[Geometry of laparoscopy, telesurgery, training and telementoring]

Area of Science:

• Minimally invasive surgery
• Surgical robotics
• Surgical training

Context:

• Laparoscopic surgery is limited by reduced degrees of freedom (DOF), impacting complex procedures like radical prostatectomy.
• Technological advancements such as surgical robots, computer simulators, and telementoring aim to overcome these limitations.
• Existing 3D systems have shown limited effectiveness due to handling issues.

Purpose:

• To evaluate the efficacy of alternative solutions for the range of motion limitations in laparoscopic surgery.
• To analyze the current literature and personal experience with robot-assisted surgery and novel training methods.
• To assess the value of surgical robots, computer simulators, and telementoring.

Summary:

• Robot-assisted surgery, including 244 procedures with AESOP and 6 with da Vinci, was evaluated.
• Experimental studies focused on laparoscopy geometry and training concepts like pelvitrainers and computer simulation.
• The da Vinci system offers 6 DOF and stereovision, with over 100 procedures performed, but showed no advantage over conventional laparoscopy.
• ZEUS with SOKRATES enables long-distance telemanipulation and telementoring.
• High costs limit the widespread adoption of robotic systems.

Impact:

• Robot-assisted surgery is a significant development in surgical research.
• Audiovisual telementoring is expected to be crucial for future surgical training.
• The necessity of telemanipulation and telesurgery remains undetermined.
• Further research is needed to clarify the role and benefits of robotic systems in complex laparoscopic procedures.