ABSTRACT
Robotic surgery make use of
Robots to perform surgery. Major potential advantages of robotic surgery are
precision and miniaturization. With our skilled surgeons and the robotic
system, we can now use minimally invasive techniques in even the most
complicated procedures like Cardiac surgery, Gastrointestinal surgery,
Gynecology, Neurosurgery, Orthopedics, Pediatrics, Urology etc.
The software is "command central" for the
device's operation, da Vinci, Aesop, Hermes etc. are different kinds of the Robotic
systems. The combination of increased view and tireless dexterity is helping us
to overcome some of the limitations of other types of less invasive surgery.
1. INTRODUCTION
Robotic surgery is the use of
robots in performing surgery. Major potential advantages of robotic surgery are
precision and miniaturization. Further advantages are articulation beyond
normal manipulation and three-dimensional magnification. At present, surgical
robots are not autonomous, but are always under the control of a surgeon. They
are used as tools to extend the surgical skills of a trained surgeon.
Robotic surgery is different
from minimally invasive surgery. Minimally invasive surgery (sometimes called
laparoscopic surgery) is a general term for procedures that reduce trauma by
performing operations through small ports rather than large incisions.
Minimally invasive surgery is now commonplace for certain procedures. But until
now, we haven't been able to use minimally invasive techniques for more complex
operations. With our skilled surgeons and the robotic system, we can now use
minimally invasive techniques in even the most complicated procedures like
Cardiac surgery, Gastrointestinal surgery, Gynecology, Neurosurgery,
Orthopedics, Pediatrics, Urology etc.
2. HISTORY
In 1985 a robot, the PUMA 560, was used
to place a needle for a hip replacement Intuitive Surgical System introduce the
da Vinci Robot in 1995 and Computer Motion, AESOP and the ZEUS robotic surgical
system.. 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 surgery. In 2001, Marescaux used the
Zeus robot to perform a surgery.
3. DIFFERENT TYPES OF ROBOTIC SYSTEMS
Computer Motion of Santa
Barbara California has become the leading producer of medical robotics.
Different types of robots are da Vinci, Aesop, Hermes, and Zeus.
The da Vinci Surgical System was the first operative
surgical robot. Products like Aesop, Hermes, and Zeus are the next generation
of surgical equipment and are used together to create a highly networked and
efficient operating room.
3.1.
da Vinci Surgical System
Incorporating
the latest advancements in robotics and computer technology, the da Vinci
Surgical System was the first operative surgical robot deemed safe and
effective by the United States Food and Drug Administration for actually
performing surgery.
The da
Vinci system was developed by Intuitive Surgical system, which was established
in 1995. Its founders used robotic surgery technology that had been developed
at SRI International, previously known as Stanford Research Institute. The FDA
approved da Vinci in May 2001
The da Vinci is a surgical
robot enabling surgeons to perform complex surgeries in a minimally invasive
way, in a manner never before experienced to enhance healing and promote
well-being. It is used in over 300 hospitals in the America and Europe. The da
Vinci was used in at least 16,000 procedures in 2004 and sells for about 1.2
million dollars.
Until very recently surgeons
options included traditional surgery with a large open incision or laparoscopy,
which uses small incisions but is typically limited to very simple procedures.
The da Vinci Surgical System provides surgeons with an alternative to both
traditional open surgery and conventional laparoscopy, putting a
surgeon's hands at the controls ofa state-of-the-art
robotic platform. The da Vinci System enables surgeons to perform even the most
complex and delicate procedures through very small incisions with unmatched
precision. It is important to know that surgery with da Vinci does not place a
robot at the controls; surgeon is controlling every aspect of the surgery with
the assistance of the da Vinci robotic platform. Thus da Vinci is changing the
experience of surgery for the surgeon, the hospital and most importantly for
the patient.
