ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS...
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Transcript of ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS...
ROBOT-ASSISTED LAPAROSCOPIC ROBOT-ASSISTED LAPAROSCOPIC
SURGERY WITH ZEUS SYSTEMSURGERY WITH ZEUS SYSTEM
: PRELIMINARY RESULTS AND : PRELIMINARY RESULTS AND
TECHNICAL ASPECTSTECHNICAL ASPECTS
Hurng-Sheng WuHurng-Sheng Wu
Department of Surgery, Show-Chwan MeDepartment of Surgery, Show-Chwan Memorial Hospital, Changhuamorial Hospital, Changhua, Taiwan, R.O., Taiwan, R.O.
CC
高雄縣立岡山醫院
( 30床)
( 731床)
(公辦民營)(公辦民營)
( 700床)
( 500床)籌設中
(全國第一家公辦民營)(全國第一家公辦民營)
台北秀傳醫院
竹山秀傳醫院彰濱秀傳健康園區
秀傳紀念醫院
台南市立醫院
Difficulties of laparoscopic surgeryDifficulties of laparoscopic surgery
Unstable camera platform
Loss of degrees of freedom
Two-dimentional imaging
Poor ergonomics for the surgeon
Ballantyne G. H.Surgical laparoscopy, endoscopy
Percutaneous techniquesVol. 12, No. 1, pp.1-5, 2002
Decades of Changes in Surgical Decades of Changes in Surgical EducationEducation
<1950 Operating room theaters1960 Experimental surgery and motion picture films1970 Industry-research laboratories1980 Endoscopic surgery1990 Laparoscopy2000 Robotics
Alberto Peracchia,Annals of Surgery
Vol.234, No. 6, 709-712, 2001
Space MedicineSpace Medicine
ZEUSda Vinci
Master-slave manipulatorSimplicityLightnessRange of freedomMotion scalingReal-time high-resolution 3D visionPhysiological tremor elimination
The key component of the Zeus Surgical System is the microwrist technology. It allows the surgeon to roll, pitch, yaw and grip laparoscopic tools.
It also provideds a real benefit for the surgeon with a 3-D view of the operative field.
Microwrist
What is about space medicine?What is about space medicine?
ROBOTROBOT: computer-enhanced : computer-enhanced humanistic devicehumanistic device
Zeus Robotic SystemZeus Robotic System
AESOP
HERMIS
SOCRATES
Surgeon Console& Three Roboyic Arms
LIMITATIONS OF ROBOTIC SURGERYLIMITATIONS OF ROBOTIC SURGERY
Ports and/or robotic arms placement eg: lithotomy position
Cosmetic
Depth perceptionNo haptic feed back
eg: needle and suture breaks
Size
Set up
Dept.Dept. OperationOperation TotalTotal
General SurgeryGeneral Surgery Robotic assisted Nissen fundoplication 44
Robotic assisted gastric band for obesity 33
Robotic assisted laparoscopic cholecystectomy 7171
Robotic assisted repair of PPU 33
Robotic assisted Choledocholithotomy with T-tube 2828
Robotic assisted laparoscopic appendectomy 11
Robotic assisted laparoscopic adrenectomy 33
Robotic assisted oophorectomy 11
Robotic assisted laparoscopic unroofing of intraabdominal cyst
22
Cardiovascular Cardiovascular Surgery Surgery
Total Zeus IMA take down 33
Robotic ACAB 66
Obstetrics & Obstetrics & GynecologyGynecology
Robotic assisted salpino-oophrectomy 22
Robotic Surgery in Show Chwan Memorial HospitalRobotic Surgery in Show Chwan Memorial HospitalBETWEEN MARCH,2002 AND NOVEMBER, 2004BETWEEN MARCH,2002 AND NOVEMBER, 2004
Endo-ACABEndo-ACABDefinition :
A less invasive bypass p
rocedure on the beating
heart where all steps are
performed endoscopicall
y with the exception of a
manual anastomosis.
