The Future of Endoscopic Surgery in Gynaecology
often outside the field of medicine and surgery. Researchers in several countries are testing the hybrid system of Microsoft® Kinect™ combined with robotic technology. The teams from the Czech Republic, Israel and the US are working to combine Kinect with a robotic arm to create a ‘scrub nurse’ system. Responsive to the ‘gesture interface’, this system will potentially simplify human-to-robot interactions in the OR of the future. Another team of researchers is fusing Kinect with the existing da Vinci surgical console, testing the wireless control of robotic arms using popular game gesture recognition technology (see Figure 12).
The introduction of light spectrum differentiation into laparoscopic and minimally invasive gynaecological surgery is the next step towards the development and refinement of future surgical techniques. One example is the use of narrow-band imaging (NBI) in laparoscopic and robotic surgery.14
Utilising the optical filter built
into the laparoscopic light source, the surgeon’s ability to differentiate the interface between normal tissue and blood vessel, for example, is greatly enhanced. Narrow-spectrum wavelengths between 415 nm and 540 nm are absorbed by the haemoglobin in the blood vessels, allowing better precision in tissue dissection. This feature becomes particularly helpful in instances where haptic feedback is lacking, such as in robotic surgery. Several studies are under way utilising NBI properties in the detection and treatment of gynaecological malignancies, both with ‘straight’ laparoscopy and robotic techniques.
Conclusion
In conclusion, it is safe to assume that in the next few decades most surgeries will be performed with the help of computer-enhanced and robotic technology. As of now, the introduction of the new concept of the hybrid OR is gaining momentum in many hospitals worldwide Equipped with state-of-the-art imaging technology and diagnostic instrumentation, it will allow surgeons and assistants to utilise not just the computer-enhanced 3D vision provided by software, but also realtime imaging capabilities, bringing surgical sophistication to a new level and potentially heralding a new era of ‘technosurgery’.
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Figure 12: Kinect™ and a da Vinci Robotic Surgical System Controlled by Custom-built Software at the Johns Hopkins University Laboratory for Computational Sensing and Robotics
As a result of this fundamental shift in surgical technology and the widespread availability of computerised medical devices, the training of future surgeons will need to be adjusted to fulfil their future roles in the OR. Utilisation of virtual reality (VR) simulation in everyday routine skills exercises will become a required part of medical school, post-graduate and speciality training. With competition from several companies, multiple available surgical platforms will make the technology widely accessible and financially feasible in the near future. Training the next generation of gynaecological surgeons, with their innate ability for computerised interaction and operation of remote objects, will revolutionise the field of surgery in general, and gynaecology in particular. Incorporation of tele-mentoring and tele-presence surgery with the development of high-fidelity dedicated connections between medical centres worldwide will allow exchange of expertise and surgical knowledge that is far superior to the current standards and practices. Development of new instrumentation, fusion of 3D imaging, radiologic studies, computer-enhanced technology and miniaturisation of invasive tools will herald a new era of minimally invasive gynaecological surgery. n
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robotics in minimally invasive gynecologic surgery, J Minim Invasive Gynecol, 2009;16(3):291–301.
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