2002, Number 2
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ABSTRACTObjective: To demonstrate navigation capacity with a five degrees of freedom was built aluminum robotic arm with a weight of 25 kg in Mexico City on November 30 2001 to assist and guide the endoscope during the vaginal hysterectomy in a female with uterine myomatosis. Material and method: Regional anesthesia was applied to the patient and she was placed in Trendelenburg position with legs open. The abdomen and the vaginal area was cleaned with antiseptic solutions and an urinary catheter was installed. The surgeon was placed between the patient’s legs, the first human assistant was placed to the right of the patient, the second human assistant was placed to the left of the patient, and the robot was installed on the right side of the patient near the thorax. The monitor was installed during the abdominal part of surgery on the left side of the patient near her feet; during the vaginal part of surgery, the monitor was installed to the left of the patient near the abdomen (picture). We chose one patient at the Troncoso Hospital of the Instituto Mexicano del Seguro Social (IMSS) with myomatosis uterine, and vaginal hysterectomy was performed. Discussion: One vaginal hysterectomy was performed successfully assisted by a robotic arm without complications. Surgical time was 2 h. Best advantage was to visualize the pelvic cavity during the vaginal procedure thanks to manual and total control of the robotic arm by the surgeon during the vaginal procedure; because the surgeon, upon operating, could see both in front and in back of the uterus. The motions of the five degrees of freedom of the robot were sufficient to navigate inside the pelvic cavity to show and guide the surgeon providing a good surgical field. The manipulator can navigate in eight directions: out; inside; right; left; up; down, and left and right rotations. The computer system offers accuracy and security. The patient left the hospital on the second day. With this experience, it can be concluded that all laparoscopic gynecologic procedures can be assisted or guided by computer, principally vaginal procedures. From this vaginal procedure, we consider that uterine curettage is the most important in Mexico, because inadvertent uterus perforations are frequent when uteri are in inflammatory conditions such as in septic abortions, which are prone to inadvertent perforations that increase maternal mortality. The man-machine relationship is closer. Furthermore, we have contributed to demonstrate new and important applications in gynecologic surgery of computer-aided surgery.
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