{"id":10326,"date":"2021-11-11T13:37:56","date_gmt":"2021-11-11T12:37:56","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=10326"},"modified":"2025-04-26T09:32:00","modified_gmt":"2025-04-26T09:32:00","slug":"prva-roboticky-asistovana-kochlearna-implantacia-v-rakusku","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/sk\/prva-roboticky-asistovana-kochlearna-implantacia-v-rakusku\/","title":{"rendered":"Prv\u00e1 roboticky asistovan\u00e1 kochle\u00e1rna implant\u00e1cia v Rak\u00fasku"},"content":{"rendered":"

HEARO \u2013 priekopn\u00edcky v\u00fdkon pri oper\u00e1cii KI<\/h1><\/div>

Prv\u00e1 roboticky asistovan\u00e1 kochle\u00e1rna implant\u00e1cia na nemecky hovoriacom \u00fazem\u00ed sa uskuto\u010dnila v septembri vo Viedni. HEARO \u2013 \u0161peci\u00e1lny chirurgick\u00fd robot pre kochle\u00e1rnu implant\u00e1ciu asistoval Prof. Dr. Wolfgangovi Gst\u00f6ttnerovi pri pr\u00edstupe k vn\u00fatorn\u00e9mu uchu.<\/strong><\/p>\n<\/div>

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

V opera\u010dnej oblasti zelen\u00e1 znamen\u00e1 \u201e\u010disto\u201c. V\u0161etko, \u010do je steriln\u00e9 a m\u00e1 zosta\u0165 steriln\u00e9 je prikryt\u00e9 zelenou l\u00e1tkou: napr\u00edklad n\u00e1strojov\u00fd st\u00f4l s klie\u0161\u0165ami, svorkami, skalpelmi a v\u0155ta\u010dkami a r\u00f4zne zariadenia pripraven\u00e9 na pou\u017eitie so steriln\u00fdmi prieh\u013eadn\u00fdmi krytmi. Chirurgick\u00fd t\u00edm m\u00e1 tie\u017e oble\u010den\u00e9 zelen\u00e9 r\u00facha a n\u00e1vleky. A nakoniec, opera\u010dn\u00fd st\u00f4l je zakryt\u00fd zelenou.<\/p>\n

Takzvan\u00fd \u201est\u00f4l\u201c je vlastne le\u017eadlo, ktor\u00e9ho \u0165a\u017eisko spo\u010d\u00edva na \u0161tvorcovej st\u013apovej z\u00e1kladni a d\u00e1 sa nakloni\u0165 do v\u0161etk\u00fdch str\u00e1n a ohn\u00fa\u0165 na viacer\u00fdch miestach. Takto je mo\u017en\u00e9 pacienta umiestni\u0165 do polohy optim\u00e1lnej pre dan\u00fa oper\u00e1ciu.<\/p>\n

Je 17. septembra a na stole le\u017e\u00ed 50-ro\u010dn\u00fd mu\u017e v celkovej anest\u00e9zii. Je zaisten\u00fd \u0161irok\u00fdmi p\u00e1smi, aby sa nemohol zo\u0161mykn\u00fa\u0165 a je tie\u017e prikryt\u00fd zelenou l\u00e1tkou. Jedin\u00e1 vidite\u013en\u00e1 oblas\u0165 je okolo jeho ucha, kde sa m\u00e1 vykona\u0165 oper\u00e1cia: vlo\u017eenie kochle\u00e1rneho implant\u00e1tu. Tri mohutn\u00e9 k\u013abov\u00e9 ramen\u00e1 vy\u010dnievaj\u00fa zo stropu miestnosti a ka\u017ed\u00e9 nesie jedno z ve\u013ek\u00fdch plo\u0161n\u00fdch svetiel, ktor\u00e9 osvet\u013euj\u00fa pacienta a opera\u010dn\u00fa oblas\u0165. V pozad\u00ed sa oz\u00fdva monot\u00f3nne p\u00edpanie, ktor\u00e9 vych\u00e1dza zo zariaden\u00ed monitoruj\u00facich srdce a d\u00fdchanie pacienta po\u010das anest\u00e9zie.<\/p>\n

