Extended Essay Final

Submitted
in
Partial
Fulfillment
of
the
International
Baccalaureate
Diploma
for
the

Examination
Session
of
May
2014

Extended
Essay

-‐Information
Technology
in
a
Global
Society
(ITGS)-‐

To
What
Extent
is
Robotic
Surgery
an
Information
Technology

Solution
to
Traditional
Laparoscopic
Surgery?

Word
Count:
3960

Reza
Talieh

ITGS

2014
Graduate

000782-‐0151

2

Abstract

The
purpose
of
this
investigation
was
to
evaluate
the
multiple
facets
of

comparison
between
traditional
laparoscopic
minimally
invasive
surgery
with
its

contemporary
robotic
counterpart
and
conclude
with
an
overall
statement
on
how

well
robotic
surgery
can
be
merited
as
a
practical
solution
to
many
of
the
limitations

that
plague
human
surgery
methods.
Robotic
surgery
naturally
relegated
to
a
more

specific
realm
of
minimally
invasive
surgery,
the
scope
of
the
investigation
would
be

narrow
and
ubiquitous
enough
that
the
question
could
be
reasonably
answered

with
existing
research
and
a
primary
investigation.
This
investigation,
specifically,

would
manifest
itself
as
a
survey
delivered
to
local
surgeons
who
identify

themselves
as
representative
of
robotic
surgery
and
who
all
use
the
same

telesurgical
system.
Their
expert
opinions
would
serve
to
mostly
support
secondary

studies
of
the
abilities
of
robotic
surgery,
and
would
provide
qualitative
appraisals

of
the
merits
of
telerobotics
unobtainable
anywhere
else.
After
a
brief
experience

with
the
da
Vinci
machine
in
question
itself,
I
released
the
anonymous
survey

through
a
relative
in
the
medical
field
who
had
contact
with
the
14
surgeons

considered.
After
holistic,
logistic,
potential,
and
even
ethical
evaluations
of
robotics

in
the
realm
of
minimally
invasive
surgery,
it
was
concluded
that
robotics
have
all

the
potential
and
tangible
results
to
market
it
as
an
IT
solution
to
multiple

shortcoming
of
laparoscopy,
yet
telerobotics
faces
its
largest
obstacles
in
logistics
of

implementation
and
moral
acceptance
as
a
valid
medical
advancement.

Word
Count:
240

000782-‐0151

3

Table
of
Contents

Abstract………………………………………………………………………………………………………………
2

1.
Introduction……………………………………………………………………………………………………..
5

1.1
Why
I
chose
robotic
surgery
for
analysis…………………………………………………………
5

1.2
The
history
of
robotic
surgery……………………………………………………………………...5-‐
6

1.3
An
exploration
into
robotic
surgery………………………………………………………………...
6

2.
The
mechanics
of
robotic
surgery……………………………………………………………………..
6

2.1
Myths
and
misconceptions…………………………………………………………………………..6-‐
7

2.2
Features
of
a
robotic
surgery
system……………………………………………………………8-‐
9

2.3
Information
technology
at
work…………………………………………………………………….10

3.
A
means
of
comparison…………………………………………………………………………………...10

3.1
Operating
room
time………………………………………………………………………………..10-‐11

3.2
Length
of
stay………………………………………………………………………………………….11-‐12

3.3
General
Benefits………………………………………………………………………………………12-‐13

3.4
Ergonomics………………………….………………………………………………………....………13-‐1
4

3.5
Learning
Curve………………………………………………………………………………………..15-‐1
6

4.
Logistics
of
implementation……………………………………………………………………………1
7

4.1
Costs………………………………………………………………………………………………….……17-‐18

4.2
Returns………………………………………………………………………………………………………..1
8

4.3
Accessibility…………………………………………………………………...…………………………….19

5.
Abilities
and
limitations
of
robotic
surgery………………………………………………………1
9

5.1
Extension
of
the
doctor……………………………………………………………………………19-‐21

000782-‐0151

4

5.2
Tactile
sensation…………………………...…………………………………………………………21-‐22

6.
Telemedicine………………………………………………………………………………………………….22

6.1
Telemedical
aspects
of
telerobotic
surgery…………………………………………………….2
2

6.2
Potential
of
a
worldwide
solution…………………………………………………………….22-‐2
3

6.3
Ethics
of
remote
teleoperations…………….……………………………………………………….23

7.
Conclusion………………………………………………………………………………………………...24-‐2
6

8.
Glossary………………………………………………………………………………….....……………...27-‐2
8

9.
Works
Cited…………………………….…………………………………………………..…………….29-‐31

10.
Bibliography…………………………………...………………………………...…………………….32-‐3
4

11.
Appendices……………………….………………………………………………………………..……35-‐44

000782-‐0151

5

1.
Introduction

1.1
Why
I
chose
robotic
surgery
for
analysis

Robotic
surgery
is
a
burgeoning
technology
in
the
medical
field
that
in
its
early

stages
has
demonstrated
tangible
medical
capabilities
while
still
retaining
the

potential
for
growth.
As
this
new
technique
is
an
avant-‐garde
field
of
study
and

practice,
and
as
robotic
surgery
plays
a
pivotal
role
in
telemedicine,
the
concept
in

