M Takahashi, MD1, N Nishinari, MD1, H Matsuya1, M Takahashi, MD2, T Tosha, MD2, Y Minagawa2, C Tono, MD2, T Yoshida2. 1Morioka Yu-ai hospital, 2Iwate Prefectural Kuji Hospital
Introduction: Advancement in both surgical technique and medical equipment has enabled Solo-surgery. ViKY® Endoscope Positioning System (ViKY®) is a robotic system that remotely controls an endoscope and provides direct vision control to the surgeon. Its voice control function offers high degree of freedom to the surgeon. It does not move against the surgeon’s will, and keeps the endoscopic image fine and stable without shaking even in longer cases; this makes Solo-surgery seem more feasible. Despite the increasing use of the transabdominal preperitoneal approach (TAPP) in recent years, there are only a few reports of Solo-surgery with this approach. Here we report our experience with ViKY®-assisted Solo-surgery.
Materials and Methods: ViKY®, with its small-sized, computer-assisted motor, is an endoscopic holder that enables Solo-surgery. It can be easily placed anywhere along the side rail of the operating table, and is designed to be extremely compact. Since July 2013, we retrospectively examined 17 cases of Solo-surgery TAPP with ViKY®. ViKY® was set-up by the surgeon alone, and the set-up duration was determined as the time at which the side rail was positioned and that when the endoscope was installed. For assessing the control unit, the number of false movements was counted. We statistically compared the operative results between ViKY®-assisted Solo-surgery TAPP and the conventional method with an assistant.
Results: The average time to set-up ViKY® was 9.1 minutes. The average number of orders given to ViKY® during each operation was 99.1, whereas the average number of false movements or the case that the control unit did not respond was 8.4. The average operative time was 140 minutes. No case required an assistant during the operation. The average postoperative hospital stay was 2.4 days. No statistical difference was observed in the operative time and postoperative hospital stay between ViKY®-assisted Solo-surgery TAPP and the conventional TAPP with an assistant.
Conclusions: We evaluated ViKY®-assisted Solo-surgery TAPP in a clinical set-up. ViKY® proved reliable in recognizing orders with very few failures, and the operations were performed safely and were comparable to the conventional operations with assistants. Because of the rapid reaction of the endoscopic holder and the extremely clear vision that lasted for longer hours, the stress level was greatly reduced and, thus, the satisfaction of the surgeon was very good. Solo-surgery can also be cost-effective as it does not require any specialized nurses and clinical engineers. Therefore, Solo-surgery with ViKY® seemed beneficial in this clinical evaluation.