THE FIRST SURGERY CONFRENCE Robotic surgery Author: Ass Prof of Surgery MohanadM Salem Al Ansari
Teacher in The College of Medicine Surgical department, Al MustansiryiaUniversity, Iraq, Baghdad.
Specialist Surgeon in Al Yarmulke Teaching Hospital, Iraq, Baghdad.
PhD. in General Surgery. Arab Board in General Surgery
Member of International Society of Surgeons.
Chief of the International surgical Robotic center USA New York
Specialist in General Surgery ,Minimal Invasive Surgery ,Robotic surgery
President and Founder of the Minimal Invasive Robotic International Association MIRIA
President and Founder of the International Stem Cell Association ISCA
Image-1 Da Vinci system. ROBOTIC SURGERY Robot is a mechanical device that performs automated physical tasks according to direct human supervision , A performed program or set of general guidelines using artificial intelligence techniques . in terms of surgery robots have been used to assist surgeons during procedures this has been primarily in the form of automated camera system and telemanipulator system thus resulting in creation of human machine interface Even though laproscopic surgery has progressed greatly over the last two decades there are limitations Restriction to two dimensional views Reduced degree of freedom.Little or no tactile feedback and ergonomically Difficult positions for surgeons Da Vinci system.2/A
Advantages for surgeon better visualization Elimination of hand tremor Improved maneuvering as result of robots wrist which allows sever degree of freedom extending the surgical ability to perform complex technical tasks in a limited space Less need for assistant
Advantages for the patients Smaller incision Decreased blood loss less pain Quicker healing time
History In 1985 a robot in the pulma 560 was used to place a needle for brain biopsy under ct guidance 1988 robot developed at imperial college London was used to perform prostatic surgery 1992 the robot from integrated surgical system was introduced to will out practice fitting in femur for hip replacement The davinci surgical system comprises here components A surgeon’s console. a patient side robotic cant with 4 arms manipulated by the surgeon to control the camera and three to manipulate instruments and high definition 3 d system .
History Articulating surgical instruments are mounted on robotic arms which are introduced into the body through canola’s the surgeon. the surgeon hand movements are scaled and filtered to eliminate hand tremor then translated into micro movements of the appropriately instruments the camera used in the system provides a true stereoscopic picture transmitted to surgeon console . The device system fda cleared for a variety of surgical procedures including surgery for prostate cancer hysterectomy, mitral valve repair and it is used in more than 800 hospitals in America and Europe
The davince system was used in 48000 procedures In 1997 reconnection of the fallopian tube was performed . 1999 the first robot performed the first robotically assisted heart bypass in USA. 2001 robotic system performed cholecystectomy on a pig in France while the surgeon was in New York 2006 the first unmanned surgery took place in Italy Preparation for robotic surgery Over all fitness cardiac arrhythmia, emphysema Previous surgery scars adhesions Normal coagulation Thrombus prophylaxis
Applications General surgery Many general surgical procedures can now be performed using the state of the robotic surgical system in 2007 the university of Illinois lead by Professor Dr. Pier performed the first ever robotic pancreatectomy which is the most complicated and demanding procedure of the abdomen Cardiothoracic surgery Robotic assisted and endoscope coronary artery bypass, mitral valve repair and replacement
Applications Gynecology Robotic assisted hysterectomies and cancer staging Pediatrics Nissenfundoplication congenital diaphragmatic hernia repair Radio surgery Delivery multiple beams of high energy radiation to the tumor UrologyRemoval of prostate gland, repair of obstructed kidney
Robot Surgery and the Anesthesiologist While still a technology that is in its infancy, the use of robots to assist in surgery is becoming more and more widespread. There are now large case series reported in the literature that show possible benefits to the patient in terms of recovery from such surgeries as prostate and cardiac procedures. Additionally, as these systems continue to develop, improved technology and software provide the surgeon with "assistance" that improves precision and accuracy. This is a technology that requires a tremendous financial investment, so you might no see it at every community hospital in the near future. However, as with all technology, the price will likely fall quickly as the applications are expanded, as more widespread adoption occurs, and as the field of robotics experiences additional breakthroughs. For now, many major academic institutions are beginning to purchase and deploy these systems.
Robot Surgery and the Anesthesiologist The use of robots in surgery is clearly a "gee-whiz" activity that is of interest to those in medicine that advocate for the application of technology. However, it also presents the anesthesiologist with significant challenges and requires careful patient screening and intraoperative management to assure patient safety. Major challenges include the use of transesophageal echocardiography, the placement of multiple access catheters, management of one-lung ventilation, etc. In addition, the initial use of these systems results in a steep learning curve for the surgeons and involves long hours in the operating room caring for patients with perhaps significant disease.
