{"id":10326,"date":"2021-11-11T13:37:56","date_gmt":"2021-11-11T12:37:56","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=10326"},"modified":"2025-04-17T04:55:09","modified_gmt":"2025-04-17T04:55:09","slug":"prvni-roboticky-asistovana-kochlearni-implantace-v-rakousku","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/cs\/prvni-roboticky-asistovana-kochlearni-implantace-v-rakousku\/","title":{"rendered":"Prvn\u00ed roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace v Rakousku"},"content":{"rendered":"

HEARO \u2013 pr\u016fkopnick\u00fd v\u00fdkon p\u0159i operaci CI<\/h1><\/div>

V z\u00e1\u0159\u00ed se ve V\u00eddni uskute\u010dnila prvn\u00ed roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace v n\u011bmecky mluv\u00edc\u00ed oblasti. Chirurgovi Prof. Dr. Wolfgangu Gst\u00f6ttnerovi asistoval p\u0159i p\u0159\u00edstupu do vnit\u0159n\u00edho ucha HEARO, speci\u00e1ln\u00ed chirurgick\u00fd robot pro kochle\u00e1rn\u00ed implantace.<\/strong><\/p>\n<\/div>

<\/span><\/div><\/div><\/div><\/div><\/div>

Zelen\u00e1 barva znamen\u00e1 \u201e\u010dist\u00fd\u201c opera\u010dn\u00ed prostor. V\u0161e, co je steriln\u00ed a m\u011blo by tak z\u016fstat, je zakryto zelen\u00fdmi l\u00e1tkami: nap\u0159\u00edklad st\u016fl s n\u00e1stroji, kle\u0161t\u011bmi, skalpely a vrt\u00e1ky a r\u016fzn\u00e9 p\u0159\u00edstroje p\u0159ipraven\u00e9 k pou\u017eit\u00ed se steriln\u00edmi pr\u016fhledn\u00fdmi kryty. Chirurgick\u00fd t\u00fdm tak\u00e9 nos\u00ed zelen\u00e9 pl\u00e1\u0161t\u011b a pantofle. A kone\u010dn\u011b opera\u010dn\u00ed st\u016fl je pokryt zelenou barvou.<\/p>\n

Takzvan\u00fd \u201est\u016fl\u201c, co\u017e je vlastn\u011b leh\u00e1tko, jeho\u017e t\u011b\u017ei\u0161t\u011b spo\u010d\u00edv\u00e1 na \u010dtvercov\u00e9 sloupov\u00e9 z\u00e1kladn\u011b, lze nakl\u00e1n\u011bt v\u0161emi sm\u011bry a n\u011bkolikr\u00e1t oh\u00fdbat. T\u00edmto zp\u016fsobem lze pacienta um\u00edstit do optim\u00e1ln\u00ed polohy pro danou operaci.<\/p>\n

17. z\u00e1\u0159\u00ed le\u017e\u00ed na stole pades\u00e1tilet\u00fd mu\u017e v celkov\u00e9 anestezii. Je p\u0159ipout\u00e1n \u0161irok\u00fdmi p\u00e1sy, aby nemohl sklouznout, a je tak\u00e9 p\u0159ikryt zelenou l\u00e1tkou. Jedin\u00e1 viditeln\u00e1 oblast je kolem jeho ucha, kde m\u00e1 b\u00fdt provedena operace: zaveden\u00ed kochle\u00e1rn\u00edho implant\u00e1tu. Ze stropu vy\u010dn\u00edvaj\u00ed do m\u00edstnosti t\u0159i mohutn\u00e1 kloubov\u00e1 ramena a ka\u017ed\u00e9 z nich nese jedno z velk\u00fdch povrchov\u00fdch sv\u011btel, kter\u00e1 osv\u011btluj\u00ed pacienta a opera\u010dn\u00ed prostor. V pozad\u00ed se oz\u00fdv\u00e1 monot\u00f3nn\u00ed p\u00edp\u00e1n\u00ed, kter\u00e9 vych\u00e1z\u00ed z p\u0159\u00edstroj\u016f monitoruj\u00edc\u00edch pacientovo srdce a d\u00fdch\u00e1n\u00ed b\u011bhem anestezie.<\/p>\n

