Technique of closed chest coronary artery surgery on the beating heart

[Miniature assistance module for robot-assisted heart surgery]

During the robotic enhanced minimally invasive cardiac surgery the approach to and the space for handling instruments in the operating field are usually reduced, compared to the conventional surgery. Additional well knewn problems are the restricted capability available for accessories into and out of the closed chest and the limited assistance during the cardiac procedure. This paper is presenting two solutions of Miniature Modules for supporting the surgeon inside the closed chest. A self-sufficient Cargo Module is developed as a transportation and depot device. It provides an "inside equipment store" for the surgeon. With the Assist Module the surgical equipment, tissue and vessels can be positioned on a desired place in the operating field. This module provides the surgeon an "assistant" inside the closed chest.

Mediastinal mass evaluation using advanced robotic techniques

The diagnosis and management of mediastinal masses frequently necessitates biopsy and surgical resection. The use of videothorascopic techniques has broadened the surgeon's ability to evaluate and treat such tumors using a minimally invasive approach. We describe herein the use of the da Vinci Robotic Surgical System for evaluating a mediastinal mass in a young woman.

Robotics and coronary artery surgery

Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology. With a combined experience of 125 patients, several groups have independently demonstrated the clinical feasibility of totally endoscopic coronary artery bypass with two commercially available robotic telemanipulation systems. Additional enabling technology is needed to overcome the challenges currently limiting development and widespread application of totally endoscopic off-pump multivessel coronary artery bypass surgery.

Laparoscopic hysterectomy using a computer-enhanced surgical robot

OBJECTIVE

The objective of this study was to describe the technique of laparoscopic hysterectomy using a computer-enhanced robotic surgical system.

METHODS

Eleven patients underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy using a computer-enhanced surgical robot. Four trocars were used: one for the camera, two for the robotic arms controlled by the operating surgeon from the surgeon's console, and an additional port for use by the surgical assistant.

RESULTS

Ages ranged from 27 to 77 years, and weight ranged from 54 to 100 kg. Operative time ranged from 4.5 to 10 hours. Estimated blood loss ranged from 50 to 1500 ml. The patients tolerated the procedure and recovered satisfactorily.

CONCLUSION

This is the first case series reporting the use of a computer-enhanced surgical robot for performing hysterectomy in humans. It is feasible and well tolerated in this series of patients. As this technology develops, the applications for its use in gynecology and gynecologic oncology will increase.

Laparoscopic hysterectomy using a computer-enhanced surgical robot

OBJECTIVE

The objective of this study was to describe the technique of laparoscopic hysterectomy using a computer-enhanced robotic surgical system.

METHODS

Eleven patients underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy using a computer-enhanced surgical robot. Four trocars were used: one for the camera, two for the robotic arms controlled by the operating surgeon from the surgeon's console, and an additional port for use by the surgical assistant.

RESULTS

Ages ranged from 27 to 77 years, and weight ranged from 54 to 100 kg. Operative time ranged from 4.5 to 10 hours. Estimated blood loss ranged from 50 to 1500 ml. The patients tolerated the procedure and recovered satisfactorily.

CONCLUSION

This is the first case series reporting the use of a computer-enhanced surgical robot for performing hysterectomy in humans. It is feasible and well tolerated in this series of patients. As this technology develops, the applications for its use in gynecology and gynecologic oncology will increase.

Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies

Laparoscopic surgery offers patients distinct benefits but is not without its disadvantages to surgeons in terms of maneuverability and visualization. Robotic telemanipulation systems were introduced with the objective of providing a solution to the problems in this field of surgery. The feasibility of robot-assisted surgery was assessed by performing 35 laparoscopic cholecystectomies with the da Vinci robotic system. Time necessary for system setup and operation was recorded, as were complications, technical problems, postoperative hospital stay, morbidity, and mortality. Thirty-four of 35 cholecystectomy procedures were completed laparoscopically with the da Vinci system. Technical problems occurred in three cases, resulting in one intraoperative complication (a minilaparotomy caused by the loss of an instrument part). Median hospitalization was 2 days. There were no postoperative deaths or morbidity within 30 days after surgery. System setup time decreased as the experience of the operating team increased. Operating times were comparable with those reported for standard laparoscopic cholecystectomy. Robot-assisted surgery was repeatedly proven as a safe and feasible approach to laparoscopic cholecystectomy.