The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not.

lgli/_325389.1bed97e2613ec3c75f4abbd2d70737db.pdf

lgrsnf/_325389.1bed97e2613ec3c75f4abbd2d70737db.pdf

zlib/Medicine/Edited by: Vanja Bozovic/Medical Robotics_1048340.pdf

Nerve Sparing Axillary Dissection Using the da Vinci Surgical System

Motion Tracking for Minimally Invasive Robotic Surgery

Susan M L Lim; Cheng-Kiong Kum; Foong-Lian Lam

Stephan Jacobs; Volkmar Falk

Martin Groeger

E. Olthof

I-Tech Herrn Dr. Vedran Kordic

Austria, Austria

до 2011-08

lg609052

{"isbns":["3902613181","9783902613189"],"last_page":536}

Improved surgical techniques in breast cancer surgery have evolved over the years, which include skin and areolar-sparing mastectomy, segmental mastectomy, oncoplastic breast procedures, and reconstructive options. (Simmons et al., 2003; Gerber et al., 2003) This increased use of breast-conserving therapy for treatment of breast cancer has nearly eliminated the major morbidity of loss of the breast. The present focus of postoperative morbidity has shifted to the axillary dissection, a procedure which for many women has become the major cause of longterm morbidity after local therapy for breast cancer. (Harris et al., 1999) In the surgical approach to the axilla however, apart from the sentinel node biopsy, there have been few innovations in techniques to spare the common complications of an axillary dissection, which range from seroma or hematoma formation to injury to the nerves that course through the axilla. Injury to the long thoracic nerve may result in a winged scapula or palsy of the serratus anterior muscle and occurs in approximately 10% of cases, (Bennion & Love, 1997) while injury to the thoracodorsal nerve will lead to weakness of the latissimus dorsi muscle. Injury to the intercostobrachial nerve may cause permanent numbness in the lateral axilla and medial portion of the upper arm. These injuries, while distressing to patients, are probably underestimated, as they are not life-threatening and do not require hospitalization. (Ivens et al., 1992) In this report, we have shown that axillary lymph node dissection with the da Vinci Surgical System is a precise, gentle, and safe alternative to lymphadenectomy performed via a standard axillary incision. The authors embarked on this technique after finding that the robotic approach yielded better precision and visualisation that could result in less morbidity following axillary dissection. This ergonomic master-slave system offered three-dimensional visualization, wristed instrumentation, intuitive finger-controlled movements and a comfortable seated position for the surgeon. While the increase in operating time reflects the initial small learning curve, the advantages of dissection using telemanipulators were striking to the surgeon and appeared to

The DaVinci Telemanipulation system has been introduced to provide the human operator with dexterity in confined space. After successfully beginning with IMA-takedown and achieving some TECAB cases on pump, the technique was underestimated by surgeons. The lack of rapid improvement and the time consuming procedure led to frustration and many centers did not proceed. Minimally invasive cardiac surgery is challenging and it takes a lot of experience to get used to the system to complete a TECAB procedure. With a step by step program and the sensibility to overcome some limitations, forcing developments of new technology, the computer enhanced surgery can be successfully performed. With refinements in telemanipulator technology and the development of adjunct devices to enhance exposure the technique of computer enhanced endoscopic cardiac surgery will further evolve and may prove beneficial for selected patients

Motion tracking in minimally invasive surgery is a fundamental issue to adapt medical robotic systems to the changing environment of the operating field. The two example scenarios show that the intelligent and adaptive robotic systems can contribute considerably to make surgery more gentle to the patient by reducing traum and to assist the surgeon with the increased demands and difficulaties of minimally invasive surgery, in which direct contact is lost to the operating field. Automated laparoscope guidance fulfills the assistant surgeon's task of camera guidance in a reliable and non-exhausting manner, and represents an important step towards minimally

2011-08-31