Robotic surgery - AbsoluteAstronomy.com

Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

.

Robotically-assisted surgery was developed to overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing open surgery. In the case of robotically assisted minimally invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments ; either a direct telemanipulator

Remote manipulator

A remote manipulator, also known as a telefactor, telemanipulator, or waldo , is a device which, through electronic, hydraulic, or mechanical linkages, allows a hand-like mechanism to be controlled by a human operator...

or by computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arm

Robotic arm

A mechanical arm is a robotic, usually programmable, with similar functions to a human arm. The links of such a manipulator are connected by joints allowing either rotational motion or translational displacement. The links of the manipulator can be considered to form a kinematic chain...

s carry out those movements using end-effector

Robot end effector

In robotics, an end effector is the device at the end of a robotic arm, designed to interact with the environment. The exact nature of this device depends on the application of the robot....

s and manipulator

Manipulator

In robotics a manipulator is a device used to manipulate materials without direct contact. The applications were originally for dealing with radioactive or biohazardous materials, using robotic arms, or they were used in inaccessible places. In more recent developments they have been used in...

s to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, indeed the surgeon could be anywhere in the world, leading to the possibility for remote surgery

Remote surgery

Remote surgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements...

. In the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could ever be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve that lion's share of surgeries, particularly cardio-thoracic, that minimally invasive techniques have so failed to supplant.

History

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

Imperial College London

Imperial College London is a public research university located in London, United Kingdom, specialising in science, engineering, business and medicine...

, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur

Femur

The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...

for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical

Intuitive Surgical

Intuitive Surgical Inc. is a corporation that manufactures robotic surgical systems, most notably the da Vinci Surgical System. The da Vinci Surgical System allows surgery to be performed remotely using robotic manipulators. The company is part of the Nasdaq-100 and S&P 500...

with the introduction of the da Vinci Surgical System

Da Vinci Surgical System

The Da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and designed to facilitate complex surgery using a minimally invasive approach...

and Computer Motion with the AESOP and the ZEUS robotic surgical system

ZEUS robotic surgical system

The ZEUS Robotic Surgical System was a medical robot designed to assist in surgery, originally produced by the American robotics company Computer Motion. It was cleared by the Food and Drug Administration in 1994 to assist surgeons in minimally invasive surgery. ZEUS had three robotic arms, which...

. (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 cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

s. The original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA. Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California.

The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA

Food and Drug Administration

The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells for about $1.2 million. The new da Vinci HD SI released in April, 2009 currently sells for $1.75 million. The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio

Columbus, Ohio

Columbus is the capital of and the largest city in the U.S. state of Ohio. The broader metropolitan area encompasses several counties and is the third largest in Ohio behind those of Cleveland and Cincinnati. Columbus is the third largest city in the American Midwest, and the fifteenth largest city...

under the direction of Dr. Robert E. Michler, Professor and Chief, Cardiothoracic Surgery.

Timeline

In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.
In May 1998, Dr. Friedrich-Wilhelm Mohr using the da Vinci Surgical System
Da Vinci Surgical System
The Da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and designed to facilitate complex surgery using a minimally invasive approach...

performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.
On 2 September 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 22 November 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 a two step 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 7 September 2001, Dr. Jacques Marescaux and Dr. Michel Gagner, while in New York, used the Zeus robotic system to remotely perform a cholecystectomy
Cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.-Open surgery:A...

on a 68-year-old female patient who was in Strasbourg
Strasbourg
Strasbourg is the capital and principal city of the Alsace region in eastern France and is the official seat of the European Parliament. Located close to the border with Germany, it is the capital of the Bas-Rhin département. The city and the region of Alsace are historically German-speaking,...

, France. (See: the Lindbergh Operation
Lindbergh Operation
The Lindbergh Operation was a complete tele-surgical operation carried out by a team of French surgeons located in New York on a patient in Strasbourg, France using telecommunications solutions based on high-speed services and sophisticated surgical robotics...

