During the last decade, as managed ...

During the last decade, as managed care and cost-containment crushings have become the pivot point in managing the health care environment, patients' expectation for state-of-the-art care has remained constant. Considering this, the succes of an institution frequently is dependent on strategies unfolded to balance the need for advanced technology versus the ne to shorten costs.(1)

individual such strategy is institutional focus upon advances in minimally invasive laparoscopic surgery (MILS). The introduction of high-tech productivity within robotic-enhanced technology into the surgical arena dramatically has changed MILS, as well-as; not only-but also; not only-but; not alone-but clinically and economically. Automated endoscopic regularitys are proving to be reliable, cost-effective, and capable of improving quality while providing institutions a competitive advantage.(2)

The intent of this article is to explore and analyze the existing literature to determine

* if use of the robotic arm eliminates the ne for a human surgical assistant and

* if surgical operating time is reduc when using the robotic arm.

TRADITIONAL LAPAROSCOPIC PROCEDURAL TECHNIQUE

Traditional nonautomated laparoscopic surgical manner of proceedings are less traumatic to patients, resulting in decreased postoperative morbidity rates, reduc fulness of hospital stay, and quicker convalescence times. This ultimately allows patients to reply to activities of daily living in a more expeditious manner as compared with similar expand procedures. Minimally invasive laparoscopic surgery is a surpassingly attractive alternative for both managed care executives and patients.

onward the downside, laparoscopic surgery is labor intensive, resulting in the ne for an extra surgical assistant to detain and position the camera/scope. Minimally invasive laparoscopic surgery is also fraught with uncertainties in confines of maintaining a stable image inherent in the arduous human task of holding the camera. The camera holder's single responsibility is to maintain a steady view of the surgical field for the surgeon The view provided according to the camera holder is sustained by on several factors:

* plain of understanding of the surgical procedure;

* evolution of keen hand-eye coordination while viewing the field within a monitor;

* understanding the surgeon's beseech to move in/out, up/down, right/left;

* ability to stay alert and maintain concentration during the entire procedure; and

* horizontal of fatigue that affects the ability to maintain a steady picture while avoiding contact with carcass organs.(3)

The seemingly simple act of having to carry the scope for cleaning or defogging each time it touches intra-abdominal tissue takes time, causing the surgeon to break his or her continuity of thinking and momentarily squander site of the surgical area. The skills demonstrated on the camera holder therefore have a direct meaning on the surgical operating time and the stres on a level experienced by the surgeon.(4) singularly enough, this important, highly skilled responsibility repeatedly is given to the principally junior or inexperienced staff member upon the surgical team (eg, resident, intern, feed or technician). Additionally, the critical task of holding the camera as a common thing [i]or[/i] matter is viewed as being tedious and frustrating.(5) In 1995 a observe was conducted of 3,500 feed at the breasts at an AORN conference in which more than 90% of respondent said they did not like to imprison the camera/scope.(6)

SHIFT TOWARD AUTOMATED ENDOSCOPIC SYSTEMS

To respond complete control of the surgical field to the surgeon and minimize take away froms during laparoscopic procedures, manufacturers have been focusing onward automated assistance. In 1995, the first US feed and Drug Administration (FDA)-approved robotic arm received recognition.(7) by the agency of the use of a lower extremity pedal, hand control, or voice command, the surgeon communicates with the robotic arm to impel the camera in multiple directions, while providing and maintaining an optimal view of the surgical field. Automated endoscopic hypothesiss as described above, are evolving into a laparoscopic technical revolution. Futuristically, the use of robotic arms technologically could become the standard of care in the performance of MILS procedures

LITERATURE SEARCH

Evidence exists to support the robotic arm as a cost-effective surgical tool. Cost-effective in this article is defined as being a reduction in manpower through using the robotic arm to shut in and position the camera/scope during surgery as oppos to the traditional mode of using a human camera assistant.

Sources of data. Our research guarded a review of literature during the last ten years, beginning in 1987 and ending in October 1997 We lay the foundation of little, if any, relevant literature before 1994 as the use of robotics was in its infancy. We used multiple sources to make secure a well-rounded search. We reviewed the Internet, MEDLINE, CINAHL, HEALTHSTAR, work and journal catalogs, and dissertations and theses (published and unpublished) from the University of southern Carolina. Reference lists from the literature that met the stipulated criteria provided additional leads.