Table Of ContentKazunori Kihara
Editor
Gasless Single-Port
RoboSurgeon Surgery
in Urology
123
Gasless Single-Port RoboSurgeon Surgery
in Urology
Kazunori Kihara
Editor
Gasless Single-Port
RoboSurgeon Surgery
in Urology
123
Editor
KazunoriKihara
GraduateSchoolofMedicalandDentalSciences
DepartmentofUrology
TokyoMedicalandDentalUniversity
Tokyo,Japan
ISBN978-4-431-54504-0 ISBN978-4-431-54505-7 (eBook)
DOI10.1007/978-4-431-54505-7
LibraryofCongressControlNumber:2015945333
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Preface
Theaimofthisbookistodemonstratehowtoperformgaslesssingle-portretroperitoneoscopic
surgeriesinurologyassistedbyasystem(RoboSurgeon)thatinvolvestherobotizationofthe
surgeon.Thissurgeryachievesfourkey“no’s”:nohighcosts,noCO ,nomultipleports,and
2
nointraperitonealinjury.Theadjustableportsizeandwidedirectviewensuresafetyandease
inlearning.Additionally,prophylacticantimicrobialagentsarefundamentallyunnecessaryin
theperioperativeperiod.
Laparoscopicsurgeryoffersreducedpain,fasterpostoperativerecovery,andbettercosmetic
results. Additionally, a master–slave type robot has improved surgical dexterity due to the
use of three-dimensionalimagesand multiarticularforceps.The presentedsurgerymayhelp
overcomesome of the disadvantagesof currentminimallyinvasivesurgicaltechniques(e.g.,
highcosts)whileretainingtheirmajorbenefits.
TheRoboSurgeonsystemconsistsofthreecomponents:athree-dimensionalhead-mounted
display,handheldrobot-likedevices,andanendoscopemanipulationrobot.Dependingonthe
conditions,partorallofthissystemwillbeused.Wewouldliketoemphasizethatevenwithout
theRoboSurgeonsystem,gaslesssingle-port-likesurgery,inwhichtheportsizeissomewhat
larger,canbeperformedbyfollowingtheprocedurespresentedherein.
The surgery described here offers positive responses to the following questions on mini-
mallyinvasiveurologicalsurgeries.
• Issingle-portaccesspossiblewithoutdifficulty?
• Isgaslessandsingle-portaccesspossible?
• Isaretroperitonealapproachcombinedwiththeabovepossible?
• Isrobotizationofthesurgeonconducivetothistypeofsurgery?
• Isthesurgeryaffordable?
• Doesthesurgeryensureoncologicefficacyandhigh-qualityperioperativeresults?
• Isavoidanceofprophylacticantimicrobialagentspossible?
• IstheRoboSurgeonsystemapplicabletovariousfieldsofsurgeryandmedicalcare?
Wewouldliketogiveapreliminary“yes”responsetoeachoftheabovequestions,although
further innovation and improvementsare needed to achieve a truly ideal form of minimally
invasivesurgery.
It is our hope that this surgery, which we have been developing for more than 15 years,
may contribute to societies that are now commonly facing issues of super-aging and highly
expensivemedicineandthatourfindingsmayleadtoanewdirectioninurologicsurgery.For
these purposes, this book is written in a plain and concise manner so as to reach as many
readersaspossible.
Tokyo,Japan KazunoriKihara
February,2015
v
Acknowledgments
Iwouldliketoexpressmyprofoundappreciationtothefollowingindividuals(inalphabetical
order)fortheircontributionincreatingthisbook.