.)
In May 2006 the first AI
Ai
AI, A.I., Ai, or ai may refer to:- Computers :* Artificial intelligence, a branch of computer science* Ad impression, in online advertising* .ai, the ISO Internet 2-letter country code for Anguilla...

doctor-conducted unassisted robotic surgery on a 34 year old male to correct heart arythmia. The results were rated as better than an above-average human surgeon. The machine had a database
Database
A database is an organized collection of data for one or more purposes, usually in digital form. The data are typically organized to model relevant aspects of reality , in a way that supports processes requiring this information...

of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient." The designers believe that robots can replace half of all surgeons within 15 years.
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.
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 the results of the largest multi-institutional study on the use of the da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess their acquisition of skills using the device.
In January 2009, the first all-robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center
Saint Barnabas Medical Center
Saint Barnabas Medical Center , an affiliate of the Barnabas Health , is a 597-bed non-profit major teaching hospital located in Livingston, New Jersey...

in Livingston, New Jersey
Livingston, New Jersey
Livingston is a township in Essex County, New Jersey, United States. As of the United States 2000 Census, the township population was 29,366.Livingston was incorporated as a township by an Act of the New Jersey Legislature on February 5, 1813, from portions of Caldwell Township and Springfield...

by Dr. Stuart Geffner. The same team performed eight more fully robotic-assisted kidney transplants over the next six months.
In September 2010, the Eindhoven University of Technology
Eindhoven University of Technology
The ' is a university of technology located in Eindhoven, Netherlands. The motto of the university is: Mens agitat molem . The university was the second of its kind in the Netherlands, only Delft University of Technology existed previously. Until mid-1980 it was known as the...

announced the development of the Sofie
Sofie (surgical robot)
The Surgeon’s Operating Force-feedback Interface Eindhoven surgical robot is a surgical robot developed at the Eindhoven University of Technology. It was developed as part of a Ph.D thesis by dr. ir. Linda van den Bedem and is the first surgical robot to incorporate force feedback.-Background:The...

surgical system, the first surgical robot to employ force feedback.
In September 2010, the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak. The robot used was the first true robot, meaning it was not simply mirroring the movement of human hands, but was guided by pressing on buttons. (See the vascular surgery section of this article.)

Advantages and disadvantages

Major advances aided by surgical robots have been remote surgery

Remote surgery

, minimally invasive surgery and unmanned surgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.

With the cost of the robot at $1,200,000 dollars and disposable supply costs of $1,500 per procedure, the cost of the procedure is higher. Additional surgical training is needed to operate the system. Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. Moreover during the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction and regret.

Advantages of this technique are that the incisions are small and patient recovery is quick. In traditional open-heart surgery, the surgeon makes a ten to twelve-inch incision, then gains access to the heart by splitting the sternum

Sternum

The sternum or breastbone is a long flat bony plate shaped like a capital "T" located anteriorly to the heart in the center of the thorax...

(breast bone) and spreading open the rib cage

Rib cage

The rib cage is an arrangement of bones in the thorax of animals. It is formed by the vertebral column, ribs and sternum and encloses the heart and lungs....

. The patient is then placed on a heart-lung machine

Heart-lung machine

Cardiopulmonary bypass is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump"...

and the heart is stopped for a period of time during the operation. This approach can be associated with postoperative infection and pain, and prolonged time to complete recovery. Because patient recovery after robot-assisted heart surgery is quicker, the hospital stay is shorter. On average patients leave the hospital two to five days earlier than patients who have undergone traditional open-heart surgery and return to work and normal activity 50% more quickly. Reduced recovery times are not only better for the patient, they also reduce the number of staff needed during surgery, nursing care required after surgery, and, therefore, the overall cost of hospital stays.

Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. While the use of robotic surgery has become an item in the advertisement of medical services, critics point out that studies that indicate that long-term results are superior to those after laparoscopic surgery are lacking. The robotic system does not come cheap and has a learning curve. Data is absent that proves the increased costs can be justified. In medical literature, very experienced surgeons tend to publish their results with robotic systems. However, these may not be representative of surgeons with lesser experience.

General surgery

In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at Ohio State University. Reports were published in esophageal and pancreatic surgery for the first time in the world and further data was subsequently published by Horgan and his group at the University of Illinois and then later at the same institution by others. In 2007, the University of Illinois at Chicago

University of Illinois at Chicago

The University of Illinois at Chicago, or UIC, is a state-funded public research university located in Chicago, Illinois, United States. Its campus is in the Near West Side community area, near the Chicago Loop...

medical team, led by Prof. Pier Cristoforo Giulianotti, reported a pancreatectomy

Pancreatectomy

In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy , distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy...

and also the Midwests fully robotic Whipple surgery

Pancreaticoduodenectomy

A pancreaticoduodenectomy, pancreatoduodenectomy, Whipple procedure, or Kausch-Whipple procedure, is a major surgical operation involving the pancreas, duodenum, and other organs...

