Robotic surgery makes sense for long and complex surgical tasks (e.g. suturing and dissection). Short and specialized tasks are more efficiently performed using advanced, clinically proven laparoscopic instruments (e.g. vessel sealers, staplers, advanced energy).
Dexter features fully articulated, single-use 8 mm instruments for suturing and dissection: Needle drivers, Johann graspers, monopolar scissors and bipolar Maryland forceps.
Laparoscopic surgery often forces the surgeon into an exhausting posture, usually for many hours during surgery. One of the great contributions of robotic surgery is the ability to operate in an ergonomic posture. Much effort has been made during the development of Dexter to provide that optimal ergonomic posture. Having the option to switch between laparoscopy and robotic surgery also means providing the choice to operate the robot in a sitting or standing position.
Dexter provides the option to switch between laparoscopic and robotic surgery at any time during surgery. By design, this defines Dexter as an open platform, giving access to all laparoscopic technology and instrumentation during surgery. Whether this is stapling, vessel sealing or any other technology – being sterile around the patient ensures the best procedure for the patient at any point in time. This is not only true today, but also gives access to any future technology evolving in surgery – you don´t have to wait until your robotics provider integrates new technology but you can use it today.
There are many differences in laparoscopic imaging systems, and new technology is evolving continuously. Not every surgeon prefers the same image – for good reasons. This is why we have opted for a modular approach: Dexter can be used with any commercial laparoscopic towers in the market. That leaves the surgeon with his preferred imaging – whether this be 4k, 3D, ICG or any other current or future imaging technologies.
Safety in the operating room is our first priority. Wherever possible, our concept is based on mechanical thinking rather than software. This ensures maximum safety, as the mechanical limitation of degrees of freedom guarantees safety at any point in time. Let’s use an example: the incision point of the trocar is a fix point during surgery. We have established a mechanical concept to maintain this, the so-called Pivot Point.
The mechanical realization of Dexter is such that the length of the arms and the joints are an exact replica on the surgeon console and the arms by the patient. To control the arms at the patient’s side, Dexter just has to replicate the angles of the joints, and the position of the instrument tip is transferred from the console to the patient. This intuitive concept allows for a mechanical fixation of the pivot point by a mechanical constraint at the surgeon console.
The robotic arms on the patient’s side replicate the movements from the console – maintaining the pivot point as fixed by the mechanical constraint on the surgeon console. In general, the concept to replicate angles at the joints simplify the complexity of the robot drastically – no need for complex computing systems facilitating elaborate coordination transformations. Simple and safe – through mechanical design.
The surgeon console is optimized for ergonomic use in a sitting and standing position. The Dexter console is draped and placed close to the patient within the sterile field to allow for easy switching between the robotic and laparoscopic access to the patient.
The two arms beside the patient control the two instruments. They can be individually re-aligned to change trocar sites during surgery and are designed to provide ample working space for the assistant surgeon to hold the endoscope and any additional retraction instrument, comparable to the laparoscopic setup. The Dexter robot is compatible with commercially available endoscope holders, to provide a stable image during surgery when needed.
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