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