Autori: Dr Adrian LOBONTIU, MD (1); Dr Daniel RABREAU, MD (2); Dr Paul-Henri CUGNENC, MD, Ph.D (2); Dr Claude TAYAR, MD (1); Dr Daniel LOISANCE, MD, Ph.D (1).

Editorial: SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) - Las Vegas, USA; April 18-22, 2007.

Rezumat:

The endolumenal surgery has tremendously been developed these last few years. So has been the robotic surgery. By combining these two recent innovative developments we may solve some limitations and open new horizons and indications in surgery.

This work describes the Longo technique performed with the aid of the da Vinci™ Surgical Robot through natural orifices (trans-anal approach).

The degrees of freedom in rectal endolumenal surgery are limited because instruments need to be long and are manipulated through limited anatomy area.

In order to solve these limitations tools have been developed that have an articulation at the tip, which increases the degrees of freedom. Computer assistance is warranted, as the human brain cannot efficiently manipulate articulated instruments by mechanical means.

The surgeon sits comfortably at a master console located at a distance from the patient with eyes focused down toward the operative site, mirroring an open surgical technique.

The anal canal is exposed by placing 3 robotic trocars in triangulation, transanal, at the level of the sphincter.

By manipulating the joysticks at the console, all movements are transmitted in real time at the tip of the articulated instruments while the surgeon navigates with the Camera inside the rectum. The 3D stereoscopic vision is 15 times magnified.

The computer allows different scale motions set ups, filtering in mean time any involuntary trembling of the surgeon’s hand.

Advantages of this technique consists in: better control for gaps of the stapler line; better inspection of bleeding points; optimal robotic hemostasis; outstanding accuracy in placing the pursestring suture: the needle is at the level of the mucosa, avoiding in this way any possible recto-vaginal or recto-urethral fistula due to including too much tissue.

We believe that endolumenal surgery and robotic surgery can develop together in a complimentary way. We continue to explore this exciting field and obtain more data for the work described.
The future is the one of robotic surgery but also the one of endolumenal surgery. By combining these two new trends in surgery we believe that new surgical indications will occur.

Cuvinte cheie: Robotic, Surgery, Natural, Orifice, Longo, da Vinci

URL: http://www.sages.org