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The Role of Robots on Surgical Operations
Almazan, Jeffrey M. Araneta, Mark Anthony P. Arquitola, Christian Glenn T. Dominguez, Jam O. Farrales, Jomar V. BSN II-2
Chapter 1 Introduction Robots in Surgical Operation Imagine ourselves being cured in a surgery without even being touched by the surgeon, amazing, this is one of the astonishing features that robotic surgery can give to the people and in the society. Just as the computers revolutionized the latter of the half of the 20th century, the field of robotics has potential to equally alter how we live in the present and in the future. We have already seen how robots have changed the manufacturing of care. And other consumer goods by stream lining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and depths of the ocean. In the coming decades, we will se robots that have artificial intelligence, coming to resemble the human that create them. They will eventually become self-aware and conscious, and be able to do anything that human can, especially on the field of medicine wherein surgeries are made more possible through the aid of the brilliants inventions of man “the robots”.
The word robot evokes many different thoughts and images, perhaps conflicting ones. Some may think of a metal humanoid, others of an industrial arm, and yet more may think, unfortunately, of a lost job. In the field of medical robotics, the word robot is just as fuzzily defined, with many different applications. These range from simplistic laboratory robots, to highly complex surgical robots that can either aid a man or execute operations by themselves.
Robotic surgery is a process in which robots are being used in performing surgeries and operations. The three major advances aided by the surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. The first generation of surgical robots is already being installed in a number of operating rooms around the world. These machines are autonomous, that still requires a human surgeon to operate them and input instructions.
Robotics is being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. For this time, these machines have been used to position an endoscope, perform gall bladder surgery and correct gastroesophogeal reflex and heartburn. The ultimate goal of robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery which can be a life saving procedure in the near future. Robotic devices could be used in more than 3.5 million medical procedures such as neurosurgery, urology, cardiothoracic surgery, general surgery, gynecologic surgery, urologic surgery, robotic lung surgery that can compensate in the process of aiding a certain disorder in the body.
Scope and Delimitation
The scope of this research focuses on robotic surgery. We tackled in this paper the history of Robotic Surgery, its uses, and its advantages and disadvantages. We did not further discuss complicated issues about the subject matter. Since Robotic Surgery is a broad topic, we decided to include in this research only the most important things we need to know that we could share to our future readers and researchers as well.
Statement of the Problem The researchers intend to find answers to explain some vague points regarding the topic on the robotic surgery, the researchers are ought to answer the following questions: 1. What is robotic surgery? 2. What is the history of robotic surgery? 3. What is the role of robot in surgical operation? 4. How is robotic surgery used in operation? 5. What are the advantages and disadvantages of robotic surgery?
Importance of the Study The prospects of this study is to eliminate the word “impossible” in the world of surgical operations with the aids of robots in operating rooms. One of robotic surgery’s most important functions is to bring remedy to cure a certain illness or diseases that the robots can make in a major or minor surgery. Relating this study in the present situation of our country, the use of robots in some surgical operations will have an impact on our surgeons and nurses. Knowing the fact that the unbalanced ratio between nurses and surgeons who are responsible in performing this surgical operation is declining due to a great demand abroad. Surgeons and doctors tend to shift to other field, like in nursing because they want to grab the opportunity to have a better life in states. In this situation, the importance of robotic surgery is rarely needed. Robots will become the substitute or maybe used in the absence for the evacuation of surgeons and doctors. Robot will be doing the primary role of a health care provider wherein they are being used in major operation, if not to save life but lengthen the lives of the people. The study on robotic surgery could lead to greater number of surgical procedures that can help to preserve the quality of life and to help more people to enjoy and see for a longer time the beauty of the creation of God.
Definition of Terms To have a common frame of reference, the following terms were defined according how they were used in the study. 1. Robotic Surgery- the use of robots in performing surgery 2. Cyber Knife- this surgical instrument enables the non-invasive ablation of small brain tumors 3. Surgical Robots- are mechanical devices that provide assistance to surgeons 4. Laparoscopic Surgery- a general term for procedures that reduce trauma by performing operations through small ports rather than large incisions. It is sometimes called minimally invasive surgery 5. Da Vinci Surgical System- it is a computer-enhanced minimally invasive surgical system. It consists of three parts: endoscope, instrument tips and viewer Chapter 2 Presentation, Analysis and Interpretation of Data Obtained I. Robotic Surgery The modern way of surgery with the aid of robots. These robots are mechanical devices that provide assistance to surgeons, while letting the human staff concentrate on more crucial aspects of the surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery, and unmanned surgery. Major potential advances of robotic surgery are precision and miniaturization. Further advances are articulation beyond normal manipulation and three-dimensional magnification. Some surgical robots are autonomous, and they are not always under the control of the surgeon. They are only sometimes used as tools to extend the surgical skills of a trained surgeon.
