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机器人手术的进展:达芬奇手术系统


Robotic surgery has allowed surgeons to perform complex procedures with improved precision,flexibility and control.机器人手术的出现始于1985年,当时Puma 560,由Victor Scheinman在Unimation开发,是用于神经外科活检.这种手术方法用于提高精度as it eliminated the hand tremors of surgeons which could cause error during needle placement.Subsequently,1988,Puma 560首次用于经尿道前列腺切除术,a more complex procedure.手术切除和神经外科活检的成功引起了机器人辅助手术需求的增加,并导致了综合外科用品有限公司机器人外科系统的发展。机器人成为第一个获得FDA批准的外科机器人。

随着机器人技术的兴起,the美国Army provided funding to devise a system可以远程操作,希望这项新技术能减少需要手术的伤员的运输时间,从而降低战时死亡率。设计的系统在动物模型上进行了测试,但从未在战场上使用过。重新设计后,this system was reintroduced as the da Vinci Surgical System by Intuitive Surgical Systems.This minimally invasive robotic surgical system was approved by the FDA in 2000 and is currently theonly robotic surgical system usedin the U.S.

达芬奇系统有三个基本组成部分:

  1. 一个装有双光源和双3芯片相机的视觉推车。
  2. 手术医生坐的主控制台。
  3. 可移动的推车,其中三个仪器臂和摄像机臂安装在S和SI系统中。

The vision cart is the brain of the da Vinci as it acts as the central computer.视觉推车中包含的每个视频芯片都是为一只眼睛指定的,允许3D图像。摄像机可以放在任何一个臂上,包括白色和U.V。光源。联合国light allows surgeons to see indocyanine green,可用于靶向癌细胞,particularly small tumors.

主控制台包含图像处理计算机,该计算机生成具有景深的三维图像。这个三维图像显示在外科医生的手上,providing an illusion that the instruments are extensions of the control grips.它还包含外科医生查看图像的视图端口,the foot pedals which control electrocautery,相机焦距,仪器/摄像机臂离合器和主控制手柄驱动患者侧的辅助机械臂。The instruments provide seven degrees of freedom which allows for endowrist manipulation providing full rotation like that of a human hand.主控台的前额有一个运动传感器,如果外科医生的头部不在适当的位置,该传感器允许系统自动关闭机器人手臂的运动。

达芬奇系统提供了许多优势,甚至超过腹腔镜手术工具提供的优势。这种机器人手术系统的使用提高了视觉效果,提高了灵活性。这样就可以接触到以前由于人类手臂的限制而无法接触到的身体远程部分。此外,the system reduces the surgeon's operating time spent on reaching difficult areas of the body,从而减少外科医生的疲劳。此外,the robotic arms circumvent any blood loss caused by tremors from the surgeon's hands.手术系统还减少了疼痛和术后并发症,因为套管针的位置只有8毫米,可以用胶水封闭。不需要缝合。达芬奇还减少了手术团队,因为只有三个人——外科医生,scrub tech assist,和住院医生-需要操作它。

The da Vinci system is currently being used for several laparoscopic surgeries.此外,the vast majority of prostate cancer surgeries in the United States are done with the aid of the da Vinci system.One study by Cadièreet al.结果表明,该系统在非常小的空间内的腹部显微手术和操作中最有用。In addition to this,许多研究表明机器人手术对妇科手术是安全的。

机器人手术改变了微创心脏手术。The most noteworthy application of the da Vinci system is endoscopic coronary grafting.This procedure was previously not achievable through laparoscopic means.A study by Kappertet al.结果显示,在19例患者中,17例成功地构建了左胸内动脉(LITA)到左前降支(LAD)的吻合,内镜冠状动脉搭桥手术具有良好的短期效果。此外,研究表明,在17例患者中,14例成功地进行了机械式二尖瓣修复,机器人内窥镜二尖瓣修复是可行的。Another extensive application of the robotic surgical system is in小儿腹腔镜手术.Pediatric laparoscopic surgery is limited by the fact that anastomoses cannot be done to a precision of 2 to 15 mm by standard laparoscopic tools.However,这可以通过使用达芬奇系统来实现。

尽管有很多优点,达芬奇系统也在摆姿势some limitations.机器人手术是一项很新的发明,其全部后果还没有被认识到。达芬奇系统的主要缺点就是机器的成本。The da Vinci system costs up to $2 million,这大大降低了它的可用性和使用。此外,the machine itself is extremely large.This makes it cumbersome to have in surgical rooms that are filled to the brim with a surgical team and other equipment.Additionally,most surgeons do not have the training and experience necessary to fully utilize a system that requires a unique and specific skill set.

除了成本和培训,还有技术限制,such as latency and the ability to change course during surgery.Latency refers to the time lapse between the moments when the physician moves the controls and when the robot responds.Also,there is still a chance for human error if the physician incorrectly programs the robot prior to surgery.计算机程序不能在手术过程中改变路线,whereas a human surgeon can make needed adjustments.There are also potential cybersecurity risks such as hacking and malware.

需要采用并不断更新治疗方案以减少错误,这对于改善患者护理至关重要。尽管机器人手术系统已经非常有益,它仍然可以通过解决上述限制并通过扩展兼容仪器的列表来添加完整的感官输入而得到很大的改进。These changes could help make the da Vinci a truly complete,外科手术的综合和基本支柱。

新提阿普里亚山卡 Nithyapriya Shankar (1 Posts)

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