. In April 2008, the same team of surgeons performed the world's first fully minimally invasive liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

resection for living donor transplantation, removing 60% of the patient's liver, yet allowing him to leave the hospital just a couple of days after the procedure, in very good condition. Furthermore the patient can also leave with less pain than a usual surgery due to the four puncture holes and not a scar by a surgeon.

Cardiothoracic surgery

Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) operations are being performed with the da Vinci system. Mitral valve

Mitral valve

The mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...

repairs and replacements have been performed. East Carolina University, Greenville (Dr W. Randolph Chitwood), Saint Joseph's Hospital, Atlanta (Dr Douglas A. Murphy), and Good Samaritan Hospital, Cincinnati (Dr J. Michael Smith) have popularized this procedure and proved its durability with multiple publications. Since the first robotic cardiac procedure performed in the USA in 1999, The Ohio State University, Columbus (Dr. Robert E. Michler

Robert E. Michler

Robert E. Michler, MD is an American surgeon who specializes in complex heart surgery, especially mitral and aortic valve repair. He is Surgeon-in-Chief at Montefiore Medical Center and Albert Einstein College of Medicine in New York, New York. He is also the Samuel I...

, Dr. Juan Crestanello, Dr. Paul Vesco) has performed CABG, mitral valve

Mitral valve

The mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...

, esophagectomy

Esophagectomy

Esophagectomy or Oesophagectomy is the surgical removal of all or part of the esophagus .-Purpose:...

, lung

Lung

The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

resection, tumor resections, among other robotic assisted procedures and serves as a training site for other surgeons. In 2002, surgeons at the Cleveland Clinic

Cleveland Clinic

The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...

in Florida (Dr. Douglas Boyd and Kenneth Stahl) reported and published their preliminary experience with minimally invasive "hybrid" procedures. These procedures combined robotic revascularization

Revascularization

Revascularization is "a surgical procedure for the provision of a new, additional, or augmented blood supply to a body part or organ." The term derives from the prefix re-, in this case meaning "restoration" and vasculature, which refers to the circulatory structures of an organ.Revascularization...

and coronary stenting and further expanded the role of robots in coronary bypass to patients with disease in multiple vessels. Ongoing research on the outcomes of robotic assisted CABG and hybrid CABG is being done by Dr. Robert Poston

Robert Poston

Robert S. Poston is an American cardiac surgeon at University of Arizona Medical Center most noted for his research in robot-assisted heart surgery and Coronary Artery Bypass Surgery. Dr. Poston’s research interest regarding the mechanism of early graft thrombosis was recognized with a five-year...

Cardiology and electrophysiology

The Stereotaxis Magnetic Navigation System (MNS

MNS

MNS may refer to:*Maharashtra Navnirman Sena, a regional political party in Maharashtra, India*The Malaysian Nature Society*Maki-Nakagawa-Sakata matrix*Ministry of National Security*Minneapolis, Northfield and Southern Railway...

) has been developed to increase precision and safety in ablation procedures for arrhythmias and atrial fibrillation

Atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...

while reducing radiation exposure for the patient and physician, and the system utilizes two magnet

Magnet

A magnet is a material or object that produces a magnetic field. This magnetic field is invisible but is responsible for the most notable property of a magnet: a force that pulls on other ferromagnetic materials, such as iron, and attracts or repels other magnets.A permanent magnet is an object...

s to remotely steerable catheters. The system allows for automated 3-D mapping of the heart and vasculature, and MNS has also been used in interventional cardiology

Interventional cardiology

Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist, Dr. Charles...

for guiding stent

Stent

In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...

s and leads in PCI and CTO procedures, proven to reduce contrast

Contrast (vision)

Contrast is the difference in visual properties that makes an object distinguishable from other objects and the background. In visual perception of the real world, contrast is determined by the difference in the color and brightness of the object and other objects within the same field of view...

usage and access tortuous anatomy unreachable by manual navigation. Dr. Andrea Natale has referred to the new Stereotaxis procedures with the magnetic irrigated catheters as "revolutionary."

The Hansen Medical

Hansen Medical

Hansen Medical, headquartered in Mountain View, California, designs and manufactures medical robotics for the accurate positioning and control of catheter-based technologies. The Company manufactures Sensei Robotic Catheter Systems, including next-generation Sensei X Robotic Catheter Systems, and...