A. History of Robotic Surgery The history of robotics in surgery begins with the PUMA 560, a robot used in 1985 by Kwoh to perform neurosurgical biopsies with greater precision. Three years later, Davies performed a transurethral resection of the prostate using the PUMA 560. This system eventually led to the development of PROBOT, a robot designed specifically for transurethral resection of the prostate. While PROBOT was being developed, Integrated Surgical Supplies Ltd. Of Sacramento, CA, was developing ROBODOC, a robotic system designed to machine the femur with greater precision in hip replacement surgeries. ROBODOC was the first surgical robot approved by the FDA. Since 1921, when Czech playwright Karel Capek introduced the notion and coined the term robot in his play Rossom’s Universal Robots, robots have taken on increasingly more importance both in imagination and reality. Robot, taken from the Czech Robota, meaning forced labor, has evolved in meaning form dumb machines that perform menial, repetitive task to the highly intelligent anthropomorphic robots of popular culture. Although today’s robots are still unintelligent machines, great strides have been made in expanding their utility. Today robots are used to perform highly specific, highly precise, and dangerous task in industry and research previously not possible with a human work force. Robots are routinely used to manufacture microprocessors used in computers, explore the deep sea, and work in hazardous environment to name a few. Robotics, however, has been slow to enter the field of medicine.
In 1992, the ROBODOC from Integrated Surgical System was introduced, a robot to will out precise fittings in the femur for hip replacement surgery. At the same year, Intuitive surgical introduced the Da Vinci Surgical System. The Da Vinci is a surgical robot enabling surgeons to perform complex surgeries in a minimally invasive way. Computer Motion introduced also the AESOP and the ZEUS robotic surgical system in that same year. In the year 2001 Mareseaux used the ZEUS robot to perform a cholecystectomy on a patient in France while he was in New York. In 2002, Dr. Noel Tulipan used the Da Vinci robot to perform in utero surgery on animal models hoping to later transfer the approach to humans. Powered by state-of-the-art robotic technology the surgeon hand movements are skilled, filtered and seamlessly translated into pre use movements of the Endowrist Instruments. In 2003, John R. Adler develop the field of Image Guided Robotic radio-surgery with his invention of the Cyberknife, a surgical instrument that enables the non-invasive ablation of small brain tumors. January 15, 2004, the use of the computer assisted surgery system. ROBODOC in Evergreen Hospital to replace worn hips probably has made a great impact in their society. In September 21, 2006 the first Bionic arm was attached to a woman. It’s the stuff of science fiction: a prosthetic arm that can be moved just by thinking about it and that can feel heat and the pressure of a handshake. It became a reality for US Marine Claudia Mitchell two years after she lost her arm to a motorcycle, researchers said last week. The bionic arm is controlled by rerouting nerves in Mitchell’s thoughts. The first major advancement in prosthetics since World War II, the bionic arm allows amputees a significantly higher level of functionality. They can open jars, reach up to high shelves and dress themselves with more ease. Researchers are hoping the bionic arms can be used to aid the more than 400 people who lost their limbs while serving in the wars in Afghanistan and Iraq. (Copied from http://manilatimes.net/national/2006/sept/21/yehey/world/2006921wor5.html). Recently the University of Calgary has began testing its neuroArm robot built by MacDonald Dettwiler’s MD robotics division.
II. Robots on Surgical Operations
A. Applications of Robotic Surgical System
1. Microsurgery Microsurgery can be done through a microscopic robot hand. It consists of four “fingers” each of which is made from six silicon wafers, with polymer balloons doing the work of “muscles” at the wafers’ joints. Each balloon is connected with narrow channels through which air is pumped in or out. When a balloon is inflated, the distance between two joints decreases, and the fingers flexes inward. Upon deflation, the fingers relax. And with selective inflation and deflation, researchers are able to manipulate the fingers into clasping or releasing an object. “The field of microsurgery and minimally invasive surgery is currently dominated by grippers and tools that are mounted at the end of long, rigid aluminum rods,” Albert Pisano, a mechanical engineer at the University of California, Berckeley, and a leader in such a research, told Technology Review. “Certainly these are adequate for many purposes, but now that functional microhands are developed, one can visualize a new set of minimally invasive surgical tools that allow the surgeon additional dexterity in complicated procedures.”