RECENT DEVELOPMENTS ALLOW BETTER RESULTS potential for better clinical exRobotic-Assisted Surgery Robotic-assisted surgery is a new category of minimally invasive surgery well as laparoscopic surgery, which uses small incisions but is limited to s. It allows the surgeon to perform complex surgical procedures using the smallest of incisions with the help of a surgical "robot." Robotic-assisted surgery is a unique alternative to traditional surgery, which involves a large open incision, as impler procedures. Outcomes plex robots peRobotic surgery is set to become the new standard in surgical procedures worldwide. The rapidly increasing adoption of surgical is due to the benefits provided to both surgeons and patients. Robotic surgery has significantly simplified many of the comprocedures. For patients, the benefits include less pain, less blood loss and quick recovery times. The US market is leading in robotic applications, with the global market a few years behind in the adoption cycle.
Benefits to Patients Compared to traditional surgery, robotic-assisted surgery offers the potential for:
less risk of infection
less blood loss
fewer blood transfusions
shorter hospital stays
faster return to normal activities
Da Vinci surgical system is the most widely accepted robotic surgery system worldwide. The five major applications of da Vinci procedures include prostatectomy, hysterectomy, mitral valve repair, coronary revascularization and gastric bypass. Out of these, prostatectomy is the most widely performed da Vinci procedure while hysterectomy is the fastest growing da Vinci procedure.Technological advancements in robotic surgery include erotelbotic procedures, where surgeons commands are relayed to a surgical robot thousand of miles away. Experiments are also going on to evaluate the benefits of robotic surgery on air and space flights. The surgeon in usa done cholecystectomy operation in france
Teleoperationmeans "doing work at a distance", although "work" may mean almost anything. The term "distance" is also vague: it can refer to a physical distance, where the operator is separated from the robot by a large distance, but it can also refer to a change in scale, where for example in robotic surgery a surgeon may use micro-manipulator technology to conduct surgery on a microscopic level.
A telemanipulator (teleoperator) is a device that is controlled remotely by a human operator. If such a device has the ability to perform autonomous work, it is called a telerobot. If the device is completely autonomous, it is called a robot. In simple cases the controlling operator's command actions correspond directly to actions in the device controlled, as for example in a radio controlled model aircraft or a tethered deep submergence vehicle. Where communications delays make direct control impractical (such as a remote planetary rover), or it is desired to reduce operator workload (as in a remotely controlled spy or attack aircraft) , the device will not be controlled directly, instead being commanded to follow a specified path. At increasing levels of sophistication the device may operate somewhat independently in matters such as obstacle avoidance, also commonly employed in planetary rovers.
Devices designed to allow the operator to control a robot at a distance is sometimes called telecheric robotics. Two major components of Telerobotics and Telepresence are the visual and control applications. A remote camera provides a visual representation of the view from the robot. Placing the robotic camera in a perspective that allows intuitive control is a recent technique that although based in Science Fiction (Robert A. Heinlein's Waldo 1942) has not been fruitful as the speed, resolution and bandwidth have only recently been adequate to the task of being able to control the robot camera in a meaningful way. Using a head mounted display, the control of the camera can be facilitated by tracking the head as shown in the figure below.
This only works if the user feels comfortable with the latency of the system, the lag in the response to ery is presentTwo major components of Telerobotics and Telepresence are the visual and control applications. A remote camera provides a visual representation of the view from the robot. Placing the robotic camera in a perspective that allows intuitive control is a recent technique that although based in Science Fiction (Robert A. Heinlein's Waldo 1942) has not been fruitful as the speed, resolution and bandwidth have only recently been adequate to the task of being able to control the robot camera in a meaningful way. Using a head mounted display, the control of the camera can be facilitated by tracking the head as shown in the figure below.
This only works if the user feels comfortable with the latency of the system, the lag in the response to movements, and the visual representation. Any issues such as, inadequate resolution, latency of the video image, lag in the mechanical and computer processing of the movement and response, and optical distortion due to camera lens and head mounted display lenses, can cause the user 'simulator sickness' which is exacerbated by the lack of vestibular stimulation with visual representation of motion. Mismatch between the users motions such as registration errors, lag in movement response due to overfiltering, inadequate resolution for small movements, and slow speed can contribute to these problems.