Sensei robotic catheter system

The Sensei X robotic catheter is a medical robot designed to enhance a physician’s ability to perform complex operations using a small flexible tube called a catheter. As open surgical procedures that require large incisions have given way to minimally invasive surgeries in which the surgeon gains...

uses a remotely operated system of pulley

Pulley

A pulley, also called a sheave or a drum, is a mechanism composed of a wheel on an axle or shaft that may have a groove between two flanges around its circumference. A rope, cable, belt, or chain usually runs over the wheel and inside the groove, if present...

s to navigate a steerable sheath for catheter

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

guidance. It allows precise and more forceful positioning of catheters used for 3-D mapping of the heart and vasculature. The system provides doctors with estimated force feedback information and feasible manipulation within the left atrium of the heart. The Sensei has been associated with mixed acute success rates compared to manual, commensurate with higher procedural complications, longer procedure times but lower fluoroscopy

Fluoroscopy

Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...

dosage to the patient.

At present, three types of heart surgery are being performed on a routine basis using robotic surgery systems. These three surgery types are:

Atrial septal defect repair – the repair of a hole between the two upper chambers of the heart,
Mitral valve repair – the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,
Coronary artery bypass – rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.

As surgical experience and robotic technology develop, it is expected that the applications of robots in cardiovascular surgery will expand.

Gastrointestinal surgery

Multiple types of procedures have been performed with either the 'Zeus' or da Vinci

Da Vinci Surgical System

The Da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and designed to facilitate complex surgery using a minimally invasive approach...

robot systems, including bariatric surgery

Bariatric surgery

Bariatric surgery includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device or through removal of a portion of the stomach or by resecting and re-routing the small intestines...

. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices. Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux and Heller myotomy for the treatment of achalasia.

Other gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approaches to pelvic disease have also been reported.

Gynecology

Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology

Oncology

Oncology is a branch of medicine that deals with cancer...

. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis

Endometriosis

Endometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...

, ovarian tumors, pelvic prolapse, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. The need for large abdominal incisions is virtually eliminated.

Robot assisted hysterectomies and cancer staging

Cancer staging

The stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...

are being performed using da Vinci robotic system. The University of Tennessee

University of Tennessee

The University of Tennessee is a public land-grant university headquartered at Knoxville, Tennessee, United States...

, Memphis (Dr. Todd Tillmanns, Dr. Saurabh Kumar), Northwestern University

Northwestern University

Northwestern University is a private research university in Evanston and Chicago, Illinois, USA. Northwestern has eleven undergraduate, graduate, and professional schools offering 124 undergraduate degrees and 145 graduate and professional degrees....

(Dr. Patrick Lowe), Aurora Health Center (Dr. Scott Kamelle), West Virginia University

West Virginia University

West Virginia University is a public research university in Morgantown, West Virginia, USA. Other campuses include: West Virginia University at Parkersburg in Parkersburg; West Virginia University Institute of Technology in Montgomery; Potomac State College of West Virginia University in Keyser;...

(Dr. Jay Bringman) and The University of Tennessee, Chattanooga (Dr. Donald Chamberlain) have extensively studied the use of robotic surgery and found it to improve morbidity and mortality

Mortality rate

Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

of patients with gynecologic cancers. They have also for the first time reported robotic surgery learning curves for current and new users as a method to assess acquisition of their skills using the device. Dr.'s Joseph Prezzato and Burton Brodsky have utilized this equipment for gynecological procedures in Southeastern Michigan.

Neurosurgery

Several systems for stereotactic intervention

Stereotactic surgery

Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation,...

are currently on the market. MD Robotic's NeuroArm

NeuroArm

NeuroArm is a surgical robot. It was specifically designed for neurosurgery. It is the first image-guided, MR-compatible surgical robot that can perform both microsurgery and stereotaxy.-Design:...

is the world’s first MRI-compatible surgical robot.

Orthopedics

The ROBODOC

ROBODoc

ROBODoc is a documentation tool similar to Javadoc and licensed under the GPL. It is used to extract API documentation from source code. It can be used with any language that supports comments and works by extracting specially formatted headers...

system was released in 1992 by Integrated Surgical Systems, Inc. which merged into CUREXO Technology Corporation. Also, The Acrobot Company Ltd. sells the "Acrobot Sculptor", a robot that constrains a bone

Bone

Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...

cutting tool to a pre-defined volume. Another example is the CASPAR robot produced by U.R.S.-Ortho GmbH & Co. KG, which is used for total hip replacement

Hip replacement

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe...

, total knee replacement

Knee replacement

Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis...

and anterior cruciate ligament

Anterior cruciate ligament

The anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...

reconstruction.

