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. 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.

Contents 1 History 2 Artificial Intelligence and the dawn of Fully Autonomous Robot Surgeons 3 Applications 3.1 General surgery 3.2 Cardiothoracic surgery 3.3 Cardiology and electrophysiology 3.4 Gastrointestinal surgery 3.5 Gynecology 3.6 Gynecologic Oncology 3.7 Neurosurgery 3.8 Orthopedics 3.9 Pediatrics 3.10 Radiosurgery 3.11 Urology 4 Limitations 5 Miniature robotics 6 Pediatric robotics 7 See also 8 References 9 Sources

[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, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. 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 bought Computer Motion in 2003; ZEUS is no longer being actively marketed.^[1])

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 cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA 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.^{[citation needed]} The new da Vinci HD SI released in April, 2009 currently sells for $1.75 million. The first robotic surgery took place at Miami Valley Hospital in Dayton, Ohio.^[2]

• In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.^[3]

• In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot 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.^[4]

• In 2001, Prof. Marescaux used the "Zeus" robot to perform gall bladder surgery on a patient in Strasbourg, France while in New York.^[5]

• In September 2001, Dr. Michel Gagner used the Zeus robotic system to perform a cholecystectomy on a woman in Strasbourg, France while in New York.

• 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. ^[6]

• In January 2009, Dr. Todd Tillmanns reported results of the largest multi-institutional study on the use of da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess acquisition of their skills using the device.

• In January 2009, the first all robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center in Livingston, New Jersey by Dr. Stuart Geffner. The same team performed eight more fully robotic-assisted kidney transplants in the next six-month period.^[7]

[edit] Artificial Intelligence and the dawn of Fully Autonomous Robot Surgeons

• In May 2006 the first AI doctor conducted unassisted surgery on a 34 year old male to correct heart arrythmia, the results were rated as better than an above average human surgeon. The machine had a database 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. ^{[8] [9]}

[edit] Applications

[edit] General surgery

Many general surgical procedures can now be performed using the state of the art robotic surgical system. In 2007, the University of Illinois at Chicago medical team, lead by Prof. Pier Cristoforo Giulianotti, performed the world's first ever robotic pancreatectomy and also the Midwests fully robotic Whipple surgery, which is the most complicated and demanding procedure of the abdomen. In April 2008, the same team of surgeons performed the world's first fully minimally invasive liver 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!

[edit] Cardiothoracic surgery

Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) surgeries are being performed with the da Vinci system. Mitral valve 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. Juan Crestanello, Dr. Paul Vesco) has performed CABG, mitral valve, esophagectomy, lung resection, tumor resections, among other robotic assisted procedures and serves as a training site for other surgeons. In 2002, surgeons at the Cleveland Clinic in Florida (Dr. Douglas Boyd and Kenneth Stahl) reported and published their preliminary experience with minimally invasive "hybrid" procedures. These procedures combined robotic revascularization and coronary stenting and further expanded the role of robots in coronary bypass to patients with disease in multiple vessels.

[edit] Cardiology and electrophysiology

The Stereotaxis Magnetic Navigation System (MNS) has been developed to increase precision and safety in ablation procedures for arrhythmias and atrial fibrillation while reducing radiation exposure for the patient and physician, and the system utilizes two magnets to remotely steer catheters. The system allows for automated 3-D mapping of the heart and vasculature, and MNS has also been used in interventional cardiology for guiding stents and leads in PCI and CTO procedures, proven to reduce contrast 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."^[10]

The Hansen Medical Sensei robotic catheter system uses a remotely operated system of pulleys to navigate a steerable sheath for catheter 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 flouroscopy dosage to the patient.^[11][12][13]

[edit] Gastrointestinal surgery

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

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

[edit] Gynecologic Oncology

Robot assisted hysterectomies and cancer staging are being performed using da-Vinci robotic system. The University of Tennessee, Memphis (Dr. Todd Tillmanns, Dr. Saurabh Kumar), Northwestern University (Dr. Patrick Lowe), Aurora Health Center (Dr. Scott Kamelle), West Virginia University (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 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.

[edit] Neurosurgery

Several systems for stereotactic intervention are currently on the market. MD Robotic's NeuroArm is the world’s first MRI-compatible surgical robot.

[edit] Orthopedics

The ROBODOC system was released in 1992 by Integrated Surgical Systems, Inc. which merged into CUREXO Technology Corporation^[14]. Also, The Acrobot Company Ltd sells the "Acrobot Sculptor", a robot that constrains a bone cutting tool to a pre-defined volume^[15]. Another example is the CASPAR robot produced by U.R.S.-Ortho GmbH & Co. KG, which is used for total hip replacement, total knee replacement and anterior cruciate ligament reconstruction^[16].

[edit] Pediatrics

Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair, cholecystectomy, nissen fundoplication, morgagni's 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] Radiosurgery

The CyberKnife Robotic Radiosurgery 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.

[edit] Urology

The da Vinci robot is commonly used to remove the prostate gland for cancer, repair obstructed kidneys, repair bladder abnormalities and remove diseased kidneys. New minimally invasive robotic devices using steerable flexible needles are currently being developed^[17][18] for use in prostate brachytherapy. A few leading urologists in the field of robotic urological surgery are Drs. David Samadi, Ashutosh Tewari, Mani Menon, Peter Schlegel, Douglas Scherr and Darracott Vaughan.^{[19][20][21][22][23][24][25]}

[edit] Limitations

Current equipment is expensive to obtain, maintain and operate though it could be argued for the AI robotic surgeons these systems are many orders of magnitude cheaper than a human surgeons wages. 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] 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 has led a multi-campus effort to provide collaborative research on mini-robotics among surgeons, engineers and computer scientists.^[26]

[edit] Pediatric robotics

The Center for Robotic Surgery at Children's Hospital Boston 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 hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic surgeries 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.[3]

[edit] See also

• Telemedicine
• Vattikuti Urology Institute
• NeuroArm
• CyberKnife
• Da Vinci Surgical System
• Remote Magnetic Navigation
• Zeus Surgical System
• Robot-assisted heart surgery

[edit] References

[edit] 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. 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 Jun. 14 1994