its
entirety
is
an
excellent
topic
for
an
Extended
Essay
regarding
Information

Technology
in
a
Global
Society
in
line
with
Strand
2.4
Health
of
the
ITGS
curriculum

in
analysis
of
IT
on
stakeholders.
Its
intrinsic
combination
with
technology
affords

this
new
category
of
procedure
a
whole
new
facet
to
medicine,
and
that
is
remotely

operated
surgery
for
a
global
approach
to
medicine.
This,
coupled
with
the
recent

adoption
of
surgical
robotics
in
our
local
hospital,
has
afforded
me
the
proximity
to

study
this
technology
first
hand,
and
affords
me
the
opportunity
beyond
simply
the

desire
to
investigate
the
objective
potential
of
robotic
surgery,
and
begs
the

question
of
to
what
extent
is
robotic
surgery
an
information
technology
solution
to

traditional
laparoscopic
surgery?

1.2
The
history
of
robotic
surgery

Since
1994,
the
modern
information
age
has
begun
to
adapt
itself
to
modern

medicine
in
the
endeavor
to
create
the
future
of
both
medicine
and
technology.
With

the
producer,
Computer
Motion,
at
the
forefront,
advanced
operating
room
tools

such
as
Aesop
have
assisted
in
over
70,000
pioneering
procedures.
Although
this

began
simply
as
a
method
to
control
a
video
interface
typical
in
normal
laparoscopic

surgery,
Aesop’s
successor,
Zeus,
performed
the
first
surgeon-‐mimicking

000782-‐0151

6

movements,
such
as
incisions
or
grabbing
motions.1
Contemporarily,
the
da
Vinci

Surgical
System
integrates
and
advances
its
predecessor’s
developments,
and
is

currently
the
leading
FDA
approved
telesurgical
device.2
Modern
robotic
surgery

can
be
defined
as
a
subset
of
minimally
invasive
surgery
where
the
surgeon
him
or

herself
is
operating
from
a
different
location
a
set
distance
away,
linked
to
a

machine
that
captures
3-‐dimensional
images
of
the
patient
for
the
surgeons

viewing,
and
translates
the
doctors
actions
into
the
surgical
procedure
done
via
the

robot’s
“arms”.

1.3
An
exploration
into
robotic
surgery

In
the
realm
of
robotic
laparoscopic
surgery,
taking
a
novel
approach
to
traditional

surgical
methods,
always
poses
the
question
of
whether
robotic
surgery
is
the

evolution
of
traditional
surgery,
or
simply
a
gimmick
with
no
future.
The
solution
to

this
question
in
a
contemporary
setting
has
its
ambiguities,
and
with
a
legal

adoption
beginning
only
in
the
year
2000,
telesurgery
is
still
in
its
youth.
Still,
with

Information
Technology
at
its
core
designed
to
overcome
shortcomings
in

traditional
laparoscopy
designed
in
mind
to
aid
human
progress
by
bringing

perhaps
both
economic
and
quality-‐of-‐life
benefits,
robotic
telesurgery
has
the

potential
to
both
enhance
and
detract
from
traditional
laparoscopic
surgery.

2.
The
mechanics
of
robotic
surgery

2.1
Myths
and
misconceptions

1
"Robotics:
The
Future
of
Minimally
Invasive
Heart
Surgery."
Robotics:
The
Future
of
Minimally

Invasive
Heart
Surgery.
Brown
University,
5
Mar.
2000.
Web.
21
July
2013.

<http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/Robotics.html>.

2
Rosen,
Jacob,
Blake
Hannaford,
and
Richard
M.
Satava.
Surgical
Robotics:
Systems,
Applications,
and

Visions.
New
York:
Springer,
2011.203.Print.

000782-‐0151

7

The
first
and
perhaps
greatest
misconception
is
that
people
believe
that
commonly

practiced
robotic
surgery
relies
on
AI,
or
artificial
intelligence
of
a
robot
completing

the
surgery
with
little
or
no
human
interaction.
The
truth
is,
while
pre-‐programmed

procedures
have
been
developed
for
robotic
purposes
in
the
past,
traditionally

adopted
telesurgery
as
with
the
FDA
approved
da
Vinci
Surgical
System
is

completely
surgeon
operated.
A
surgeon
stationed
in
the
same
room
operates
at
a

console
input
directly
wired
to
the
surgical
system
output,
which
performs
only

movements
directed
by
the
surgeon.
The
second
misconception
is
that
there
is
lag,

or
a
latency
period
between
the
surgeon’s
actions
and
those
of
the
robot
arm.

Latency
is
a
major
issue
with
any
remote
IT,
however,
in
this
case
again
the
surgeon

is
directly
wired
to
the
robot
in
the
same
room,
and
the
feedback
and
output
of
the

robot
are
all
but
synchronized
with
the
surgeon.3
The
third
major
myth
suggests

that
robotic
surgery
reduces
the
viewing
capabilities
of
the
surgeon,
who
looks
now

at
a
screen
instead
of
the
actual
patient.
While
this
is
true
to
a
small
degree,
that

traditional
endoscopic
instruments
allow
a
larger
range
of
view,
the
robotic
surgical

system
permits
the
doctor
a
3D
1080i
HD
view
of
the
patient,
which
when
coupled

with
greater
zoom
capabilities,
more
than
compensates
for
the
negligible
difference

in
range
of
view.4

3
"All
About
Robotic
Surgery."
Q&A
about
Robotic
Surgery.
World
Wide
Information
Center
for

Minimally
Invasive
Robotic
Surgery,
2011.
Web.
31
July
2013.

