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The Cleveland Clinic and Viking Systems

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Innovative combination of new technologies in reconstructive laparoscopic surgery an evaluation in animal model. In this video, we present a combination of articulated instruments, 3D vision, and a new robotic scope-holder, to perform laparoscopic reconstructive urological surgery. The Radius Surgical System is a two-hand-guided, 10mm instrument developed by Tuebingen Scientific. The tip deflex by the deflexion of a handle and rotates 360 degrees by rotation of knob at the top of handle. The 3D vision is developed by Viking Systems using a stereoscopic camera. The image is displayed on a novel 3D screen, a 3D glasses, or a 3D display headset. The light endoscopic robot is a novel scope holder, developed by Endocontrol Medical, with foot control and voice control system. The light endoscopic robot has a diameter of 110mm, a height of 33cm, and a weight of 1kg. It can perform a rotation of 360 degrees and inclination of 70 degrees and translation of 15cm. The robot is fixed to the OR table by a passive arm and can operate in dorsal and lateral decubitus. Using these three technologies, we'll perform in 10 farm pigs with the mean weight of 71 kg. 10 dismembered pyeloplasties 10 Urethrovesical anastomsis and 10 Partial Nephrectomy. Herein is the demonstration of single surgeon laparoscopic dismembered pyeloplasty through a transperitoneal approach with a robot holding 3D camera and using the articulating needle holders to complete the anastomosis. 4-0 manacle suture was used. 3D visions and articulating needle holder made suturing less challenging. Median OR time was 84 minutes, suturing time was 24 minutes, EBL was minimal. By the end of the learning curve, the suturing time decreased by half. At autopsy, we found 3 tissue lacerations and 3 anastomotic leaks on retrograde pyelography. At the end of learning curve, there were no anastomotic leaks. This technology was also applied for pelvic surgery. Here is a demonstration of retrovesical anastomosis using the articulated 3D system. Note that even in the challenging narrow coursing pelvis the 10mm articulating needle holders proved effective in optimizing suturing angles and minimizing tissue handling. The anastomosis was completed in a running water type fashion. Median suturing time was 32 minutes in order to place 8 sutures, EBL was minimal. By the 10th case, suturing time went 20 minutes. At autopsy, we found 3 anastomotic leaks in initial 3 cases. The anastomosis was tested and proved to be water-tight by retrograde injection in the last 7 cases. In more complex procedures, such as laparoscopic partial nephrectomy, with the hilum clamped, lower pole of the kidney was excised. The collecting system was sutured, duplicating our technique in clinical practice. Note the steady image provided by robotic camera holder and the advantage provided by articulating needle holder. 3D vision provided perception of depth and articulation optimized suturing angle, allowing for precise renorraphy. Median OR time was 105 minutes, median warm ischemia time was 27 minutes, EBS was 40 cc. One renal vein injury occurred during dissection and was suture-repaired. Warm ischemia time decreased by half at the end of the learning curve. At autopsy, we found 3 minimal tissue lacerations. The combination of robotic endoscopic holder, 3D vision, and articulated instruments should perform reconstructive laparoscopic urologic surgery represents an effective alternative to the main advantages of articulation and 3D vision afforded by current robotic surgical system. The addition of instrument tracking to the light endoscopic robot will provide an automated intuitive control and a 3D localized tool for augmented reality. The combination of multiple compact robots with instrument tracking tool and tactile feedback is currently under investigation.

Video Details

Duration: 6 minutes and 52 seconds
Country: South Korea
Language: English
Views: 263
Posted by: hschoimd on Oct 4, 2010

Video for the Cleveland Clinic and Viking systems

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