Robotic Surgery History Details

History of Robotic Surgery:

Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery.

Traditional Laparoscopic Surgery compared to da Vinci Robotic Surgery:

The technology used in Intuitive Surgical's da Vinci surgical robot is made to allow surgeons to operate through the small ports used in non-invasive surgery however with the same direct approach learned in open surgery and similar or even better range of motion.

This is as opposed to traditional laparoscopic surgery, in which the surgeon must move the instrument handles within the other direction because the instrument tips - left means right and right means left. Many surgeons describe this approach to be counter-intuitive. Instead, when the da Vinci surgeon moves the console controls clockwise, the tiny wristed instruments inside the patient twist clockwise too.

Surgeons state that they benefit from the user interface design, which is very much like the experience of performing open surgery. Their patients benefit from a non-invasive approach that provides better precision, visualization and control as compared to conventional laparoscopy.

Health Tech Trends : Roles in Robotic Surgery featuring Dr. David Samadi:

The Institute for Health Technology Transformation (iHT²) commissioned this piece of "Roles in Robotic Surgery". It features Intuitive Surgical's da Vinci Surgical Robotic System and Dr. David Samadi of Mount Sinai School of Medicine offering his thoughts on the future of robotic surgery, specifically robotic prostatectomy.

Lack of crossover between industrial robotics and medicine,particularly surgery:

Surgical robots have entered the field in force. Robotic telesurgical machines have already been used to perform transcontinental cholecystectomy. Voice-activated robotic arms routinely maneuver endoscopic cameras, and complex master slave robotic systems are currently FDA approved, marketed, and used for a variety of procedures. It remains to be seen, however, if history will look on the development of robotic surgery as a profound paradigm shift or as a bump in the road on the way to something even more important.

Paradigm shift or not, the origin of surgical robotics is rooted in the strengths and weaknesses of its predecessors. Minimally invasive surgery began in 1987 with the first laparoscopic cholecystectomy. Since then, the list of procedures performed laparoscopically has grown at a pace consistent with improvements in technology and the technical skill of surgeons. The advantages of minimally invasive surgery are very popular among surgeons, patients, and insurance companies. Incisions are smaller, the risk of infection is less, hospital stays are shorter, if necessary at all, and convalescence is significantly reduced. Many studies have shown that laparoscopic procedures result in decreased hospital stays, a quicker return to the workforce, decreased pain, better cosmesis, and better postoperative immune function.

As attractive as minimally invasive surgery is, there are several limitations. Some of the more prominent limitations involve the technical and mechanical nature of the equipment. Inherent in current laparoscopic equipment is a loss of haptic feedback (force and tactile), natural hand-eye coordination, and dexterity. Moving the laparoscopic instruments while watching a 2-dimensional video monitor is somewhat counterintuitive. One must move the instrument in the opposite direction from the desired target on the monitor to interact with the site of interest. Hand-eye coordination is therefore compromised. Some refer to this as the fulcrum effect. Current instruments have restricted degrees of motion; most have 4 degrees of motion, whereas the human wrist and hand have 7 degrees of motion. There is also a decreased sense of touch that makes tissue manipulation more heavily dependent on visualization. Finally, physiologic tremors in the surgeon are readily transmitted through the length of rigid instruments. These limitations make more delicate dissections and anastomoses difficult if not impossible. The motivation to develop surgical robots is rooted in the desire to overcome the limitations of current laparoscopic technologies and to expand the benefits of minimally invasive surgery.From their inception, surgical robots have been envisioned to extend the capabilities of human surgeons beyond the limits of conventional laparoscopy. The history of robotics in surgery begins with the Puma 560, a robot used in 1985 by Kwoh et al to perform neurosurgical biopsies with greater precision. Three years later, Davies et al performed a transurethral resection of the prostate using the Puma 560  This system eventually led to the development of PROBOT, a robot designed specifically for transurethral resection of the prostate. While PROBOT was being developed, Integrated Surgical Supplies Ltd. of Sacramento, CA, was developing ROBODOC, a robotic system designed to machine the femur with greater precision in hip replacement surgeries. ROBODOC was the first surgical robot approved by the FDA.

