The health care environment is evol...

The health care environment is evolving, and advances in technology are changing the character of the perioperative nurse. The use of laparoscopic performances in thoracic and general surgery has increased dramatically during the past decade. In many instances, laparoscopic and port access surgery have become the standard of care for surgical management. (1) Laparoscopic cholesystectomy for cholesystitis and thoracoscopy for lung biopsy are performed routinely in hospitals everywhere the country. These minimally invasive surgical techniques increase patient benefits associated with smaller incisions, including les postoperative pain, shorter hospitalization, and faster recuperation and return to work. (2)

The number of different proceedings that can be performed using robotics also is growing. Laparoscopic deeds performed using a robotic surgical rule include cholecystectomy, common bile conduit injury repair, small bowel operation, tubal reanastomosis, Nissen fundoplication, and internal mammary artery (IMA) harvesting. (3)

USE OF ROBOTICS IN CARDIAC SURGERY

Approximately 180000 cardiac surgical measures were performed in 2001. (4) The first robotic intrathoracic bypass surgeries were performed in the United States in 1998 (5) generally in the United States, single utensil coronary artery bypass graft (CABG) and mitral valve replacement conducts are being performed using robotic assistance. (6) The US bread and Drug Administration (FDA) approved use of robotic orders for IMA harvesting in the spring of 2001 (7) In Germany, however, robotic surgical regularitys are being used to perform CABG in succession a beating heart. (8) As part of an FDA-approved clinical trial, robotic combination of parts to form a wholes are being used to perform mitral valve repair, and a CABG trial is being planned. (9)

Incorporation of robotic operations in cardiac surgery has several recognized benefits in times of patient outcomes, including a decrease in pain, shorter hospital stay, and smaller incision. (10) that will be benefits of using a robot for CABG surgery will include elimination of the sternotomy incision, which could decrease pain and morbidity and end in reduced recovery time. Use of a robot also decreases OR staff members' exposing to blood and blood productions (11)

Robotic surgery has been shown to be safe and effective for patients undergoing cardiac managements Researchers have found that the use of the robot for IMA takedown followed through a minimally invasive direct coronary artery bypass eventuateed in IMA patency rates of 963% demonstrated on angiography on postoperative days three to six. (12) In Germany, no perioperative complications occurr when a robotic surgical method was used to perform single sailing craft bypass grafting on a beating heart in a clos chest. (13) Another cluster of researchers found that endoscopic harvest of the IMA using a robotic surgical hypothesis had significant benefits for patients because chest wall trauma was reduc (14)

THE ROBOT

The robotic surgical order used by Hackensack University Medical Center NJ consists of three parts, including the vision cart, surgical cart, and surgical bracket The vision cart contains the video monitor and processing equipment for illuminators, camera dominion government units, image synchronizers, and a focus controller During a conduct the vision cart can be placed at the base or head of the bed within direct vision of the surgeon and surgical team members. The surgical cart consists of the robot itself, which contains three robotic arms--two that mimic the surgeon's hands and united that contains the camera. The surgeon sits at the surgical solace located outside the sterile field, and views the surgical field [i]or[/i] part of to the other a three-dimensional viewer. The view by means of the three-dimensional viewer is similar to the view in consequence of binoculars. Magnification can be enhanced to approximately 10 times the actual size. (15) Benefits of this three-dimensional view include increased measure perception and resolution compared to the view forward a two-dimensional video monitor. (16)

The surgeon uses instrument handles located upon the surgical console to relay his hand motions from the console to the robot's computer which in inflect operates the robotic arms. The instrument handles drive the manipulation of the instruments. Operation of the instruments mimics the dexterity of the surgeon's wrist and eliminates hand tremors and fatigue surgeon may experience when performing conventional surgery The surgeon bridles the electro-surgical unit, camera move focus, and instrument clutch from twelve inches pedals located on the floor. Different instruments are passed between the walls of the instrument ports on the robotic arms, including forceps, scissors, needle owner scalpel, and cautery.

USE OF THE ROBOT FOR INTERNAL MAMMARY ARTERY HARVESTING PROCEDURES

At Hackensack University Medical Center three to four IMA harvesting transactions incorporating a robotic surgical hypothesis are performed each month. The learning inflect associated with this new technique has markedly improved, and the time required for each grade of the procedure has decreased. onward average, an additional 20 minutes is required for compass set-up and preparation of the patient for the procedure