3.2. Aesop
Aesop's function is quite
simple merely to maneuver a tiny video camera inside the patient according to
voice controls provided by the surgeon. By doing so, Aesop has eliminated the
need for a member of the surgical team to hold the endoscope in order for a
surgeon to view his operative field in a closed chest procedure. This advance
marked a major development in closed chest or port-access bypass techniques, as
surgeons could now directly and precisely control their operative field of
view. Today about 1/3 of all minimally invasive procedures use Aesop to control
an endoscope. Considering each Aesop machine can handle 240 cases a year, only
17,000 machines are needed to handle all minimally invasive procedures a
relatively small number considering the benefits of this technology.
3.3. Zeus
Zeus is the youngest and most technically advanced
robotic aid. Zeus contains robotic arms that mimic conventional surgical
equipment and a viewing monitor that gives the surgeon a view of his operative
field. More importantly, Zeus enables a surgeon to operate on a patient using
joystick like handles which translate the surgeon's hand movements into precise
micro-movements inside the patient. For example a 1-cm movement by a surgeon's
hand is translated into a .1 cm movement of the surgical tip held by a robotic
arm. Zeus also has the unique capability of reducing human hand tremor and greatly
increasing the dexterity of the surgeon. Zeus allows surgeons to go beyond the
limits of MIS enabling a new class of delicate procedures currently impossible
to perform. The main disadvantage is high machine cost. It is around 1 million
dollars. Its FDA approval is pending.
3.4. Hermes
Unlike Aesop and Zeus, Hermes
does not use robot arms to make the Operating Room more efficient. Rather
Hermes is platform designed to network the OR, integrating surgical devices,
which can be controlled by simple voice commands. Many pieces of surgical
equipment are outside the range of sterility for the surgeon and must be
manipulated by a surgical staff while Hermes enables all needed equipment to be
directly under the surgeon's control. Hermes can integrate tables, lights,
video cameras and surgical equipment decreasing the time and cost of surgery.
Ultimately Hermes decreases the need for a large surgical staff and facilitates
the establishment of a networked, highly organized OR. Ultimately Computer
Motion is working to bring Hermes into 84,000 operating rooms worldwide
4. WORKING OF ROBOTIC SYSTEM
Today's robotics devices
typically have a computer software component that controls the movement of
mechanical parts of the device as it acts on something in its environment The
software is "command central" for the device's operation.
Surgeon sits in the console
of the surgical system several feet from the patient. He looks through the
vision system - like a pair of binoculars - and gets a huge, 3-D view of inside the patient's
body and area of the operation.
The
surgeon, while watching through the vision system, moves the handles on the
console in the directions he wants to move the surgical instruments. The
handles make it easier for the surgeon to make precise movements and operate
for long periods of time without getting tired.
The robotic system translates
and transmits these precise hand and wrist movements to tiny instruments that
have been inserted into the patient through small access incisions.
This combination of increased
view and tireless dexterity is helping us overcome some of the limitations of
other types of less invasive surgery. It's also allowing us to finally use
minimally invasive surgery for more complex operations.
Figure. 1: Operating Room
The working of da Vinci is explained as follows.
There are four main
components to da Vinci: the surgeon console, patient-side cart, Endo Wrist
Instruments, and Insite Vision System with high resolution 3D Endoscope and
Image Processing Equipment
Figure.2: da Vinci Surgical System
4.1. Surgeon
Console
The surgeon is situated at
this console several feet away from the patient operating table. The surgeon
has his head tilted forward and his hands inside the system's master interface.
The surgeon sits viewing a magnified three- dimensional image of the surgical
field with a real-time progression of the instruments as he operates. The
instrument controls enable the surgeon to move within a one cubic foot area of
workspace.
Figure.3: Surgeon Console
4.2. Patient-side Cart
This component of the system
contains the robotic arms that directly contact the patient. It consists of two
or three instrument arms and one endoscope arm. As of 2003, Intuitive launched
a fourth arm, costing $175,000, as a part of a new system installation or as an
upgrade to an existing unit. It provides the advantages of being able to
manipulate another instrument for complex procedures and removes the need for
one operating room nurse.
