Major digestive surgery using a remote-controlled robot: the next revolution.

摘要

HYPOTHESIS: A remote-controlled robot can be used to perform computer-enhanced major digestive laparoscopic surgery. DESIGN: Cases series for assessment of the feasibility and safety of this technology in major digestive surgery. SETTING: Tertiary care referral center. PATIENTS: Between September 5, 2001, and December 20, 2001, 5 patients (4 men and 1 woman; mean +/- SD age, 66 +/- 5 years) underwent laparoscopic sigmoidectomy, proctectomy, restoration of continuity after Hartmann operation, Whipple procedure, and right liver lobectomy. In each of the procedures, a remote-controlled robot was used to perform some stages of the surgery. During these stages, the surgeon was seated at a distance from the operating table and performed the surgery using the robot, which offers enhanced intracorporeal tool manipulation and spatial vision. RESULTS: Sigmoidectomy was the only procedure that was completely performed with the robot. For the other procedures, the mean +/- SD duration of robot use was 25% +/- 10% of the operative time. Stages of colorectal surgery, retroportal dissection, 2 anastomoses during a Whipple procedure, hepatic pedicle dissection, and initial hepatotomy were performed using the robot. This technology facilitates laparoscopic anastomoses. The principal drawbacks were the time required for robot mobilization, absence of grip strength feedback, limited availability of adapted surgical tools, and the cost of the system. There was no mortality. Two of the 5 patients experienced complications, a postoperative ileus and unexplained sepsis after the Whipple procedure, both of which were treated medically. CONCLUSIONS: For these procedures, laparoscopic computer-enhanced surgery seems safe and feasible. This introduction of computing to major digestive surgery opens the door to enhanced-reality surgery and new types of surgical education.