Roboty na opera\u010dnej s\u00e1le KI s\u00fa novinkou<\/h2>\n

Ak by nech\u00fdbali mikroskopy, opera\u010dn\u00e1 s\u00e1la vo viedenskej fakultnej nemocnici AKH by na za\u010diatku ka\u017edej kochle\u00e1rnej implant\u00e1cie vyzerala ako obvykle. Namiesto toho teraz v rohu \u010dak\u00e1 CT pr\u00edstroj a na mal\u00fdch mobiln\u00fdch stol\u00edkoch s\u00fa pripraven\u00e9 \u010fal\u0161ie po\u010d\u00edta\u010de. Tieto bud\u00fa pou\u017eit\u00e9 na pl\u00e1novanie, ovl\u00e1danie chirurgick\u00e9ho robota a fin\u00e1lne testovanie pri prvej roboticky asistovanej kochle\u00e1rnej implant\u00e1cii vo Viedni.<\/p>\n

K\u00fdm roboticky asistovan\u00e1 chirurgia v ortop\u00e9dii je pou\u017e\u00edvan\u00e1 od 90-tych rokov minul\u00e9ho storo\u010dia, HEARO bol prv\u00fd robot pou\u017eit\u00fd pri kochle\u00e1rnej implant\u00e1cii v Berne vo \u0160vaj\u010diarsku v roku 2016. \u201ePo dvoch desa\u0165ro\u010diach sk\u00fasenost\u00ed v neurochirurgii a ORL m\u00e1me st\u00e1le nieko\u013eko milimetrov odch\u00fdlky s konven\u010dn\u00fdmi naviga\u010dn\u00fdmi syst\u00e9mami,\u201c vysvet\u013euje Prof. Wolfgang Gst\u00f6ttner, MD. Av\u0161ak pri kochle\u00e1rnej implant\u00e1cii zlomky milimetrov s\u00fa d\u00f4le\u017eit\u00e9 na ochranu bl\u00edzkych krvn\u00fdch ciev a citliv\u00fdch nervov. To si vy\u017eaduje v\u00e4\u010d\u0161iu presnos\u0165 a spo\u013eahlivos\u0165 ne\u017e v ortop\u00e9dii.<\/p>\n

T\u00fato presnos\u0165 a spo\u013eahlivos\u0165 poskytuje HEARO \u2013 robot na kochle\u00e1rnu implant\u00e1ciu, v kombin\u00e1cii s po\u010d\u00edta\u010dovou tomografiou a monitoringom tv\u00e1rov\u00e9ho nervu. Je to v\u00fdsledok 10-ro\u010dn\u00e9ho v\u00fdvoja spolo\u010dnost\u00ed CAScination a MED-EL, spolu s vedcami a klinick\u00fdmi lek\u00e1rmi.<\/p>\n

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

Najprv je pacient opatrne umiestnen\u00fd na opera\u010dnom stole: jeho hlava mus\u00ed by\u0165 umiestnen\u00e1 tak, aby sa CT skener mohol nesk\u00f4r ot\u00e1\u010da\u0165 okolo nej bez toho, aby sa jej dotkol. N\u00e1sledne s\u00fa umiestnen\u00e9 jednotliv\u00e9 \u010dasti robota HEARO. Ramenom bude nesk\u00f4r nav\u00e1dzan\u00fd vrt\u00e1k. Najcitlivej\u0161ou \u010das\u0165ou robota HEARO je kamera. Hne\u010f ako nasmeruje svoje dva senzory na pacientovo ucho, HEARO pripom\u00edna robota Wall-E z rovnomenn\u00e9ho animovan\u00e9ho filmu od spolo\u010dnosti Pixar, v ktorom m\u00e1 Wall-E za \u00falohu uprata\u0165 chaos na Zemi.<\/p>\n

