Robotic surgery

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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.[1] 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.

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[edit] 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 Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. Intuitive Surgical purchased computer Motion in 1994 and discontinued development of the ZEUS System.

The da Vinci Surgical System is comprised of three components. A surgeon’s console, a patient-side robotic cart with four arms that are manipulated by the surgeon at the console and a high definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary Instruments. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair and used in over 500 hospitals in the Americas and Europe. The da Vinci System was used in at over 48,000 procedures in 2006 and sells for about 1.2 million dollars.

  • The first unmanned robotic surgery took place in May 2006 in Italy.[2]

[edit] Applications

[edit] Cardiac surgery

Endoscopic coronary bypass surgery and mitral valve replacement have been performed. Totally closed chest, endoscopic mitral valve surgeries are being performed now with the robot.

[edit] Gastrointestinal surgery

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

[edit] Gynecology

Reproductive surgery and ablative surgery including hysterectomy have been performed.

[edit] Neurosurgery

The PUMA was the first system for stereotactic interventions.[citation needed] 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 know as spina bifida.Powered by state-of-the-art robotic technology, the surgeon’s hand movements are scaled, filtered and seamlessly translated into precise movements of the EndoWrist Instruments

Neurosurgeon John R Adler developed the field of Image-Guided Robotic Radiosurgery with his invention of the CyberKnife.[citation needed] This surgical instrument 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.

In 2007, the University of Calgary is to begin testing of its neuroArm robot built by MacDonald Dettwiler's MD Robotics division.

[edit] Orthopedics

The ROBODOC system has been accused to have led to a series of complications in Mexico.[3]

[edit] 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.

[edit] 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.

[edit] Notes

  1. ^ http://www.dlmag.com/1653/robot-successfully-completes-unassisted-heart-surgery.html
  2. ^ http://www.dlmag.com/1653/robot-successfully-completes-unassisted-heart-surgery.html
  3. ^ http://www.hoise.com/vmw/04/articles/vmw/LV-VM-02-04-30.html

[edit] References

  • 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. 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.

[edit] External links

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