Roboti na opera\u010dn\u00edm s\u00e1le CI jsou novinkou<\/h2>\n

Kdyby nechyb\u011bly mikroskopy, opera\u010dn\u00ed s\u00e1l v\u00edde\u0148sk\u00e9 univerzitn\u00ed nemocnice AKH by se podobal sv\u00e9 obvykl\u00e9 podob\u011b na za\u010d\u00e1tku ka\u017ed\u00e9 kochle\u00e1rn\u00ed implantace. M\u00edsto toho v rohu \u010dek\u00e1 CT p\u0159\u00edstroj a na mal\u00fdch poj\u00edzdn\u00fdch stolc\u00edch jsou p\u0159ipraveny dal\u0161\u00ed po\u010d\u00edta\u010de. Budou slou\u017eit k pl\u00e1nov\u00e1n\u00ed, ovl\u00e1d\u00e1n\u00ed opera\u010dn\u00edho robota a z\u00e1v\u011bre\u010dn\u00e9mu testov\u00e1n\u00ed p\u0159i prvn\u00ed roboticky asistovan\u00e9 kochle\u00e1rn\u00ed implantaci ve V\u00eddni.<\/p>\n

Zat\u00edmco roboticky asistovan\u00e1 chirurgie v ortopedii je mo\u017en\u00e1 ji\u017e od 90. let 20. stolet\u00ed, v roce 2016 byl ve \u0161v\u00fdcarsk\u00e9m Bernu poprv\u00e9 pou\u017eit robot HEARO pro kochle\u00e1rn\u00ed implantaci. \u201ePo dvou desetilet\u00edch zku\u0161enost\u00ed v neurochirurgii a ORL m\u00e1me st\u00e1le n\u011bkolikamilimetrovou odchylku u konven\u010dn\u00edch naviga\u010dn\u00edch syst\u00e9m\u016f,\u201c vysv\u011btluje profesor Wolfgang Gst\u00f6ttner, MD. P\u0159i kochle\u00e1rn\u00ed implantaci jsou v\u0161ak zlomky milimetr\u016f d\u016fle\u017eit\u00e9 pro ochranu bl\u00edzk\u00fdch c\u00e9v a citliv\u00fdch nerv\u016f. To vy\u017eaduje vy\u0161\u0161\u00ed p\u0159esnost a spolehlivost ne\u017e v ortopedii.<\/p>\n

Robot HEARO CI v kombinaci s CT zobrazen\u00edm a monitorov\u00e1n\u00edm l\u00edcn\u00edho nervu tuto p\u0159esnost a spolehlivost zaji\u0161\u0165uje. Jedn\u00e1 se o v\u00fdsledek desetilet\u00e9ho v\u00fdvoje spole\u010dnost\u00ed CAScination a MED-EL ve spolupr\u00e1ci s v\u011bdci a klinick\u00fdmi l\u00e9ka\u0159i.<\/p>\n

Jedno rameno a dva senzory<\/h2>\n

Nejprve je pacient pe\u010dliv\u011b um\u00edst\u011bn na opera\u010dn\u00ed st\u016fl: jeho hlava mus\u00ed b\u00fdt um\u00edst\u011bna tak, aby se kolem n\u00ed pozd\u011bji mohl ot\u00e1\u010det CT skener, ani\u017e by se j\u00ed dot\u00fdkal. Pot\u00e9 se um\u00edst\u00ed jednotliv\u00e9 \u010d\u00e1sti robota HEARO. Rameno pozd\u011bji povede vrt\u00e1k. Nejcitliv\u011bj\u0161\u00ed \u010d\u00e1st\u00ed robota HEARO je kamera. Jakmile nam\u00ed\u0159\u00ed sv\u00e9 dva senzory na ucho pacienta, p\u0159ipomene HEARO robota Wall-E ze stejnojmenn\u00e9ho animovan\u00e9ho filmu spole\u010dnosti Pixar, kter\u00fd m\u00e1 za \u00fakol uklidit chaos na Zemi.<\/p>\n

Ne\u017e HEARO \u201euvoln\u00ed cestu\u201c elektrod\u011b, je t\u0159eba se ujistit, \u017ee jeho navigace je spolehliv\u00e1. V\u00fdchoz\u00edm bodem je model z \u010derno\u0161ed\u00e9ho 3D tisku, kter\u00fd p\u0159edstavuje pacientovu kost. Mod\u0159e sv\u00edt\u00ed jehly s kol\u00edky, kter\u00e9 ozna\u010duj\u00ed p\u0159\u00edzniv\u00e9 body pro robotickou navigaci. \u201eTo bude budoucnost pro v\u0161echny pacienty s CI,\u201c spekuluje Prof. Dr. Christoph Arnoldner, kter\u00fd p\u0159i operaci asistuje. Chirurgem je Prof. Dr. Wolfgang Gst\u00f6ttner. Za\u010dne operaci kr\u00e1tk\u00fdm \u0159ezem skalpelu, trochu odsune k\u016f\u017ei a nastav\u00ed zna\u010dky. Person\u00e1l, kter\u00fd kontroluje CT, se p\u0159ipravuje na operaci a m\u00e1 na sob\u011b ochranu proti z\u00e1\u0159en\u00ed.<\/p>\n

