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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

2 彰濱秀傳健康園區 秀傳紀念醫院 (700床) (731床) (全國第一家公辦民營) (公辦民營) (500床) 籌設中 台北秀傳醫院
(30床) 竹山秀傳醫院 (500床) 彰濱秀傳健康園區 籌設中 (700床) (731床) 秀傳紀念醫院 台南市立醫院 (全國第一家公辦民營) 高雄縣立岡山醫院 (公辦民營)

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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
< Operating room theaters Experimental surgery and motion picture films Industry-research laboratories Endoscopic surgery Laparoscopy Robotics Alberto Peracchia, Annals of Surgery Vol.234, No. 6, , 2001

8 Space Medicine ZEUS da Vinci Master-slave manipulator 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 Robotic Surgery in Show Chwan Memorial Hospital
BETWEEN MARCH,2002 AND NOVEMBER, 2004 Dept. Operation Total General Surgery Robotic assisted Nissen fundoplication 4 Robotic assisted gastric band for obesity 3 Robotic assisted laparoscopic cholecystectomy 71 Robotic assisted repair of PPU Robotic assisted Choledocholithotomy with T-tube 28 Robotic assisted laparoscopic appendectomy 1 Robotic assisted laparoscopic adrenectomy Robotic assisted oophorectomy Robotic assisted laparoscopic unroofing of intraabdominal cyst 2 Cardiovascular Surgery Total Zeus IMA take down Robotic ACAB 6 Obstetrics & Gynecology Robotic assisted salpino-oophrectomy

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 CO2 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 Show Chwan Memorial Hospital, Changhua. Taiwan
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 Between January 2000 and November 2003
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

29 Criteria of difficult common bile duct stone
LCBDE (n=25) Robotic-Assisted (n=28) Big stone (>1cm) 9 10 multiple stones Impacted CBD stone 2 4 ERC failed 5 s/p Billroth II resection 1 duodenal diverticulum uncooperative behavior Intolerance Total 25 28

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) Variables LCBDE Robotic-Assisted P value 0.031 22 28
No. of patients 22 28 No.(%) of conversion 3 (12%) 3(10%) NP Mean age( years old) 58 (range 23~83) 59 (range 41-84) Sex= M : F 8:14 11:14 Total Bilirubin level ≦ 2 (mg/dl) 13 7 0.031 2 ~ 10 (mg/dl) 9 18 Mean caliber of CBD (cm) 1.43 (range 0.8~2.2) 1.6 (range 1.2~2.5) No.(%) of complication 2 (9%) 2 (8%) No.(%) of retained stone No.of recurrent stone 1 Follow-up( months ) 3~39 1-20

33 Result (2 ) CBD diameter (cm) Suture stitches Time to liquid (days)
LCBDE Robotic-Assisted P CBD diameter (cm) 1.45±0.36 (1-7.2) 1.6±0.3 ( ) NP Suture stitches 2.05±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) Postoperative hospital stay (days) 6.8±3.1 (5-14) 6.6±0.36 (4-11)

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35 Result (3) Mortality Conversion to open Conversion to LCBDE
Robotic-Assisted Mortality Conversion to open 3 Conversion to LCBDE Complications: Acute hepatitis 1 Wound infection Bile leakage 2 Retained stone(s) T-tube Dislodge

36 (min) Person Robot Set time (min) Person Robot Suture Time

37 OP TIME & Learning Curve
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 CIMIT Center for Integration of Medicine and Innovative Technology
Founding Members: CIMIT facility in Cambridge, Massachusetts

42 Thank You


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