Autori: Doctor Adrian LOBONTIU, Doctor Daniel RABREAU, Professor Daniel LOISANCE

Editorial: Dallas April 26-29, 2006 (SAGES: Society of American Gastrointestinal and Endoscopic Surgeons), 2006.

Rezumat:

Adrian Lobontiu, M.D. (1), Daniel Rabreau, M.D. (2), Daniel Loisance (1)

(1)Department of Cardio-Thoracic Surgery, Henri Mondor Hospital, University Paris 12, France
(2)Department of Surgery , European Hospital Georges Pompidou, Paris , France

Abstract
Backround: Two of major evolutions of the modern surgery of today are robotic surgery and the endoluminal surgery. By combining these two new techniques we describe a completely novel way of performing Zenker diverticula’s surgery: the robotic endoluminal approach.

Description of the technology and methods: The da Vinci surgical system (Sunnyvale, CA) is composed of a Surgeon Console with an integrated 3D display Stereo Viewer, a Surgical Cart with a Camera Arm and two Instrument Arms and a Vision Cart. All three robotic arms were placed intra orally at the level of the eso-pharyngeal junction in a female cadaver. Seated at the Console, at a remote location, the surgeon operates using two master joysticks [7]. The articulated instruments with 7 degrees of freedom which extend the surgeons capabilities to a new level and the outstanding 3D vision enables performing complex cricopharyngeal myotomy with enhanced dexterity and precision eliminating the risk of pharyngo-esophageal perforation.

Results: The articulated robotic round tip scissors are oriented perpendicular to the cricopharyngeal muscle, strictly on the median line, with one jaw in the pouch and one jaw in the esophagus. By remote control navigation with the 30° endoscope we obtained a high resolution 3D image of the eso pharyngeal junction that allowed us to divide the muscle transmucosally with an instinctive movement of open surgery. The system electronics allowed us to use motion scaling of hand movements and to optimize scaling for cutting the muscle by eliminating the natural tremor of the surgeon’s hand.

Conclusion: The robotic endoluminal surgery for Zenker diverticula is feasible in humans. The robotic articulated instruments and the 3D camera placed trans-orally at the level of the eso-pharyngeal junction extend the surgeon’s capabilities to a new level of precision and control in performing the myotomy for Zenker diverticulum. This opens a completely novel approach: the endoluminal robotic remote surgery in patients with this pathology.

Cuvinte cheie: Robotic, Surgery, Diverticula, Zenker, Endoluminal