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Chirurgiarobotica1 PDF
Chirurgiarobotica1 PDF
CHIRURGIA ROBOTIC
S. Lunc *, G. Bouras **
* Spitalul Clinic de Urgene Iai, Universitatea de Medicin i Farmacie Gr. T. Popa Iai
** IRCAD, Hpital Universitaire de Strasbourg
LUniversit Louis Pasteur, Strasbourg, France
ROBOTIC SURGERY (Abstract):. With the advent of laparoscopy and computer technology, surgery stepped in
a new era. Robotic surgery appeared as a logical consequence of this at the end of 80s. Surgical robotic systems
are used today to apply minimally invasive procedures to the surgical treatment of diseases in a wide range of
fields: neurosurgery, cardio-vascular, orthopedics, urology, gynecology, general surgery. While cardiac surgery
or urology took great advantages of robotic surgery, general surgery is still in infancy. Only few operations are
done today using robotics in the field of general surgery. DaVinci surgical system represents today the most
advanced robot used in clinical practice. Robotic surgery demonstrated to be safe and feasible, offers better
visualization, improved dexterity and high level of precision. Whereas robotic systems promised great
advantages over laparoscopic and open surgery, clinical reports demonstrating improved outcomes are lacking
for abdominal surgery. Main drawbacks of robotic systems seems to be the absence of feed-back and extremely
high costs.
Coresponden: Dr. Lunc Sorinel, Spitalul Clinic de Urgene Iai, Clinica de Urgene Chirurgicale, Str. Gen.
Berthelot nr. 2, Iai, tel: 0232 216586, e-mail: slunca@hotmail.com
INTRODUCERE
Lumea a fost ntotdeauna fascinat de roboi. Oamenii au visat s construiasc, s
foloseasc, s se bucure de avantajele acestora. Dac la nceput erau prezeni doar n
imaginaie, n cri, astzi au devenit o realitate. Scriitorul ceh Karel Capek n 1920 a fost
primul care a utilizat cuvntul robot n piesa sa Rossums Universal Robots, o parodie la
dezumanizarea omului ntr-o lumea prea tehnologizat. Termenul de robotic, tiina care se
ocup cu studiul roboilor a fost utilizat pentru prima dat de Isaac Asimov n povestirea sa
Runaround. Cu aceast ocazie el stabilete i primele legi pe care trebuie s le respecte
roboii: acetia trebuie s se supun oamenilor doar dac aceasta nu contravine unei legi
superioare: umanitatea trebuie protejat mai presus de oameni.
Un robot este definit ca o main ce poate semna fiinei umane i care ndeplinete
mecanic sarcinile acesteia, fiind lipsit de emoii i sentimente sau o main care utilizeaz o
inteligen apropiat de cea uman. Tehnologia roboilor a fost utilizat deja de muli ani n
diferite domenii, altele dect cele medicale, aa cum sunt industria automobilelor, mediul
subacvatic, spaiul extraterestru sau zonele cu risc de radiaii nucleare.
SISTEME ROBOTICE
Chirurgia a profitat relativ trziu de avantajele acestei tehnologii. Utilizarea iniial a
roboilor n chirurgia a nceput la sfritul anilor 80 cnd un robot industrial a fost utilizat
pentru a susine instrumentele pentru biopsie stereotactic n neurochirurgie. Tot la sfritul
anilor 80 IBM a construit primul robot utilizat n practica clinic, numit Robo-doc [1].
Prima utilizare a unui robot n chirurgia uman a fost pentru o rezecie transuretral a prostatei
[2]. n 1993 Computer Motion, Inc., a introdus un bra controlat prin voce, AESOPTM
(Automated Endoscopic System for Optimal Positioning), utilizat pentru susinerea
instrumentelor, a opticului n chirurgia laparoscopic. Varianta sa, AESOPTM 2000 este
primul robot controlat prin voce uman aprobat de Food and Drug Administration din Statele
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Articole de sinteza Jurnalul de Chirurgie, Iasi, 2005, Vol. 1, Nr. 2 [ISSN 1584 9341]
Alte dou brae, utiliznd instrumente daVinci specifice, sunt capabile de a se mica
cu 7 grade de libertate, simulnd micrile braului, umrului i pumnului (Fig.2).
Interfaa computerizat este cea care semneaz diferena major dintre chirurgia
robotic i cea tradiional. Micrile chirurgului sunt digitalizate, aceast informaie
digitalizat este apoi manipulat de computer pentru a controla ntr-un mod ct mai perfect
micrile chirurgicale. Digitalizarea micrilor minilor permite eliminarea tremorului i
produce o mrire a exactitii de pn la cinci ori, crescnd astfel precizia operatorie.
mbuntirea ergonomiei reprezint un alt avantaj al sistemului daVinci. Chirurgul st aezat
la consola sistemului, plonjat n cmpul chirurgical, este mai puin distras, cu un confort
operator crescut, toate acestea considerndu-se c ajut ca performanele chirurgului s
rmn optime o perioad mai lung de timp (Fig.3).
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Articole de sinteza Jurnalul de Chirurgie, Iasi, 2005, Vol. 1, Nr. 2 [ISSN 1584 9341]
Din datele care exist la aceast or n literatur se poate spune c sistemul robotic
daVinci ofer o mai bun vizualizare, o dexteritate mbuntit, reducerea oboselii, un nivel
crescut al preciziei gesturilor, dar costurile sunt nc mari.
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Articole de sinteza Jurnalul de Chirurgie, Iasi, 2005, Vol. 1, Nr. 2 [ISSN 1584 9341]
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