Pediatrics

Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula

Tracheoesophageal fistula

A tracheoesophageal fistula is an abnormal connection between the esophagus and the trachea...

repair, cholecystectomy

Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.-Open surgery:A...

, nissen fundoplication

Nissen fundoplication

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure...

, morgagni's hernia repair, kasai portoenterostomy, congenital diaphragmatic hernia

Congenital diaphragmatic hernia

Congenital diaphragmatic hernia is a congenital malformation of the diaphragm. The most common type of CDH is a Bochdalek hernia; other types include Morgagni's hernia, diaphragm eventration and central tendon defects of the diaphragm...

repair, and others. On 17 January 2002, surgeons at Children's Hospital of Michigan

Children's Hospital of Michigan

Children’s Hospital of Michigan is a hospital located in Detroit, Michigan. It is part of the Detroit Medical Center. It is an international provider of pediatric neurology, neurosurgery, cardiology, oncology and diagnostic services including Positron Emission Tomography and MRI...

in Detroit performed the nation's first advanced computer-assisted robot-enhanced surgical procedure at a children's hospital.

The Center for Robotic Surgery at Children's Hospital Boston

Children's Hospital Boston

Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...

provides a high level of expertise in pediatric robotic surgery. Specially-trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings. The results are less pain, faster recoveries, shorter hospital stays, smaller scars, and happier patients and families.

In 2001, Children's Hospital Boston was the first pediatric

Pediatrics

Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...

hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic operations than any other hospital in the world. Children's Hospital physicians have developed a number of new applications to expand the use of the robot, and train surgeons from around the world on its use.

Radiosurgery

The CyberKnife

Cyberknife

The CyberKnife is a frameless robotic radiosurgery system used for treating benign tumors, malignant tumors and other medical conditions. The system was invented by John R. Adler, a Stanford University Professor of Neurosurgery and Radiation Oncology, and Peter and Russell Schonberg of Schonberg...

Robotic Radiosurgery

Radiosurgery

Radiosurgery is a medical procedure that allows non-invasive treatment of benign and malignant tumors. It is also known as stereotactic radiotherapy, when used to target lesions in the brain, and stereotactic body radiotherapy when used to target lesions in the body...

System uses image guidance and computer controlled robotics to treat tumors throughout the body by delivering multiple beams of high-energy radiation to the tumor from virtually any direction. The system uses a German KUKA

KUKA

KUKA is a leading German producer of industrial robots for a variety of industries - from automotive and fabricated metals to food and plastics...

KR 240. Mounted on the robot is a compact X-band linac that produces 6MV X-ray radiation. Mounting the radiation source on the robot allows very fast repositioning of the source, which enables the system to deliver radiation from many different directions without the need to move both the patient and source as required by current gantry configurations.

Urology

Robotic surgery in the field of urology has become very popular, especially in the United States. It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilized for kidney

Kidney

The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

cancer surgeries and to lesser extent surgeries of the bladder

Bladder

Bladder usually refers to an anatomical hollow organBladder may also refer to:-Biology:* Urinary bladder in humans** Urinary bladder ** Bladder control; see Urinary incontinence** Artificial urinary bladder, in humans...

. New minimally invasive robotic devices include ultrasound probes for selective excisions of kidney tumors, steerable flexible needles for use in prostate brachytherapy

Prostate brachytherapy

Brachytherapy is a type of radiotherapy, or radiation treatment, offered to certain cancer patients. There are two types of brachytherapy – high dose-rate and low dose-rate...

.

In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.

Surgeons at the University of Illinois at Chicago College of Medicine were the first to offer robotic kidney transplantation to morbidly obese patients- having BMIs (body mass index

Body mass index

The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...

es) over 50- and since 2009, have done 13 procedures (100 percent patient and graft survival with no complications). They report fewer complications among this high-risk population (wound infections go from 15 percent in open surgery to 0 percent, pulmonary complications decrease to 0 percent from 9 percent, length of hospitalization is reduced from 8.5 days to 5 days). Most Illinois transplant centers do not take anyone for renal transplant with a BMI of over 40- and so those patients have no other access to kidney transplantation and experience high mortality rates while on dialysis, which becomes their only other available therapy.