Mus\u00edte m\u00edt d\u016fv\u011bru<\/h2>\n

D\u00e1le se pracuje ve skupin\u00e1ch. Prof. Gst\u00f6ttner p\u0159ipravuje l\u016f\u017eko implant\u00e1tu, kde bude pozd\u011bji bezpe\u010dn\u011b le\u017eet elektronika implant\u00e1tu. T\u00fdm technik\u016f se star\u00e1 o data z CT vy\u0161et\u0159en\u00ed. Na druh\u00e9m konci opera\u010dn\u00edho s\u00e1lu ji\u017e technici spou\u0161t\u011bj\u00ed na po\u010d\u00edta\u010di program OTOPLAN.
\nOTOPLAN, kter\u00fd je rovn\u011b\u017e produktem spole\u010dnosti CAScination, je speci\u00e1ln\u00ed prohl\u00ed\u017ee\u010d DICOM. To znamen\u00e1, \u017ee zobrazuje data z CT vy\u0161et\u0159en\u00ed ve form\u011b dvojrozm\u011brn\u00fdch \u0159ez\u016f a trojrozm\u011brn\u00fdch model\u016f. P\u0159i kochle\u00e1rn\u00ed implantaci m\u016f\u017ee OTOPLAN pomoci vybrat vhodnou elektrodu ji\u017e ve f\u00e1zi pl\u00e1nov\u00e1n\u00ed. Pro roboticky asistovanou implantaci OTOPLAN vypo\u010d\u00edt\u00e1 p\u0159esn\u00fd a optim\u00e1ln\u00ed p\u0159\u00edstup. Tato data jsou odes\u00edl\u00e1na do syst\u00e9mu HEARO.<\/p>\n

A pak nastane ten velk\u00fd okam\u017eik: na obrazovce u opera\u010dn\u00edho stolu se objev\u00ed n\u00e1pis \u201eHEARO-Surgery\u201c a pod n\u00edm ikona tla\u010d\u00edtka Start. Nejcitliv\u011bj\u0161\u00ed \u010d\u00e1st\u00ed je inicializace, kter\u00e1 mus\u00ed b\u00fdt provedena na za\u010d\u00e1tku. Pokud dojde k naru\u0161en\u00ed procedury, nap\u0159\u00edklad prudk\u00fdm pohybem v bl\u00edzkosti opera\u010dn\u00edho stolu, je v z\u00e1jmu bezpe\u010dnosti opakov\u00e1na. V ka\u017ed\u00e9m p\u0159\u00edpad\u011b se na obrazovce zobraz\u00ed aktu\u00e1ln\u00ed pr\u016fb\u011bh a pokyny pro dal\u0161\u00ed kroky. Po n\u011bkolika m\u00e1lo kliknut\u00edch se rameno robota p\u0159esune k lebce pacienta.\u201c<\/p>\n

Pot\u00e9 ji\u017e chirurg nem\u00e1 mo\u017enost zas\u00e1hnout, krom\u011b \u00fapln\u00e9ho zastaven\u00ed operace. To je nov\u00fd krok, kter\u00fd mi byl trochu ciz\u00ed,\u201c popisuje tento moment specialistka CI Gst\u00f6ttnerov\u00e1. Na opera\u010dn\u00edm s\u00e1le nyn\u00ed m\u016f\u017ee uvoln\u011bn\u011b zk\u0159\u00ed\u017eit ruce: \u201eJe to jako horolezectv\u00ed: od chv\u00edle, kdy se zav\u011bs\u00edte na lano, mus\u00edte lanu d\u016fv\u011b\u0159ovat.\u201c Pomoc\u00ed ped\u00e1l\u016f ovl\u00e1d\u00e1 robota, kter\u00fd samostatn\u011b vyvrt\u00e1 kan\u00e1l pro elektrodu. \u201eT\u00edm se velmi li\u0161\u00ed od n\u011bkter\u00fdch jin\u00fdch roboticky asistovan\u00fdch syst\u00e9m\u016f, kdy robot pouze kop\u00edruje pohyb rukou chirurga.\u201c<\/p>\n