Also in the mid-to-late 1980s a group of researchers at the National Air and Space Administration (NASA) Ames Research Center working on virtual reality became interested in using this information to develop telepresence surgery. This concept of telesurgery became one of the main driving forces behind the development of surgical robots. In the early 1990s, several of the scientists from the NASA-Ames team joined the Stanford Research Institute (SRI). Working with SRI's other robotocists and virtual reality experts, these scientists developed a dexterous telemanipulator for hand surgery. One of their main design goals was to give the surgeon the sense of operating directly on the patient rather than from across the room. While these robots were being developed, general surgeons and endoscopists joined the development team and realized the potential these systems had in ameliorating the limitations of conventional laparoscopic surgery.

The US Army noticed the work of SRI, and it became interested in the possibility of decreasing wartime mortality by "bringing the surgeon to the wounded soldier-through telepresence." With funding from the US Army, a system was devised whereby a wounded soldier could be loaded into a vehicle with robotic surgical equipment and be operated on remotely by a surgeon at a nearby Mobile Advanced Surgical Hospital (MASH). This system, it was hoped, would decrease wartime mortality by preventing wounded soldiers from exsanguinating before they reached the hospital. This system has been successfully demonstrated on animal models but has not yet been tested or implemented for actual battlefield casualty care.Several of the surgeons and engineers working on surgical robotic systems for the Army eventually formed commercial ventures that lead to the introduction of robotics to the civilian surgical community. Notably, Computer Motion, Inc. of Santa Barbara, CA, used seed money provided by the Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled by the surgeon voice commands to manipulate an endoscopic camera.

Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery system. This system underwent extensive redesign and was reintroduced as the Da Vinci surgical system. Within a year, Computer Motion put the Zeus system into production.

Source: Medscape Visit our robotic surgery Pages for more information

History• The world's first surgical robot was the "Arthrobot", which was developed and used for the first time in Vancouver, BC, Canada in 1983. The robot was developed by a team led by Dr. James McEwen and Geof Auchinlek, in collaboration with orthopaedic surgeon, Dr. Brian Day. National Geographic produced a movie on robotics which featured the Arthrobot. In related projects at that time, other medical robots were developed, including a robotic arm that performed eye surgery and another that acted as an operating assistant, and handed the surgeon instruments in response to voice commands.

• In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance.

• In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery.

• In 1992, the ROBODOC from Integrated Surgical Systems was introduced to mill out precise fittings in the femur for hip replacement.

Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical systems.
Intuitive Surgical bought Computer Motion in 2003; ZEUS is no longer being actively marketed.The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system.

Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. 

 The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments.The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console.

 some interesting records of Robotic Surgery

• In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.

• On September 2nd 1999, Dr. Randall Wolf and Dr. Robert Michler performed the first robotically assisted heart bypass in the USA at The Ohio State University.

• In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada by Dr. Douglas Boyd and Dr. Reiza Rayman using the ZEUS surgical robot.

• On November 22, 1999 - the first closed-chest beating heart cardiac hybrid revascularization procedure is performed at the London Health Sciences Centre (London, Ontario).

In the first step of the procedure Dr. Douglas Boyd used Zeus to perform an endoscopic, single-vessel heart bypass surgery on a 55 year-old male patient's left anterior descending artery.

In the next step of the procedure William Kostuk, MD, Professor of Cardiology of the University of Western Ontario, completed an angioplasty revascularization on the patient's second occluded coronary vessel. This multi-step procedure marked one of the first integrative approaches to treating coronary disease.

• On September 7, 2001, Dr. Jacques Marescaux and Dr. Michel Gagner, while in New York, used the Zeus robotic system to remotely perform a cholecystectomy on a 68 year old female patient who was in Strasbourg, France.

