Abstract: The emergence of laparoscopy in the 1980s has made great progress in the development of minimally invasive techniques. On this basis, the development and application of surgical robots has opened a new era of minimally invasive surgery. This paper introduces the composition and function of the "Da Vinci" surgical robot system and its specific application in various surgical operations. It analyzes the technical advantages of surgical robots compared with traditional endoscopic techniques, and the bottleneck of current clinical application, and minimally invasive surgery. The development of surgical robots has been prospected.
1 Introduction
Reducing the surgical trauma of patients has always been a goal of modern medicine. In the 1980s, laparoscopic surgery opened the era of minimally invasive surgery, but laparoscopic limitations: limited rotation angle of surgical instruments, resulting in some surgical blind spots, and can only provide two-dimensional surgery for surgeons Vision. These factors limit the expansion of laparoscopic techniques to more complex surgical procedures and become the "bottleneck" in the development of current laparoscopic techniques. In the 21st century, in order to overcome the deficiencies of laparoscopic techniques, surgical robotic surgery has gradually become the main trend of minimally invasive surgery. The development of surgical robots and rapid clinical application, with its new ideas and effects, is considered a revolution in the history of surgical development, and also indicates the advent of the third generation of surgical surgery.
The research and development of medical surgical robot systems has attracted great attention from many governments in the West, such as the United States, Italy, Japan and other countries, and has invested a lot of manpower and financial resources. In 1994, Computer Motion of the United States developed the first automatic endoscope positioning system to assist minimally invasive surgery, named Aesop, which took a key step in the development of robotic surgical systems. A breakthrough in surgical robot systems is the first to be introduced to Intuitive Surgical in the United States, a pioneer in the development of revolutionary minimally invasive surgical instruments and techniques. They have successfully expanded the use of minimally invasive surgery (MIS) by improving surgical procedures to make surgical precision and technology beyond the limits of human hands. In January 1999, the "daVinci" robotic surgical system manufactured by Intuitive Surgical was awarded the European CE market certification, marking the birth of the world's first real surgical robot; in July 2000, it passed the US FDA market certification. Later, "Da Vinci" became the world's first robotic surgical system that can be officially used in the operating room.
2 System introduction and function
The "Da Vinci" surgical robot is the only robotic surgical system in the world that can be officially used in abdominal surgery and is one of the most complicated and expensive surgical systems available. The system combines the advanced technologies developed by NASA and numerous research institutes to represent the highest level of surgical robots in the world today. Its surgical features are as fine as Leonardo da Vinci's paintings, which can minimize the trauma caused by surgery. Currently, widely used in clinical practice is the latest third generation product developed by Intuitive Surgical.
The "Da Vinci" robot is actually an "endoscopic surgical instrument control system", which is significantly different from the robot in the usual sense. The surgical system consists of three main subsystems: the physician console, the bedside robotic surgery system, and the 3D imaging system. The three seemingly independent subsystems have their own divisions of labor when performing surgery on patients, each of which has its own functions, but complement each other and are closely related. Simply put, the doctor performing the operation operates on the console, and the system accurately transmits the movement of the doctor outside the patient to the robot arm, which is converted into the action of the surgical instrument in the patient, thereby completing the surgery.
(1) Physician console
The console is the control core of the DaVinci system and consists of a computer system, a monitor, an operating handle and an output device. During the operation, the doctor sits in front of the console outside the aseptic area, and puts both hands into the operating handle ring. The two-handed action drive drives the simulated robotic arm on the operating table to complete various operations, and can be controlled by voice, hand or pedal. Control the laparoscope. The operator's feet are placed on the console pedal to complete the electric cutting, electrocoagulation and other related operations, and a binocular endoscope is used to observe the three-dimensional image of the patient's body cavity.
(2) Bedside robotic arm surgery system
Includes 2 to 3 working arms and 1 holding arm. The arm is used to hold the laparoscopic objective during surgery. Compared with the traditional laparoscopic assistant, it can provide a more stable image and avoid the problem of unstable vision caused by hand fatigue in the conventional laparoscopic surgery. The working arm is used to complete various operations during the operation. There are 7 degrees of freedom, including 7 movements of the arm joint up and down, front and rear, left and right movement and the left and right, rotation, opening and closing, and end joint bending of the manipulator, which can be used as a vertical axis 360. ° and the horizontal axis 270° rotation, and each joint activity is >90°. The surgeon translates and transmits the surgeon's hand movements to the end of the robot arm through the operating handle, and can perform continuous movements such as up, down, left and right, and rotation, so that it has greater flexibility than the human hand. A physician assistant and a brushing nurse can be placed next to the operating table. The robot is replaced by the robot according to the surgeon's wishes, and can be operated through the auxiliary hole to carry out some work such as pulling and attracting.
(3) 3D imaging system
The image processing equipment of the da Vinci system is equipped with a monitor, and can also be equipped with auxiliary surgical equipment (such as carbon dioxide inflation system), a dual high-intensity light source system, and a dual CCD camera system. During the operation, the nurses were operated by the audience. One of the main drawbacks of traditional laparoscopic techniques is the two-dimensional planar imaging. The surgeon can't distinguish the relative relationship between the tissues in the monitor. Only after thorough practice can the operation be mastered. The Da Vinci robot's 3D high-definition imaging system can completely solve this problem, providing the surgeon with a real surgical field, which facilitates the identification of tissue relationships during surgery, and makes the suturing and knotting operations easier and easier to learn and improve the efficiency of surgery.
From the first-generation surgery to the second-generation surgery represented by laparoscopic surgery, the surgical incision is large, the trauma is large, the bleeding is more, the postoperative complications are more, the pain is more obvious, and the patient is psychologically and physiologically s pain. Compared with traditional surgery, robotic surgery represented by "Da Vinci" has three distinct advantages: First, it breaks through the limitations of the human eye, and can enter the machine mirror inside the human body, so that the surgical field of view is magnified 20 times. The robotic arm increases the freedom of movement, greatly improving the surgeon's ability to operate, and can convert the large movement of the handle proportionally into a fine movement in the patient's body. The second is to break through the limitations of the manpower. In the area where the hand can't reach, the robot can walk through the 360-degree space to complete the movements of turning, moving, swinging, clenching, etc., and the stabilizer has a manipulator on the manipulator. Unmatched scientific and technological progress and accuracy, to prevent possible jitter in the human hand, more flexible than the human hand in the narrow anatomical region, thus assisting in the completion of sophisticated and other difficult operations. Third, there is no need to open the abdomen, the wound is only about 1 cm, the wound is small, the bleeding is less, the recovery is faster, the postoperative hospital stay is greatly shortened, and the postoperative survival rate and recovery rate are greatly improved.
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