Minim\u00e1ln\u011b invazivn\u00ed p\u0159\u00edstup do vnit\u0159n\u00edho ucha d\u00edky syst\u00e9mu HEARO<\/h2>\n

Robot vrt\u00e1 do kosti s kontrolou, pomalu a \u0161etrn\u011b. Pouze se na chv\u00edli zastav\u00ed kv\u016fli kontroln\u00edmu CT a pak pokra\u010duje. V p\u0159\u00edpad\u011b kochle\u00e1rn\u00edch implant\u00e1t\u016f zp\u016fsobuje souvisej\u00edc\u00ed zah\u0159\u00edv\u00e1n\u00ed lidsk\u00e9 kosti p\u0159i vrt\u00e1n\u00ed a fr\u00e9zov\u00e1n\u00ed obvykle typick\u00fd z\u00e1pach. Jen o n\u011bkolik minut pozd\u011bji je elektrodov\u00fd kan\u00e1l p\u0159ipraven a p\u0159\u00edstup do hlem\u00fd\u017ed\u011b je voln\u00fd.<\/p>\n

Nam\u00edsto pom\u011brn\u011b \u0161iroce otev\u0159en\u00e9ho st\u0159edou\u0161\u00ed a\u017e po spojen\u00ed s vnit\u0159n\u00edm uchem ponech\u00e1v\u00e1 HEARO pouze 1,8 milimetru \u00fazk\u00fd otvor od povrchu lebky a\u017e po hlem\u00fd\u017e\u010f, kter\u00fdm profesor Gst\u00f6ttner zav\u00e1d\u00ed elektrodu. Zde p\u0159ich\u00e1z\u00ed ke slovu velk\u00fd mikroskop, kter\u00fd byl mezit\u00edm p\u0159em\u00edst\u011bn zp\u011bt na opera\u010dn\u00ed s\u00e1l. Telemetrie a z\u00e1v\u011bre\u010dn\u00e9 CT vy\u0161et\u0159en\u00ed potvrd\u00ed funk\u010dnost a spr\u00e1vn\u00e9 um\u00edst\u011bn\u00ed implant\u00e1tu a elektrody. Pozd\u011bji, p\u0159i aktivaci syst\u00e9mu, m\u016f\u017ee CT sn\u00edmek pomoci optimalizovat rozlo\u017een\u00ed frekvenc\u00ed p\u0159i programov\u00e1n\u00ed zvukov\u00e9ho procesoru.<\/p>\n

Monot\u00f3nn\u00ed monitorovac\u00ed sign\u00e1l z anesteziologick\u00e9ho za\u0159\u00edzen\u00ed st\u00e1le p\u00edp\u00e1 na pozad\u00ed, zat\u00edmco chirurg Prof. Gst\u00f6ttner uzav\u00edr\u00e1 r\u00e1nu. \u201ePro mlad\u00e9 chirurgy nen\u00ed \u0161patn\u00e9 se je\u0161t\u011b nau\u010dit konven\u010dn\u00ed kochle\u00e1rn\u00ed implantaci,\u201c porad\u00ed pozd\u011bji Prof. Gst\u00f6ttner sv\u00fdm koleg\u016fm na jin\u00fdch klinik\u00e1ch. Pro ka\u017edodenn\u00ed klinick\u00e9 pou\u017eit\u00ed se mu HEARO st\u00e1le zd\u00e1 p\u0159\u00edli\u0161 \u010dasov\u011b a person\u00e1ln\u011b n\u00e1ro\u010dn\u00e9. \u201eJe to v\u0161ak pohled do budoucnosti kochle\u00e1rn\u00ed implantace.\u201c Budoucnosti, kter\u00e1 ji\u017e za\u010dala ve V\u00edde\u0148sk\u00e9 univerzitn\u00ed nemocnici \u2013 AKH.<\/p>\n

\n

Roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace pomoc\u00ed p\u0159\u00edstroje HEARO<\/strong><\/p>\n

