Robotic and thoracoscopic-assisted coronary artery bypass grafting

Conventional surgical instruments are unable to perform coronary artery bypass grafting with the aid of thoracoscopic surgery. For this reason, a robot or robot system has emerged, which increases the flexibility and accuracy of the operation. The surgical robot system consists of three main components: a surgeon operating device (console), including a TV monitor and 2 instrument handles, 2 computer control systems and 32 or 3 robots (arms). The surgeon manipulates the instrument handle, and the computer controller digitizes the operator's movements and relays the information to two robots in real time. The two robots are extended from the side of the operating table to the surgical field and accurately manipulated in the surgical field. instrument. The third voice control mechanism is used to operate the endoscope. The robot is also equipped with a zeus robotic microsurgical system to amplify the surgical field image by 2:1 to 10:1, usually 2.5:1. Treatment of diseases: coronary heart disease Indication Robotic and thoracoscopic assisted minimally invasive coronary artery bypass grafting is currently in clinical trials and is currently only used for anastomosis between the left internal mammary artery and the left anterior descending artery. Surgical procedure Surgery was performed under heart port access, and it was reported that it was not performed under cardiopulmonary bypass. The patient lies supine on the operating table, general anesthesia, placement of arterial pressure measurement and intravenous infusion tube, and after disinfection and placement, the three robotic arms of the sterilized robot are placed next to the operating table. The left internal mammary artery was obtained by thoracoscopic surgery through three small incisions through the chest wall. The low-energy electrosurgical knife was used to separate the subclavian artery from the subclavian artery to the sixth intercostal space. The branch was cut with low energy electrocautery to stop bleeding, and the distal soft tissue was removed. Heparinization After temporarily clamping the internal mammary artery for use. These 3 incisions can then be used for thoracoscopic coronary artery bypass anastomosis. The left instrument port (5mm) is located below the midline xiphoid process. The middle small incision is a thoracoscopic-camera catheter access port (10mm), located outside the midline. The 5th or 6th intercostal space of about 7cm depends on the left anterior descending branch; the right instrument port (5mm) is located 7cm outside the thoracoscope cannula, and the 4th or 6th intercostal space of the anterior line. The thoracoscope is attached to the TV camera and the light source, and the thoracoscope is manipulated by the Aesop voice control device. A TV screen is displayed on both the operator's operating site and the operating table side to display the surgical field image. The tip of the special surgical instrument is sent from the instrument incision into the surgical field and operated according to the image provided by the thoracoscopic lens. Endoscopically cut the happy bag and identify the target vessel before the cardiac arrest. The pericardium is not suspended and the heart is in situ. After the arrest, the incision was made on the distal wall of the left anterior descending stenosis. The image of the surgical field was very clear. The robotic and thoracoscopic assisted continuous suture method was used to perform the internal mammary artery-anterior descending artery (IMA). -LAD) end-to-side anastomosis, first suture the "heel" part of the internal mammary artery incision, tighten the suture, and then perform the "toe" section anastomosis, endoscopic knotting, according to statistics, each anastomosis averaged 23.6 ± 1.4 (18 ~ 30) min. Generally, it is not necessary to supplement the needle, loosen the left internal mammary artery clamp, open the ascending aorta, gradually stop the extracorporeal circulation after rewarming, and then close the chest as usual. The computer-mediated system can manipulate the surgical instrument and the thoracoscopic camera head, especially the mechanical arm can reach the multi-target blood vessel, and enlarge the image through the surgical field, so that the operator can operate more accurately and dexterously in a limited space, improving The precision of the stitching. The robotic system adds a voice-activated arm (Aesop) to control the thoracoscopic mirror, which is equivalent to giving the operator the third arm, adding one hand, and improving the stability of the image and shortening the operation time. However, there are also great challenges. 1 The heart can not contract, and the space under special beating is limited. It is difficult to expose and accurately locate the coronary lesion. 2 Due to the lack of tactile feedback, it is difficult to select anastomotic. 3 target vessel calcification and bleeding are more difficult to fit. 4 The mechanical arm knotted lacks a moderate elastic feedback.

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