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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 Hospital, Changhua , Taiwan, R.O.C. 台北秀傳醫院. ( 30 床). ( 500 床). 竹山秀傳醫院. 彰濱秀傳健康園區. ( 700 床). 籌設中. ( 731 床). 秀傳紀念醫院. 台南市立醫院.
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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 Hospital, Changhua, Taiwan, R.O.C
台北秀傳醫院 (30床) (500床) 竹山秀傳醫院 彰濱秀傳健康園區 (700床) 籌設中 (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)
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
Decades of Changes in Surgical Education <1950 Operating room theaters 1960 Experimental surgery and motion picture films 1970 Industry-research laboratories 1980 Endoscopic surgery 1990 Laparoscopy 2000 Robotics Alberto Peracchia, Annals of Surgery Vol.234, No. 6, 709-712, 2001
Space Medicine • ZEUS • da Vinci • Master-slave manipulator • Simplicity • Lightness • Range of freedom • Motion scaling • Real-time high-resolution 3D vision • Physiological tremor elimination
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
Zeus Robotic System • AESOP • HERMIS • SOCRATES • Surgeon Console& Three Roboyic Arms
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
Robotic Surgery in Show Chwan Memorial Hospital BETWEEN MARCH,2002 AND NOVEMBER, 2004
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.
Technique of Endo-ACAB • Endoscopic IMA Harvest • voice-activated robotic-assisted • and a 5mm thoracoscope under • single lung ventilation and CO2 • insufflation
Technique of Endo-ACAB • Atrumatic Thoracotomy
Technique of Endo-ACAB • Direct vision anastomosis
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
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
Aims • Compare the results in patients with CBD stones by Laparoscopic to robotic-assisted CBD exploration
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
Mr. Ker. 43/yrs male C.C. : RUQ pain tea-color urine Lab. : GPT:65 Alk-P:368
(min) Person Robot Set time (min) Person Robot Suture Time
OP TIME & Learning Curve Time Person
ZEUS suture=37.76±24.33min (stitches=3.84) LCBDE suture=24.65±10.82min (stitches=2.05)
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