Pred t\u00fdm, ne\u017e HEARO \u201evy\u010dist\u00ed cestu\u201c pre elektr\u00f3du, je potrebn\u00e9 zabezpe\u010di\u0165, \u017ee jeho navig\u00e1cia je spo\u013eahliv\u00e1. V\u00fdchodiskov\u00fdm bodom je model vyroben\u00fd \u010dierno-sivou 3D tla\u010dou, ktor\u00fd predstavuje kos\u0165 pacienta. \u0160pendl\u00edkov\u00e9 ihly \u017eiaria modrou farbou a ozna\u010duj\u00fa vhodn\u00e9 body pre robotick\u00fa navig\u00e1ciu. \u201eToto je bud\u00facnos\u0165 pre v\u0161etk\u00fdch KI pacientov,\u201c \u0161pekuluje Prof. Dr. Christoph Arnoldner, ktor\u00fd pri oper\u00e1cii asistuje. Operat\u00e9rom je Prof. Dr. Wolfgang Gst\u00f6ttner. Oper\u00e1ciu za\u010d\u00edna kr\u00e1tkym rezom skalpela, ko\u017eu trochu odsunie a nastav\u00ed zna\u010dky. Person\u00e1l, ktor\u00fd riadi CT sken, sa pripravuje na oper\u00e1ciu, m\u00e1 na sebe ochranu proti \u017eiareniu.<\/p>\n

Mus\u00edte ma\u0165 vieru<\/h2>\n

\u010ealej sa pr\u00e1ca vykon\u00e1va v skupin\u00e1ch. Prof. Gst\u00f6ttner pripravuje l\u00f4\u017eko implant\u00e1tu, v ktorom bude nesk\u00f4r bezpe\u010dne umiestnen\u00e1 elektronika implant\u00e1tu. T\u00edm technikov m\u00e1 na starosti d\u00e1ta z CT skenu. Na druhom konci opera\u010dnej s\u00e1ly u\u017e technici sp\u00fa\u0161\u0165aj\u00fa na po\u010d\u00edta\u010di program OTOPLAN.
\nOTOPLAN, ktor\u00fd je tie\u017e produktom spolo\u010dnosti CAScination, je \u0161peci\u00e1lny DICOM prehliada\u010d. To znamen\u00e1, \u017ee zobrazuje \u00fadaje z CT skenera v dvojrozmern\u00fdch rezoch a trojrozmern\u00fdch modeloch. Pre kochle\u00e1rnu implant\u00e1ciu dok\u00e1\u017ee OTOPLAN vybra\u0165 vhodn\u00fa elektr\u00f3du u\u017e vo f\u00e1ze pl\u00e1novania. Pre roboticky asistovan\u00fa implant\u00e1ciu OTOPLAN vypo\u010d\u00edta presn\u00fd a optim\u00e1lny pr\u00edstup. Tieto \u00fadaje s\u00fa odoslan\u00e9 do robota HEARO.<\/p>\n

A potom nastane ten moment: slov\u00e1 \u201eHEARO-Surgery\u201c sa objavia na obrazovke bl\u00edzko opera\u010dn\u00e9ho stola a pod n\u00edm je ikona tla\u010didla \u0161tart. Najcitlivej\u0161ou \u010das\u0165ou je inicializ\u00e1cia, ktor\u00e1 mus\u00ed by\u0165 vykonan\u00e1 na za\u010diatku. Ak je proced\u00fara naru\u0161en\u00e1 napr\u00edklad prudk\u00fdm pohybom v bl\u00edzkosti opera\u010dn\u00e9ho stola, kv\u00f4li bezpe\u010dnosti sa opakuje. V ka\u017edom pr\u00edpade sa na obrazovke zobrazuje aktu\u00e1lny postup a pokyny pre \u010fal\u0161ie kroky. Po nieko\u013ek\u00fdch kliknutiach sa rameno robota presunie k lebke pacienta.<\/p>\n

Potom u\u017e chirurg nem\u00e1 ako zasiahnu\u0165, m\u00f4\u017ee jedine celkom zastavi\u0165 oper\u00e1ciu. \u201eToto je nov\u00fd krok, ktor\u00fd mi bol trochu cudz\u00ed,\u201c opisuje tento moment KI \u0161pecialista Gst\u00f6ttner. Na opera\u010dnej s\u00e1le si u\u017e m\u00f4\u017ee uvo\u013enene prekr\u00ed\u017ei\u0165 ruky: \u201eJe to ako horolezectvo: od chv\u00edle, ke\u010f vis\u00edte na lane, mus\u00edte lanu d\u00f4verova\u0165.\u201c Pomocou ped\u00e1lov ovl\u00e1da robota, ktor\u00fd samostatne vyv\u0155ta kan\u00e1l pre elektr\u00f3du. \u201eToto je ve\u013emi odli\u0161n\u00e9 od niektor\u00fdch in\u00fdch robotom podporovan\u00fdch syst\u00e9mov, pri ktor\u00fdch robotick\u00e9 ruky s\u00fa len prenesen\u00e9 ruky chirurga.<\/p>\n