Presentcoworkers:
Yasuhisa Fujii, Masaharu Inoue, Junichiro Ishioka, Masaya Ito, Naoko Kawamura, Toshiki
Kijima, Masaki Kobayashi, Yoh Matsuoka, Shingo Moriyama, Yuki Nakamura, Takayuki
Nakayama, Noboru Numao, Kazutaka Saito, Hajime Tanaka, Manabu Tatokoro, Yuma
Waseda,MinatoYokoyama,SoichiroYoshida
Ourdoctors:
SaoriAraki,ChizuruArisawa,ToukoAsano,KojiChiba,ShoheiFukuda,NaotakaFukui,Hi-
roshiFukushima,NobutakaIchiyanagi,YasumasaIimura,YudaiIshikawa,KazuhiroIshizaka,
AkiIwai,ToshibumiIzutani,MakotoKagawa,YukioKageyama,ShigeyoshiKamata,Toshi-
hiro Kanda, Hideto Kano, Satoru Kawakami, Keizo Kawano, Satoshi Kitahara, Sachi Ki-
tayama, Nobuyuki Kobayashi, Shuichiro Kobayashi, Tsuyoshi Kobayashi, Fumitaka Koga,
Yusuke Kohno, Yoshinobu Komai, Hitoshi Masuda, Akitetsu Miyagawa, Shinji Morimoto,
Katsushi Nagahama, Hideki Nagamatsu, Kazuaki Nakagomi, Yasukazu Nakanishi, Akira
Noro, Yukihiro Ohtsuoka, Hideyuki Ohashi, Kazuhiro Ohya, Yohei Okada, Tetsuo Okuno,
YasuyukiSakai,MizuakiSakura,MasahitoSuzuki,RyojiTakazawa,HidekiTakeshita,Masaki
Tanaka,ToshiyaTerao,MasahiroToide,AkiraTosaka,ToshihikoTsujii,TetsuroTsukamoto,
Yusuke Uchida, Sho Uehara, Masayasu Urushibara, Akihiro Yano, Masataka Yano, Yosuke
Yasuda,JunjiYonese,SatoshiYoshida,AtsushiYoshinaga,ShujiYoshino,TakumiYamada
Secretaries:ErikoOkamoto,KumiTakeda
Moralsupporter(previousprofessor):HiroyukiOshima
Supporters:
Doctors:
KohzohFuji (Showa University),KenjiKawashima (TokyoMedical andDental University),
KiyotakaKawashima(TochigiCancerCenter),KazuyukiKojima(TokyoMedicalandDental
University), Tatsuya Nagai (ToyohashiMunicipalHospital), Tomoyasu Tsushima (Okayama
MedicalCenter),HidekiYoshida(ShowaUniversity)
Engineers:
Tsuneo Fukuyo (Shinko Optical), Takeshi Maeda (Sony), Takamasa Nakamura (Sony),
TomoyukiOhki(Sony),
Friend:
AkiraHoriguchi(Medicon,KobayashiPharmaceutical)
vii
Contents
1 FundamentalsofGaslessSingle-PortRoboSurgeonSurgery ................ 1
KazunoriKihara
1.1 Introduction...................................................... 1
1.2 GeneralConcept.................................................. 2
1.3 GaslessSingle-PortSurgery ........................................ 4
1.3.1 ApproachandPositioningofthePatient....................... 4
1.3.2 WorkingSpace............................................ 4
1.3.3 SinglePort ............................................... 5
1.4 RoboSurgeonSystem.............................................. 6
1.4.1 Three-DimensionalHead-MountedDisplay.................... 6
1.4.2 HandheldRobot-LikeDevices............................... 6
1.4.3 EndoscopeManipulationRobot.............................. 8
1.5 CommonlyUsedDevices .......................................... 8
1.6 AdvantagesandDrawbacksofThisSurgery........................... 10
1.7 ApplicationtoTransurethralExamination/SurgeryandPatient’sUse ...... 15
1.8 SurgeryWithouttheRoboSurgeonSystemandTransition
fromOpenSurgery................................................ 16
References............................................................. 20
2 GaslessSingle-PortRoboSurgeonRetroperitoneoscopicRadical
Nephrectomy.......................................................... 23
KazunoriKihara,YasuhisaFujii,KazutakaSaito,FumitakaKoga,
NoboruNumao, YohMatsuoka, JunichiroIshioka, MinatoYokoyama,
andHitoshiMasuda
2.1 Introduction...................................................... 23
2.2 GeneralConcept.................................................. 24
2.3 PreoperativePreparation ........................................... 25
2.4 Instruments ...................................................... 25
2.5 SurgicalTechniques............................................... 25
2.5.1 Principle ................................................. 25
2.5.2 FlowchartoftheProcedure.................................. 26
2.5.3 PatientPositioning......................................... 27
2.5.4 PortPlacement............................................ 27
2.5.5 HoldingtheUreter......................................... 27
2.5.6 TransectingtheRenalArteryandtheUreter.................... 28
2.5.7 TransectingtheRenalVein.................................. 28
2.5.8 CompletelyFreeingtheKidneyCoveredwithPerinephricFat..... 31
2.5.9 ExtractingtheKidneyCoveredwithPerinephricFat............. 32
2.5.10 ClosingthePort ........................................... 33
ix
