Simply put, the Da Vinci robot is an advanced laparoscopic system. You may be familiar with the popular minimally invasive treatment methods, such as thoracoscope, laparoscopy and gynecological endoscopy. Leonardo da Vinci robots also need a mechanical arm to pass through the chest and abdominal wall during surgery.
Da Vinci robot consists of three parts: the surgeon's console; Bedside manipulator system; Imaging system.
First, the surgeon's console
The surgeon sits on the console outside the sterile area of the operating room and controls the instrument and 3D HD endoscope with his hands (by operating two main controllers) and feet (by pedals). As seen in the stereoscopic eyepiece, the tip of the surgical instrument moves synchronously with the surgeon's hand.
Second, the bedside mechanical arm system
The patient cart is the operating part of the surgical robot, and its main function is to support the instrument arm and the camera arm. The assistant doctor works next to the bedside robotic arm system in the sterile area, responsible for replacing instruments and endoscopes and assisting the surgeon to complete the operation. In order to ensure the safety of patients, assistant doctors have higher priority control over the movement of bedside manipulator system than surgeons.
Third, the imaging system
The video car is equipped with the core processor and image processing equipment of the surgical robot, which is located outside the sterile area during the operation, can be operated by the visiting nurse, and can be equipped with various auxiliary surgical equipment. The endoscope of the surgical robot is a high-resolution three-dimensional (3D) lens, and the magnification of the surgical field of vision is more than 10, which can bring the surgeon a three-dimensional high-definition image of the patient's body cavity, so that the surgeon can better grasp the surgical distance, identify the anatomical structure and improve the surgical accuracy than ordinary laparoscopic surgery.
What diseases can Da Vinci surgical robot treat?
1, cardiothoracic surgery:
Open cardiothoracic surgery needs to open the chest, separate the sternum and free the ribs, and it is completed under cardiopulmonary bypass, which has great trauma, high surgical risk and long postoperative recovery time. Thoracoscopic surgery has been used in cardiothoracic surgery, such as lobectomy and coronary artery bypass grafting. This minimally invasive surgery method does not need to open the chest, but only needs to make a few small incisions between the ribs to complete the operation. The patient suffered little postoperative pain and recovered quickly. However, its application scope is limited, and it is impossible to complete some operations with complicated anatomical structures, so it is not popular. The surgical robot completed the first coronary artery bypass grafting in 1999, and has been used in various open heart operations since 2003. Under the premise of not destroying the integrity of the chest, the operation can be completed accurately, with a wide range of indications, covering almost all cardiothoracic surgery, such as total intracavitary shunt, extraction of internal mammary artery with beating heart, mitral valvuloplasty, mitral valve replacement, atrial septal defect repair, tricuspid valvuloplasty, cardiac tumor resection, thoracic surgery lobectomy, esophageal cancer resection, thymectomy, and treatment of esophageal achalasia. Among them, total intracavitary bypass surgery and mitral valvuloplasty are representative operations performed by surgical robots in cardiothoracic surgery. Clinical application shows that the robot has high safety and better curative effect than thoracotomy and thoracoscopic surgery.
2, urology:
Laparoscopic surgery is more and more widely used in urology. This minimally invasive surgery is suitable for many routine urological operations, such as nephrectomy, adrenalectomy, ureterotomy, bladder tumor resection, prostate tumor resection and so on. However, due to the particularity of urinary anatomy, the popularization and popularization of laparoscopic technique are limited, and some complicated operations are often difficult to master, and the incidence of surgical complications is high. At present, Professor Sun Yinghao in China has been able to make good use of the unique technical advantages of deep surgery and fine surgery of surgical robots, and has been widely used in various urological operations, including radical prostatectomy, nephrectomy, pyeloplasty, total cystectomy, vasectomy, ureteroplasty, and living donor nephrectomy. Among them, radical prostatectomy is the operation that can best reflect its technical advantages. Surgical robot provides a broad field of vision and precise and flexible control ability, which can clearly display the anatomical structure of tissues and organs and the course of neurovascular bundles. Fine separation is beneficial to lymph node dissection, accurate suture ensures high quality of anastomosis, and accurate preservation of lateral fascia of prostate during operation is beneficial to reduce the influence of operation on patients' sexual life. Postoperative pathological examination and follow-up showed that the tumor resection was effective. Since the first surgical robot radical prostatectomy was carried out in 2000, the operation has been rapidly popularized abroad. In Nordic countries, more than half of radical prostatectomy is performed by surgical robots, while in the United States, the proportion is as high as 90%, which has become the "gold standard" for radical prostatectomy.
3. Gynecology:
Minimally invasive surgery, represented by laparoscopy, is gradually replacing the traditional open surgery, and is applied to a variety of gynecological operations, from fenestration and drainage of ovarian cysts to total hysterectomy and pelvic lymph node dissection. However, most gynecological operations need to be completed in a narrow pelvic cavity, and the vision and space of the operation are very limited, which limits the freedom of movement of laparoscopic instruments and the instability of the operation scope, and it is difficult to complete some operations that require fine separation, suture and lymph node dissection, which limits the application of laparoscopic technology in complex gynecological operations. Da Vinci surgical robot was approved by FDA in 2005 for gynecological minimally invasive surgery, and the technology has been rapidly popularized since then. The results of clinical application show that the robot surgery has high accuracy and maneuverability, and can complete fine surgery in pelvis, which is beneficial to functional reconstruction and pelvic lymph node dissection. It is widely reported abroad for radical operation of cervical cancer. This kind of operation requires the use of accurate separation techniques, such as cutting off ligaments, freeing ureters and cleaning lymph nodes, which can give full play to the technical advantages of surgical robots and achieve ideal surgical results. For complicated hysteromyomectomy and other operations that require complicated suture technology, it is helpful to reduce postoperative complications by using the dexterous surgical arm of surgical robot to complete suture with high quality. In addition, the reported robotic surgery also includes total hysterectomy, tubal recanalization and anastomosis, oophorectomy and pelvic floor reconstruction.
4, abdominal surgery:
Early surgical robots were mainly used for abdominal surgery and performed some simple operations, but they did not show more obvious advantages than laparoscopic surgery, so they were not popularized. With the successful development of surgical robot in other surgical fields, its application and research in abdominal surgery have revived, and various operations have been carried out rapidly. According to its influence on the second generation of laparoscopic surgery, surgical robot abdominal surgery can be divided into three categories: ① robot surgery that has little influence on conventional laparoscopic surgery, such as robotic cholecystectomy, anti-reflux fundoplication, hernia repair, appendectomy, adjustable binding gastric volume reduction, and benign gastrointestinal tumor resection. ② Robotic surgery that can significantly improve the effect of laparoscopic surgery covers a wide range, including robotic hepatectomy, complex biliary reconstruction, gastric bypass weight reduction, radical gastrectomy, radical resection of colorectal cancer, partial pancreatectomy, pancreatoduodenectomy and so on. ③ Some operations that are difficult to be performed under laparoscopy and can only be accurately performed by surgical robots, such as resection and anastomosis of visceral aneurysms, open-field anastomosis of small-caliber bile ducts, and complicated intra-abdominal lymph node dissection.