<http://www.allaboutroboticsurgery.com/qaaboutroboticsurgery.php>.

4
"Da
Vinci®
Surgical
System."
Robot-‐Assisted
Surgery:
Da
Vinci.
Brown
University,
2005.
Web.
31
July

2013.
<http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/davinci.html>.

000782-‐0151

8

2.2
Features
of
a
robotic
surgery
system

While
many
devices
fall
under
the
umbrella
of
robotically
assisted
surgery,
this

paper
will
focus
specifically
on
telesurgical
machines
such
as
the
da
Vinci
System.

The
basic
layout
(figure
1)
involves
a
console
at
which
the
doctor
sits
and
views
a

3D
zoomed
and
enhanced
reproduction
of
whatever
is
in
front
of
the
patient
cart’s

endoscope.
The
patient
cart,
connected
via
direct
cables
or
wireless,
is
where
the

surgery-‐performing
robot
is
stationed.
Both
the
console
and
the
patient
cart
are

adjustable
via
turn
knobs
to
suit
the
doctor
and
the
patient
respectively.
In
an

unveiling
of
the
robot
at
the
local
hospital,
I
had
the
fortune
of
using
the
machine

myself.
Two
pincer
like
controls
lie
beneath
the
robot,
operated
by
mainly
the

thumb
and
forefinger
to
control
the
7-‐degree
robots
grip,
and
hand
movements
of

the
surgeon
can
be
scaled
down
up
to
one-‐fifth
the
motion
by
the
robot.5

A
pedal

known
as
the
“clutch”
is
used
readjust
the
operator’s
hand
movements
while
the

robot
lies
perfectly
still,
and
also
functions
as
a
zoom
if
coupled
with
push
and
pull

movements.
A
special
holding
rack
displays
the
multiple
EndoWrist®
surgical

instruments
for
a
nurse
to
swap
out
instruments
for
the
use
of
three
of
the
arms

(the
fourth
is
dedicated
to
the
endoscope).
The
da
Vinci
System
console
is

compatible
with
surgeon
training
software,
models,
and
simulations.6

5
"Parkridge
East
Hospital."
The
Center
for
Robotic
Surgery.
Brigham
and
Women's
Hospital,
16
Oct.

2012.
Web.
12
Aug.
2013.
<http://parkridgeeasthospital.com/service/the-‐center-‐for-‐robotic-‐
surgery>.

6
"Da
Vinci®
Skills
Simulator™."
Intuitive
Surgical.
Intuitive
Surgical,
Oct.
2010.
Web.
07
Aug.
2013.

<http://www.intuitivesurgical.com/products/skills_simulator/>.

000782-‐0151

9

Figure
1-‐Diagram
of
da
Vinci
Surgical
System7

7
Bonsor,
Kevin,
and
Jonathan
Strickland.
"How
Robotic
Surgery
Will
Work."HowStuffWorks.

HowStuffWorks,
30
Oct.
2000.
Web.
08
Aug.
2013.
<http://science.howstuffworks.com/life/human-‐
biology/robotic-‐surgery1.htm>.

000782-‐0151

10

2.3
Information
technology
at
work

In
the
aspiration
of
aiding
all
stakeholders,
i.e.
the
hospital,
the
surgical
staff,
and
the

patients,
multiple
facets
of
Information
Technology
hardware
are
put
to
task.

Beginning
with
computer
simulations
synced
to
the
movements
of
the
surgical

console
to
train
surgeons,
the
telesurgical
system
progresses
to
a
thinner
3D

endoscope
with
10-‐35x
zoom
of
traditional
endoscopes
plus
digital
zoom

capabilities.8
The
camera
of
the
endoscope
provides
direct
stereoscopic
1080i
High

Definition
video
uplink
to
the
surgical
console.9
Limited
haptic
sensors
provide

feedback
when
two
robotic
arms
come
into
contact
with
each
other,
and
sensors
on

the
console’s
controls
even
filter
tiny
hand
tremors
for
more
precise
surgery10.
Via

fiber
optics
at
an
average
speed
of
50
megabits
per
second,
there
is
the
capability
of

wireless
telesurgery
overseas
via
a
Protected
Network
connection,
although
this
has

yet
to
be
put
into
normal
practice.11

3.
A
means
of
comparison

3.1
Operating
room
time

Currently,
surgery
with
the
da
Vinci
Surgical
System
is
estimated
to
take
40-‐50

minutes
longer
than
traditional
laparoscopy.12
This
figure
is
corroborated
by
the

8
Nightdale,
C.
J.
"What
Can
Be
Expected
from
Magnification
Endoscopy?"
What
Can
Be
Expected
from

Magnification
Endoscopy?
Oeso
Knowledge,
May
1998.
Web.
08
Aug.
2013.

<http://www.hon.ch/OESO/books/Vol_5_Eso_Junction/Articles/art265.html>.