B\u011bhem kochle\u00e1rn\u00ed implantace 17. z\u00e1\u0159\u00ed 2021 pod veden\u00edm Prof. Dr. Wolfganga Gst\u00f6ttnera v Univerzitn\u00ed nemocnici ve V\u00eddni provedl CI robot HEARO tak\u00e9 kochleostomii \u2013 otev\u0159en\u00ed vnit\u0159n\u00edho ucha. \u0160lo o prvn\u00ed operaci tohoto druhu nejen v Rakousku, ale v cel\u00e9 n\u011bmecky mluv\u00edc\u00ed oblasti! B\u011bhem v\u00fdvojov\u00e9 f\u00e1ze syst\u00e9mu HEARO bylo ve \u0161v\u00fdcarsk\u00e9 univerzitn\u00ed nemocnici v Bernu provedeno dev\u011bt implantac\u00ed, ale chirurgov\u00e9 v\u017edy otev\u0159eli hlem\u00fd\u017e\u010f. Po certifikaci HEARO CE v roce 2020 n\u00e1sledovaly operace v belgick\u00fdch Antverp\u00e1ch a nakonec ve V\u00eddni.<\/p>\n

HEARO nenahrad\u00ed chirurga ani chirurgick\u00fd t\u00fdm. Robota bude v\u017edy ovl\u00e1dat a \u0159\u00eddit chirurg a bude muset manipulovat s CT p\u0159\u00edstrojem a softwarem OTOPLAN.<\/p>\n

P\u0159edopera\u010dn\u00ed pl\u00e1nov\u00e1n\u00ed operace pomoc\u00ed HEARO-CI je slo\u017eit\u00e9, ale velmi p\u0159esn\u00e9. B\u011bhem operace se prov\u00e1d\u011bj\u00ed t\u0159i CT vy\u0161et\u0159en\u00ed s n\u00edzkou d\u00e1vkou. Vyvrt\u00e1n\u00ed elektrodov\u00e9ho kan\u00e1lu pomoc\u00ed syst\u00e9mu HEARO trv\u00e1 jen asi deset minut. Vzhledem k p\u0159esn\u00e9 p\u0159\u00edprav\u011b p\u0159ed operac\u00ed a kontroln\u00edm zast\u00e1vk\u00e1m b\u011bhem operace je v\u0161ak celkov\u00e1 doba operace s robotem del\u0161\u00ed ne\u017e u konven\u010dn\u00ed kochle\u00e1rn\u00ed implantace.<\/p>\n

\u201eNejd\u016fle\u017eit\u011bj\u0161\u00ed je, \u017ee postup HEARO umo\u017e\u0148uje chirurg\u016fm otev\u0159\u00edt minim\u00e1ln\u011b invazivn\u00ed p\u0159\u00edstup k hlem\u00fd\u017edi a zvolit ide\u00e1ln\u00ed trasu pro \u00fapln\u00e9 zaveden\u00ed atraumatick\u00e9ho elektrodov\u00e9ho pole do hlem\u00fd\u017ed\u011b,\u201c uvedla Dr. Ingeborg Hochmairov\u00e1, gener\u00e1ln\u00ed \u0159editelka spole\u010dnosti MED-EL. Tento mal\u00fd otvor sni\u017euje dopad operace na pacienta a zvy\u0161uje kvalitu a bezpe\u010dnost.<\/p>\n

Dal\u0161\u00ed informace o syst\u00e9mech HEARO a OTOPLAN naleznete na str\u00e1nk\u00e1ch www.cascination.de<\/a>, www.medel.pro\/products\/otoplan<\/a>, na You-Tube Play-Listu spole\u010dnosti MED-EL Germany OTOPLAN a v p\u0159\u00edslu\u0161n\u00fdch d\u00edlech podcastu https:\/\/podtail.com\/podcast\/med-el-podcast\/<\/a>.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

V z\u00e1\u0159\u00ed se ve V\u00eddni uskute\u010dnila prvn\u00ed roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace v n\u011bmecky mluv\u00edc\u00ed oblasti.<\/p>\n","protected":false},"author":4,"featured_media":31952,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[470],"tags":[416,417,422,412],"class_list":["post-10326","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-veda","tag-accessories","tag-ci","tag-hearing-implant-reliability","tag-hearing-implants"],"yoast_head":"\nPrvn\u00ed roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace v Rakousku<\/title>\n<meta name=\"description\" content=\"V z\u00e1\u0159\u00ed se ve V\u00eddni uskute\u010dnila prvn\u00ed roboticky asistovan\u00e1 kochle\u00e1rn\u00ed implantace v n\u011bmecky mluv\u00edc\u00ed oblasti za pomoci robota HEARO.\" \/>\n<meta name=\"robots\" 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