title: A comprehensive review of anti-reflux procedures completed by computer-assisted tele-surgery.
abstract: Gastro-esophageal reflux disease (GERD) is the most common esophageal disorder. Although GERD is an illness primarily treated by medical management, patients refractory to, or those unwilling to endure long-term medical therapy often undergo anti-reflux surgery. Laparoscopic surgery made the surgeon's task technically more challenging. While laparoscopy provides a good field of vision, all depth perception is lost. Furthermore, the movements of the chopstick-like instruments are counter-intuitive with limited degrees of freedom, diminished tactile feedback, and disassociated movement. Now that advanced minimally invasive surgeons have acquired the necessary skills to overcome these hurdles, technology has developed a way to make laparoscopic surgery easier. The latest advance in laparoscopic surgery is computer-assisted telesurgery (CATS) which allows the surgeon to be seamlessly submerged into the surgical field while being seated at a distance from the patient. The technological advances afforded by CATS make minimally-invasive surgery easier by adding stereoscopic vision, which provides depth perception, and the endo-wrist, which provides wrist-like dexterity within the abdominal cavity. The advantages of CATS are: the ergonomic positioning of the surgeon thus decreasing fatigue; stereoscopic vision with possibility of 10x magnification; wrist-like manual dexterity with intuitive motion; motion-scaling and tremor elimination all of which enhance precision and accuracy. A small yet growing body of evidence has provided information which suggests that the use of CATS for anti-reflux surgery is equivalent to the current gold standard, unassisted laparoscopy.
authors.affiliation: Department of Surgery, Minimally-Invasive Surgical Training Centre, The Johns Hopkins University, Baltimore, MD 21287-4665, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Aurora
authors.forename: M A
authors.initials: MA
authors.lastname: Talamini
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006804:Ergonomics; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012371:Robotics; D012449:Safety; D025321:Surgery, Computer-Assisted; D013525:Surgical Instruments; D013997:Time Factors