Technique of Endo-ACABTechnique of Endo-ACAB
Endoscopic IMA Harvest
voice-activated robotic-assisted and a 5mm thoracoscope under single lung ventilation and CO2
insufflation
Technique of Endo-ACABTechnique of Endo-ACAB
Atrumatic Thoracotomy
Technique of Endo-ACABTechnique of Endo-ACAB
Direct vision anastomosis
Robotic-Assisted Laparoscopic Surgery in Difficult Robotic-Assisted Laparoscopic Surgery in Difficult Common Bile Duct Stone: Preliminary Results in ShCommon Bile Duct Stone: Preliminary Results in Sh
ow Chwan Memorial Hospitalow Chwan Memorial Hospital
Hurng-Sheng WuHurng-Sheng Wu
Department of Surgery, Department of Surgery,
Show Chwan Memorial Hospital, Changhua. Show Chwan Memorial Hospital, Changhua. TaiwanTaiwan
BackgroundBackground
Common bile duct stones are a frequent problem (1
0-15%) in patients with symptomatic cholecystolithi
asis
Laparoscopic techniques have expanded the options
for their treatment
Difficulty in laparoscopic surgery
AimsAims
Compare the results in patients with CBD
stones by Laparoscopic to robotic-assisted
CBD exploration
PatientsPatients
919 patients with GB stones and/or CBD stone
772 patients(84%) – LC (including 55 robotic-assisted )
55 patients(6% )- Open Cholecystectomies
92 patients(10%) with CBD stone
IHS excluded
42 patients(45%) – open CBDE
22 patients(24%) – LCBDE
28 patients(31%) – Robotic-assisted
Between January 2000 and November 2003Between January 2000 and November 2003
Criteria of difficult common bile duct Criteria of difficult common bile duct stonestone
LCBDELCBDE(n=25)(n=25)
Robotic-AssistedRobotic-Assisted(n=28)(n=28)
Big stone (>1cm) 99 1010
multiple stones 1010 99
Impacted CBD stone 22 44
ERC failed 44 55
s/p Billroth II resection s/p Billroth II resection 11 duodenal diverticulumduodenal diverticulum 22 22 uncooperative behavioruncooperative behavior 11
IntoleranceIntolerance 22 11
TotalTotal 2525 2828
Mr. Ker. 43/yrs male C.C. : RUQ pain tea-color urine
Lab. : GPT:65 Alk-P:368
Results(1)Results(1)
VariablesVariables LCBDELCBDE Robotic-AssistedRobotic-Assisted P valueP valueNo. of patients 2222 2828
No.(%) of conversion 3 (12%)3 (12%) 3(10%)3(10%) NPNP
Mean age( years old) 58 (range 23~83)58 (range 23~83) 59 (range 41-84)59 (range 41-84) NPNP
Sex= M : F 8:148:14 11:1411:14 NPNP
Total Bilirubin level
≦ 2 (mg/dl) 1313 77 0.0310.031 2 ~ 10 (mg/dl) 99 1818
Mean caliber of CBD (cm)
1.43 (range 0.8~2.2)1.43 (range 0.8~2.2) 1.6 (range 1.2~2.5)1.6 (range 1.2~2.5) NPNP
No.(%) of complication 2 (9%)2 (9%) 2 (8%)2 (8%) NPNP
No.(%) of retained stone 2 (9%)2 (9%) 2 (8%)2 (8%) NPNP
No.of recurrent stone 11 00 NPNP
Follow-up( months ) 3~393~39 1-201-20
Result (2 )Result (2 )
LCBDELCBDE Robotic-AssistedRobotic-Assisted PP
CBD diameter (cm) 1.45±0.36 (1-1.45±0.36 (1-7.2)7.2)
1.6±0.3 (1.2-2.5)1.6±0.3 (1.2-2.5) NPNP
Suture stitches 2.05±0.56(1-3)2.05±0.56(1-3) 3.84±0.90(3-6)3.84±0.90(3-6) <0.001<0.001
Time to liquid (days) 2.55±0.78 (2-5)2.55±0.78 (2-5) 2.32±0.97 (1-4)2.32±0.97 (1-4) NPNP
Postoperative
hospital stay (days)
6.8±3.1 (5-14)6.8±3.1 (5-14) 6.6±0.36 (4-11)6.6±0.36 (4-11) NPNP
Result (3)Result (3)
LCBDELCBDE Robotic-AssistedRobotic-Assisted
Mortality 00 00
Conversion to open 33 00
Conversion to LCBDE 33
Complications:
Acute hepatitisAcute hepatitis 00 11
Wound infectionWound infection 11 11
Bile leakageBile leakage 22 00
Retained stone(s)Retained stone(s) 22 22
T-tube DislodgeT-tube Dislodge 11 00
0
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Robot Set timeRobot Set time
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Robot Suture TimeRobot Suture Time
Person
Person
(min)
(min)
OP TIME & Learning CurveOP TIME & Learning Curve
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1 3 5 7 9 11 13 15 17 19 21 23 25
LCDL
Robotic-Assisted
TimePerson
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1 3 5 7 9 11 13 15 17 19 21 23 25
LCBDE縫合TimeRobot縫合Time
ZEUS suture=37.76±24.33min (stitches=3.84)ZEUS suture=37.76±24.33min (stitches=3.84)LCBDE suture=24.65±10.82min (stitches=2.05)LCBDE suture=24.65±10.82min (stitches=2.05)
THE FUTURE OF ROBOTIC THE FUTURE OF ROBOTIC
SURGERY SURGERY
Founding Members:
CIMIT
Center for Integration of Medicine and Innovative Technology
CIMIT facility in Cambridge, Massachusetts