Release date: 2014-06-30
The rapid advancement of robotics has made remote surgery possible, combining medical surgical robots with telemedicine. Doctors can remotely operate robots on the network to provide consultation, treatment and care for patients in different places, saving a lot of time and money.
Only open a keyhole-sized mouth in the chest, bleeding only 100 ml, can successfully complete a coronary artery bypass surgery within two hours, and still complete under the premise of the heart beating, you will not think this is A miracle?
On June 22nd, at the 4th Beijing International Robotic Surgery Demonstration and Symposium, the surgical team led by Prof. Gao Changqing, the deputy dean of the PLA General Hospital, demonstrated the coronary artery bypass surgery without a cardiopulmonary bypass. Win the unanimous praise of the experts present.
"By the heartbeat surgery means to perform surgery on a two-millimeter blood vessel, to cut the coronary artery, and finally to perform vascular anastomosis. The difficulty is conceivable. This is the minimally invasive limit of robotic heart surgery. Several cardiac surgeons are able to perform this procedure.†The foreign experts commented that “the robot allows the doctor to break through the limitations of the human eye. Through robotic surgery, the patient’s trauma is minimized and the surgery is more precise.â€
Robotic surgery makes patients less traumatic
In the 20th century, the formation and development of minimally invasive surgery in the medical field, laparoscopic technology is a typical representative, but the instruments used by the surgeon at this stage are still traditional common thoracoscopy equipment, it is difficult for surgeons to master precise operation, and operation It is very uncomfortable, and true intracardiac operation still requires the auxiliary incision of the chest wall to complete.
Until the end of the 1990s, research and development of medical surgical robot systems came into being to overcome the defects of endoscopic techniques and to pursue more perfect minimally invasive surgery.
The earliest concept of robotic surgery was the first automatic endoscope positioning system developed by Computer Motion in 1994 to assist minimally invasive surgery. However, it was not able to perform instructions alone for surgery, but only a mirror. "Electronic manipulator."
The robotic surgical instrument used in the operating room of the hospital is the da Vinci system of Intuitive Surgical of the United States. The advent of robotic systems has made it possible for some of the original surgeons to be technically difficult or even impossible to solve.
“Through the video manipulation system, the operator and the robot arm are connected by circuit. The doctor console is equipped with a three-dimensional vision system and an action calibration system. The movement of the doctor's arm, wrist and fingers is accurately recorded in the computer by sensors and simultaneously translated. Give the robot arm. The operator moves away from the operating table, and directs and controls the bedside robot to realize the complete imitation of the operation in the patient's body." Intuitive Surgical staff introduced.
"The advantages of robotic manipulation of surgical instruments are many. For example, accurate positioning of medical images can eliminate manual vibration to perform continuous movements, and it can work in an environment that is unfavorable to doctors," said Dr. Yang Ming, Department of Cardiovascular Surgery, PLA General Hospital.
Compared with traditional heart surgery, the incision is usually less than 1 cm in the sternum, and the robotic incision is generally less than 1 cm. The trauma is very small and the bleeding is less. In general, traditional thoracotomy surgery takes about 3 months to recover, and robotic cardiovascular surgery, the patient's postoperative recovery time is only about 1 week. Even in the case of heart bypass, major surgery such as heart valve repair, patients can get out of bed the next day after surgery.
Mastering the basic clinical foundation for robotic surgery
In the studio of the International Conference Center of the Surgical Building of the General Hospital of the People's Liberation Army, the surgical team is demonstrating the operation of the robot: the doctor first opens a small opening of less than 1 cm in the chest wall of the patient, and inserts the robotic arm of the surgical robot into the patient's body in turn. Through the 3D imaging system, it can be clearly seen that under the control of the doctor, the robot accurately performs each action of the doctor to complete the surgery in the chest of the patient.
