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首页> 外文期刊>Surgical Endoscopy >Video. Chopstick surgery: a novel technique enables use of the Da Vinci Robot to perform single-incision laparoscopic surgery.
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Video. Chopstick surgery: a novel technique enables use of the Da Vinci Robot to perform single-incision laparoscopic surgery.

机译：视频。筷子手术：一种新颖的技术使达芬奇机器人能够执行单切口腹腔镜手术。

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INTRODUCTION: Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with "wristed" instruments could overcome this limitation but the "arms" collide when working coaxially. This video demonstrates a new technique of "chopstick surgery," which enables use of the robotic arms through a single incision without collision. METHODS: Experiments were conducted utilizing the da Vinci S(R) robot (Sunnyvale, CA) in a porcine model with three laparoscopic ports (12 mm, 2-5 mm) introduced through a single "incision." Pilot work conducted while performing Fundamentals of Laparoscopic Surgery (FLS) tasks determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, an experienced robotic surgeon performed a cholecystectomy and nephrectomy in a porcine model utilizing the "chopstick" technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This arrangement prevents collision of the external robotic arms. To correct for the change in handedness, the robotic console is instructed to drive the "left" instrument with the right hand effector and the right completed with no external collision of the robotic arms, in acceptable times and with no technical complications. This is consistent with results obtained in the box trainer where the chopstick configuration enabled significantly improved times in all tasks and decreased number of errors and eliminated instrument collisions. CONCLUSION: Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.
机译：简介：单切口腹腔镜手术（SILS）受器械同轴布置的限制。具有“腕式”器械的外科手术机器人可以克服此限制，但同轴工作时“臂”会发生碰撞。该视频演示了一种“筷子手术”的新技术，该技术可以通过一个切口使用机器人手臂而不会发生碰撞。方法：在猪模型中，使用da Vinci S（R）机器人（加利福尼亚州桑尼维尔）进行了实验，该猪模型具有通过单个“切口”引入的三个腹腔镜端口（12 mm，2-5 mm）。在执行“腹腔镜手术基本原理”（FLS）任务时进行的试点工作确定了SILS的最佳设置是三角管排列，其套管针距离为2厘米，腹壁中心较远。使用这种设置，经验丰富的机器人外科医生使用“筷子”技术在猪模型中进行了胆囊切除术和肾切除术。筷子排列在腹壁处与器械交叉，因此右器械在目标的左侧，左器械在右侧。这种布置防止了外部机械手的碰撞。为了纠正手性的变化，指示机器人控制台在可接受的时间内并且在没有技术复杂性的情况下驱动右手执行器和右手完成的“左”器械，而不会发生机械臂的外部碰撞。这与盒式训练机中获得的结果一致，在该训练器中，筷子配置可显着缩短所有任务的时间，并减少错误数量并消除仪器碰撞。结论：筷子手术在通过小切口进行手术时可显着增强手术机器人的功能。这项技术将使外科医生能够将机器人用于SILS以及可能的腔内或腔内手术。

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