Surgical Assistive Robots

The advancements in robotics have seen huge strides from the time when robots were considered to be uncommunicative machines doing repetitive tasks to the present day when robots can perform high-accuracy, highly specific and difficult tasks in research and industries that are not difficult to be accomplished by humans.

Robots now assist surgical procedures and do so with very high precision and reliability. Today, robotic telesurgical machines have been used to perform complicated procedures such as transcontinental cholecystectomy.

Voice activation is now a common feature to controlling the movement of robotic along with complicated master-slave robotic systems that are FDA-approved, marketed and used for a number of procedures.

Etienne Dombre (2005)  Research focusing on the potential of surgical robots to work in conjunction with a surgeon to perform procedures beyond traditional laproscopy document the Puma 560 - the first surgical robot designed in 1984 to assist neurosurgical biopsies with high-precision (Dombre E, 2005).

The Puma 560.12 was used to perform a transethral resection of the prostate, a procedure which encouraged the development of the PROBOT, a surgical robot designed specifically for transurethral resection of the prostate.

Advantages of Surgical Assistive Robots

John E Speich et al (2004) discusses the benefits of these systems:

• They improve dexterity, restore an ergonomic position and proper hand-eye coordination.
• The systems enable complicated surgical procedures to be performed  with ease and with limited damage to surrounding tissue.
• Instruments having more degrees of freedom improve the ability of the surgeon drastically to manipulate instruments and the soft tissue.
• The systems are designed such that the surgeon’s tremor can be compensated on the end-effector motion through suitable software and hardware filters.
• The systems are capable of scaling movements so that large control grip movements can be changed to micromotions in the patient.
• These systems offer improved vision and enable a 3D view with depth perception marking a significant improvement over traditional laparoscopic camera views.
• The surgeon can directly control a stable visual field with high maneuverability and magnification resulting in high resolution images, which combined with more degrees of freedom and dexterity improves the ability of the surgeon to detect and dissect anatomic structures.

Working of Surgical Robots

Lafranco AR (2009) suggests that in order to perform a surgical task, three main entities are involved: the medium, the surgeon and the patient. The medium is the channel through which the surgeon sees and communicates with the patient. It may include an endoscopic camera, standard surgical instruments, a robotic surgery system, laproscopic instruments or several other technologies.

The complex medium, in most cases, offers valuable data improving vision, providing force feedback and improves the kinematic capabilities of the surgeon by filtering hand tremor and scaling down motion.

With minimally invasive surgery, the endoscopic camera and tools are inserted through ports in the body’s cavity.

The tool/port and camera/port introduce a fulcrum while bringing down the number of degrees of freedom from six in an open surgery to four in MIS. It is possible to use a voice-activated robotic arm such as the AESOP that automates the task of endoscopic camera positioning and offers the surgeon direct control over a precise, smooth and stable view of the internal surgical field.

Products in the Market – Advancements

The da Vinci Robot from Intuitive Surgical

The da Vinci surgery system from Intuitive Surgical, Inc. became the first robotic system in 2000 approved by the FDA for laparoscopic surgery.

Prostate cancer surgery using da Vinci Surgery - 2011 Intuitive Surgical, Inc.

The 3D magnification screen of the da Vinci system helps the surgeon to view the operative area with high resolution.

Modern-day surgical arms with a 1 cm diameter signify a major advancement in robotic surgery from large-armed systems such as the PUMA 560. The miniaturizaion of surgical robotic systems has eliminated the need for using supporting equipment for leverage. The da Vinci system has been approved for pediatric and adult procedures in the following areas:

• Urological surgeries
• General laparoscopic surgeries
• General non-cardiovascular thoracosopic surgeries
• Thoracoscopically assisted cardiotomy procedures.

Cyberknife from Accuray

The CyberKnife^® system from Accuray features innovative robotic mobility and sophisticated image solutions following the target all through the treatment, delivering treatments intelligently with sub-millimeter precision.

This system is key for treatments that have high tumor coverage, tight dose conformality and steep dose gradients regardless of target shape. The need for restrictive head frames and gating techniques are eliminated offering better comfort for the patient.

Sources and Further Reading

• Etienne Dombre, Introduction to Surgical Robots –LIRMM, Montpellier, 2005.
• Katherine M. Tsui and Holly A. Yanco, Assistive, Rehabilitation, and Surgical Robots from the Perspective of Medical and Healthcare Professionals, University of Masachusetts, 2007.
• Anthony R Lafranco , Robotic Surgery – A current perspective, 2009, 239, 14 -21

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