The three complex robotic abdominal operations were successfully completed without difficulty or intraoperative complications. The use of the Tilepro to simultaneously visualize the images from the colonoscope, gastroscope, and choledochoscope made it possible to perform additional intraoperative endoscopic procedures without extra monitors or interference with the operations. The surgeons were able to continue with the operative procedures without distraction from their 3D view from the surgeon’s console.
We describe a novel application of integrating intraoperative endoscopy during robotic abdominal operations using a multi-input display program available on the da Vinci Surgical System. Three different intraoperative endoscopic procedures were successfully delivered to the surgeon’s console during robotic left hepatectomy, low anterior resection, and radical gastrectomy by employing the Tilepro, a multi-input display program. These three surgeries demonstrate the safety and feasibility of using the Tilepro to provide simultaneous, one-screen views of endoscopic procedures during robotic abdominal surgery, including rectal, gastric, and hepatobiliary operations.
Robotic operations have demonstrated safety and feasibility in various fields
[20–22]. Robotic surgery offers the surgeon the potential to perform complex operations with increasing ease and precision as well as a quicker learning curve and adaptation to minimally invasive surgery over conventional laparoscopy
[23, 24]. Patients have benefited by decreased blood loss, decreased hospital stay, decreased pain, and increased satisfaction after their robotic procedures
[5, 8, 9, 25–27]. The advantages of robotic technology over conventional laparoscopic instruments have been predominantly attributed to the 3D operative view, tremor filter, 7 degrees of endowrist function, and control of four arms by the surgeon
As experience increases with the use of robotic surgical platforms, additional advantages are being realized. Recently, a group of urologists used Tilepro for image-guided surgery during robotic nephrectomies
. Patient specific information such as preoperative CT scans and intraoperative ultrasound was viewed intraoperatively on the surgeon’s console to assist decision making during key portions of the operations. A multi-input display system permits the surgeon to view preoperative radiological images during surgery for guidance during the procedure.
Our study demonstrates another advantage of the surgical robotic platform: the ability of the surgeon to access various endoscopic images from the colonoscopy, gastroscopy, and choledochoscopy simultaneously during complex intraabdominal operations. This function shows the versatility of the multi-input display program and the ability of the surgeon to command a wider range of patient-specific information during the operation at his master console. No additional monitors are needed for the endoscopic views, not requiring the surgeon to stop the intraperitoneal portion of the operations. In fact, two views can be seen by the assistant and the scrub nurse on the assistant monitors, enabling everyone involved in the operation to share the same view. This function is especially useful during robot-assisted common bile duct exploration, where the surgeon was able to control the choledochoscope with the robotic arms without the need for another skilled assistant. The ability to perform both laparoscopy and choledochoscopy simultaneously using the current robotic surgical system demonstrates the potential for the development of a new integrated robotic surgery platform that allows the surgeon to simultaneously control two different procedures on one console. Since our study is an introduction of initial successful application of multi-image display system, we could not evaluate its clinical impact of by comparing with and without this new system. Apart from our study, this multi-image display system has innate limitations such as transmission failure due to a cabling problem