Shinichiro Okada

Single-surgeon thoracoscopic surgery with a voice-controlled robot

The purpose of applying high-technology innovations to endoscopic surgery is for computers and robotics to play the part of an operating surgeon assistant. We investigated the use of a voice-controlled robot arm compared with a human surgical assistant during thoracoscopic surgery. From January, 1995, to October, 1997, 34 patients, aged 14 to 80 years with thoracic diseases were involved in this study. 17 thoracoscopic procedures (partial resection of the lung, 15; removal of the mediastinal tumour, 2) were done by a thoracoscopic surgeon assisted by a voice-controlled robot arm. Operative time, time for setup and breakdown of the operative field, number of times a thoracoscope required cleaning per hour, and complications were compared with 17 human-assisted thoracoscopic procedures (partial resection of the lung, 15; removal of the mediastinal tumour, 2). The patient was placed in the lateral position with general anesthesia and single-lung ventilation. The main body of the robotic arm was established on the operating table anterior to the patient’s thigh (figure). The first trocar was placed in the midaxillary line, in the 5th intercostal space. The thoracoscope connected with the robotic arm was inserted through the trocar. Other trocars, 12 mm and 10 mm in diameter, were placed in the 4th intercostal anterior and posterior axillary lines, respectively, and instruments, such as a grasper and an automatic stapler, were inserted through the trocars. The operating surgeon registered 23 distinct voice commands into a voice card by means of a voice trainer. All procedures were successfully completed with only one surgeon and did not require human assistance. No technical operative mishaps related to robot-assisted thoracoscopic manoeuvres occurred. Operation times between with the robot and human assistants were not statistically different. There was no statistical difference between the setup and breakdown times. The mean number of times that the thoracoscope was removed from the thoracic cavity to clean the tip were 1·16 with the robot and 3·9 with human assistance (p<0·05). There were no postoperative complications during the follow-up period. We have found that use of a voice-controlled robotic arm as a substitute for a surgical assistant is feasible and may be cheaper. 1 Rininsland HH. Basics of robotics and manipulators in endoscopic

Emergent Bronchofiberoptic Bronchial Occlusion for Intractable Pneumothorax with Severe Emphysema

Emergent bronchofiberoptic bronchial occlusion using fibrin glue and woven polyglycolic acid mesh for persistent pneumothorax with severe emphysema is described. A 74-year-old man who had severe pulmonary dysfunction accompanying chronic emphysema was admitted with a complaint of sudden severe dyspnea. The chest X-ray on admission revealed collapse of the right lung. The patient was placed on a mechanical ventilator because of acute respiratory failure. In spite of continuous suction through a chest drainage tube, air leakage persisted. On the seventh hospital day, subcutaneous emphysema was apparent in the face and scrotum in addition to the chest. First, a double-lumen catheter was inserted into the right B5 bronchus, and fibrin glue was infused into the drainage bronchus via the double-lumen catheter. However, the procedure failed. Next, a combination of fibrin glue and woven polyglycolic acid mesh which had been cut into small pieces was introduced and pushed into the B5 bronchus using forceps. The air leakage stopped immediately after the administration. This procedure is simple and a minimally invasive method for the treatment of intractable pneumothorax in a compromised patient on a mechanical ventilator.