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In-Depth Information
addition, robotic endoscopic mitral valve repair was successful in 14 of 17 patients. By
contrast, several groups in Europe have successfully performed closed-chest, off-pump
coronary artery bypass grafting using an endoscopic stabilizer. Kappert
et al
. [38] per-
formed 37 off-pump totally endoscopic coronary artery bypasses (TECABs) on a beating
heart using the da Vinci
system and an endoscopic stabilizer. In this series, they reported
a 3.4% rate of conversion to median sternotomy. They concluded that their results pro-
mote optimism about further development of TECAB. Another study by Boehm
et al
.
[39] using a similar stabilizer to the ZEUS
™
system had similar results and conclusions
about TECAB. Interestingly, a study by Cisowski and Drzewiecki in Poland [40] com-
pared percutaneous stenting with endoscopic coronary artery bypass grafting in patients
with single-vessel disease. In this series of 100 patients, percutaneous stenting resulted in
restenosis in 6 and 12% at 1 and 6 months, respectively, compared with 2% at 6 months
in the endoscopic bypass group.
Another use for robotic systems that is being investigated is pediatric laparoscopic
surgery. Currently, this type of surgery is limited by an inability to perform precise
anastomoses of 2 - 15 mm [41]. Although laparoscopic techniques may be used to treat
infants with intestinal atresia, choledochal cysts, biliary atresia, and esophageal atresia, it
is not the standard approach because of technical difficulties. To evaluate the feasibility of
robotic systems in pediatric minimally invasive surgery, Hollands and Dixey [42] devel-
oped a study where enteroenterostomy, hepaticojejunostomy, and portoentorostomy were
performed on piglets. They found all the procedures to be technically feasible with the
ZEUS™ robotic system. The study concludes that robot-assisted laparoscopic techniques
are technically feasible in pediatric surgery and may be of benefit in treating various disor-
ders in term and preterm infants. More recently, Hollands and Dixey [43] devised a study
using 10 piglets to develop the procedure and evaluate the feasibility of performing a
robot-assisted esophagostomy. In this study, robot-assisted and thoracoscopic approaches
were evaluated and compared for leak, narrowing, caliber, mucosal approximation, as
well as anesthesia, operative, anastomotic, and robotic set-up times and found that, in all,
the robotic-assisted approach is feasible. They also discerned no statistically significant
difference between the two approaches based on the above variables. Notwithstanding the
feasibility of robotic surgical systems, further high-quality clinical trials still need to be
performed before their full potential can be realized.
™
9.4.1 Practical Applications of Robotic Surgery Today
In today's competitive healthcare market, many organizations are interested in making
themselves 'cutting-edge' institutions with the most advanced technological equipment
and the very newest treatment and testing modalities and, by so doing, allow themselves
to capture more of the healthcare market. Acquiring a surgical robot is, essentially, the
entry fee into marketing an institution's surgical specialties as 'the most advanced.' It is
not uncommon, for example, to see a photograph of a surgical robot on the cover of a
hospital's marketing brochure and yet see nothing within it that mentions robotic surgery.
Although surgical robotics is still in its embryonic stage there is, nonetheless, the full
expectation that rapid and strident technological advances will secure its place in the
appliances of tomorrow. Already, the development of robotics is spurring interest in new
