ROBOT-ASSISTED LAPAROSCOPIC ROBOT-ASSISTED LAPAROSCOPIC

SURGERY WITH ZEUS SYSTEMSURGERY WITH ZEUS SYSTEM

: PRELIMINARY RESULTS AND : PRELIMINARY RESULTS AND

TECHNICAL ASPECTSTECHNICAL ASPECTS

Hurng-Sheng WuHurng-Sheng Wu

Department of Surgery, Show-Chwan MeDepartment of Surgery, Show-Chwan Memorial Hospital, Changhuamorial Hospital, Changhua, Taiwan, R.O., Taiwan, R.O.

CC

高雄縣立岡山醫院

（ 30床）

（ 731床）

（公辦民營）（公辦民營）

（ 700床）

（ 500床）籌設中

（全國第一家公辦民營）（全國第一家公辦民營）

台北秀傳醫院

竹山秀傳醫院彰濱秀傳健康園區

秀傳紀念醫院

台南市立醫院

Difficulties of laparoscopic surgeryDifficulties 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 techniquesVol. 12, No. 1, pp.1-5, 2002

Decades of Changes in Surgical Decades of Changes in Surgical EducationEducation

<1950 Operating room theaters1960 Experimental surgery and motion picture films1970 Industry-research laboratories1980 Endoscopic surgery1990 Laparoscopy2000 Robotics

Alberto Peracchia,Annals of Surgery

Vol.234, No. 6, 709-712, 2001

Space MedicineSpace Medicine

ZEUSda Vinci

Master-slave manipulatorSimplicityLightnessRange of freedomMotion scalingReal-time high-resolution 3D visionPhysiological 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

What is about space medicine?What is about space medicine?

ROBOTROBOT: computer-enhanced : computer-enhanced humanistic devicehumanistic device

Zeus Robotic SystemZeus Robotic System

AESOP

HERMIS

SOCRATES

Surgeon Console& Three Roboyic Arms

LIMITATIONS OF ROBOTIC SURGERYLIMITATIONS OF ROBOTIC SURGERY

Ports and/or robotic arms placement eg: lithotomy position

Cosmetic

Depth perceptionNo haptic feed back

eg: needle and suture breaks

Size

Set up

Dept.Dept. OperationOperation TotalTotal

General SurgeryGeneral Surgery Robotic assisted Nissen fundoplication 44

Robotic assisted gastric band for obesity 33

Robotic assisted laparoscopic cholecystectomy 7171

Robotic assisted repair of PPU 33

Robotic assisted Choledocholithotomy with T-tube 2828

Robotic assisted laparoscopic appendectomy 11

Robotic assisted laparoscopic adrenectomy 33

Robotic assisted oophorectomy 11

Robotic assisted laparoscopic unroofing of intraabdominal cyst

22

Cardiovascular Cardiovascular Surgery Surgery

Total Zeus IMA take down 33

Robotic ACAB 66

Obstetrics & Obstetrics & GynecologyGynecology

Robotic assisted salpino-oophrectomy 22

Robotic Surgery in Show Chwan Memorial HospitalRobotic Surgery in Show Chwan Memorial HospitalBETWEEN MARCH,2002 AND NOVEMBER, 2004BETWEEN MARCH,2002 AND NOVEMBER, 2004

Endo-ACABEndo-ACABDefinition :

A less invasive bypass p

rocedure on the beating

heart where all steps are

performed endoscopicall

y with the exception of a

manual anastomosis.

Technique of Endo-ACABTechnique of Endo-ACAB

Endoscopic IMA Harvest

voice-activated robotic-assisted and a 5mm thoracoscope under single lung ventilation and CO2

insufflation

Technique of Endo-ACABTechnique of Endo-ACAB

Atrumatic Thoracotomy

Technique of Endo-ACABTechnique of Endo-ACAB

Direct vision anastomosis

Robotic-Assisted Laparoscopic Surgery in Difficult Robotic-Assisted Laparoscopic Surgery in Difficult Common Bile Duct Stone: Preliminary Results in ShCommon Bile Duct Stone: Preliminary Results in Sh

ow Chwan Memorial Hospitalow Chwan Memorial Hospital

Hurng-Sheng WuHurng-Sheng Wu

Department of Surgery, Department of Surgery,

Show Chwan Memorial Hospital, Changhua. Show Chwan Memorial Hospital, Changhua. TaiwanTaiwan

