Direct target NOTES: prospective applications for next generation robotic platforms
Direct target NOTES: prospective applications for next generation robotic platforms
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DOI：
10.1007/s10151-018-1788-z
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发表时间：
2018-05-01
影响因子：
3.3
通讯作者：
Larach, S. W.
中科院分区：
文献类型：
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作者：
Atallah, S.;Hodges, A.;Larach, S. W.
Tic经阴道输卵管卵巢切除术，在体外模型中，(D)经盲肠阑尾切除术。所有病例都证明了使用带有结肠驱动的Flex(A(R))机器人系统的可行性。在TTME期间，平台漂移是17摄氏度外科机器人的新时代已经集中在替代接近解剖目标的途径上，下一代设计包括灵活的单端口系统，它遵循迂回路径而不是直线路径。这种系统占地面积小，可用于基于直接器官靶向自然口腔内内窥镜手术(NOTES)的专门手术，其中经肛门全直肠系膜切除术(TaTME)是一种重要的衍生手术。在两次会议中，使用灵活的机器人系统在身体模型上进行了四次直接靶向NOTES手术，以展示下一代机器人系统应用于特定类型的NOTES手术的概念验证，所有这些手术都需要通过自然开口途径摘除直接靶器官。这四种手术是(A)机器人TTME，(B)机器人经阴道子宫切除术，(C)机器人沿非线性路径行子宫切除术；手术时间为57min，用于经肛门部分的剥离。机器人经阴道子宫切除术在78分钟内成功完成，子宫经阴道摘除，尽管需要腹腔镜辅助。机器人经阴道单侧输卵管切除术联合经阴道摘除卵巢和输卵管，在13.5min内完成。在体外模型中，还成功地进行了机器人经盲肠阑尾切除术，仅用于演示概念验证；手术在24分钟内完成。灵活的机器人系统具有沿着迂回路径访问解剖结构的潜力，使其成为直接靶点笔记的合适平台。一旦技术得到优化，并经过进一步的临床前验证，所提出的概念性操作可以被认为适用于下一代机器人。
tic transvaginal salpingo-oophorectomy, and in an ex vivo model, (d) trans-cecal appendectomy.Feasibility was demonstrated in all cases using the Flex(A (R)) Robotic System with Colorectal Drive. During taTME, the platform excursion was 17 c A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small footprint and could be utilized for specialized operations based on direct organ target natural orifice transluminal endoscopic surgery (NOTES), of which transanal total mesorectal excision (taTME) is an important derivative.During two sessions, four direct target NOTES operations were conducted on a cadaveric model using a flexible robotic system to demonstrate proof-of-concept of the application of a next generation robotic system to specific types of NOTES operations, all of which required removal of a direct target organ through natural orifice access. These four operations were (a) robotic taTME, (b) robotic transvaginal hysterectomy in conjunction with (c) robom along a non-linear path; operative time was 57 min for the transanal portion of the dissection. Robotic transvaginal hysterectomy was successfully completed in 78 min with transvaginal extraction of the uterus, although laparoscopic assistance was required. Robotic transvaginal unilateral salpingo-oophorectomy with transvaginal extraction of the ovary and fallopian tube was performed without laparoscopic assistance in 13.5 min. In an ex vivo model, a robotic trans-cecal appendectomy was also successfully performed for the purpose of demonstrating proof-of-concept only; this was completed in 24 min.A flexible robotic system has the potential to access anatomy along circuitous paths, making it a suitable platform for direct target NOTES. The conceptual operations posed could be considered suitable for next generation robotics once the technology is optimized, and after further preclinical validation.