9"Da
Vinci
Surgical
System
Overview
Video."
Intuitive
Surgical.
Intuitive
Surgical,
Oct.
2010.
Web.
08

Aug.
2013.

<http://www.intuitivesurgical.com/products/davinci_surgical_system/overview_video.html>.

10
Park,
J.
"A
Haptic
Teleoperation
Approach
Based
on
Contact
Force
Control."
The
International

Journal
of
Robotics
Research
25.5-‐6
(2006):
575-‐91.
Print.

11
Bell,
Kay.
"Comparison
of
DSL,
Cable
&
Fiber
Optic."
Science.
OpposingViews.com,
n.d.
Web.
09
Aug.

2013.
<http://science.opposingviews.com/comparison-‐dsl-‐cable-‐fiber-‐optic-‐12994.html>.

12
"Da
Vinci®
Surgical
System."
Robot-‐Assisted
Surgery:
Da
Vinci.
Brown
University,
2005.
Web.
9
Aug.

2013.

000782-‐0151

11

expert
survey
in
figure
2,
which
demonstrates
that
more
than
half
of
the
doctors

surveyed
believe
that
robotic
surgery
increases
procedure
time
on
average.
This

factor,
however,
is
heavily
linked
to
the
learning
curve
of
the
IT.
Once
robotic
arm

movements
become
familiar
and
truly
an
extension
of
the
surgeon,
then
this
statistic

could
very
well
change.

Figure
2
–
Robotic
surgery
decreases
OR
time
statistic

3.2
Length
of
stay

When
one
considers
that
the
duration
spent
recovering
in
any
hospital
is
not
only

detrimental
to
the
hospital’s
resources
but
the
patient’s
physical
and
financial
well

being
in
addition
to
time
spent
away
from
work,
this
becomes
a
significant
point
of

discussion;
both
parties
are
now
stakeholders.
According
to
a
study
conducted
by

the
Department
of
Urology
at
the
University
of
Washington,
“When
the
total
(fixed,

variable,
OR,
and
hospital
stay)
costs
for
robotic
surgery
and
open
surgery
are

comparable,
it
is
largely
due
to
a
considerable
shortening
of
the
length
of
hospital

stay
after
the
robotic
surgery,
resulting
in
total
cost
savings”13.
Logic
would
dictate

that,
a
more
minimally
invasive
surgery
would
result
in
a
faster
natural
healing

13
Leddy,
Laura
S.,
Thomas
S.
Lendvay,
and
Richard
M.
Satava.
"Robotic
Surgery:
Applications
and

Cost
Effectiveness."
Robotic
Surgery:
Applications
and
Cost
Effectiveness.
Dove
Press,
2
Sept.
2012.

Web.
11
Aug.
2013.
<http://www.dovepress.com/robotic-‐surgery-‐applications-‐and-‐cost-‐
effectiveness-‐peer-‐reviewed-‐article-‐OAS>

000782-‐0151

12

process.
Fifty-‐eight
percent
of
surgeons
surveyed
agreed
in
their
experience
that

telerobotic
methods
decrease
length
of
stay
for
their
patients
(figure
3).

Figure
3-‐
Robotic
surgery
decreases
length
of
stay
statistic

3.3
General
benefits

One
must
also
consider
the
benefits
posed
for
the
patients
themselves.

Thirteen
doctors
agreed
that
telesurgery
provides
a
technical
advantage
for
the

surgeon
(figure
4)
and
six
doctors
(figure
5)
agreed
that
telerobotics
provided
a

better
overall
patient
outcome.

Figure
4
–
Technical
advantage
statistic

Figure
5
–
Better
comparative
patient
outcome
statistic

000782-‐0151

13

The
facets
of
this
general
conclusion
are
multiple
and
debatable.
One
sure

fact
is
the
size
of
incision,
usually
only
1-‐2
centimeters,
made
possible
by
the

degrees
of
rotation
and
compact
3D
camera,
is
far
superior
to
the
wider
incisions

demanded
by
open
surgery,
reducing
blood
loss
and
potentially
length
of
stay
and

pain.14
Opinions
were
mixed
amongst
the
surgeons
surveyed
concerning
port
site

pain,
demonstrating
that
perhaps
this
qualitative
factor
might
be
specific
to
the
type

of
laparoscopic
surgery
or
the
patient
him
or
herself
as
opposed
to
the
robotic

appendages
versus
normal
endoscopic
instrumentation.

Figure
6-‐
Robotic
surgery
decreases
port
site
pain
statistic

3.4
Ergonomics

It
is
essential
to
remember
that
the
patient
isn’t
the
only
one
whose
comfort
and

condition
matters
in
the
operating
room.
An
essential
element
of
ITGS
studies
is

Information
Technology’s
effect
on
the
ergonomics
of
the
user
of
the
technology
in

question.
Repetitive
strain
injury
exists
here
too,
as
the
doctor
is
performing
the

same
precise
movements
of
the
hand
with
high
levels
of
finesse
whilst
standing

upright
for
up
to
hours
on
end.
Over
years
of
this
physical
stress,
surgeons
will
often

14
"EndoWrist®
Instruments."
Intuitive
Surgical.
Intuitive,
2012.
Web.
05
Aug.
2013.

<http://www.intuitivesurgical.com/products/instruments/>.

