Transcript 副甲腺放射導引微創手術：術中伽瑪探頭偵測的必要性

ROBOT-ASSISTED LAPAROSCOPIC
SURGERY WITH ZEUS SYSTEM
: PRELIMINARY RESULTS AND TECHNICAL
ASPECTS
Hurng-Sheng Wu
Department of Surgery, Show-Chwan
Memorial Hospital, Changhua, Taiwan,
R.O.C
台北秀傳醫
院
（30床）
竹山秀傳醫院
（500床）
彰濱秀傳健康園區籌設中
（700床）
（731床）
秀傳紀念醫院
台南市立醫院
（全國第一家公辦民營）
高雄縣立岡山醫院
（公辦民營）
Difficulties 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 techniques
Vol. 12, No. 1, pp.1-5, 2002
Decades of Changes in Surgical
Education
<1950
1960
1970
1980
1990
2000
Operating room theaters
Experimental surgery and motion picture films
Industry-research laboratories
Endoscopic surgery
Laparoscopy
Robotics
Alberto Peracchia,
Annals of Surgery
Vol.234, No. 6, 709-712, 2001
Space Medicine
ZEUS
da Vinci
Master-slave manipulator
Simplicity
Lightness
Range of freedom
Motion scaling
Real-time high-resolution 3D vision
Physiological 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?
ROBOT: computer-enhanced
humanistic device
Zeus Robotic System
AESOP
HERMIS
SOCRATES
Surgeon Console& Three Roboyic Arms
LIMITATIONS OF ROBOTIC SURGERY
Ports and/or robotic arms placement
eg: lithotomy position
Cosmetic
Depth perception
No haptic feed back
eg: needle and suture breaks
Size
Set up
Robotic Surgery in Show Chwan Memorial Hospital
BETWEEN MARCH,2002 AND NOVEMBER, 2004
Dept.
General Surgery
Cardiovascular
Surgery
Obstetrics &
Gynecology
Operation
Total
Robotic assisted Nissen fundoplication
4
Robotic assisted gastric band for obesity
Robotic assisted laparoscopic cholecystectomy
Robotic assisted repair of PPU
Robotic assisted Choledocholithotomy with T-tube
Robotic assisted laparoscopic appendectomy
Robotic assisted laparoscopic adrenectomy
Robotic assisted oophorectomy
3
71
3
28
1
3
1
Robotic assisted laparoscopic unroofing of
intraabdominal cyst
Total Zeus IMA take down
2
Robotic ACAB
6
Robotic assisted salpino-oophrectomy
2
3
Endo-ACAB
Definition :
A less invasive bypass
procedure on the
beating heart where all
steps are performed
endoscopically with
the exception of a
manual anastomosis.
Technique of Endo-ACAB
Endoscopic IMA Harvest
voice-activated robotic-assisted
and a 5mm thoracoscope under
single lung ventilation and CO2
insufflation
Technique of Endo-ACAB
Atrumatic Thoracotomy
Technique of Endo-ACAB
Direct vision anastomosis
Robotic-Assisted Laparoscopic Surgery in Difficult
Common Bile Duct Stone: Preliminary Results in
Show Chwan Memorial Hospital
Hurng-Sheng Wu
Department of Surgery,
Show Chwan Memorial Hospital, Changhua.
Taiwan
Background
Common bile duct stones are a frequent problem
(10-15%) in patients with symptomatic
cholecystolithiasis
Laparoscopic techniques have expanded the options
for their treatment
Difficulty in laparoscopic surgery
Aims
Compare the results in patients with CBD
stones by Laparoscopic to robotic-assisted
CBD exploration
Patients
Between January 2000 and November 2003
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
Criteria of difficult common bile duct
stone
LCBDE
Robotic-Assisted
(n=25)
(n=28)
Big stone (>1cm)
9
10
multiple stones
Impacted CBD stone
10
2
4
9
4
5
2
1
2
1
2
1
25
28
ERC failed
s/p Billroth II resection
duodenal diverticulum
uncooperative behavior
Intolerance
Total
Mr. Ker. 43/yrs male
C.C. : RUQ pain
tea-color urine
Lab. : GPT:65
Alk-P:368
Results(1)
Variables
LCBDE
Robotic-Assisted
P value
No. of patients
22
28
No.(%) of conversion
3 (12%)
3(10%)
NP
Mean age( years old)
58 (range 23~83)
59 (range 41-84)
NP
Sex= M : F
8:14
11:14
NP
≦ 2 (mg/dl)
13
7
0.031
2 ~ 10 (mg/dl)
9
18
Total Bilirubin level
Mean caliber of CBD (cm) 1.43 (range 0.8~2.2)
1.6 (range 1.2~2.5)
NP
No.(%) of complication
2 (9%)
2 (8%)
NP
No.(%) of retained stone
2 (9%)
2 (8%)
NP
No.of recurrent stone
1
0
NP
Follow-up( months )
3~39
1-20
Result (2 )
LCBDE
Robotic-Assisted
P
NP
CBD diameter (cm)
1.45±0.36 (1-7.2) 1.6±0.3 (1.2-2.5)
Suture stitches
2.05±0.56(1-3)
3.84±0.90(3-6)
<0.001
Time to liquid (days) 2.55±0.78 (2-5)
2.32±0.97 (1-4)
NP
6.6±0.36 (4-11)
NP
Postoperative
hospital stay (days)
6.8±3.1 (5-14)
Result (3)
Mortality
Conversion to open
LCBDE
Robotic-Assisted
0
0
3
0
3
Conversion to LCBDE
Complications:
Acute hepatitis
0
1
Wound infection
1
1
Bile leakage
2
0
Retained stone(s)
T-tube Dislodge
2
1
2
0
80
70
60
50
40
30
20
10
0
(min)
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
Person
Robot Set time
120
100
80
60
40
20
0
(min) 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
Person
Robot Suture Time
OP TIME & Learning Curve
450
400
350
300
250
LCDL
200
Robotic-Assisted
150
100
50
0
Time
1
3
5
7
9
11
13
15
17
19
21
23
25 Person
120
100
ZEUS suture=37.76±24.33min (stitches=3.84)
LCBDE suture=24.65±10.82min (stitches=2.05)
80
60
40
20
0
1
3
5
7
9
11
13
15
17
19
21
23
25
LCBDE縫合
Time
Robot縫合
Time
THE FUTURE OF ROBOTIC
SURGERY
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