The same technology can control the robot, but then the eye–hand coordination issues become even more pervasive through the system, and user tension or frustration can make the system difficult to use. Ironically the tendency to build robots has been to minimize the degrees of freedom because that reduces the control problems. Recent improvements in computers has shifted the emphasis to more degrees of freedom, allowing robotic devices that seem more intelligent and more human in their motions. This also allows more direct teleoperation as the user can control the robot with their own motions.
Interfaces A telerobotic interface can be as simple as a common MMK (monitor-mouse-keyboard) interface. While this is not immersive, it is inexpensive. Telerobotics driven by internet connections are often of this type. A valuable modification to MMK is a joystick, which provides a more intuitive navigation scheme for planar robot movement. Dedicated telepresence setups utilize a head mounted display with either single or dual eye display, and an ergonomically matched interface with joystick and related button, slider, trigger controls. Future interfaces will merge fully immersive virtual reality interfaces and port real-time video instead of computer-generated images. Another example would be to use an omnidirectional treadmill with an immersive display system so that the robot is driven by the person walking or running. Additional modifications may include merged data displays such as Infrared thermal imaging, real-time threat assessment, or device schematics.
Applications With the exception of the Apollo program most space exploration has been conducted with teleroboticspace probes. Most space-based astronomy has been conducted with telerobotictelescopes. Recent noteworthy examples include the Mars exploration rovers (MER) and the Hubble Space Telescope. In the case of the MER mission, the spacecraft and the rover were each telerobotically operated. The International Space Station (ISS) uses a two armed telemanipulator called Dextre. Marine remotely operated vehicles (ROVs) are widely used to work in water too deep or too dangerous for divers. They repair offshore oil platforms and attach cables to sunken ships to hoist them. They are usually attached by a tether to a control center on a surface ship. The wreck of the Titanic was explored by an ROV, as well as by a crew-operated vessel. Additionally, a lot of telerobotic research is being done in the field of medical devices, and minimally invasive surgical systems. With a robotic surgery system, a surgeon can work inside the body through tiny holes just big enough for the manipulator, with no need to open up the chest cavity to allow hands inside. Remote manipulators are used to handle radioactive materials.
Robotic Surgery and NASA Operating rooms are stepping into the 21st century thanks to a robotic arm that can assist surgeons in non-invasive, endoscopic procedures. Computer Motion, Inc., in Santa Barbara, California, originally performed research under a NASA Small Business Innovation Research (SBIR) contract from the Jet Propulsion Laboratory to develop AESOP,® (Automated Endoscopic System for Optimal Positioning).
Robotic Surgery and NASA NASA hopes to make use of the technology powering the robotic arm of AESOP to service satellites and inspect payloads on the Space Shuttle in the future. The hope is to use robotics on space repair missions requiring exact and precise movements that exceed human dexterity. Nearly a million endoscopic surgeries are performed annually by inserting a slender camera into a small incision in the patient to access the part of the body targeted for the operation. The surgeon uses the camera to monitor the operation, which requires long, narrow instruments. This endoscopic approach reduces the healing and recovery time needed by the patient and lowers healthcare costs. Now, with Computer Motion’s AESOP, surgeons can control the motion of the camera, which is attached to a robotic arm. AESOP eliminates the need for surgical staff to hold the camera in place. The robotic arm also allows for a steadier view of the surgery and more precise and consistent movements of the camera.
Doctors seated in the ZEUSTM Robotic Surgical System can perform minimally invasive surgeries without suffering from fatigue or stress during lengthy operations.
The AESOP arm uses Computer Motion's voice recognition software, which is pre-recorded onto a voice card and inserted into the controller. Computer Motion's NASA-funded research determined that voice controlled commands are preferred in the operating room as opposed to alternatives such as eye-tracking and head-tracking, which control motion in response to movements of the surgeon's head. A second generation of this technology, called the ZEUSTM Robotic Surgical System, has the potential to make endoscopic procedures even more accessible. Traditional endoscopic methods require a long learning curve and a greater dexterity than some possess. Also, suturing for microsurgical procedures such as endoscopic coronary artery bypass graft often exceeds typical human dexterity limits.
However, through the use of a master-slave robotic system, surgeon motions are scaled down, allowing the doctor to make more natural movements. By manipulating additional robotic arms, the surgeon can move the instruments with the precision the procedure requires. Incisions can be made smaller than the diameter of a pencil as compared to the 12- to 15-inch incision and cracked ribs traditional open-heart surgery requires. One final benefit of the ZEUS system is that it allows the surgeon to perform the operation seated in an ergonomic position, eliminating the problems of fatigue and frustration resulting from leaning over the patient in an awkward posture for hours