000782-‐0151

14

face
symptoms
of
bodily
degradation,
such
as
carpal
tunnel
syndrome
or
cervical

disc
disease15.
A
synthesis
of
studies
between
master-‐slave
robotic
systems
and

traditional
laparoscopy
yielded
less
musculoskeletal
stress
to
the
back,
arms,
and

legs
with
only
minor
increases
in
stress
to
the
neck
from
monitor
viewing
in
terms

of
ergonomics16.
My
own
survey
also
concluded
with
11
out
of
14
surgeons
agreeing

that
robotic
surgery
reduced
overall
ergonomic
stress
on
their
bodies
(figure
7).

Figure
7-‐
Ergonomic
stress
statistic

3.5
Learning
Curve

15
Lawson,
Elise
H.,
Myriam
J.
Curet,
Barry
R.
Sanchez,
Rob
Schuster,
and
Ramon
Berguer.
"Postural

Ergonomics
during
Robotic
and
Laparoscopic
Gastric
Bypass
Surgery:
A
Pilot
Project."
Journal
of

Robotic
Surgery
1.1
(2007):
61-‐67.
Print.

16
Lawson,
Elise
H.,
Myriam
J.
Curet,
Barry
R.
Sanchez,
Rob
Schuster,
and
Ramon
Berguer.
"Postural

Ergonomics
during
Robotic
and
Laparoscopic
Gastric
Bypass
Surgery:
A
Pilot
Project."
Journal
of

Robotic
Surgery
1.1
(2007):
61-‐67.
Print.

000782-‐0151

15

Investigating
the
learning
curve
for
such
a
relatively
new
surgical
procedure
type

involves
a
look
at
not
only
personal
surgeon
opinions
but
also
the
IT
behind
the

surgical
training.
Standard
with
da
Vinci
Surgical
SI
systems
is
software
for
the

surgeons
to
hone
the
movements
specific
to
instrument
handling
inside
the
robot.

These
system
specific
simulations
utilize
seemingly
simple
“games”
that
react
to
the

console’s
movements
like
virtual
reality
to
train
the
dexterity
of
the
surgeon.
A

grade
is
issued
upon
completion
of
the
exercise,
deeming
whether
the
surgeon
can

move
onto
the
next
exercise
if
a
90%
quota
is
met.
While
this
can
help
the
novice

surgeon
become
familiar
with
the
reflexes
and
coordination
of
the
robot,
IT

simulation
serves
still
as
no
substitute
for
actual
surgical
practice.
On
average,
the

surgeons
interviewed
found
37
hours
of
actual
patient
surgery
practice
was
needed

to
reach
what
they
felt
was
proficiency.
Now
the
standard
deviation
of
this
data
was

high,
about
23
hours,
signaling
the
doctors
weren’t
in
consensus,
and
time
to
reach

proficiency
was
personal
to
the
doctor
(table
1).

000782-‐0151

16

Table
1-‐
Hours
to
Proficiency
Data

Number
of
Surgeon
Surveyed
Hours
to
Proficiency

1
40

2
25

3
30

4
100

5
50

6
10

7
50

8
50

9
50

10
12

11
20

12
30

13
20

14
25

Arithmetic
Mean
36.57142857

Standard
Deviation
23.15404695

000782-‐0151

17

4.
Logistics
of
implementation

4.1
Costs

A
first
glimpse
at
the
cost
of
the
da
Vinci
Surgical
System
is
grim,
with
an
average

price
of
1.5
million
U.S.
dollars
per
unit
with
prices
ranging
between
1
million
and
2

million
depending
on
the
number
of
robotic
arms
and
dual
console
capabilities.17

This
high
acquisition
cost
is
coupled
with
the
costs
of
the
Endowrist®
attachment

surgical
instruments
for
the
robotic
arm
extensions,
which
can
cost
anywhere
from

$600
to
$1000
a
piece18.
Furthermore,
like
any
other
laparoscopic
instrument,
these

instruments
will
need
to
be
replaced
periodically,
making
the
cost
of
the
Endowrist

technology
a
linear
function,
and
not
simply
factored
into
the
acquisition
cost.

Another
important
facet
of
the
da
Vinci
Surgical
System
to
factor
in
is
its
user

interface,
simulation,
and
weak-‐AI
software.
Being
the
only
brand
of
FDA
approved

telerobotic
systems
on
the
market,
and
containing
only
proprietary,
not
open

source,
software,
and
the
software
that
operates
the
master-‐slave
surgical
tool
is
un-‐
editable
and
incompatible
with
other
software19.
This
presents
a
scenario
where
the

cost
of
such
technology
is
artificially
higher
than
market
value,
since
competition

doesn’t
present
a
need
to
lower
prices.
Since
advancements
in
the
da
Vinci
product

line
have
not
yet
yielded
a
situation
where
a
software
upgrade
has
been
available

17
Rosen,
Jacob,
Blake
Hannaford,
and
Richard
M.
Satava.
Surgical
Robotics:
Systems,
Applications,

and
Visions.
New
York:
Springer,
2011.216.Print.

18
"EndoWrist®
Instruments."
Intuitive
Surgical.
Intuitive,
2012.
Web.
03
Aug.
2013.

<http://www.intuitivesurgical.com/products/instruments/>.

