Beruflich Dokumente
Kultur Dokumente
Robotic Surgery
Pembimbing
dr. M Iqbal Rivai, SpB KBD
I. ARNIF
Definition
Modern technology and surgical innovation
Minimal somatic and psychological trauma
Shorten operating time, shorten hospitality, faster
recuperation
trauma
Exposure to atmoshere evaporation
Adhesion
Handling intestines adynamic ileus
demanding)
No tactile feedback (laparoscopic USG)
convert to an open operation isnt a complication
Arterial bleeding
Large pieces of resected tissue
Improvement
Hand assisted laparoscopic surgery
Ultrasonic dissection, tissue fusion device, tissue
Robotic surgery
Mechanical device
Automatic physical tasks
Direct human supervision
Redefined program/general guidelines
Artificial intelligence techniques
(robotic wrist)
Large external movement limited internal
movement (robotic hand)
Ergonomic place, less stress, higher concentration
preoperative evaluation
History
Examination
Premedication
Prohylaxis against thromboembolism
Urinary catheters and nasogastric tubes
Informed consent
Preoperative problems
Previous abdominal surgery
obesity
Operative problems
Intraoperative perforation, bleding (operative)
correct plane
Bleeding from trocar site upwards and lateral
pressure with the trocar
pressure (folley balloon catheter), and sutures
Blood clots avoid by careful dissection,
identification of artery
Routine 5000-7000 units heparin per litre of
irrigation fluids, small pool irrigation fluid, suction
Postoperative care
Complaints: upper abdominal pain (dull), nausea,
hospital
Sutures non absorbable in 7 days
Mobility and convalescence. move A.S.A.p
Robotic disadvantages
Increased cost
Increased set up of the system and operating time
Sosioeconomic implications
Significant risk of conversion to convensional
techniques
Prolonged learning curve
Multiple repositioning of the arms can cause trauma
Haemostasis
Collision of the robotic arms in extreme positions
Further developments
Natural Orifice Translumenal endoscopic surgery
(NOTES)
Single Incision Laparoscopic surgery (SILS),
Laparoendoscopic singlesite surgery (LESS), Single
port Access (SA)
NOTES
SILS
The future
No change in nature of disease
Training is a key to progress
Robotic surgery now available not only for assisting,
Terima Kasih