2. Neurosurgery Neurosurgeon John R. Adler developed the field of Image-Guided Robotic Radiosurgery with his invention of the Cyberknife. This surgical instrument as what I have said above enables the non-invasive ablation of small brain tumors. Technological refinements now make it possible to use the Cyberknife to eliminate tumors virtually anywhere in the body. The PUMA was the first system for stereotactic interventions. Another robot is the Neuromate (Integrated Surgical Systems). The PathFinder stereotactic robot has been used recently in Europe, procedures including introduction of electrodes for deep brain stimulation in Parkinson’s disease. At Vanderbilt Medical Center in 2002, Dr. Noel Tulipan used the Da Vinci Robot to perform in utero surgery on gravid animal models hoping to later transfer the approach to humans. This approach would have been used to improve the in utero surgical correction of some common spinal malformations known as spina bifida.
3. Coronary Artery Bypass Surgeons conclude that robotically assisted endoscopic coronary bypass surgery showed favorable short-term outcomes with no adverse events and found robotic assistance is an enabling technology that allows surgeons to perform endoscopic coronary anastosomes. Surgeons conducted a multicenter clinical trial of robotically assisted coronary bypass grafting. In this study 32 patients scheduled for primary coronary surgery underwent endoscopic anastomosis of the LITA to LAD. Two-month follow-up revealed a graft patency of 93%. This study concluded that robotic assisted coronary bypass grafting is feasible.
4. Tumors of the Esophagus The treatment of benign and malignant tumors of the esophagus can now be approach through many minimally invasive and robotic techniques. For patients with esophageal cancer, minimally invasive and robotic techniques are being applied in the removal of the entire esophagus. These techniques help to improve recovery ad decrease pain in patients. Benign tumors and cysts in the esophagus are able to be approached and treated using VATS and robotic techniques. This saves the patient the pain and the long recovery periods associated with large thoracotomies.
5. Gastroesophageal Reflux Disease (GERD) Presently, our surgeons perform minimally invasive anti-reflux surgery through small incisions in the abdomen. Patients’ hospital stay is decreased to 1-2 days and they are able to return to full activity within 2 weeks after surgery. Gastroesophageal reflux disease is a common disease affecting millions of people in the world. Common symptoms of heartburn, regurgitation, cough and asthma may be related to GERD. Medical management is very successful in managing many of the symptoms of this disease. However, patients who do not respond to medical therapy ma y be candidates for surgical correction of the esophageal anti-reflux mechanism.
6. Thymectomy The thymus gland is situated under the sternum. There are several reasons that necessitate removal of this gland, including thymomas and myasthenia gravis. Previously, patients required large sternotomies in order to remove the thymus gland. Minimally invasive incisions and robotic technology now allow our surgeons to routinely remove the thymus gland for tumors or in the treatment of myasthenia gravis through smaller incisions and a less invasive manner. Our surgeons performed the world’s first complete endoscopic robotic thymectomy for myasthenia gravis. Our minimally invasive techniques and robotic technology enable our patients to return to normal activity quicker and experience less pain.
7. Gynecologic Surgery Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has for many years been the standard approach to many gynecologic procedures. Yet with open surgery can come significant pain, trauma, a long recovery process and threat to surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can understandably cause significant anxiety. Fortunately, less invasive options are available. Some gynecologic procedures enable surgeons to access the target anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, robot-assisted surgery with the da Vinci Surgical System may be the most effective, least invasive treatment option. Through tiny, 1-2 cm incisions, surgeons using the da Vinci system can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.
8. 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.
9. Urology The robotic surgical system has proven itself to be highly effective for the minimally invasive surgical treatment of prostate cancer. In prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function, the robotic surgical system provides an integrated set of technologies that enable very precise surgery. Using the articulating instrumentation of the robotic surgical system, the surgeon has a range of 8mm tools to excise the cancerous prostate while potentially sparing the surrounding nerve bundles. This precision in addition to high-definition 3D visualization enhance the surgeon’s ability to perform in a very controlled and repeatable manner. The result for the patient is a better operation for the removal of cancer and a quicker recovery.