19
"All
About
Robotic
Surgery."
Q&A
about
Robotic
Surgery.
World
Wide
Information
Center
for

Minimally
Invasive
Robotic
Surgery,
2011.
Web.
31
July
2013.


000782-‐0151

18

separate
from
an
entirely
new
surgical
system
set,
this
concept
of
restrictive
and

potentially
costly
software
costs
is
still
speculative.

4.2
Returns

If
one
were
to
look
at
the
acquisition
of
telerobotics
from
the
perspective
of
a
capital

venture,
the
potential
for
“breaking
even”
or
turning
a
profit
is
ambiguous.
It
would

appear
that
most
hospitals
thus
far
have
not
been
fiscally
successful
if
one
considers

the
costs
of
performing
any
minimally
invasive
surgery
via
telerobotics
or

traditional
laparoscopy20.
However,
there
are
other
costs
to
consider
with
which
the

robotic
surgical
system
can
ameliorate.
From
a
patient’s
perspective,
the
prospect
of

a
more
advanced
minimally
invasive
surgery
that
can
reduce
return-‐visits
is
in
itself

its
own
reward
for
the
higher
costs.
Often
for
the
patient,
he
or
she
only
pays
for
the

insurance
and
not
for
the
procedure
itself.
For
both
the
patient
and
the
hospital,

decreased
hospital
stays
will
reduce
the
expensive
costs
of
resources
post-‐operation

by
33%,
and
will
consequently
lower
the
cost
on
the
patient’s
stay
as
well.21
In
short,

the
robot
is
a
cost-‐effective
solution
only
in
a
liberal
sense
of
the
benefits
it
provides

and
potential
resources
it
saves
the
hospital
in
the
form
of
staff
and
hospital
beds,

but
can
easily
repay
a
patient,
who
opts
for
the
more
expensive
robotic
procedure,

in
his
or
her
health
and
time
spent
in
the
hospital
(paying
bills
and
away
from

work).

20Aston,
Geri.
"Hospitals
and
Health
Network
Magazine."
Hospitals
and
Health
Network
Magazine.

Hospitals
&
Health
Networks,
Apr.
2012.
Web.
13
Aug.
2013.

<http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/04APR2
012/0412HHN_FEA_clinicalmanagement>.

21
"Da
Vinci®
Surgical
System."
Robot-‐Assisted
Surgery:
Da
Vinci.
Brown
University,
2005.
Web.
4
Aug.

2013.

000782-‐0151

19

4.3
Accessibility

In
a
truly
Global
Society,
it
is
unfortunate
that
in
terms
of
the
3D
visuals,
reduced

patient
and
doctor
stress,
and
potential
for
remote
use
that
an
IT
solution
such
as

this
can
be
confined
to
only
wealthier
parts
of
the
world
based
solely
on
costs.
This

is
evident
in
how
the
Digital
Divide
concept
applies
to
Internet
access
in
a
world
that

relies
on
wireless
communications
and
databases,
the
immense
cost
of
just
one
of

these
units
puts
it
out
of
the
reach
of
even
modest
universities
in
the
United
States.

Even
if
surgeons
were
to
work
“pro
bono”,
and
could
operate
from
richer
nations

overseas,
the
third
world
would
lack
the
technology
on
the
receiving
end
to
accept

the
satellite
uplink.
The
World
Health
Organization
“considers
equitable
access
to

safe
and
affordable
medicines
as
vital
to
the
attainment
of
the
highest
possible

standard
of
health
by
all”22,
which
would
define
telerobotic
surgery
as
failing
to

meet
the
quality
of
standards
of
world
health.

5.
Abilities
and
limitations
of
robotic
surgery

The
questions
of
whether
telerobotics
can
serve
as
and
the
degree
to
which
it
can

ameliorate
problems
are
two
different
questions,
and
with
the
former
answered,
the

latter
shall
be
explored.

5.1
An
extension
of
the
doctor

While
termed
“robotic”,
again,
this
system
is
really
only
a
telehealth-‐advanced
tool

for
the
doctor,
an
extension
for
the
surgeon
not
unlike
the
endoscope
for

laparoscopy.
With
336o
of
rotation,
the
Endowrist
technology
allows
the
surgeon
to

enter,
and
adjust
even
within
the
body,
at
angles
impossible
physically
for
a
human

22
"Access
to
Medicines."
WHO.
N.p.,
n.d.
Web.
12
Aug.
2013.

<http://www.who.int/mediacentre/news/statements/2009/access-‐medicines-‐20090313/en/>.

