【正文】 meday have in human life. In both microscopic and macroscopic scales, from DNA structure to the symbolism in human achievement, our progress along the spiral curve has been enormous. Today39。盡管醫(yī)療服務(wù)的根本目的就是在于使病人更加健康，但由于經(jīng)濟(jì)因素的制約，使得醫(yī)療服務(wù)的管理問題上無法正常運(yùn)作，不但沒有把基本的要求做好，甚至違背了醫(yī)療服務(wù)的預(yù)期目的。而另一種應(yīng)用于微創(chuàng)外科手術(shù)的系統(tǒng)是基于利用運(yùn)動(dòng)感知反饋原理。 ROBODOC 系統(tǒng)通過計(jì)算機(jī)圖像技術(shù)收集病變圖像，對(duì)手術(shù)進(jìn)行預(yù)測(cè)。腸腔鏡的使用原理就是一個(gè)微型機(jī)器人探頭以半自主的方式進(jìn)入到腸腔管道進(jìn)行內(nèi)部操作。在連續(xù)的接觸過程中保持適當(dāng)?shù)牧Χ?。在這些手術(shù)過程中，利用計(jì)算機(jī)技術(shù)將微觀的操作通過按比例縮減的方法使這種操作轉(zhuǎn)換成人所能感知的程度，這樣不僅能提高手術(shù)的質(zhì)量，而且很可能創(chuàng)造出新的微觀外科手術(shù)途徑。機(jī)器人系統(tǒng)配備的輔助工具常見的有超聲波探針，攝像頭， XRAY 發(fā)生器以及有 6 個(gè)自由度的新型 CYBERKNIFE 裝置。 典型的機(jī)器人輔助作業(yè)有：手術(shù)工具的定位及顯微定位，軌跡的設(shè)計(jì)以及精確引導(dǎo)探針進(jìn)行作業(yè)。相比之下，機(jī)器人的優(yōu)越性包括能精確定位和復(fù)位裝置、工作過程穩(wěn)定，重復(fù)手術(shù)一致性好，還可以控制手術(shù)過程中的各種參數(shù)如力 度、持久力、強(qiáng)度等；也存在著許多不足，包括隨機(jī)判斷能力與空間位置的感知能力差，適應(yīng)性不好，對(duì)故障敏感。無論從微觀世界還是宏觀世界，從 DNA結(jié)構(gòu)的發(fā)展過程到影響人類文明的重大發(fā)明，人類都是在以這種螺旋式的方式盤旋上升，并不斷進(jìn)步。 醫(yī)療器械的發(fā)展也有著相似的過程，但在技術(shù)上還有待完善。 指導(dǎo)教師評(píng)語： 翻譯基本正確，中文敘述通順。從另一個(gè)角度來說，心理學(xué)上解釋為人類本能 的一種表現(xiàn)，對(duì)新事物的接受總需要一些時(shí)間。盡管機(jī)器人本來在手術(shù)過程就扮演輔助的角色，但從某種程度上來說加以半自 主性的內(nèi)窺技術(shù)勢(shì)必效果回更好。也就是說，新技術(shù)在解決實(shí)際問題的時(shí)候反而是弊大于利。 機(jī)器人技術(shù)在外科環(huán)境中提供了良好的輔助性，它們的應(yīng)用提高了手術(shù)的精確度和靈活度，減輕了醫(yī)生由于生理因素而產(chǎn)生的顫抖，并能擴(kuò)展增加機(jī)械手減少工作量，從而減少手術(shù)中操作人員，所以機(jī)器人技術(shù)在外科 領(lǐng)域中得到了越來越廣泛的應(yīng)用。 精確引導(dǎo)探針進(jìn)行活體組織檢查 據(jù)報(bào)道：一種被命名為 MINIRCM 的小型機(jī)器人系統(tǒng)在外科手術(shù)中精確引導(dǎo)探針進(jìn)行手術(shù)操作。 位置移動(dòng)和力度范圍 現(xiàn)代神經(jīng)外科手術(shù)由于手術(shù)工具在手術(shù)過程中操作范圍太小以致于那些技術(shù)熟練的醫(yī)生也無法得心應(yīng)手。 ZEUS 系統(tǒng)對(duì)手術(shù)的實(shí)時(shí)控制排除了醫(yī)生手部的顫抖，并能使醫(yī)生在大范圍內(nèi)自然的移動(dòng)手的位置來實(shí)現(xiàn)人體內(nèi)部手術(shù)操作的微觀運(yùn)動(dòng)。 腹腔鏡 LARS 系統(tǒng)的主要功能是配合腹腔鏡進(jìn)行圖像收集并診斷，提高了末端執(zhí)行器的作業(yè)精度。通過人在操 縱臺(tái)上實(shí)施操作，加以機(jī)器人輔助技術(shù)使得手術(shù)作業(yè)環(huán)境更加寬敞，并為人類對(duì)外科手術(shù)的認(rèn)識(shí)打開了新的天地。機(jī)器人輔助設(shè)備通過按比例縮減人工操作時(shí)的力和力矩進(jìn)行微創(chuàng)外科手術(shù)，是得人操作機(jī)器人手臂進(jìn)行手術(shù)且簡(jiǎn)單自如。據(jù)報(bào)道：機(jī)器人位置控制系統(tǒng)通過對(duì)由呼吸運(yùn)動(dòng)而使腦部腫瘤位置的隨機(jī)變化進(jìn)行分析，然后給予補(bǔ)償，這樣提高了 CYBERKNIFE 在手術(shù)過程中精確度和相對(duì)安全程度。 即使這種技術(shù)能成功的應(yīng)用與外科領(lǐng)域，機(jī)器人輔助系統(tǒng)也將不會(huì)完全取代和制約外科醫(yī)生；它們使得外科手術(shù)有了重大的改觀，機(jī)器人系統(tǒng)使得各種有效的輔助設(shè)備得到綜合的應(yīng)用，使得在手術(shù)環(huán)境中各種儀器和諧統(tǒng)一的配合對(duì)病人實(shí)施手術(shù)操作，這一切對(duì)于病人的手術(shù)后效果都是大大有 利的。m peak to peak at the handheld instrument tip. Robots developed for instrument positioning 。 