ROBOT-ASSISTED LAPAROSCOPIC SURGERY WITH ZEUS SYSTEM : PRELIMINARY RESULTS AND TECHNICAL ASPECTS

1. 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

2. 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）

4. 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

7. 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

8. Space Medicine • ZEUS • da Vinci • Master-slave manipulator • Simplicity • Lightness • Range of freedom • Motion scaling • Real-time high-resolution 3D vision • Physiological tremor elimination

10. 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

11. What is about space medicine?

12. ROBOT: computer-enhanced humanistic device

13. Zeus Robotic System • AESOP • HERMIS • SOCRATES • Surgeon Console& Three Roboyic Arms

17. 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

18. Robotic Surgery in Show Chwan Memorial Hospital BETWEEN MARCH,2002 AND NOVEMBER, 2004

19. 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.

20. Technique of Endo-ACAB • Endoscopic IMA Harvest • voice-activated robotic-assisted • and a 5mm thoracoscope under • single lung ventilation and CO2 • insufflation

22. Technique of Endo-ACAB • Atrumatic Thoracotomy

23. Technique of Endo-ACAB • Direct vision anastomosis

25. 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

26. 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

27. Aims • Compare the results in patients with CBD stones by Laparoscopic to robotic-assisted CBD exploration

28. 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

29. Criteria of difficult common bile duct stone

30. Mr. Ker. 43/yrs male C.C. : RUQ pain tea-color urine Lab. : GPT:65 Alk-P:368

32. Results(1)

33. Result (2 )

35. Result (3)

36. (min) Person Robot Set time (min) Person Robot Suture Time

37. OP TIME & Learning Curve Time Person

38. ZEUS suture=37.76±24.33min (stitches=3.84) LCBDE suture=24.65±10.82min (stitches=2.05)

39. THE FUTURE OF ROBOTIC SURGERY

41. CIMIT Center for Integration of Medicine and Innovative Technology Founding Members: CIMIT facility in Cambridge, Massachusetts

42. Thank You