Robot-assisted surgery

Robot-assisted surgery is the latest development in the larger movement of endoscopy, a type of minimally invasive surgery–the idea being that less invasive procedures translate into less trauma and pain for patients. Surgery through smaller incisions typically results in less scarring and faster recovery. It’s not that robots are changing the basics of surgery. Surgeons are still cutting and sewing like they have been for decades. Robots represent a new computer-assisted tool that provides another way for surgeons to work.

Rather than cutting patients open, endoscopy allows surgeons to operate through small incisions by using an endoscope. This fiber optic instrument has a small video camera that gives doctors a magnified internal view of a surgical site on a television screen.
In abdominal endoscopy, known as laparoscopy, surgeons thread the fiber optic instrument into the abdomen. First performed in the late 1980s, laparoscopy is now routine for many procedures, such as surgery on the gallbladder and on female organs.

With robotic surgical systems, 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.

MODERN ROBOTIC SURGERY SYSTEMSGENERAL LAYOUT OF A ROBOTIC SURGICAL SYSTEM

A General Surgical System consists of the following:-

  • Surgeon Console
  • Image processing Equipment
  • Endowrist Instruments
  • Surgical Arm Cart
  • High Resolution 3D Endoscope

TYPES OF ROBOTIC SYSTEM

  1. AESOP ROBOTIC SYSTEM :- AESOP stands for Automated Endoscopic System for Optimal Positioning. Basically, it consists of one robotic arm, which holds the endoscope in position. Foot-pedals or voice activated software allow the physician to control the endoscope as required. This system was developed by Computer motion. AESOP is the first FDA approved robot for operating room assistance (1994).
  2. Da VINCI SURGICAL SYSTEM :- In July 2000, the FDA cleared da Vinci as an endoscopic instrument control system for use in laparoscopic (abdominal) surgical procedures such as removal of the gallbladder and surgery for severe heartburn. In March 2001, the FDA cleared da Vinci for use in general non-cardiac thoracoscopic (inside the chest) surgical procedures–surgeries involving the lungs, esophagus, and the internal thoracic artery. This is also known as the internal mammary artery, a blood vessel inside the chest cavity. In coronary bypass surgery, surgeons detach the internal mammary artery and reroute it to a coronary artery. In June 2001, the FDA cleared da Vinci for use during laparascopic removal of the prostate (radical prostatectomy). The da Vinci is intended to assist in the control of several endoscopic instruments, including rigid endoscopes, blunt and sharp dissectors, scissors, scalpels, and forceps. The system is cleared by the FDA to manipulate tissue by grasping, cutting, dissecting and suturing. In use, a surgeon sits at a console several feet away from the operating table and manipulates the robot’s surgical instruments. The robot has three hands attached to a free-standing cart. One arm holds a camera (endoscope) that has been passed into the patient through small openings. The surgeon operates the other two hands by inserting fingers into rings. The arms use a technology called EndoWrist, flexible wrists that surgeons can bend and twist like human wrists. The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms. The da Vinci has a three-dimensional lens system, which magnifies the surgical field up to 15 times. Another surgeon stays beside the patient, adjusting the camera and instruments if needed.
  3. ZEUS SURGICAL SYSTEM :- The most exciting product to date from Computer Motion is the Zeus minimal invasive surgical robot system. It is also the one making regular headlines in the second half of 1999 and early in 2000. Minimal invasive surgery (MIS) has been around for over a decade now. About 4 million procedures are carried out annually around the world by surgeons using long slender devices to probe, cut and repair patient tissues and organs. While MIS has led to faster recovery time for patients, surgeons find the technique physically challenging because it limits precision and dexterity, and brings on fatigue more rapidly. In introducing the AESOP robot, Computer Motion has already improved one element of MIS, namely support and positioning of endoscopic cameras. With the Zeus system, all the instruments are robotic. The surgeon, as seen above, can sit comfortably at a master console and control the slave robotic instruments using a pair of master manipulators. The following advantages are achieved:
  • The fatigue factor is substantially reduced as the surgeon is seated and does not have to constantly hold onto the instruments.
  • The robotic instruments follow the surgeon’s motion while filtering out tremors. With motion scaling, they can also execute micro-movements which may be humanly impossible.
  • With robotic instruments, the incisions needed are even smaller than with previous MIS instruments, leading to fewer traumas on the patients and hence shorter recovery times.

Zeus has a similar setup to the Da Vinci system. It includes the following:

  • A computer workstation
  •  A video display
  • Hand controls to move table mounted with Surgical Instruments
  • Endoscope inserted into patient
  • A set of Working Robotic Arms

Using the Zeus system, surgeons have achieved the following remarkable milestones:

  • In France, a series of operations have been performed on infants to repair a condition known as patent ductus arteriosis. Using the Zeus robotic system, a surgeon was able to close an open artery with only 3 incisions of 0.2″ diameter each on the patient’s body, in contrast to the 4-5″ opening and rib cage separation which were previously necessary.
  • In Canada, a surgeon using the Zeus system was able to perform a bypass procedure on a beating heart, again with small incisions only rather than a split chest. The patient was able to return home the day after the operation

FUTURE SCOPE

  1. TELESURGERY :- Telesurgery is basically Robotic Surgery that is done across long distances. This means that the surgeon and the patient are at two different places while the surgery is carried out.World’s First Telesurgery :  On September 7, 2001 a doctor in New York removed the diseased gallbladder of a 68-year-old patient in Strasbourg, France. The surgeon used a computer with a high-speed network connection to move robotic tools in the French operating room.Someday doctors may be able to use this technology to operate on patients in dangerous or inaccessible locations.
  2. THE HEALING TOUCH :- Research is being done to allow robots experience ‘Robotic Feeling’ of the patients body tissues. Sensors are being developed to send three-dimensional information of organs to tiny pins on the surgeon’s fingertips. The doctor can then feel changes in texture or the strength of his grip. This technology may be used to detect lung tumors or to work on delicate tissues.
  3. VOICE CONTROLLED SURGERY :- The microphone and headset that a surgeon is wearing while Voice Controlled surgery allows him to control robotic surgical instruments and cameras, as well as room lighting and other equipment, with voice commands. This frees the other operating room personnel from adjusting equipment. Voice Command is the basic tool for HERMES robotic system.
  4. ROBOTIC BRAIN SURGERY :- Robotic surgical tools give the doctor finer control over delicate movements and more accurate pinpointing of the diseased area in the Brain. This allows the surgery to be performed without fitting patients with a painful, cumbersome immobilizing frame that is needed for traditional brain surgery.
  5. PRACTICE MAKES PERFECT :- Doctors at the Surgical Planning Lab in UK can use 3D images of their patients to see the shapes of tumors and to practice surgeries. This technology is also used to track changes in the body over time, either for disease sufferers or for aging patients. NASA is developing a robotic probe to detect the shape of brain tumors. The robot’s precise movements and the probe’s thin wires cause less damage to the brain than traditional surgery.

REFERENCES
1. Science and Technology Review, June 1998.
2. en.wikipedia.org
3. www.o-keating.com

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