Technology Insight: surgical robots—expensive toys or the future of urologic surgery?
Technology Insight: surgical robots—expensive toys or the future of urologic surgery?
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技术洞察：手术机器人——昂贵的玩具还是泌尿外科的未来？
DOI：
10.1038/ncpuro0055
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
N. P. Wiklund
中科院分区：
文献类型：
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作者：
N. P. Wiklund;N. P. Wiklund
对微创手术的需求越来越大，尽管对于患者是否从微创手术中受益而不是接受开放手术存在任何争议。在泌尿外科领域，即使对经验丰富的腹腔镜外科医生来说，执行更复杂的手术仍然是一个挑战。近年来，机器人被引入以提高手术性能，增加腹腔镜的适用性和精确度，并改善复杂的微创手术的学习曲线。随着主从式系统的引入，外科医生坐在远离机器人的位置，使用控制器来操纵放置在患者体内的机械臂，机器人辅助手术的新发展已经开始。几位作者建议，类似于达芬奇外科系统®(Intuitive Surgical，Sunnyvale，CA)的手术机器人具有三维(3D)视觉和扭曲的器械，因此比刚性腹腔镜器械提供更大的自由度，将有助于这些更具挑战性的腹腔镜手术的结果。这些特征是否会转化为更好的功能和肿瘤学结果仍有待评估。到目前为止公布的数据清楚地表明，与开腹手术相比，患者将受益于更少的术后疼痛、更少的出血和更短的住院时间，而且外科医生受益于比传统腹腔镜手术更快的学习曲线。为了患者的利益和泌尿外科的发展，我们必须了解远程机器人技术的局限性，以及何时适合将这些新技术应用于日常的泌尿外科手术。
There is an increasing demand for minimally invasive surgery, despite any controversy over whether patients benefit from minimally invasive procedures rather than undergoing open surgery. In the field of urology, the performance of more complicated procedures is still a challenge even for experienced laparoscopic surgeons. Recently, robots have been introduced to enhance operative performance, increase applicability and precision of laparoscopy, and improve the learning curve for complicated minimally invasive procedures. With the introduction of master–slave systems where the surgeon is seated remotely from the robot and uses controls to maneuver the mechanical arms placed inside the patient, a new development in robot-assisted surgery has commenced. Several authors have suggested that surgical robots similar to the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA), which have three-dimensional (3D) vision and wristed instruments thus giving a greater degree of freedom than rigid laparoscopic instruments, will facilitate the outcome of these more challenging laparoscopic procedures. Whether these features will translate into better functional and oncological results remains to be evaluated. Data published so far clearly suggest that the patient will benefit from less postoperative pain, decreased bleeding and a shorter hospital stay compared with open surgery, and that the surgeon benefits from a faster learning curve than for conventional laparoscopy. For the benefit of our patients and for the development of urology it is vital that we understand both the limitations of telerobotics and when it is appropriate to incorporate these new techniques in day-to-day urologic surgery.