Performance Measurements in Endolaparoscopic Infrarenal Aortic Graft Implantation using Computer-enhanced Instrumentation: a Laboratory Model for Training
Performance Measurements in Endolaparoscopic Infrarenal Aortic Graft Implantation using Computer-enhanced Instrumentation: a Laboratory Model for Training
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使用计算机增强仪器进行内腹腔镜肾下主动脉移植物植入的性能测量：用于培训的实验室模型
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发表时间：
2007
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通讯作者：
Jose Mendez
中科院分区：
文献类型：
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作者：
B. Martinez;Catherine S. Wiegand;Jose Mendez
背景：自Dion的工作（1995）以来，已经报道了内镜下主动脉动物实验室模型的性能测量。本文的目的是报告使用计算机增强手术器械在猪模型中的性能测量。方法：自2000年2月至2002年12月，采用机器人器械训练方法，分3组，每组5只动物进行肾下主动脉瓣植入术。完成所有15个手术的时间框架反映了两个主要困难：需要根据外科医生的单独执业时间安排手术，以及实验室场地的可用性来完成手术。采用全腹腔镜技术经腹腔入路进行2例端对端吻合。每组动物采用不同的计算机增强仪器方法：(1)AESOP机械臂和HERMES集成语音控制仪器；(2)AESOP-HERMES- zeus机器人系统；(3)达芬奇机器人系统。记录每次手术的主动脉夹夹时间、总手术时间和出血量。次要终点包括脊髓缺血、移植物血栓形成和出血。结果：所有动物都能耐受手术。所有移植物均通畅，吻合缝完整。发生了两例出血，均经腹腔镜控制。3组主动脉夹持时间较2组明显缩短（P=0.008）。结论：第一组的结果反映了以前使用AESOP-HERMES仪器的经验。然而，宙斯集团和达芬奇集团的时代反映了最初接触这项技术。正如最后一组所示，外科医生在控制台的远程位置似乎并不影响手术的表现。与ZEUS组相比，达芬奇组具有优势。这两种系统在控制不良出血遭遇方面表现出适应性和多功能性。
Background: Performance measurements in an endolaparoscopic aortic animal laboratory model have been reported since Dion's work (1995). The purpose of this paper is to report performance measurements using computer-enhanced surgical instrumentation in a porcine model. Methods: From February 2000 to December 2002, training in robotic instrumentation consisted of implantation of infrarenal aortic grafts in 3 groups of 5 animals each. The time frame to complete all 15 procedures reflects 2 major difficulties: the need to schedule procedures based on the surgeon's time off from his solo practice and the availability of laboratory sites to complete the procedures. A full endolaparoscopic technique was used to perform 2 endto-end anastomoses through an intraperitoneal approach. A different method of computer-enhanced instrumentation was used for each group of animals as follows: (1) AESOP robotic arm and HERMES integrated voice control instrumentation, (2) AESOP-HERMES-ZEUS robotic systems, (3) da Vinci robotic system. The aortic clamp time, total operative time, and blood loss were recorded for each procedure. Secondary endpoints included spinal cord ischemia, graft thrombosis, and bleeding. Results: All animals tolerated the procedure. All grafts were patent and suture anastomoses intact. Two instances of bleeding, both of which were controlled laparoscopically, occurred. Aortic clamping time was significantly improved in Group 3 compared with that in Group 2 (P=0.008). Conclusion: The results of the first group reflect previous experience with the AESOP-HERMES instrumentation. However, the times of the ZEUS group and da Vinci group reflect initial exposure to the technology. The remote position of the surgeon at the console did not appear to affect the performance as shown in the last group. The da Vinci group provides an advantage compared with the ZEUS group. Both systems showed adaptability and versatility in controlling adverse bleeding encounters.