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4.3. Detachable Instruments
The Endowrist
detachable instruments allow the robotic arms to maneuver in ways that simulate
fine human movements. Each instrument has its own function from suturing to
clamping, and is switched from one to the other using quick-release levers on
each robotic arm. The device memorizes the position of the robotic arm before
the instrument is replaced so that the second one can be reset to the exact
same position as the first. The instruments' abilities to rotate in full
circles provide an advantage over non-robotic arms. The seven degrees of
freedom (meaning the number of independent movements the robot can perform)
offers considerable choice in rotation and pivoting. Moreover, the surgeon is
also able to control the amount of force applied, which varies from a fraction
of an ounce to several pounds. The Intuitive Masters technology also has the
ability to filter out hand tremors and scale movements. As a result, the
surgeon's large hand movements can be translated into smaller ones by the
robotic device. Carbon dioxide is usually pumped into the body cavity to make
more room for the robotic arms to maneuver.
Figure.5: Robotic
Arm
4.4. 3-D Vision System
The
camera unit or endoscope arm provides enhanced three-dimensional images. This
high-resolution real-time magnification showing the inside of the patient
allows the surgeon to have a considerable advantage over regular surgery. The
system provides over a thousand frames of the instrument position per second
and filters each image through a video processor that eliminates background
noise. The endoscope is programmed to regulate the temperature of the endoscope
tip automatically to prevent fogging during the operation. Unlike The Navigator
Control, it also enables the surgeon to quickly switch views through the use of
a simple foot pedal.
5. ADVANTAGES
Robotic surgery offers many
benefits over traditional surgery. The Robotic Surgical System is great for
patients and for surgeons. Robotic surgery gives us even greater vision,
dexterity and precision than possible with standard minimally invasive surgery,
so we can now use minimally invasive techniques for a wider range of
procedures. The patient side benefits include,
•
Reduced pain and trauma
•
Fewer complications
•
Less blood loss and need for transfusions
•
Less post-operative pain and discomfort
•
Less risk of infection
•
Shorter hospital stay
•
Faster recovery and return to work
•
Less scarring and improved appearance
6. LIMITATIONS
•
Current equipment is expensive to obtain, maintain,
and operate.
•
Surgeons and staff need special training.
•
Data collection of procedures and their outcomes
remains limited.
7. CONCLUSION
Robotic surgery is an
emerging technology in the medical field. It gives us even greater vision,
dexterity and precision than possible with standard minimally invasive surgery,
so we can now use minimally invasive techniques for a wider range of
procedures. But it's main drawback is high cost. Besides the cost, Robotic
System still has many obstacles that it must overcome before it can be fully
integrated into the existing healthcare system. More improvements in size,
tactile sensation, cost, and are expected for the future
8. REFERENCE
CONTENTS
1. INTRODUCTION........................................................................................
1
2. HISTORY................................................................................................. 2
3. DIFFERENT TYPES OF ROBOTIC
SYSTEMS.......................................................... 3
3.1. DA VINCI SURGICAL SYSTEM................................................................ 3
3.2. AESOP........................................................................................... 4
3.3. ZEUS............................................................................................. 4
3.4. HERMES.......................................................................................... 5
4. WORKING
OF ROBOTIC SYSTEM...................................................................... 6
4.1. SURGEON CONSOLE............................................................................ 9
4.2. PATIENT-SIDE CART............................................................................ 9
4.3. DETACHABLE INSTRUMENTS............................................................... 10
4.4. 3-D VISION SYSTEM............................................................................... 11
5. ADVANTAGES........................................................................................... 12
6. LIMITATIONS........................................................................................... 13
7. CONCLUSION........................................................................................... 14
8. REFERENCE............................................................................................ 15