10. Cardiac Surgery Cardiac surgery has traditionally been performed through a long cut through the breastbone. This has given good exposure to the heart, but comes at the expense of prolonged discomfort and pain, not to mention an unattractive scar. Cardiac surgeons have tried to do operations through smaller incisions but have been limited by the size of their hands and the ability of instruments to perform complex movements at a distance. Inability to see well through a small cut has been another major limitation. The robotic surgical system has resolved these problems. The robotic surgical system is a highly sophisticated device that consists of a high resolution 3D surgical telescope, three arms with endoscopic wrist that work like human wrists, but are tiny in comparison, and a surgeon console from which the surgeon has complete and accurate control of both the telescope and operating arms. We are now able to offer patients complex cardiac surgical operations through a 4cm incision in naturally occurring skin creases. 11. Congenital Cardiac Surgery Over the past 5 years, robotic system that combine advanced endoscopic imaging with computer-enhanced instrument control have been used for both coronary revascularization and intracardiac procedures in adult. In addition, endscope positioning systems and articulated instruments with a robotic wrist mechanism have further expanded the potential application for robotics in cardiac surgery. In pediatric cardiac surgery, potential application can be divided into simple scope manipulation versus the use 3-dimensional imaging and the robotic wrist for dissection and reconstruction. A voice-controlled robotic arm for scope manipulation can facility current pediatric thoracoscopic procedures such as ligation of patent ductus arteriosus and division of vascular rings. By using advance imaging system along with a robotic wrist, more complex extracardiac and even intracardiac procedures can be performed in children. Examples include coarctation repair, septal defect repair, and mitral or tricuspid valvuplasty. Furthermore, with adequate intracardiac imaging, are robot-assisted off-pump approach to intracardiac pathology is conceivable. New real-time 3-dimensional echocardiography now offers sufficient resolution to enable such procedures, while the addition of instrument tracking, haptic feedback, and novel tissue fixation devices can facilitate safe and reliable intracardiac repair without extracorporeal circulation.
12. Robotic Ocular Surgery Using a robotic surgical system, ocular microsurgery was performed with repair of a corneal laceration in porcine model. The experiments were performed on harvested porcine eyes in placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360 degree-rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography.
B. Robots in Action Robotic surgical system basically consists of three parts, namely the endoscope, the instrument tips and the viewer. These are the basic concept behind robotic surgical system. In the Endoscope and the Viewer, the surgeon sits in the console of the surgical system several feet from the patient. The surgeon looks through the vision system-like a pair of binoculars- and gets a huge, 3D view of 3d view of inside the patient’s body and area of operation. The surgeon while watching through the vision system, moves the handle on the console in the directions he wants to move the surgical instruments. The handles make the surgeon to make movements and operate for more period of time without getting tired. The robotic system translates and transmits these precise hand and wrist movements to tiny instruments that have been inserted to the patients through small access incisions. This is now the instrument tips of the Robotic Surgery system. This combination of increased view and tireless dexterity is helping the surgeons to overcome some limitations of other types of less invasive surgery. This will also allow surgeons to use minimally invasive surgery for more complex operations for patients comfort. This makes Robotic Surgery different from the traditional way of surgery. Because of its versatility, Robotic Surgery is use in a variety of surgical procedures such as microsurgery, neurosurgery etc. C. Specific Features of Robotic Surgery One type of the Robotic Surgical System is the Da Vinci. The Da Vinci Surgical System is working behind these technologies, the Insite Vision System, the surgical Carf and the Surgeon Console. The Insite Vision System gives the surgeon a true minimally invasive 3D view of the surgical field. It includes dual 3-drip digital cameras that take surgery “inside’ the patient. It is the only 3D vision that offers enhanced depth of field and resolution. The 3-D image is aligned over the master controls, providing natural hand-eye coordination that is inherent in open surgery. Next is the surgical cart, it works with the endowrist instruments. These instrument are designed to mimic the movement of the surgeon’s hand, wrists and fingers. This reproduce the exact movements of the surgeon’s hand and extend the normal hand range motion, allowing the more precise suturing, dissection and tissue manipulation. Last is the Surgeon Console which contains the master control that surgeons use to manipulate the endowrist instruments. The surgeon actually operates from the surgeon console which contains both video monitor showing the 3-D image and the master controls used to manipulate the EndoWrist instrument.
