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.

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.

The da Vinci Surgical System is comprised of three components: a surgeon’s console, a patient-side robotic cart with 2 arms manipulated by the surgeon, and a high-definition 3D vision system in connection with a camera introduced into the body by a voice-controlled third arm on the robotic cart. 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 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.


 * In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleavland using ZEUS.


 * 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.


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


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

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

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

Gynecology
Reproductive surgery and ablative surgery including hysterectomy have been performed.

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

Orthopedics
The ROBODOC system was released in 1992 by the Integrated Surgical Systems, Inc.

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
The da Vinci robot is commonly used to remove the prostate gland for cancer, repair obstructed kidneys, repair bladder abnormalities and removed diseased kidneys.

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.

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.