"Robot surgery has unparalleled advantages: the robot's robot has 7 degrees of freedom that human hands can't match, it can filter the shaking of the human hand, making the operation more precise; with the movement reduction function, the doctor moves the joystick during the manipulation process. 10 mm, the mechanical end of the patient only moves 1 mm, which greatly improves the accuracy and safety of the operation. In addition, in the remote control, the robot is manipulated through the console to expand the space of the operation, and the doctor does not have to Standing in front of the operating table for a long time not only saves physical exertion, but also helps doctors to concentrate." Yang Ming, assistant of Gao Changqing, the chief surgeon of the operation team.
However, in the face of cold machines, many people have worried that there will be uncontrollable safety factors. Many doctors feel helpless and do not know how to let the machine listen to people.
“In fact, this is one of the challenges that robotic surgery is currently experiencing. Not all doctors can use robots for surgical procedures. Without strong clinical experience, they can only do nothing about the robot. The key is to have good surgery. Experience, including the clinical experience of the entire team is very high." Yang Ming said.
"The defect of the tactile feedback system is a major defect in robotic surgery, so that the surgeon can only make up for the lack of tactile feedback through visual information feedback, and puts higher demands on the surgeon's surgical skills. It must be professionally trained and operated. Familiar with the process and able to deal with possible mechanical obstacles during the operation in a timely and effective manner," said Intuitive Surgical staff.
From the initial exploration of the needle to the in vitro pig heart test, the simulated chest test and the live animal test, until the successful completion of the first full robot in China without the repair of the thoracic septal defect, the robotic heart surgery team experience of the PLA General Hospital The tough challenge has opened the door to Chinese robotic surgery. Up to now, the robotic heart surgery team of the General Hospital of the People's Liberation Army has completed more than 700 cases of all-robot non-thoracic heart surgery under the leadership of Gao Changqing, covering all the cardiac operations that can be completed by the current Da Vinci robotic surgery system. It is the world's largest cardiac surgery center for robotic heart surgery, and several of them are the world's first.
Occupy the forefront of the future minimally invasive field
Today, the PLA General Hospital robotic surgery is developing from a single discipline into a number of disciplines, including urology, hepatobiliary surgery, general surgery, oncology surgery, obstetrics and gynecology, thoracic surgery, otolaryngology, etc., more than 2,300 cases.
"Minimally invasive surgery is the future development trend. Undoubtedly, robotic surgery is an important development direction of minimally invasive surgery. We must seize the opportunity to develop the level of minimally invasive surgery in China and benefit the majority of patients." Gao Changqing said.
Currently, robotic surgery is on an upward trend in countries such as Europe and the United States. Up to now, the total installed capacity of Da Vinci robots worldwide is 3,039, 2,116 in the US, 488 in Europe and 311 in Asia. In Asia, Japan has developed rapidly. From 2007, several units have grown into more than 100 units, while China has only 18 units.
The research and development of medical surgical robot systems has aroused great concern from governments and academia in many developed countries in the West, and has invested a lot of manpower and financial resources. Governments not only hope that the research of medical surgical robot system can bring convenience to the treatment of diseases, but also produce good social benefits. It is hoped that the systematic research of medical surgical robots can generate a new economic growth point and obtain good economic benefits.
Since 2009, the Department of Cardiovascular Surgery of the General Hospital of the People's Liberation Army has established the "Minimally Invasive Robotic Heart Surgery Center" and the "International Robotic Heart Surgery Cooperation and Research Center", and obtained international training qualifications. Co-hosted four "International Robotic Heart Surgery Demonstrations and Symposiums" with the American Society of Minimally Invasive Robotics and the International Society of Robotic Surgery. It has become an international, national and military robotic cardiac surgery training base. It has trained robotic cardiac surgery teams in many countries and regions such as Singapore, Brazil, Japan, Hong Kong and Taiwan, and has won a good reputation among international peers.
"The rapid advancement of robotics has made remote surgery possible. The combination of medical surgical robots and telemedicine allows doctors to remotely operate robots over the network, allowing patients to receive consultations and treatments from remote experts in situ and in the original hospital. Nursing, which saves a lot of time and money. These are the prospects for the future application of robotic surgery." Yang Ming said.
Source: Technology Daily
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