• In December 2003, TAMPA, Fla. - A woman whose husband died after a doctor using a surgical robot accidentally cut two of his main blood vessels is suing the hospital. Al Greenway's widow is suing St. Joseph's Hospital, saying it's at fault for her husband's October 2002 death. Brenda Greenway says hospital administrators allowed doctors inexperienced with the $1 million robot to perform her husband's surgery, which was to remove a cancerous kidney. Greenway, a 53-year-old Desert Storm veteran and Plant High School science teacher, died when the surgeon cut his abdominal aorta, which provides blood to the abdominal organs and legs, and the inferior vena cava, the neighboring vein that returns that blood to the heart. (AP News.)

• In May 2006, The first unmanned robotic surgery took place in Italy.

• In August 2007: Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.

• In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. The operation was performed on a 10-year-old girl.

• On May 12, 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.

• In June 2008 the German Aerospace Center (DLR) presented the first robotic system for minimally invasive surgery with force-feedback in 7 dof in the tip of the instrument, distal of the 2-dof handwrist (MiroSurge).

• In January 2009, Dr. Todd Tillmanns reported results of the largest multi-institutional study on the use of da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess acquisition of their skills using the device.

• Also in January 2009, the first all-robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center in Livingston, New Jersey by Dr. Stuart Geffner. The same team performed eight more fully robotic-assisted kidney transplants over the next six months.

• In September 2010, The Netherlands - The Eindhoven University of Technology announced the development of the Sofie (Surgeon’s Operating Force-feedback Interface Eindhoven) surgical system, the first surgical robot to employ force feedback.

In spite of its futuristic name

Robotic surgery is not performed by a Data type character from Star Trek.
Rather, robotic surgery puts a computer between the surgeon and the surgical tools
operating on the patient.
Robotic surgery incorporates the latest advances in robotics, computing, and medical imaging. In the past few years, robotic surgery has made newspaper headlines and enjoyed a rapid rise in popularity.

According to a 2005 Business Week article, about 20,000 procedures were performed using robotic surgery in 2004, compared to just 1,500 procedures in 2000.

Robotic surgery falls into the broader field of minimally invasive surgery (MIS).
MIS, also known as endoscopic surgery or keyhole surgery, was pioneered in 1987.

Endoscopic surgery uses small incisions and devices on the end of tubes, along with a camera to perform the surgery. But endoscopic surgery still requires that a surgeon manipulate those tools directly.

Robotic surgery takes the next step, which is to attach those tools to a computer and do it all remotely.With robotic surgical systems, also called computer-assisted surgery, surgeons don't move endoscopic instruments directly with their hands. Instead, surgeons sit at a console several feet from the operating table and use joysticks similar to those used in video games.

They perform surgical tasks by guiding the movement of the robotic arms in a process known as tele-manipulation. The da Vinci Robotic Surgery System was the first robotic system approved by the Food and Drug Administration (FDA) for assisting surgery.

Robots have superhuman capabilities that make surgery easier. For instance, they don't tire. Robotic arms don't have a tremor, so they can remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles.

The FDA, which must approve all such devices, says robotic surgical machines have a number of other advantages as well:• Robotic surgical systems can also improve depth perception, giving surgeons three-dimensional vision, compared with the two-dimensional vision they would normally get with normal endoscopic procedures.

• The surgical field can be magnified so that millimeter-sized veins appear as big as pencils.• Compared with the long instruments used in endoscopy, robotic surgical systems use smaller instruments that provide increased range of motion. This can be very helpful when operating on children.• Robotics also offers motion scaling, which means that a surgeon's gross hand movements can be reduced to fine movements, allowing for accuracy in tight spaces.
For example, with motion scaling, one inch of movement by the surgeon results in a quarter-inch movement by the robotic surgical instruments.

There are also advantages for the patient. The FDA says that robotic surgery can mean less time in the hospital along with other positives such as:

• less pain and scarring
• less risk of infection
• less blood loss and fewer transfusions
• faster recovery
• quicker return to normal activities

The FDA say there may be times when the surgeon will begin a surgical procedure with the robot and then for one reason or another have to abandon it and do the surgery using traditional methods.

