Abstrakt Technologie Leden 2010

“Umbilicus, navel, belly button-Vitruvian guide for esthetic cosmetics: A da Vinci code for beautiful informed consent.”

Agarwal, B. B. (2010).

Surgical Endoscopy and Other Interventional Techniques 24(1): 236-238.




“Transvaginal NOTES nephrectomy: first clinical experiment.”

Crouzet, S., G. P. Haber, et al. (2009).

Néphrectomie NOTES transvaginale : première expérience clinique 19(4).


Introduction: Natural orifice transluminal endoscopic surgery (NOTES) or scarless surgery offers the potential for reduced comorbidities. Herein, we present the first NOTES transvaginal nephrectomy in human. Methods: NOTES transvaginal nephrectomy in a 57-year-old woman. A multidisciplinary team carried out the procedure. Pneumoperitoneum was achieved using a transumbilical Veress needle. Transvaginal port was placed through a posterior colpotomy. A 5 mm port was used to control the safe placement of the transvaginal port. Using articulated instruments, the kidney was mobilized and the renal hilum controlled with an EndoGIA. The kidney was extracted through the vaginal incision. Results: Visualization, renal dissection, hilar control and extraction were performed transvaginally. The 5 mm umbilical port was only used to control vaginal port placement and retraction of the colon during hilar stapling. No intra or postoperative complications occurred. Hospital stay was 23 hours. Conclusion: NOTES transvaginal nephrectomy is technically feasible. Instrumentation is limited. Future study is needed to better define patient selection and advantages of this technique. © 2009 Elsevier Masson SAS. All rights reserved.




“Single incision laparoscopic surgery (SILS) using cross hand technique.”

Ishikawa, N., Y. Arano, et al. (2009).

Minimally Invasive Therapy and Allied Technologies 18(6): 322-324.


Single incision laparoscopic surgery (SILS) was developed as a less invasive surgical procedure, but it remains difficult because of its specific skills and left-right reversal of the instruments. Such a difference makes manipulating endoscopic instruments more challenging and increases the risk. In this study, we introduce the cross hand technique allowing the surgeon to manipulate instruments with intuitive movement.




“Laparoscopic cholecystectomy with single incision laparoscopic surgery.”

Misiak, A. and A. B. Szczepanik (2009).

Cholecystektomia laparoskopowa wykonywana metoda̧ jednego ciȩcia 27(161): 372-374.


For the last seventeen years laparoscopic cholecystectomy has remained the gold standard procedure for gallbladder surgery. The single incision laparoscopic surgery (SILS) approach is a step toward less invasive surgery and the intraumbilical access improves the cosmetic effect (no scar surgery). The aim of the study was to present our preliminary experience in laparoscopic cholecystectomy through single intraumbilical incision. Material and methods. Three patients with gallbladder symptoms (2 female, 1 male) underwent surgery through single intraumbilical incision. In two cases the procedure was performed with three 5 mm Dexide port approach and in one, with a flexible rubber/gel SILSTM- Port (Covidien, USA) access. A simple 5 mm optics was employed. In two procedures the following disposable instruments were used: roticulator Endo dissect, roticulator Endo grasp, mini Sears scissors as well as standard hook and clips while for the third procedure, a conventional multi-use grasp and roticular Endo dissect. The gallbladder was elevated to the integuments by two sutures to expose Calot’s triangle and bladder site. Following exposure, the bile duct and the vesical artery were clipsed and cut routinely to remove the gallbladder in a plastic bag through the bell- button. After procedures no drains were left in the peritoneal cavities. Results. In all three cases the laparoscopic procedure was performed. The median operative time was 88 min. In one female patient, bleeding into the peritoneal cavity was reported and called for laparotomy within a few hours of laparoscopic procedure. Intraoperatively, the branch of vesical artery was sutured to arrest bleeding. The median hospital stay following procedure was 3, 8 and 5 days respectively. After the procedure, the last female patient was observed to have pharyngitis and enlarged jugular lymph nodes that abated after antibiotic therapy. Conclusions. Single-incision laparoscopic cholecystectomy should be performed by experienced laparoscopic surgeons. For adequate evaluation of the efficacy and safety of this procedure it is necessary to perform further clinical studies on a larger number of patients.




“Natural orifice surgery (NOS)-Toward a single-port transdouglas approach for intra-abdominal procedures.”

Stark, M., G. C. Di Renzo, et al. (2010).

European Journal of Obstetrics Gynecology and Reproductive Biology 148(2): 114-117.


Objective: To describe a future method for abdominal surgical procedures in women using a single-port Transdouglas Endoscopic Device (TED). Methods and description: The first successful laparotomy was performed in the 19th century, and the first endoscopic operation in the 20th century. The 21st century started with experimental operations using the natural body openings. Various abdominal procedures have already been performed through the stomach, but it seems that the transdouglas pathway in women is the most promising access into the peritoneal cavity, for its safety and cost-effectiveness. The TED is designed to perform operations in the upper and the lower abdomen. The New European Surgical Academy (NESA) founded the first European based interdisciplinary working group in order to plan and design instruments toward future gynaecological, urological and surgical applications. Conclusion: The single-port TED is expected to replace many of today’s endoscopic procedures due to its probably higher safety and better ergonomics. © 2009 Elsevier Ireland Ltd. All rights reserved.




