[Geometry of laparoscopy, telesurgery, training and telementoring].
Laparoscopic surgery in general is handicapped by the reduction of the range of motion from 6 to 4 degrees of freedom. This has a major impact on technically difficult procedures such as laparoscopic radical prostatectomy. Solutions for this problem include understanding the geometry of laparoscopy with sophisticated training programs, but also newly developed surgical robots, computer simulators, and telementoring. This article evaluates the value of these alternatives based on own experience and an analysis of the current literature. Our experience with robot-assisted surgery includes 244 laparoscopic radical prostatectomies using a voice-controlled camera arm (AESOP) and 6 telesurgical interventions with the da Vinci system. Additionally, experimental studies were performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and computer simulation. Three-dimensional systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets, or reduced brightness. At present, there are only two robotic surgical systems (ZEUS, da Vinci) in clinical use for telesurgery, of which only the da Vinci provides stereovision and all 6 degrees of freedom (DOF). In the meantime, more than 100 laparoscopic radical prostatectomies have been performed with this system. However, there was no evidence of any advantages over the conventional laparoscopic approach. The ZEUS in combination with the telecommunication system SOKRATES is the only device that enables telemanipulation and telementoring over long distances (i.e., transatlantic). Robotic surgery represents a turning point in surgical research. However, broad use of robotic systems is limited mainly because of high investment and running costs. Whereas audiovisual telementoring will play a clear role in future training concepts, the need for telemanipulation or telesurgery has not yet been clarified.
Rassweiler
J
J
Urologische Klinik, SLK Kliniken, Klinikum Heilbronn, AM Gesundbrunnen 20, 74074 Heilbronn. jens.rassweiler@klinikum-heilbronn
Frede
T
T
D003198:Computer Simulation; D005060:Europe; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation; D007318:Inservice Training; D020706:Laparoscopes; D008297:Male; D052801:Male Urogenital Diseases / Q000601:surgery*; D008611:Mentors; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000295:instrumentation; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D019114:Remote Consultation / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D013523:Surgical Equipment; D013996:Time and Motion Studies