BackgroundBackground

Common bile duct stones are a frequent problem (1

0-15%) in patients with symptomatic cholecystolithi

asis

Laparoscopic techniques have expanded the options

for their treatment

Difficulty in laparoscopic surgery

AimsAims

Compare the results in patients with CBD

stones by Laparoscopic to robotic-assisted

CBD exploration

PatientsPatients

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

Between January 2000 and November 2003Between January 2000 and November 2003

Criteria of difficult common bile duct Criteria of difficult common bile duct stonestone

LCBDELCBDE(n=25)(n=25)

Robotic-AssistedRobotic-Assisted(n=28)(n=28)

Big stone (>1cm) 99 1010

multiple stones 1010 99

Impacted CBD stone 22 44

ERC failed 44 55

s/p Billroth II resection s/p Billroth II resection 11 duodenal diverticulumduodenal diverticulum 22 22 uncooperative behavioruncooperative behavior 11

IntoleranceIntolerance 22 11

TotalTotal 2525 2828

Mr. Ker. 43/yrs male C.C. : RUQ pain tea-color urine

Lab. : GPT:65 Alk-P:368

Results(1)Results(1)

VariablesVariables LCBDELCBDE Robotic-AssistedRobotic-Assisted P valueP valueNo. of patients 2222 2828

No.(%) of conversion 3 (12%)3 (12%) 3(10%)3(10%) NPNP

Mean age( years old) 58 (range 23~83)58 (range 23~83) 59 (range 41-84)59 (range 41-84) NPNP

Sex= M : F 8:148:14 11:1411:14 NPNP

Total Bilirubin level

≦ 2 (mg/dl) 1313 77 0.0310.031 2 ~ 10 (mg/dl) 99 1818

Mean caliber of CBD (cm)

1.43 (range 0.8~2.2)1.43 (range 0.8~2.2) 1.6 (range 1.2~2.5)1.6 (range 1.2~2.5) NPNP

No.(%) of complication 2 (9%)2 (9%) 2 (8%)2 (8%) NPNP

No.(%) of retained stone 2 (9%)2 (9%) 2 (8%)2 (8%) NPNP

No.of recurrent stone 11 00 NPNP

Follow-up( months ) 3~393~39 1-201-20

Result (2 )Result (2 )

LCBDELCBDE Robotic-AssistedRobotic-Assisted PP

CBD diameter (cm) 1.45±0.36 (1-1.45±0.36 (1-7.2)7.2)

1.6±0.3 (1.2-2.5)1.6±0.3 (1.2-2.5) NPNP

Suture stitches 2.05±0.56(1-3)2.05±0.56(1-3) 3.84±0.90(3-6)3.84±0.90(3-6) <0.001<0.001

Time to liquid (days) 2.55±0.78 (2-5)2.55±0.78 (2-5) 2.32±0.97 (1-4)2.32±0.97 (1-4) NPNP

Postoperative

hospital stay (days)

6.8±3.1 (5-14)6.8±3.1 (5-14) 6.6±0.36 (4-11)6.6±0.36 (4-11) NPNP

Result (3)Result (3)

LCBDELCBDE Robotic-AssistedRobotic-Assisted

Mortality 00 00

Conversion to open 33 00

Conversion to LCBDE 33

Complications:

Acute hepatitisAcute hepatitis 00 11

Wound infectionWound infection 11 11

Bile leakageBile leakage 22 00

Retained stone(s)Retained stone(s) 22 22

T-tube DislodgeT-tube Dislodge 11 00

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LCBDE縫合TimeRobot縫合Time

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

THE FUTURE OF ROBOTIC THE FUTURE OF ROBOTIC

SURGERY SURGERY

Founding Members:

CIMIT

Center for Integration of Medicine and Innovative Technology

CIMIT facility in Cambridge, Massachusetts