Application of a Surgical Robot to Open Microsurgery: The Equipment

摘要

Background: Computer-assisted robot-enhanced surgery can enhance minimally invasive surgery by providing a wrist at the end of the instruments and by scaling motion and filtering tremor. Motion scaling and tremor filtration are most enabling at high magnification. Goal: To explore the possibility of using a surgical robot designed for minimally invasive surgery during open microsurgical procedures. Materials and Methods: Using the Zeus MicroWrist™ Robotic Surgical System in conjunction with the triple-alpha port, we performed suture tasks on a glove box with microsurgical suture (8-0 to 10-0) in three different configurations. First, we used a standard 10- mm laparoscope, camera, and the Zeus monitor. Next, we used an operating microscope for visualization with the surgeon at the operative table while controlling the instruments. Third, we allowed the surgeon to sit at the standard Zeus console and transmitted the image from the microscope to the monitor at the Zeus console. Results: In all three configurations, we were able to manipulate small suture effectively. Using the standard laparoscope, we measured a maximum working magnification of 27 times. At the maximum magnification, we had some difficulty resolving 10-0 suture. Using the operative microscope, we found that the surgeon was crowded by equipment. However, the maximum working magnification was 50 times, the resolution of the fine suture was excellent, and the surgeon had better depth perception. Connecting the operating microscope to the video monitor combined the best features of both systems. Conclusion: We effectively used the Zeus system in manipulating microsurgical suture with both a standard laparoscope and a surgical microscope. The microscope provides better visualization. We plan to explore this application of the surgical robot further by working in a microsurgical animal model.