Validated robotic laparoscopic surgical training in a virtual-reality environment

Background  A robotic virtual-reality (VR) simulator has been developed to improve robot-assisted training for laparoscopic surgery and to enhance surgical performance in laparoscopic skills. The simulated VR training environment provides an effective approach to evaluate and improve surgical performance. This study presents our findings of the VR training environment for robotic laparoscopy. Methods  Eight volunteers performed two inanimate tasks in both the VR and the actual training environment. The tasks were bimanual carrying (BC) and needle passing (NP). For the BC task, the volunteers simultaneously transferred two plastic pieces in opposite directions five times consecutively. The same volunteers passed a surgical needle through six pairs of holes in the NP task. Both tasks require significant bimanual coordination that mimics actual laparoscopic skills. Data analysis included time to task completion, speed and distance traveled of the instrument tip, as well as range of motion of the subject’s wrist and elbow of the right arm. Electromyography of the right wrist flexor and extensor were also analyzed. Paired t-tests and Pearson’s r were used to explore the differences and correlations between the two environments. Results  There were no significant differences between the actual and the simulated VR environment with respect to the BC task, while there were significant differences in almost all dependent parameters for the NP task. Moderate to high correlations for most dependent parameters were revealed for both tasks. Conclusions  Our data shows that the VR environment adequately simulated the BC task. The significant differences found for the NP task may be attributed to an oversimplification in the VR environment. However, they do point to the need for improvements in the complexity of our VR simulation. Further research work is needed to develop effective and reliable VR environments for robotic laparoscopic training.     

机器人辅助腹腔镜保留肾单位肾部分切除术（附6例报告）

目的：总结我院机器人辅助腹腔镜保留肾单位肾部分切除术的手术经验,探讨此术式疗效及安全性。方法：2007年12月～2008年10月,对6例肾肿瘤患者行达·芬奇机器人（Da Vinci机器人手术系统）辅助腹腔镜保留肾单位肾部分切除术,将相关资料与国外此手术初期资料及我院同组人员腹腔镜保留肾单位肾部分切除术的资料进行比较分析。结果：6例患者中,1例改行开放性保留肾单位肾部分切除术,其余5例手术均成功。手术时间（不包括术前机器人准备时间）130（110～160）min,肾动脉阻断时间40（33～50）min,术中出血量188（100380）ml。术后7天下床活动,3天拔除引流管,术后住院9（8～12）天,肾功能均在正常范围。术后病理检查提示为肾透明细胞癌5例,乳头状癌1例,无一例切缘阳性。随访4～15个月,全部患者未见局部病灶残留、局部复发、切口种植及远处转移。结论：机器人辅助腹腔镜保留肾单位肾部分切除术是一种创伤小、安全可靠、疗效确切的手术方法。随着操作熟练程度的提高,此术式优势将更加明显。     

50例全机器人房间隔缺损修补术的麻醉方法总结

目的总结50例使用da Vinci S型机器人手术系统行不开胸房间隔缺损修补术的麻醉管理方法。方法50例房间隔缺损修补手术均在全麻体外循环下由da Vinci S手术系统操作完成。麻醉诱导采用依托咪酯、利多卡因、哌库溴铵及舒芬太尼静脉注射,诱导后插入左侧双腔支气管导管,术中持续监测食道超声、脑电双频指数、血流动力学及动脉血气分析等。结果所有患者均顺利完成手术,围手术期无死亡病例。转流前,32例（64％）患者在单肺通气后脉搏氧饱合度（SpO2）下降（94．5％±1．2％）,未做特殊处理;脱机后,有14例（28％）患者SpO,进行性下降,其中9例（18％）在使用气道内持续正压装置（CPAP）后缓解,有5例（10％）需要间断行双肺通气维持呼吸及循环稳定。平均麻醉时间（254．2±37．6）min,体外循环时间（76．5±22．4）min,升主动脉阻断时间（38．4±19．5）min,术后呼吸机辅助时间（3．2±2．5）h,ICU停留时间（1．9±1．3）d,术后平均住院时间（6．2±2．4）d。术中失血量（152．5±66．2）ml,术后引流量（89．6±41．5）ml。结论全机器人房间隔缺损修补术的麻醉管理复杂,CO2气胸和单肺通气对血流动力学及呼吸功能的影响较大,对麻醉技术是一项新的挑战。     

22例经达芬奇-S外科手术辅助系统行纵隔肿物切除术后患者的护理

目的总结达芬奇-S外科手术辅助系统下行纵隔肿物切除术后患者的护理要点。方法回顾分析本科行纵隔肿物切除术后22例患者的临床资料,根据手术特点,术后护理应密切观察引流液的量、颜色及性状的变化,监测生命体征及末梢循环,定时抽血查血气分析,观察红细胞压积有无异常等情况,出现异常及时汇报医生,警惕胸腔内活动性出血。结果通过有效的护理措施,患者的术后安全得以保障,所有患者均康复出院。结论根据此类手术的特点,总结的护理经验能够很好地应用于护理工作中为患者服务。     

机器人辅助腹腔镜结直肠癌肝转移手术中的肝切除技术

目的：探讨达芬奇机器人手术系统在结直肠癌肝转移中的肝切除技术。方法回顾性分析我中心自2011年5月至2013年12月应用达芬奇机器人手术系统对4例结直肠癌肝转移患者行肝切除手术的临床资料。结果通过该系统,所有患者均成功完成手术。其中2例为单独切除肝转移瘤,2例为同期切除结肠原发灶及肝转移瘤。手术时间为210-510 min。术中失血量100-900 ml,输血1例。术后未发生并发症。术后住院时间8-15 d。结论达芬奇机器人手术系统能够安全有效地完成结直肠癌肝转移的微创外科手术。