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 ^*. Major potential advantages of robotic surgery are precision and miniaturization. Further advantages are articulation beyond normal manipulation and three-dimensional magnification. Some surgical robots are autonomous, and they are not always under the control of a surgeon. They are only sometimes used as tools to extend the surgical skills of a trained surgeon.

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 was used to perform prostatic surgery in England. The ROBODOC from Integrated Surgical Systems was introduced in 1992, and is a robot to mill out precise fittings in the femur for hip replacement surgery. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Robot and Computer Motion with the AESOP and the ZEUS robotic surgical system.

The da Vinci is a surgical robot enabling surgeons to perform complex surgeries in a minimally invasive way. It is FDA approved and used in over 300 hospitals in the Americas and Europe. The Da Vinci was used in at least 16,000 procedures in 2004 and sells for about 1.2 million dollars.

In 2001, Marescaux used the Zeus robot to perform a cholecystectomy on a patient in Strasbourg, France while in New York.

The first unmanned robotic surgery took place in May 2006 in Italy ^*.

Applications

Cardiac surgery

Endoscopic coronary bypass surgery and mitral valve replacement have been performed.

Gastrointestinal surgery

Multiple types of procedures have been performed with either the Zeus or da Vinci systems, including bariatric surgery.

Gynecology

Reproductive surgery and ablative surgery including hysterectomy have been performed.

Neurosurgery

The PUMA was the first system for stereotactic interventions. Another robot is the Neuromate (Integrated Surgical Systems).

Orthopedics

The ROBODOC system has been accused to have led to a series of complications in Germany ^*.

Pediatrics

Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair, cholecystectomy, nissen fundoplication, morgagni hernia repair, kasai portoenterostomy, congenital diaphragmatic hernia repair, and others. On January 17, 2002, surgeons at Children's Hospital of Michigan in Detroit performed the nation's first advanced computer-assisted robot-enhanced surgical procedure at a children's hospital.

Urology

Surgical studies have been done with the Zeus and the da Vinci models. A urological procedure, Robotic Assisted Radical Prostatectomy (RLP), is rapidly growing. From only 247 procedures in 2001, there were 2648 in 2003 and 16,500 were projected for 2005. The robotic version of this procedure is beginning to show increased patient benefits in terms of smaller incisions and quicker recovery times.

Robotic Scrub Nurse

In June 2005, at the NewYork-Presbyterian Hospital, a robot scrub nurse named Penelope assisted in the performance of the excision of a benign tumor.

Limitations

Current equipment is expensive to obtain, maintain, and operate. If one of the older model non-autonomous robots is being used, surgeons and staff need special training. Data collection of procedures and their outcomes remains limited.

External links

References

Daniel Ichbiah. 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.

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