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The fourth-generation da Vinci robot-assisted minimally invasive laparoscopy helps doctors complete difficult and complex operations


 

Date:[2023/12/6]
 

The robotic surgical system is a comprehensive system that integrates multiple modern high-tech methods, with a wide range of applications and extensive clinical applications in surgery. Surgeons can operate machines far from the operating table for surgery, which is completely different from traditional surgical concepts and is undoubtedly a revolutionary surgical tool in the field of minimally invasive surgery worldwide.
The use of robots for surgical procedures has become increasingly popular. When using robots for surgery, doctors do not touch patients with their hands. Once the incision position is determined, the robotic arm equipped with a camera and other surgical tools will perform actions such as cutting, hemostasis, and suturing. Surgeons only need to sit on the usually operating room console to observe and guide the work of the robotic arm.
Recently, the Third People's Hospital of Shenzhen successfully completed a highly difficult and complex pancreaticoduodenectomy surgery for a patient using the latest introduced fourth generation da Vinci robot. The patient had only 5 8mm small incisions at the wound site. The da Vinci robot is an advanced laparoscopic system that can achieve naked eye 3D effects. Not only can it complete the vast majority of surgeries in liver and gallbladder surgery, but it can also be applied to surgeries in departments such as urology, obstetrics and gynecology, cardiology, and gastrointestinal surgery, covering almost all surgical procedures.
Laparoscopy, similar to electronic gastroscopy, is a medical device with a miniature camera. Laparoscopic surgery is a surgical procedure performed using laparoscopy and its related instruments. Laparoscopy consists of five basic components: laparoscopic video surveillance system, CO2 pneumoperitoneum system, electric cutting system, flushing suction system, surgical instruments, etc. The laparoscopic video surveillance system consists of a laparoscope, a light source and optical path, a miniature camera, a camera converter, a monitor (TV), an automatic cold light source, and a video recorder. The CO2 pneumoperitoneum system consists of a spring pneumoperitoneum needle, an inflation catheter, an pneumoperitoneum machine, and a CO2 steel cylinder.
The flushing absorption system mainly includes two parts: 1) Flushing: its function is to observe and protect tissues, prevent adhesions, stop bleeding, repair tissues, etc. 2) Attraction: Using the catheter effect for attraction, sometimes even using a filter. The surgical instrument system consists of basic instruments for cholecystectomy: 2 10mm trocars, 2 5mm trocars, 1 10mm instrument converter, 2 non-invasive grasping forceps, 1 curved dissecting forceps, pneumoperitoneum needles, scissors, titanium clamps, flushing suction tubes, electrocoagulation separation shovels, and separation hooks. Special instruments include contrast tubes for cholangiography, needle holding forceps, interlocking needles, snares for ligation, and retrieval nets.
Da Vinci robots and their systems
It is an advanced robot platform designed to perform complex surgical procedures using minimally invasive methods. The da Vinci robot consists of three parts: a surgeon's console, a bedside robotic arm system, and an imaging system. The da Vinci robot is an advanced laparoscopic system. The flexible "inner wrist" can eliminate the tremor of the doctor's hand, and the unique three-dimensional imaging system can enlarge the surgical field of view by 15 times during surgery, increasing the field of view angle; Reduce hand tremors; The robot's "inner wrist" is more flexible than laparoscopy and can operate around target organs from different angles. It is smaller than human hands and can work in limited and narrow spaces; Enable the surgeon to work in a relaxed work environment, reduce fatigue, and concentrate more; Reduce the number of participants in surgery. Greatly improves the accuracy and stability of surgery. Smaller trauma leads to wider indications for minimally invasive surgery; Reduce postoperative pain; Shorten hospitalization time; Reduce blood loss; Reduce intraoperative tissue trauma and postoperative adhesions caused by inflammatory reactions. Minimally invasive treatment methods such as thoracoscopy, laparoscopy, gynecological laparoscopy, etc.
Components and operating methods
The da Vinci robot consists of three parts: a surgeon's console, a bedside robotic arm system, and an imaging system. It mainly consists of a control console and an operating arm. The control console consists of a computer system, a surgical operation monitor, a robot control monitor, an operating handle, and input/output devices. During surgery, the surgeon can sit in front of the control panel far from the operating table, with their head resting on the field of view frame, and their eyes receiving complete images from different cameras to jointly synthesize a three-dimensional view of the surgical field. The doctor controls the operating lever with both hands, transmitting hand movements to the tip of the robotic arm to complete surgical operations, thereby increasing the accuracy and stability of the operation. This is a newly proposed master-slave remote operation mode.
1. Surgeon Console
The chief surgeon sits in the control console, outside the sterile area of the operating room, using both hands (by operating the two main controllers) and feet (by using a foot pedal) to control the instruments and a 3D high-definition endoscope. As seen in the stereoscopic eyepiece, the surgical instrument tip moves synchronously with the surgeon's hands.
2. Bedside robotic arm system
The bedside robotic arm system is the operating component of surgical robots, whose main function is to provide support for instrument arms and camera arms. The assistant doctor works at the bedside robotic arm system in the sterile area, responsible for replacing instruments and endoscopes, and assisting the chief surgeon in completing the surgery. To ensure patient safety, assistant doctors have higher priority control over the movement of the bedside robotic arm system than the chief surgeon.
3. Imaging system
The imaging system is equipped with the core processor and image processing equipment of surgical robots, which are located outside the sterile area during the surgical process. They can be operated by itinerant nurses and can accommodate various auxiliary surgical equipment. The endoscope of the surgical robot is a high-resolution three-dimensional (3D) lens, which has a magnification of more than 10 times for the surgical field of view. It can bring high-definition three-dimensional images of the patient's body cavity to the surgeon, enabling them to better grasp the operating distance and identify anatomical structures compared to ordinary laparoscopic surgery, improving surgical accuracy.