The Surgical clinics of North America
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At the present time, the decision to resect and the choice of the extent ofa hepatic resection are largely based on surgical judgment. The CP score is the best assessment tool we can now employ. There is uniform agreement that even segmental resections are not possible in the vast majority of Child Class B patients, CP score 7 to 9. ⋯ For hepatocellular carcinoma or metastasis in cirrhotic patients, portal vein occlusion may be the best way to improve hepatic functional reserve. ICG retention may not corroborate return-to-baseline hepatic function within 2 weeks of portal vein occlusion,but may demonstrate a return to baseline when studied 6 to 8 weeks following the procedure. 99m-Tc-GSA is presently the best means to document compensatory hyperplasia and, possibly, a shift of functional reserve to the planned remnant of a more than four-segment hepatic resection. Whether this will predict the safe outcome of resection remains to be seen.
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Ultimately, neurosurgery performed via a robotic interface will serve to improve the standard of a neurosurgeon's skills, thus making a good surgeon a better surgeon. In fact, computer and robotic instrumentation will become allies to the neurosurgeon through the use of these technologies in training, diagnostic, and surgical events. ⋯ The future operating room should be regarded as an integrated information system incorporating robotic surgical navigators and telecontrolled micromanipulators, with the capabilities of all principal neurosurgical concepts, sharing information, and under the control of a single person, the neurosurgeon. The eventual integration of robotic technology into mainstream clinical neurosurgery offers the promise of a future of safer, more accurate, and less invasive surgery that will result in improved patient outcome.
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Most endoscopic procedures are excisional, not reconstructive or microsurgical, mostly because conventional endoscopic instrumentation lacks dexterity due to long, nonarticulated instruments, a fixed pivot point and counterintuitive movement of the instrument tip, and lack of depth perception. Endoscopic approaches to cardiac surgery have not been successful; however, the development of robotic surgical systems has overcome many limitations of endoscopy. ⋯ Recently, robotic systems have allowed cardiac surgeons to perform minimally invasive endoscopic coronary artery bypass grafting (CABG) and valve procedures. This article summarizes the use of robotics in cardiac surgery and discusses its potential in our specialty.
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A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. ⋯ Traditional valve operations still enjoy long-term success with ever-decreasing morbidity and mortality, and remain our measure for comparison. Surgeons must remember that we are seeking the most durable operation with the least human trauma and quickest return to normalcy, all done at the lowest cost with the least risks. Although we have moved more asymptotically to these goals, surgeons alone must map the path for the final ascent.
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Surg. Clin. North Am. · Dec 2003
Biography Historical ArticleRobotic surgery: from past to future--a personal journey.
A review of the history of robotic surgery--from its beginnings in a collaboration of engineers, computer scientists, and a plastic surgeon from Stanford Research Institute (SRI) and the NASA-Ames Research Center to the next generation of systems on the drawing board in the Department of Defense--provides a rich and colorful look at the author's participation in its development. Although Dr. Satava has participated in the development of other systems (orthopedic, ophthalmologic, and neurosurgical) that have contributed to the current distribution of robotic, computer-aided, and image-guided surgical systems, this article focuses on the development of the telemanipulation systems used for thoracic, abdominal, and pelvic surgery. Based upon emerging technologies, speculation is provided on the next generation of systems.