Minim\u00e1lne invaz\u00edvny pr\u00edstup do vn\u00fatorn\u00e9ho ucha v\u010faka HEARO<\/h2>\n

Robot v\u0155ta do kosti riadene, pomaly a jemne. Zastav\u00ed sa len na kr\u00e1tko, kv\u00f4li kontroln\u00e9mu CT a potom pokra\u010duje. V pr\u00edpade kochle\u00e1rnych implant\u00e1ci\u00ed, s\u00favisiace zahrievanie \u013eudskej kosti po\u010das v\u0155tania a fr\u00e9zovania zvy\u010dajne vytv\u00e1ra typick\u00fd z\u00e1pach. Len o nieko\u013eko min\u00fat nesk\u00f4r je elektr\u00f3dov\u00fd kan\u00e1l pripraven\u00fd a pr\u00edstup do kochley je vo\u013en\u00fd.<\/p>\n

Namiesto pomerne do\u0161iroka otvoren\u00e9ho stredn\u00e9ho ucha k napojeniu na vn\u00fatorn\u00e9 ucho ponech\u00e1va HEARO len 1,8-milimetrov\u00fd tenk\u00fd otvor od povrchu lebky po slim\u00e1k, cez ktor\u00fd Prof. Gst\u00f6ttner zav\u00e1dza elektr\u00f3du. Tu prich\u00e1dza na rad ve\u013ek\u00fd mikroskop, ktor\u00fd bol medzi\u010dasom premiestnen\u00fd sp\u00e4\u0165 do opera\u010dnej s\u00e1ly. Telemetria a z\u00e1vere\u010dn\u00e9 CT zobrazenie potvrdzuj\u00fa funkciu a spr\u00e1vne umiestnenie implant\u00e1tu a elektr\u00f3dy. Nesk\u00f4r, po\u010das aktiv\u00e1cie syst\u00e9mu, m\u00f4\u017ee CT sn\u00edmka pom\u00f4c\u0165 optimalizova\u0165 distrib\u00faciu frekvenci\u00ed pri programovan\u00ed audio procesora.<\/p>\n

Monot\u00f3nny monitorovac\u00ed sign\u00e1l z pr\u00edstrojov anest\u00e9ziol\u00f3ga st\u00e1le p\u00edpa v pozad\u00ed, zatia\u013e \u010do chirurg Prof. Gst\u00f6ttner zatv\u00e1ra ranu. \u201eU mlad\u00e9ho chirurga neza\u0161kod\u00ed, ke\u010f sa bude na\u010falej u\u010di\u0165 na konven\u010dnej kochle\u00e1rnej implant\u00e1cii,\u201c rad\u00ed nesk\u00f4r Prof. Gst\u00f6ttner kolegom na in\u00fdch klinik\u00e1ch. Pre ka\u017edodenn\u00e9 klinick\u00e9 pou\u017eitie sa mu robot HEARO zd\u00e1 st\u00e1le pr\u00edli\u0161 \u010dasovo a person\u00e1lne n\u00e1ro\u010dn\u00fd. \u201eJe to v\u0161ak poh\u013ead do bud\u00facnosti kochle\u00e1rnej implant\u00e1cie.\u201c Bud\u00facnosti, ktor\u00e1 sa u\u017e za\u010dala vo Viedenskej univerzitnej nemocnici \u2013 AKH.<\/p>\n

\n

Roboticky asistovan\u00e1 kochle\u00e1rna implant\u00e1cia s HEARO<\/strong><\/p>\n