D. Advantages Robotic Surgical System
The advantages of robotic surgical systems are many because they overcome many of the obstacles of laparoscopic surgery. They increase dexterity, restore proper hand-eye coordination and an ergonomic position, improve visualization, patients will experience lesser pain, fast recovery and favorable outcome. These robotic system enhance dexterity in several ways. Instruments with increased degrees of freedom greatly enhance the surgeon’s ability to manipulate instruments and thus the tissues. These systems are designed so that the surgeon’s tremor can be compensated on the end-effector motion through appropriate hardware and software filters. In addition, these sytems can scale movements so that large movements of the control grips can be transformed into micromotions inside the patient. Another important advantage is the restoration of proper hand-eye coordination and an ergonomic position. These robotic systems eliminate the fulcrum effect, making instrument manipulation more intuitive. With the surgeon sitting at remote, ergonomically designed workstation, current systems also eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor. Enhanced vision afforded by these systems is also remarkable. The 3-dimensional view with depth perception is a marked improvement over the conventional laparoscopic camera views. Also to one’s advantage is the surgeon’s ability to directly control a stable visual field with increased magnification and maneuverability. All of this creates images with increased resolution that, combined with the increased degrees of freedom and enhanced dexterity, greatly enhances the surgeon’s ability to identify and dissect anatomic structures as well as to construct microanatosomes. The robotic surgical system also guarantees the patient to experience lesser pain due to smaller incisions made and through the non-invasive methods being applied. These methods also assures the patient of faster recovery and more favorable outcome than the traditional way of surgery. E. Disadvantages Robotic Surgical System There are also some disadvantages of robotic surgical system. This is a new technology and its uses and efficacy have not yet been well established. To date, mostly studies of feasibility have been conducted and almost no long-term follow-up studies have been performed. Many procedures will also have to be redesigned to optimize the use of robotic arms and increase efficiency. However, time will most likely remedy these disadvantages. Another disadvantage of these systems is their cost. With a price tag of a million dollars, their cost is nearly prohibitive. Whether the price of these systems will rise or fall s a matter of conjecture. Some believe that with improvements in technology and as more experience is gained with robotic systems, the price will fall. Others believe that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems.
F. Robotic Surgery versus the Conventional Surgery
Table 1. Advantages and Disadvantages of Robot-Assisted Surgery versus Conventional Surgery Human Strengths Robot Strengths • Strong hand-eye coordination • Dexterous • Flexible and adaptable • Can integrate extensive and diverse information • Rudimentary haptic abilities • Able to use qualitative information • Good judgment Easy to instruct and debrief • Good geometric accuracy • Stable and untiring • Scale motion • Can use diverse sensors in control • May be sterilized • Resistant to radiation and infection
Table 2. Advantages and Disadvantages of Robot-Assisted Surgery versus Conventional Surgery Human Limitation Robot Limitation • Limited dexterity outside natural scale • Prone to tremor and fatigue • Limited geometric accuracy • Limited ability to use quantitative information • Limited sterility • Susceptible to radiation and infection • No judgment • Unable to use qualitative information • Absence of haptic sensation • Expensive • Technology in flux • More studies needed
Chapter III Summary, Conclusion and Recommendation Summary Robotic surgery is the newest method of surgery which is done through the assistance of robots. This system of surgery is controlled by humans, first, the surgeon must perform an Endoscope to make a 3D view of the patient’s internal body systems. This is done through a Viewer which is like a huge binocular. Then the surgeon takes over the console, the main control of the whole surgical system. This type of surgical method assures the patient with less pain, faster recovery, favorable outcome etc. but this kind of surgical system is more expensive than the traditional surgery. Robotic surgery started its history in 1985 where PUMA560 as the first robot to perform robotic-assisted surgery. Year after year robotic surgery cannot be stopped from improving and with this gradual development, robotic surgery is now the next generation of surgery.
Conclusion From this research we have learned that robots are of great help in surgeries. This modern treatment technology has made a great impact on our society especially in the field of medicine. This robotic-assisted surgery have started with a humble beginning, from a robotic-assisted neurological surgery to a hip replacement surgical robot has branches out to give a more sufficient management in dealing to a certain complaint. With its highly sophisticated systems patients are guaranteed with comfort, safety, faster recovery, lesser pain and a quality health care delivery. This will also decrease hospital stay making now the patient more productive on his lifestyle rather using the traditional method of surgery where in the recovery time is longer and the length duration of stay in the hospital is longer. We therefore can say that this breakthrough in technology is of an enormous impact in prolonging the life of the people.
Recommendation We therefore recommend to our fellow paramedical students and to all the people to conduct a further study about robotic surgery for us to have a better and broader knowledge about the new trends in medical procedures of this day. This research is of a great help in the fast changing world where in different illnesses comes out and to those who want to have a quicker result on any surgery made, the answer is robotic surgery.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&list_uids=12740773&cmd=retrieve&indexed=google http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1356187 http://www.roboticheartsurgery.com.au/ http://www.slrcsurgery.com/center/minimallyinvasive_robotic.html http://stronghealth.com/services/surgical/aboutdavinci.cfm {{subst:afc copy}} Nol888(Talk)(Review me please) 12:18, 10 March 2007 (UTC)
Note: you said this was a term paper?