In March 2011, the President of Slovenia Danilo Türk

Danilo Türk

- Early life :Türk was born in a lower middle class family in Maribor, Slovenia . His father died when he was a child. He attended the prestigious II. Gymnasium High school in Maribor. In 1971 he enrolled to the University of Ljubljana where he studied law...

underwent robot-assisted prostate cancer treatment at the Urology Institute in Innsbruck

Innsbruck

- Main sights :- Buildings :*Golden Roof*Kaiserliche Hofburg *Hofkirche with the cenotaph of Maximilian I, Holy Roman Emperor*Altes Landhaus...

Vascular surgery

In September 2010, the first robotic operations at the femoral vasculature were performed at the University Medical Centre Ljubljana (UMC Ljubljana), Slovenia

Slovenia

Slovenia , officially the Republic of Slovenia , is a country in Central and Southeastern Europe touching the Alps and bordering the Mediterranean. Slovenia borders Italy to the west, Croatia to the south and east, Hungary to the northeast, and Austria to the north, and also has a small portion of...

. The research was led by Borut Geršak, the head of the Department of Cardiovascular Surgery at the centre. Geršak explained that the robot used was the first true robot in the history of robotic surgery, meaning the user interface was not resembling surgical instruments and the robot was not simply imitating the movement of human hands but was guided by pressing buttons, just like one would play a video game. The robot was imported to Slovenia from the United States.

Miniature robotics

As scientists seek to improve the versatility and utility of robotics in surgery, some are attempting to miniaturize the robots. For example, the University of Nebraska Medical Center

University of Nebraska Medical Center

The University of Nebraska Medical Center is a public academic health sciences center located on 42nd and Emile Streets in Midtown Omaha, Nebraska. UNMC is the only public academic health science center in Nebraska.-Academics and rankings:...

has led a multi-campus effort to provide collaborative research on mini-robotics among surgeons, engineers and computer scientists. There may also be a day and age where nanorobots may be inserted into peoples bloodstreams to act as general practitioner

General practitioner

A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

s; Analysing the problem and sending the information back to the hospital.

Sources

Monkman. G.J., S. Hesse, R. Steinmann & H. Schunk – Robot Grippers – Wiley, Berlin 2007.
Füchtmeier. B., S. Egersdoerfer, R. Mai, R. Hente, D. Dragoi, G.J. Monkman & M. Nerlich – Reduction of femoral shaft fractures in vitro by a new developed reduction robot system "RepoRobo" – Injury – 35 ppSA113-119, Elsevier 2004.
Daniel Ichbiah
Daniel Ichbiah
Daniel Ichbiah is a French author of several books on musical and technical topics. He has written a biography of Bill Gates which was published in some 15 countries and also a big book about Robots, which appeared in the USA and Germany as well as in France...

. Robots : From Science Fiction to Technological Revolution.
Dharia SP, Falcone T. Robotics in reproductive medicine. Fertil Steril 84:1–11,2005.
Pott PP, Scharf H-P, Schwarz MLR, Today’s State of the Art of surgical Robotics, Journal of Computer Aided Surgery, 10,2, 101–132, 2005.
Lorincz A, Langenburg S, Klein MD. Robotics and the pediatric surgeon. Curr Opin Pediatr. 2003 Jun;15(3):262-6.
Campbell A, Larenzo xR3Nz0x 14 Jun. 1994
Jacob Rosen ; Blake Hannaford; Richard M. Satava (Eds.) (2011) Surgical Robotics – Systems Applications and Visions, Springer, ISBN 978-1-4419-1125-4

External links

Surgical Robotics – Bionics Lab, University of California, Santa Cruz
University of California, Santa Cruz
The University of California, Santa Cruz, also known as UC Santa Cruz or UCSC, is a public, collegiate university; one of ten campuses in the University of California...
"Doctor Robot, I presume?" Robots are set to revolutionize healthcare (International Electrotechnical Commission
International Electrotechnical Commission
The International Electrotechnical Commission is a non-profit, non-governmental international standards organization that prepares and publishes International Standards for all electrical, electronic and related technologies – collectively known as "electrotechnology"...

, July 2011)
Robotic Surgery – A Current Perspective – Annals of Surgery 2004 January; 239(1): 14–21.
roboticsurgery.com
Robotic gynecological surgery in SE Michigan
Medical Robots International Conference

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

History

Timeline

Advantages and disadvantages

General surgery

Cardiothoracic surgery

Cardiology and electrophysiology

Gastrointestinal surgery

Gynecology

Neurosurgery

Orthopedics

Pediatrics

Radiosurgery

Urology

Vascular surgery

Miniature robotics

See also

Sources

External links