Po\u010das kochle\u00e1rnej implant\u00e1cie 17. septembra 2021 pod veden\u00edm Prof. Dr. Wolfganga Gst\u00f6ttnera vo Viedenskej univerzitnej nemocnici vykonal KI robot HEARO aj kochleost\u00f3miu \u2013 otvorenie vn\u00fatorn\u00e9ho ucha. To bola novinka nielen pre Rak\u00fasko, ale pre cel\u00fd nemecky hovoriaci regi\u00f3n! Po\u010das v\u00fdvojovej f\u00e1zy robota HEARO bolo v Univerzitnej nemocnici v Berne vo \u0160vaj\u010diarsku vykonan\u00fdch dev\u00e4\u0165 implant\u00e1ci\u00ed, no kochleu v\u017edy otv\u00e1rali chirurgovia. Po CE certifik\u00e1cii robota HEARO v roku 2020, nasledovali oper\u00e1cie v Antwerp\u00e1ch v Belgicku a nakoniec vo Viedni.<\/p>\n

HEARO nenahrad\u00ed chirurga ani chirurgick\u00fd t\u00edm. Robot bude v\u017edy riaden\u00fd a usmer\u0148ovan\u00fd chirurgom a bude potrebn\u00e9 obsluhova\u0165 CT pr\u00edstroj a softv\u00e9r OTOPLAN.<\/p>\n

Predopera\u010dn\u00e9 pl\u00e1novanie oper\u00e1cie s KI robotom HEARO je zlo\u017eit\u00e9, ale zato ve\u013emi presn\u00e9. Po\u010das oper\u00e1cie sa vykonaj\u00fa tri n\u00edzkod\u00e1vkov\u00e9 CT vy\u0161etrenia. V\u0155tanie elektr\u00f3dov\u00e9ho kan\u00e1la pomocou HEARO trv\u00e1 len asi desa\u0165 min\u00fat. Av\u0161ak kv\u00f4li prec\u00edznej pr\u00edprave pred oper\u00e1ciou a kontroln\u00fdm zast\u00e1vkam po\u010das oper\u00e1cie je celkov\u00fd opera\u010dn\u00fd \u010das s robotom dlh\u0161\u00ed ako pri klasickej kochle\u00e1rnej implant\u00e1cii.<\/p>\n

\u201eNajd\u00f4le\u017eitej\u0161ie je, \u017ee proced\u00fara HEARO umo\u017e\u0148uje chirurgom otvori\u0165 minim\u00e1lne invaz\u00edvny pr\u00edstup ku kochlei a zvoli\u0165 ide\u00e1lnu cestu na \u00fapln\u00e9 vlo\u017eenie atraumatickej elektr\u00f3dovej s\u00fastavy do kochley,\u201c povedala Dr. Ingeborg Hochmair, gener\u00e1lna riadite\u013eka spolo\u010dnosti MED-EL. Tento mal\u00fd otvor zni\u017euje chirurgick\u00fd dopad na pacienta a zvy\u0161uje kvalitu a bezpe\u010dnos\u0165.<\/p>\n

Viac inform\u00e1ci\u00ed o HEARO a OTOPLAN n\u00e1jdete na\u00a0www.cascination.de<\/a>,\u00a0www.medel.pro\/products\/otoplan<\/a>, MED-EL Germany You-Tube Play-List OTOPLAN a v pr\u00edslu\u0161n\u00fdch epiz\u00f3dach podcastu\u00a0https:\/\/podtail.com\/podcast\/med-el-podcast\/<\/a>.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

Prv\u00e1 roboticky asistovan\u00e1 kochle\u00e1rna implant\u00e1cia na nemecky hovoriacom \u00fazem\u00ed sa uskuto\u010dnila v septembri vo Viedni.<\/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":[418],"tags":[416,417,422,412],"class_list":["post-10326","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-veda-sk","tag-accessories","tag-ci","tag-hearing-implant-reliability","tag-hearing-implants"],"yoast_head":"\nSlovak<\/title>\n<meta name=\"description\" content=\"Prv\u00e1 roboticky asistovan\u00e1 kochle\u00e1rna implant\u00e1cia na nemecky hovoriacom \u00fazem\u00ed sa uskuto\u010dnila v septembri vo Viedni za pomoci robota HEARO.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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