The introduction of robots into the field of medicine can be dated back to the 1990s, due to the demand for minimally invasive surgery, and since then, the evolution of artificial intelligence technology has driven the field of robotic surgery forward.
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The first robot developed for surgery was approved for clinical use by the Food and Drug Administration in 1994 and a 2008 collaborative project resulted in the development of a novel robotic system for multi-incision laparoscopic surgery that was hopeful for clinical approval.
The da Vinci surgical system, created by the US company, Intuitive Surgical, is the most popular surgical robot in the present day and was approved by the FDA in 2000. It provides surgeons with an advanced set of instruments used for robotic-assisted minimally invasive surgery, with the surgeon guiding the surgical instruments through a console. This innovative system translates the surgeon’s hand movements and actions at the console in real-time, including bending and rotating the instruments enabling the procedure to be performed.
The tiny wristed instruments have similar movements to the human hand; however, they hold a higher and greater range of motion. Additionally, the system also includes high magnification and 3D high-definition imaging of the surgical area for the procedure. The small size of the instruments also enables surgeons to perform operations using only one or a couple of small incisions at the site of operation.
How Does It Work?
The da Vinci surgical system has three components: the surgical console, patient cart and the vision cart.
To perform a surgical procedure, the surgeon would sit at the console to control the surgical instruments while having a 3D and high-definition view of the patient’s anatomy. The patient cart is placed along the side of the patient’s bed, and this component holds all the surgical instruments and cameras that the surgeon has access and command of from the console. The purpose of the vision cart is to communicate between the components as well as supporting the 3D high-definition vision system.
There are four different models of the da Vinci system that hospitals can adopt and access for minimally invasive surgery, including the da Vinci SI, X, XI, and SP.
The da Vinci surgical system has been reported by the manufacturer to be used for various surgical procedures pertaining to the following areas, (i) cardiovascular, such as the heart, (ii) colorectal, (iii) general surgery, such as for the digestive tract and hernia repairs, (iv) gynecology, (v) head and neck, (vi) thoracic, and (vii) urology.
Robotic-Assisted Surgery for Cardiovascular Conditions
With heart disease being one of the leading causes of mortality in both men and women in the United States, research into innovations to alleviate these statistics is significant.
Coronary heart disease is one of the most common conditions that affect the heart, resulting from the build-up of plaque in the arteries and can narrow and even stop blood flow to the heart muscle. This can lead to a heart attack due to the deprivation of oxygen to the heart muscles.
Previously, the only method to operate on the heart included open heart surgery, including a long incision down the center of the chest area. This surgery also consists of the surgeon cutting through the breastbone and opening the ribcage to allow the heart to be seen for the surgery.
However, with recent innovations, the options for heart surgery have expanded. While open heart surgery is still a viable and commonly used option, minimally invasive approaches are also available.
In the example of coronary artery bypass surgery, there are two other minimally invasive options available to surgeons instead of open-heart surgery. These include thoracoscopic surgery and robotic-assisted surgery via the da Vinci surgical system, which only require a couple of small cuts to be made to insert the surgical instruments and a camera to view the heart.
In thoracoscopic heart surgery, special long-handled tools are used for the surgical procedure and the thoracoscope camera provides a magnified image that can be seen on a video screen by the surgeon.
Thoracoscopic and robotic-assisted surgery can also be used for mitral valve repair. However, there is also a third minimally invasive option, such as using a catheter, where a small cut is made in the groin area, and a thin tube is threaded through a vein toward the heart, enabling the repair or replacement of the valve.
While there are many viable options for the da Vinci surgical system, in the United States the da Vinci SP surgical system has only been provided clearance for three different procedures, including single-port urological procedures, lateral oropharyngectomy/ radical tonsillectomy, and tongue base resection.
Performance and Future Outlook
The da Vinci system was introduced into the Chinese market in 2008 and by 2019 had 112 installations, as well as more than 110,000 uses within surgical operations across anatomical areas such as gastrointestinal to cardiothoracic.
The advantage of this system includes aiding surgeons with a clearer image, higher accuracy rate, stability, and a greater range of motion. This also has eliminated the challenge of fatigue associated with surgeries, which can result in fewer human errors and benefit the patient with smaller incisions translating to faster recovery time and less pain.
However, while this system holds major benefits, the challenges it faces include price and accessibility within all countries. Additionally, competitors that have access to clinical data can also improve this model and create more desirable features for future robotics; an example of this includes the Micro Hand S surgical robot. This team of researchers has built a classified database of physical characteristics of patients, as well as the interaction between the surgical instruments and soft tissue to inform the safety and reliability of updated designs.
The innovation of surgical robotics has been strong since the 1990s and with more companies releasing models into clinical use, it may soon be commonplace to use robotics for minimally invasive and even invasive surgeries.
References and Further Reading
The Da Vinci Systems. [Online] Intuitive.com. Available at: https://www.intuitive.com/en-us/patients/da-vinci-robotic-surgery/about-the-systems
Turchetti, G. et al. (2011) “Economic evaluation of da vinci-assisted robotic surgery: A systematic review,” Surgical Endoscopy, 26(3), pp. 598–606. https://doi.org/10.1007/s00464-011-1936-2.
Yi, B. et al. “The future of robotic surgery in safe hands,” Nature Portfolio [Preprint]. Advertisement Feature. www.nature.com/articles/d42473-020-00176-y
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