A novel, new robotic platform for natural orifice distal pancreatectomy.
Identifieur interne : 000653 ( Main/Exploration ); précédent : 000652; suivant : 000654A novel, new robotic platform for natural orifice distal pancreatectomy.
Auteurs : Shyam Thakkar ; Michael Awad [États-Unis] ; Krishna C. Gurram [États-Unis] ; Steven Tully [États-Unis] ; Cornell Wright [États-Unis] ; Siddharth Sanan [États-Unis] ; Howie Choset [États-Unis]Source :
- Surgical innovation [ 1553-3514 ] ; 2015.
Descripteurs français
- KwdFr :
- Animaux, Chirurgie endoscopique par les voies naturelles (), Chirurgie endoscopique par les voies naturelles (instrumentation), Conception d'appareillage, Femelle, Génie biomédical, Interventions chirurgicales robotisées (), Interventions chirurgicales robotisées (instrumentation), Pancréatectomie (), Pancréatectomie (instrumentation), Suidae.
- MESH :
English descriptors
- KwdEn :
- Animals, Biomedical Engineering, Equipment Design, Female, Natural Orifice Endoscopic Surgery (instrumentation), Natural Orifice Endoscopic Surgery (methods), Pancreatectomy (instrumentation), Pancreatectomy (methods), Robotic Surgical Procedures (instrumentation), Robotic Surgical Procedures (methods), Swine.
- MESH :
Abstract
Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications.
DOI: 10.1177/1553350614554232
PubMed: 25320108
Affiliations:
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Gurram</name><affiliation wicri:level="2"><nlm:affiliation>West Penn Allegheny Health System, Pittsburgh, PA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>West Penn Allegheny Health System, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Tully, Steven" sort="Tully, Steven" uniqKey="Tully S" first="Steven" last="Tully">Steven Tully</name><affiliation wicri:level="4"><nlm:affiliation>Carnegie Mellon University, Pittsburgh, PA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carnegie Mellon University, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université Carnegie-Mellon</orgName></affiliation></author><author><name sortKey="Wright, Cornell" sort="Wright, Cornell" uniqKey="Wright C" first="Cornell" last="Wright">Cornell Wright</name><affiliation wicri:level="4"><nlm:affiliation>Carnegie Mellon University, Pittsburgh, PA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carnegie Mellon University, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université Carnegie-Mellon</orgName></affiliation></author><author><name sortKey="Sanan, Siddharth" sort="Sanan, Siddharth" uniqKey="Sanan S" first="Siddharth" last="Sanan">Siddharth Sanan</name><affiliation wicri:level="4"><nlm:affiliation>Carnegie Mellon University, Pittsburgh, PA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carnegie Mellon University, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université Carnegie-Mellon</orgName></affiliation></author><author><name sortKey="Choset, Howie" sort="Choset, Howie" uniqKey="Choset H" first="Howie" last="Choset">Howie Choset</name><affiliation wicri:level="4"><nlm:affiliation>Carnegie Mellon University, Pittsburgh, PA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carnegie Mellon University, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université Carnegie-Mellon</orgName><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName></affiliation></author></analytic><series><title level="j">Surgical innovation</title><idno type="eISSN">1553-3514</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Animals</term><term>Biomedical Engineering</term><term>Equipment Design</term><term>Female</term><term>Natural Orifice Endoscopic Surgery (instrumentation)</term><term>Natural Orifice Endoscopic Surgery (methods)</term><term>Pancreatectomy (instrumentation)</term><term>Pancreatectomy (methods)</term><term>Robotic Surgical Procedures (instrumentation)</term><term>Robotic Surgical Procedures (methods)</term><term>Swine</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Animaux</term><term>Chirurgie endoscopique par les voies naturelles ()</term><term>Chirurgie endoscopique par les voies naturelles (instrumentation)</term><term>Conception d'appareillage</term><term>Femelle</term><term>Génie biomédical</term><term>Interventions chirurgicales robotisées ()</term><term>Interventions chirurgicales robotisées (instrumentation)</term><term>Pancréatectomie ()</term><term>Pancréatectomie (instrumentation)</term><term>Suidae</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Natural Orifice Endoscopic Surgery</term><term>Pancreatectomy</term><term>Robotic Surgical Procedures</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Natural Orifice Endoscopic Surgery</term><term>Pancreatectomy</term><term>Robotic Surgical Procedures</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Animals</term><term>Biomedical Engineering</term><term>Equipment Design</term><term>Female</term><term>Swine</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="fr"><term>Animaux</term><term>Chirurgie endoscopique par les voies naturelles</term><term>Conception d'appareillage</term><term>Femelle</term><term>Génie biomédical</term><term>Interventions chirurgicales robotisées</term><term>Pancréatectomie</term><term>Suidae</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Missouri (État)</li><li>Pennsylvanie</li></region><settlement><li>Pittsburgh</li></settlement><orgName><li>Université Carnegie-Mellon</li></orgName></list><tree><noCountry><name sortKey="Thakkar, Shyam" sort="Thakkar, Shyam" uniqKey="Thakkar S" first="Shyam" last="Thakkar">Shyam Thakkar</name></noCountry><country name="États-Unis"><region name="Missouri (État)"><name sortKey="Awad, Michael" sort="Awad, Michael" uniqKey="Awad M" first="Michael" last="Awad">Michael Awad</name></region><name sortKey="Choset, Howie" sort="Choset, Howie" uniqKey="Choset H" first="Howie" last="Choset">Howie Choset</name><name sortKey="Gurram, Krishna C" sort="Gurram, Krishna C" uniqKey="Gurram K" first="Krishna C" last="Gurram">Krishna C. Gurram</name><name sortKey="Sanan, Siddharth" sort="Sanan, Siddharth" uniqKey="Sanan S" first="Siddharth" last="Sanan">Siddharth Sanan</name><name sortKey="Tully, Steven" sort="Tully, Steven" uniqKey="Tully S" first="Steven" last="Tully">Steven Tully</name><name sortKey="Wright, Cornell" sort="Wright, Cornell" uniqKey="Wright C" first="Cornell" last="Wright">Cornell Wright</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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