“Robotic single-site surgery.”

White, M. A., G. P. Haber, et al. (2010).

Curr Opin Urol 20(1): 86-91.


PURPOSE OF REVIEW: Minimally invasive urology is rapidly advancing, and single-site laparoscopic surgery is being explored clinically. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing. RECENT FINDINGS: The da Vinci surgical system, with its Endowrist technology, three-dimensional visualization, and motion scaling, has recently been used during single-site surgery, with the aim of reducing technical challenges posed by single-site surgery. To date, we have completed a total of 13 robotic single-site surgeries utilizing the da Vinci system. A total of seven kidney procedures and six pelvic procedures were completed. Total operative time of 195 and 258 min, estimated blood loss of 184 and 175 ml, and hospital stay of 2.3 and 2.8 days were observed for the kidney and pelvic single-site robotic surgery, respectively. SUMMARY: Robotic single-site surgery is feasible and effective using current robotic system, however, with considerable limitations. Robotic systems designed specifically for single-site approach have the potential of alleviating several of the limitations, which exist with traditional laparoendoscopic single-site surgery.




“Single-Port Laparoscopic Salpingectomy for the Surgical Treatment of Ectopic Pregnancy.”

Yoon, B. S., H. Park, et al. (2010).

Journal of Minimally Invasive Gynecology 17(1): 26-29.


Study Objective: To evaluate the feasibility of a single-port laparoscopic salpingectomy in the surgical treatment of tubal pregnancy. Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: University teaching hospital. Patients: Twenty women with tubal pregnancy, as determined by ultrasonography. Intervention: All patients have undergone single-port laparoscopic salpingectomy. Entry through a single port was established with a wound retractor as fascial retractor and a surgical glove, which served as the working channels for the laparoscopic equipment. A 30-degree laparoscope and a rigid or flexible grasper were used during the procedure. Measurements and Main Results: Single-port laparoscopic salpingectomy was successfully performed in all 20 patients with ectopic pregnancy. The median operative time was 55 minutes (range 25-85 minutes), and blood loss in all patients was minimal. The median difference between preoperative and postoperative hemoglobin was 1.8 g/dL (range 0-3.2 g/dL). The median postoperative hospital stay was 2 days (range 2-4 days). No complication was encountered, nor was there any need for conversion to conventional laparoscopy. Conclusions: Single-port laparoscopic salpingectomy is feasible and promising. However, for drawing the definite conclusion of the surgical efficacy, additional investigations to compare this approach with conventional laparoscopy are needed. © 2010 AAGL.




“Potential applications of medical and non-medical robots for neurosurgical applications.”

Alric, M., F. Chapelle, et al. (2009).

Minimally Invasive Therapy and Allied Technologies 18(4): 193-216.


The objective of the paper is to review the state-of-the-art in medical robotic systems used for different surgical applications, and to position and evaluate their concepts according to the design requirements of an innovative, robotized neurosurgical system, capable of performing tumor ablation or electrode positioning. A few other non-medical systems, which have interesting concepts, will also be discussed. The overall aim is to determine the robotic concept (structure, actuation, etc.) most applicable to specific tasks in neurosurgery. The first section of the article describes the requirements of the task and each important aspect is expressed by an evaluation criterion. Then, 59 systems are described, according to the fields of medical applications and the robotic concepts. An evaluation of the different systems is conducted, based on the five most significant criteria. However, the main characteristic assessed is the deployment capability of the system i.e. extension and retraction. The final section presents an overview of concepts transferable to neurosurgical applications. Continuum concepts, such as elephant trunks, seem to be the most adapted solutions, utilizing pneumatic and/or spring and/or cable actuations. Pneumatics offer deployment forces and cables can control and guide the deployment. The design of a new neurosurgical device should take into account these observations as a base. © 2009 Informa UK Ltd.




“Robotic technology in ophthalmic surgery.”

Jeganathan, V. S. and S. Shah (2010).

Curr Opin Ophthalmol 21(1): 75-80.


PURPOSE OF REVIEW: To provide an overview of the history, development, and potential applications of robotic technology, with a focus on ophthalmic surgery. An extensive literature review and authors’ own perspectives were taken into account in selecting the most relevant articles from MEDLINE and Google scholar. RECENT FINDINGS: Most surgical specialties have introduced robots in current use. Although the application of robots in ophthalmic surgery is in its infancy today, its advantages and great potential is quite apparent. As robotics transcends utility and attain wider consensus among the surgical profession, ophthalmologists must acquaint themselves with this novel interdisciplinary field and its relevance to their specialty. SUMMARY: Future possibilities, including the prospects for nanotechnology in ophthalmology, are awaited.




Tests on cardiosurgical robot robin heart 3

Podsedkowski, L. and P. Zak (2009)..

396: 433-442.