000782-‐0151

20

to
perform.
Regarding
any
delay
between
the
robot’s
actions
and
the
surgeons’,
the

doctors
surveyed
came
to
a
100%
degree
consensus
that
there
is
no
noticeable
time

lapse
or
latency
present
in
the
robot
(figure
8)

Figure
8-‐
Time
lapse
statistic

In
addition,
a
comparative
chart
of
human
versus
robotic
surgery
talents
is
listed

below
(table
2):

000782-‐0151

21

Table
2-‐
Comparison
of
Human
versus
Robotic
Surgery

Human
Surgical
Strengths
Robot
Surgical
Strengths

1) More
direct
hand
eye
coordination

2) Tactile
sensation
in
the
patient

3) Faster
Procedure
Time

4) Can
quickly
adjust
to
unexpected
events

5) Easier
for
universities
to
teach

6) Initial
costs
cheaper

7) Has
been
improved
and
developed
for

decades

1) Clean
and
geometric
precision

2) Operational
in
smaller
incisions

3) Filters
surgeon
hand
tremors

4) 3D
HD
1080i
view
of
insides

5) Potential
for
remote
surgery

6) Four
appendages
usable

7) Superior
zoom
capabilities

8) More
degrees
of
rotation

Human
Surgical
Weaknesses
Robot
Surgical
Weaknesses

1) Larger
Incisions

2) Many
angles
of
entry
physiologically

impossible
for
surgeon

3) Humans
degrade
with
age

4) No
depth
perception
with
Endoscope

5) Fatigues
surgeon
faster
(with
hours
of

standing
still)

1) Limited
tactile
sensation

2) Danger
to
ever
roam
out
of
view

3) Only
as
talented
as
the
surgeon

4) Viable
mainly
in
simpler
surgeries

5) Costlier
procedures
to
cover
expenses

6) Reliant
on
a
power
source

7) Lengthier
procedures
on
average

5.2
Tactile
sensation

While
the
da
Vinci
system
does
support
tool
on
tool
haptic
responses,
the
machine
is

“numb”
to
the
insides
of
the
patient,
as
there
is
no
tactile
sensation,
a
doctor
could

tear
or
damage
the
patients
organs.
Developments
in
kinesthesia
have
allowed
for

the
machine
to
detect
some
of
the
force
of
harder
tissues
or
sutures
and
stop
the

appendages
and
alert
the
doctor,
yet
this
too
is
limited.
Biologic
sensors
have
been

developed
to
use
feedback
if
the
balloon
simulator
collapses
too
far,
yet
these
and

000782-‐0151

22

other
tactile
feedback
IT
solutions
have
been
difficult
to
integrate
into
existing

technology.23

6.
Telemedicine

In
accordance
to
multiple
resource
definitions
of
what
telemedicine
entails,

telemedicine
can
be
defined
as
the
phenomenon
of
providing
healthcare
from
a

source
remote
to
the
patient
utilizing
information
technology
in
some
type
of

telecommunications
method.
When
considering
robotic
surgery
as
the
quintessence

of
telemedicine,
both
the
potential
solutions
it
provides
and
the
ethical
questions
it

raises
shall
be
considered.

6.1
Telemedical
aspects
of
telerobotic
surgery

Robotic
surgery
as
a
whole
encompasses
far
more
ITGS
centric
telehealth
concepts

than
simply
the
“remote”
aspect
of
telesurgery.
One
must
also
consider
the
other
IT

aspects
of
telesurgery
that
comprise
it
as
a
whole.
The
same
monitor
that
projects

the
3D
visuals
also
carries
digital
information
from
the
patient
vital
to
the
surgeon’s

understanding.
The
robot
is
its
own
video
output
of
progress,
a
useful
tool
in

teaching
and
in
evaluation
of
medical
errors
as
well.
Finally,
the
same
charts
and
x-‐
rays
created
in
the
radiology
department
are
electronically
available
to
surgeon
at

his
very
own
console,
integrated
with
the
rest
of
the
features
of
the
telesurgical

system.

6.2
Potential
of
a
worldwide
solution

In
2001,
the
da
Vinci
system’s
predecessor
Zeus
made
history
by
performing
the

first
complete
remote
robotic
surgery
via
fiber
optic
link
on
a
patient
in
France
from

23
Rosen,
Jacob,
Blake
Hannaford,
and
Richard
M.
Satava.
Surgical
Robotics:
Systems,
Applications,

and
Visions.
New
York:
Springer,
2011.463.Print.

000782-‐0151

23

New
York,
3,800
miles
away24.
The
danger
of
latency,
or
delay,
was
overcome
by

fiber
optics,
and
the
entire
scenario
became
known
as
the
Lindbergh
Operation
XXII.

The
patient
was
discharged
after
a
typical
2
days,
and
while
currently
the
only
FDA

approved
telesurgical
devices
are
not
wireless
capable,
the
technology,
typically

fiber
optics
or
cell
relay
technology,
in
theory
exists
for
true
remote
surgery.

6.3
Ethics
of
remote
teleoperations

One
has
to
question
the
ethics
of
remote
telesurgery
to
go
into
true
ITGS
level

analysis.
Does
this,
perhaps,
remove
a
level
of
intimacy
between
the
patient
and
the

surgeon;
does
it
remove
the
“human”
element?
Is
trusting
a
secure
and
protected

wireless
network,
which
is
not
nearly
as
scrutinized
as
a
board
certified
surgeon,

ethical
and
in
the
patient’s
best
interest?
These
are
but
a
few
questions
that
plague

the
steady
adoption
of
telerobotics
worldwide.
In
regards
to
the
data
collected,

those
surveyed
seemed
reluctant
to
consider
performing
remote
surgery
between

different
hospitals
(figure
9).