If you or a loved one has been diagnosed with a condition that may require surgery, you owe it to yourself to learn about all of your medical options, including the most effective, least invasive surgical treatments available.

The da Vinci® Surgical System provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting a surgeon's hands at the controls of a state-of-the-art robotic platform. The da Vinci System enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision.

Robotic Surgery vs. Life Support Devices!!

 Now-a-days Robotic Surgery system has become a Life Support Device to the Modern World. These devices are used by qualified health professionals to support life in critically-ill people, in surgical settings or to improve quality of life.

Computer-Assisted (Robotic) Surgical SystemsWhat are Computer-Assisted (Robotic) Surgical Systems?

Different types of computer-assisted surgical systems can be used for pre-operative planning, surgical navigation and to assist in performing procedures. One type is computer-assisted surgical systems, commonly called robotic-assisted surgical systems or robotic surgery.
These medical devices enable the surgeon to use computer and software technology to control and move surgical instruments through one or more tiny incisions in the patient’s body (minimally invasive) for a variety of surgical procedures. The benefits of computer-assisted surgical systems can include the device’s ability to facilitate minimally invasive surgery and assist with complex tasks in areas of the body that may be difficult to navigate, as well as shorter post-operative recovery times. The device is not actually a robot because it cannot perform surgery without direct human control.
Computer-assisted surgical systems generally have several components, which may include:

• A console, where the surgeon sits during surgery. The console is the control center of the system and allows the surgeon to view the surgical field and control movement of the surgical instruments and the camera (endoscope) though a 3D monitor;
• The bedside cart that includes three or four hinged mechanical arms, camera (endoscope) and surgical instruments that the surgeon controls the during surgical procedures; and
• A separate cart that contains supporting hardware and software components, such as an electrical surgical unit (ESU), suction/irrigation pumps, and light source for the endoscope.

Most surgeons use multiple surgical instruments and accessories with the computer-assisted surgical system, such as scalpels, forceps, graspers, dissectors, cautery, scissors, retractors and suction irrigators.

 Source from- www.fda.gov

Common uses of Computer-Assisted Surgical Systems

The FDA has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general surgery cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. Some common procedures that may involve computer-assisted surgical systems are gall-bladder removal, hysterectomy and prostatectomy (removal of the prostate).

Recommendations for Patients and Health Care Providers about Computer-Assisted Surgical Systems:

Health Care Providers:

Computer-assisted surgery is an important treatment option that is safe and effective when used appropriately and with proper training. The FDA does not regulate the practice of medicine and therefore does not supervise or provide accreditation for physician training nor does it oversee training and education related to legally marketed medical devices. 

Instead, training development and implementation is the responsibility of the manufacturer, physicians, and health care facilities. In some cases, professional societies and specialty board certification organizations may also develop and support training for their specialty physicians. Specialty boards also maintain certification status of their specialty physicians.

Physicians, hospitals and facilities that use computer-assisted surgical systems should ensure that proper training is completed and that surgeons are appropriately credentialed. Device users should ensure they maintain their credentialing. Hospitals and facilities should also ensure that other surgical staff that use these devices complete proper training.

Users of the device should realize that there are several different models of computer-assisted surgical systems. Each model may operate differently and may not have the same functions. Users should know the differences between the models and make sure to get appropriate training on each model.

If you suspect a problem or complications associated with the use of computer-assisted surgical systems, the FDA encourages you to file a voluntary report through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Healthcare personnel employed by facilities that are subject to FDA's user facility reporting requirements should follow the reporting procedures established by their facilities. Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices.

Patients:

Computer-assisted surgery is an important treatment option but may not be appropriate in all situations. Talk to your physician about the risks and benefits of computer-assisted surgeries, as well as the risks and benefits of other treatment options.

Patients who are considering treatment with computer-assisted surgeries should discuss the options for these devices with their health care provider, and feel free to inquire about their surgeon’s training and experience with these devices.

Source from- www.fda.gov


To get more details about Robotic Surgery get connected with our site: 

Robot Surgery System