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ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS Hurng-Sheng Wu Department of Surgery, Show-Chwan Memorial.

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Presentation on theme: "ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS Hurng-Sheng Wu Department of Surgery, Show-Chwan Memorial."— Presentation transcript:

1 ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS Hurng-Sheng Wu Department of Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan, R.O.C

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4 Difficulties of laparoscopic surgery Unstable camera platform Loss of degrees of freedom Two-dimentional imaging Poor ergonomics for the surgeon Ballantyne G. H. Surgical laparoscopy, endoscopy Percutaneous techniques Vol. 12, No. 1, pp.1-5, 2002

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7 Decades of Changes in Surgical Education <1950 Operating room theaters 1960 Experimental surgery and motion picture films 1970 Industry-research laboratories 1980 Endoscopic surgery 1990 Laparoscopy 2000 Robotics Alberto Peracchia, Annals of Surgery Vol.234, No. 6, , 2001

8 Space Medicine ZEUS da Vinci Master-slavemanipulator Simplicity Lightness Range of freedom Motion scaling Real-time high-resolution 3D vision Physiological tremor elimination

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10 The key component of the Zeus Surgical System is the microwrist technology. It allows the surgeon to roll, pitch, yaw and grip laparoscopic tools. It also provideds a real benefit for the surgeon with a 3-D view of the operative field. Microwrist

11 What is about space medicine?

12 ROBOT: computer-enhanced humanistic device

13 Zeus Robotic System AESOP HERMIS SOCRATES Surgeon Console& Three Roboyic Arms

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17 LIMITATIONS OF ROBOTIC SURGERY Ports and/or robotic arms placement eg: lithotomy position Cosmetic Depth perception No haptic feed back eg: needle and suture breaks Size Set up

18 Dept.OperationTotal General Surgery Robotic assisted Nissen fundoplication4 Robotic assisted gastric band for obesity3 Robotic assisted laparoscopic cholecystectomy71 Robotic assisted repair of PPU3 Robotic assisted Choledocholithotomy with T-tube28 Robotic assisted laparoscopic appendectomy1 Robotic assisted laparoscopic adrenectomy3 Robotic assisted oophorectomy1 Robotic assisted laparoscopic unroofing of intraabdominal cyst2 Cardiovascular Surgery Total Zeus IMA take down3 Robotic ACAB6 Obstetrics & Gynecology Robotic assisted salpino-oophrectomy2 Robotic Surgery in Show Chwan Memorial Hospital BETWEEN MARCH,2002 AND NOVEMBER, 2004

19 Endo-ACAB Definition : A less invasive bypass procedure on the beating heart where all steps are performed endoscopically with the exception of a manual anastomosis.

20 Technique of Endo-ACAB Endoscopic IMA Harvest voice-activated robotic-assisted and a 5mm thoracoscope under single lung ventilation and CO 2 insufflation

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22 Technique of Endo-ACAB Atrumatic Thoracotomy

23 Technique of Endo-ACAB Direct vision anastomosis

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25 Robotic-Assisted Laparoscopic Surgery in Difficult Common Bile Duct Stone: Preliminary Results in Show Chwan Memorial Hospital Hurng-Sheng Wu Department of Surgery, Show Chwan Memorial Hospital, Changhua. Taiwan

26 Background Common bile duct stones are a frequent problem (10-15%) in patients with symptomatic cholecystolithiasis Laparoscopic techniques have expanded the options for their treatment Difficulty in laparoscopic surgery

27 Aims Compare the results in patients with CBD stones by Laparoscopic to robotic-assisted CBD exploration

28 Patients 919 patients with GB stones and/or CBD stone 772 patients(84%) – LC (including 55 robotic-assisted ) 55 patients(6% )- Open Cholecystectomies 92 patients(10%) with CBD stone IHS excluded 42 patients(45%) – open CBDE 22 patients(24%) – LCBDE 28 patients(31%) – Robotic-assisted Between January 2000 and November 2003

29 Criteria of difficult common bile duct stone LCBDE(n=25)Robotic-Assisted(n=28) Big stone (>1cm)910 multiple stones109 Impacted CBD stone24 ERC failed45 s/p Billroth II resection s/p Billroth II resection1 duodenal diverticulum duodenal diverticulum22 uncooperative behavior uncooperative behavior1 Intolerance Intolerance21 Total2528

30 Mr. Ker. 43/yrs male C.C. :RUQ pain tea-color urine Lab. : GPT:65 Alk-P:368

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32 Results(1) VariablesLCBDERobotic-Assisted P value No. of patients2228 No.(%) of conversion 3 (12%) 3(10%)NP Mean age( years old) 58 (range 23~83) 59 (range 41-84) NP Sex= M : F8:1411:14NP Total Bilirubin level 2 (mg/dl) ~ 10 (mg/dl)918 Mean caliber of CBD (cm) 1.43 (range 0.8~2.2) 1.6 (range 1.2~2.5) NP No.(%) of complication 2 (9%) 2 (8%) NP No.(%) of retained stone 2 (9%) 2 (8%) NP No.of recurrent stone10NP Follow-up( months )3~391-20

33 Result (2 ) LCBDERobotic-AssistedP CBD diameter (cm) 1.45±0.36 (1-7.2) 1.6±0.3 ( ) NP Suture stitches2.05±0.56(1-3)3.84±0.90(3-6)<0.001 Time to liquid (days) 2.55±0.78 (2-5) 2.32±0.97 (1-4) NP Postoperative hospital stay (days) 6.8±3.1 (5-14) 6.6±0.36 (4-11) NP

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35 Result (3) LCBDERobotic-Assisted Mortality00 Conversion to open30 Conversion to LCBDE3 Complications: Acute hepatitis 01 Wound infection 11 Bile leakage 20 Retained stone(s) Retained stone(s)22 T-tube Dislodge T-tube Dislodge10

36 Robot Set time Robot Suture Time Person (min)

37 OP TIME & Learning Curve Time Person

38 ZEUS suture=37.76±24.33min (stitches=3.84) LCBDE suture=24.65±10.82min (stitches=2.05)

39 THE FUTURE OF ROBOTIC SURGERY

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41 Founding Members: CIMIT Center for Integration of Medicine and Innovative Technology CIMIT facility in Cambridge, Massachusetts

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