Biomedical Engineering Reference
In-Depth Information
39 anti-reflux procedures, 48 cholecystectomies, 28 tubal reanastomoses, 10 gastroplas-
ties for obesity, 3 inguinal hernia repairs, 3 intrarectal procedures, 2 hysterectomies, 2
cardiac procedures, 2 prostatectomies, 2 artiovenous fistulas, 1 lumbar sympathectomy, 1
appendectomy, 1 laryngeal exploration, 1 varicocele ligation, 1 endometriosis cure, and 1
neosalpingostomy. This study found robotic laparoscopic surgery not only to be feasible,
but also found the robot to be most useful in intra-abdominal micro-surgery or for manip-
ulations in very small spaces, and reported no robot-related morbidity. Another study by
Falcone
et al
. [32] tested the feasibility of robot-assisted laparoscopic micro-surgical tubal
anastomosis. In this study, 10 patients who had previously undergone tubal sterilization
underwent tubal reanastomosis. They found that the 19 tubes were reanastomosed suc-
cessfully, of which 17 were still patent six weeks postoperatively. There have been five
pregnancies in this group so far. Margossian and Falcone [33] also studied the feasibility
of robotic surgery in complex gynecologic surgeries in pigs. In this study, 10 pigs under-
went adnexal surgery or hysterectomy using the ZEUS™ robotic system. They found that
robotic surgery is safe and feasible for complex gynecological surgeries. In yet another
study by Marescaux
et al
. [34], the safety and feasibility of telerobotic laparoscopic chole-
cystectomy was tested in a prospective study of 25 patients undergoing the procedure,
of which 24 were performed successfully, and one was converted to a traditional laparo-
scopic procedure. This study concluded that robotic laparoscopic cholecystectomy is safe
and feasible. Another study, by Abbou
et al
. [35], found telerobotic laparoscopic radical
prostatectomy to be feasible and safe, with dramatically enhanced dexterity.
One of the areas where robotic surgery is transforming medicine the most, and one
of the areas generating the most excitement, is in minimally invasive cardiac surgery.
Several groups have developed robotic procedures that expand laparoscopic techniques
into this previously unexplored territory, with encouraging results. Prasad
et al
. success-
fully constructed left internal thoracic artery (LITA) to left anterior descending (LAD)
artery anastomoses on 17 of 19 patients with the use of a robotic system [32]. They
concluded that robotically assisted endoscopic coronary bypass surgery showed favor-
able short-term outcomes with no adverse events and found robotic assistance to be an
enabling technology that allows surgeons to perform endoscopic coronary anastomoses.
Damiano
et al
. [36] conducted a multi-center clinical trial of robotically assisted coronary
artery bypass grafting. In this study 32 patients scheduled for primary coronary surgery
underwent endoscopic anastomosis of the LITA to LAD. A two-month follow-up revealed
a graft patency of 93%, after which it was concluded that robot-assisted coronary bypass
grafting is feasible. In another study, Mohr
et al
. [37] used the da Vinci™ system to
perform coronary artery bypass grafting on 131 patients and mitral valve repair on 17
patients. They used the robot to perform LITA take down, LITA-LAD anastomosis in
standard sternotomy bypass, and total endoscopic coronary artery bypass grafting LITA-
LAD anastomosis on the arrested heart and the beating heart. They found that robotic
systems could be used safely with selected patients to perform endoscopic cardiac surgery.
Internal thoracic artery takedown is an effective modality, and total endoscopic bypass on
an arrested heart is feasible, but does not offer a major benefit to the minimally invasive
direct approach, because cardiopulmonary bypass is still required. Their study suggests
that robotic systems have not yet advanced far enough to perform endoscopic closed-chest
beating-heart bypass grafting, despite some technical success in two of eight patients. In
