Page 22 - Journal of WALS

George Chilaka Obonna, RK Mishra

First, let us look at the capability of the current robot the current Si model updated da Vinci with all its
da Vinci. It has a dual console capability which enables enhancement like fluorescence imaging, lightweight
two surgeons to work simultaneously in the surgical field. intelligent camera head, boom compatible vision system,
3D HD vision with up to 10× magnification offering high skills stimulator, multifunction energy control, remains
level of visual acuity and good perception of depth of the unbeatable in task performance especially for complex
hepatobilliary complex and carlot’s triangle with no surgery of MS type 1 and 2.
obscurity by the liver. The digital zoom and high definition Operative cholangiography is advocated to improve the
of the operation field can detect pinpoint fistula better than safety of cholecystectomy, but an accurate transcystic
the human eye. This offers an immense view of the Calot’s cholangiogram will not be possible in MS. A standard
triangle superior to laparoscopic and open surgery. It thus technique in open surgery for the difficult laparoscopic
provides unsurpassed visual clarity for precise visualization cholecystectomy was the fundus first approach. This can
of target anatomy or anomaly. Its endowrist instrumentation- be replicated in laparoscopic surgery by the use of a liver
a multiuse facility with natural dexterity available in 8 and retractor and means that exposure does not rely on traction
8
5 mm diameter ensures refined movement. The intuitive on the fundus of the GB. In MS, the GB is often fibrosed
motion it provides is best for operation at the Calot’s triangle and contracted so that fundic traction gives relatively poor
where avoidance of billiary injury is paramount. It maintains exposure of the hepatobiliary triangle. Also once the GB is
a corresponding eye hand instrument tip alignment allowing freed from the liver, the obliterated Calot’s triangle can be
for intuitive instrument control. Surgeons hand movements more easily evaluated. The highly magnified view combined
are scaled, filtered and seamlessly translated to the robotic with its modern technology makes robotic surgery superior
arms and instrument (Fig. 4). In this type of complex surgery, in most cases.
with robotics there is perfect alignment between visual and
motor axis thus preventing injury to the billiary system.
The ergonomic settings are well-customized with a
surgeons touch pad offering comprehensive control of video,
audio and system settings, unique user profile providing
automatic recall for future cases (Fig. 5). A wide touch
screen with telestration capability facilitates team
communication with improved visualization of anatomy and
instruments entering from the periphery. The integration
with electrosurgical devices enables a bloodless surgery.
The cross-quadrant access means that there are extended
reach instruments offering improved arm range of
movements. The implication is that in the same sitting the
surgeon can conveniently cover all quadrants of the
abdomen unlike in conventional laparoscopic setting. Thus, Fig. 4: da Vinci surgical robot

Fig. 3: Portposition in robotic cholecystectomy Fig. 5: Robotic console
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