they will help them to achieve their transmutation toward a higher being capable of harmoniously melting the human body holistic approach and the robotic synthesizing and bine enormous capacities, all for the good of the patien. 。m. Currently, this technology is limited to animal models but if transposed to the operating room in human subjects, such precision would be attainable only through robotic assistance. Scaling small motions and forces to the range of human perception may provide not only improved performance but also potentially the creation of novel microsurgical procedures. A telemanipulator RAMS (RobotAssisted MicroSurgery) scales down the surgeon39。s Perspective Alim Louis Benabid and Wieslaw Nowinski INTRODUCTION Since its inception, neurosurgery has continually distinguished itself as the most innovative field among surgical specialties, possibly secondary to the inherently innovative nature of the an system it serves. Driven by changes in patient needs, technological advances, and significant progress in our understanding of the neurosciences, neurosurgery has maintained an everchanging face to the extent that, at times, even those within the field find it difficult to recognize. As with rapid change in any aspect of life, a wide array of attitudes are elicited. Denial of progress, and tenacity toward that which is familiar, is certainly the safest, easiest response and, rhinencephalically speaking, may be the most physiological attitude manifested. Arising from the temporal lobe, disbelief and disorientation are also frequently encountered responses to change. These attitudes, however, are often overe through the acquisition of knowledge and experience. The frontal lobes are responsible for balancing inhibition with disinhibition. They serve as the source of curiosity housing the motor cortex necessary to engage in exploratory behavior, the planning areas to evaluate riskbearing trials, and the sanctuary for plex decision making. Because of the frontal lobes, we move forward down a path toward invention, trial, and ultimately, final design. The history of surgical tools follows a similar path and is far from being perfected. The introduction of novel tools into the operating room through the form of puter informatics, online radiology review, and intraoperative imaging has revolutionized both the design and the ambience of the operating room. This, however, is only the beginning. Progress is more than the simple acquisition of vast amounts of highly sophisticated equipment and the teams of specialists required to operate it. The entire concept has to be rethought to truly achieve a higher level of structure. The overwhelming amount of information now available to the neurosurgeon must be seamlessly integrated and coupled with intraoperative machinery capable