotic surgery over the past 10 years is likely to be eclipsed by even greater advances over the next decade. We review the current status of robotic technology in surgery. The Medline database was searched for the terms “robotic surgery, telesurgery, and laparoscopy.” A total of 2,496 references were found. All references were considered for information on robotic surgery in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. There is a paucity of control studies on a sufficient number of subjects in robot-assisted surgeries in all fields. Studies that meet more stringent clinical trials criteria show that robot-assisted surgery appears comparable to traditional surgery in terms of feasibility and outcomes but that costs associated with robot-assisted surgery are higher because of longer operating times and expense of equipment. While a limited number of studies on the da Vinci robotic system have proven the benefit of this approach in regard to patient outcomes, including significantly reduced blood loss, lower percentage of postoperative complications, and shorter hospital stays, there are mechanical and institutional risks that must be more fully addressed. Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers.     

A history of robots: from science fiction to surgical robotics

Surgical robotics is an evolving field with great advances having been made over the last decade. The origin of robotics was in the science-fiction literature and from there industrial applications, and more recently commercially available, surgical robotic devices have been realized. In this review, we examine the field of robotics from its roots in literature to its development for clinical surgical use. Surgical mills and telerobotic devices are discussed, as are potential future developments.     

机器人微创心脏手术的应用现状

微创是心脏外科的发展方向之一.随着自动机械和计算机技术的进步,机器人微创外科手术已成为现实.机器人微创心脏手术具有创伤小、操作精细等优点,是微创心脏外科的前沿技术之一.作为一种革新的手术方式,机器人辅助下微创心脏手术得到了极大的关注,本文就机器人心脏手术的临床应用及手术效果作一综述.     

Robotic surgery versus laparoscopy; a comparison between two robotic systems and laparoscopy

Laparoscopy has found a role in standard urologic practice, and with training programs continuing to increase emphasis on its use, the division between skill sets of established non-laparoscopic urologic practitioners and urology trainees continues to widen. At the other end of the spectrum, as technology progresses apace, advanced laparoscopists continue to question the role of surgical robotics in urologic practice, citing a lack of significant advantage to this modality over conventional laparoscopy. We seek to compare two robotic systems (Zeus and DaVinci) versus conventional laparoscopy in surgical training modules in the drylab environment in the context of varying levels of surgical expertise. A total of 12 volunteers were recruited to the study: four staff, four postgraduate trainees, and four medical student interns. Each volunteer performed repeated time trials of standardized tasks consisting of suturing and knot tying using each of the three platforms: DaVinci, Zeus and conventional laparoscopy. Task times and numbers of errors were recorded for each task. Following each platform trial, a standardized subjective ten-point Likert score questionnaire was distributed to the volunteer regarding various operating parameters experienced including: visualization, fluidity, efficacy, precision, dexterity, tremor, tactile feedback, and coordination. Task translation from laparoscopy to Zeus robotics appeared to be difficult as both suture times and knot-tying times increased in pairwise comparisons across skill levels.