Figure
9-‐
Would
you
consider
remote
telesurgery
statistic

24
"Remote
Gallbladder
Operation
Spans
3,800
Miles."
The
New
York
Times.
The
New
York
Times,
20

Sept.
2001.
Web.
10
Aug.
2013.
<http://www.nytimes.com/2001/09/20/world/remote-‐gallbladder-‐
operation-‐spans-‐3800-‐miles.html>.

000782-‐0151

24

7.
Conclusion

Independent
of
the
research
this
paper
has
concluded,
the
majority
of
surgeons

surveyed
do
not
believe
that
traditional
laparoscopy
will
be
completely
phased
out

by
telerobotic
techniques
(figure
10).

Figure
10
–
Will
Robotic
surgery
phase
out
laparoscopic
surgery
statistic

This
said,
it
is
appropriate
to
criticize
the
survey
carried
out
as
perhaps
limited
in
its

scope
for
only
interviewing
local
surgeons,
of
difference
specialties
and
in
relatively

low
numbers.
It’s
also
important
to
note
that
those
surveyed,
coming
from
different

age
and
experience
backgrounds,
individually
shoulder
different
biases
and
even

interest
in
the
realm
of
robotic
surgery.
Fortunately,
the
survey
results
find
their

highest
merit
in
corroborating
or
simply
refuting
the
secondary
research
of
this

paper.
In
the
holistic
judgment
of
the
areas
to
compare
laparoscopic
and
robotic

surgery,
the
surveys
were
invaluable
as
a
method
to
measure
otherwise
difficult

qualitative
aspects
of
robotic
surgery.
Disputes
within
the
data
can
be
best

attributed
to
different
specializations
in
surgery
and
simply
different
levels
of

experience.

The
secondary
research
was
conducted
in
a
manner
to
avoid
potential
bias

and
to
extract
relevant
information
to
supplement
the
investigation
of
the
research

000782-‐0151

25

question.
Internet
sources
advertising
the
surgical
system
as
a
product
were
used

sparingly
and
only
to
describe
the
features
of
the
robotic
tool.
Multiple
medical

studies
were
chosen
as
representative
of
general
robotic
or
laparoscopic
surgery,
as

to
avoid
results
relevant
only
to
one
type
of
procedure.
The
efforts
of
surgeons

themselves
or
universities
in
their
evaluations
of
robotic
surgery
comprised
the

majority
of
sources.
While
this
essay
isn’t
simply
a
synthesis
of
past
research

endeavors,
it
would
be
futile
to
answer
such
a
pressing
research
question
with

limited
resources.

Where
does
this
leave
the
research
question
on
the
degree
that
telerobotics

is
an
IT
solution
to
many
shortcomings
of
traditional
human
laparoscopy?
With
the

undeniable
aspects
of
Information
Technology
permeating
the
existence
of

telesurgery,
any
advantage
should
be
seen
as
a
potential
solution.

In
the
realms
of

general
benefits,
length
of
stay,
ergonomics,
and
potential
for
remote
procedures,

the
da
Vinci
System,
and
those
akin
to
it,
are
undeniably
victorious
in
the
aspects
of

patient
and
surgeon
health.
That
being
established,
the
logistics
of
implementation,

often
the
only
factor
pragmatically
worth
considering,
and
ethics
of
robotic
surgery

cast
doubt
on
its
utility
and
functionality,
opening
the
door
to
labels
such
as

“gimmick
surgery”.
A
full
embrace
of
the
technology
would
sacrifice
limited
funds,

precious
time
in
the
operative
theatre,
and
breed
new
challenges
applicable
only
to

robotics.

A
hasty
appraisal
would
market
telerobotics
as
an
unobtainable
direction
in

the
future
of
medicine,
not
much
unlike
cold-‐fusion
for
the
realm
of
energy.
But
is

this
taking
too
strict
a
definition
of
an
IT
solution?
The
earliest
computers
could
do

000782-‐0151

26

nothing
pen
and
paper
could
not,
were
prohibitively
expensive
and
occupied
the

space
of
a
room.
In
a
practical,
fiscal,
and
environmental
viewpoint,
the
technology

failed
miserably.
Seemingly,
what
constitutes
an
IT
solution
is
sheer
potential,

something
telerobotics
has
on
top
of
contemporary,
tangible
success.
As
much
as

surgical
technique
advances,
it
is
logarithmic
at
best,
only
slightly
deviating
from
its

predecessor
with
each
advance.
Technology
in
health
grows
exponentially;
doing

what
humans
can’t,
which
is
fundamentally
changed
in
only
a
few
short
years.
The

future
might
be
speculative,
but
the
field
of
medicine
will
never
vanish.
There
will

always
be
a
demand
to
fill,
and
upon
careful
and
thorough
research,
early

inclinations
support
that
robotic
surgery
could
more
than
hope
to
be
an
IT
solution,

or
evolution,
to
traditional
laparoscopy,
especially
when
considering
how
robotic

methods
provide
the
option
at
least
to
improve
the
well
being
of
all
types
of

stakeholders,
and
the
only
route
of
possibility
for
an
improvement
in
global,

international
health.

000782-‐0151

27

8.
Glossary
of
Terms

Accessibility:
Equitable
access
to
safe
and
affordable
medicines.

Biologic
Sensors:
Devices
intended
to
convert
biological
stimuli
into
readable

electronic
signals.

Endoscope:
An
optical
tool
designed
for
use
in
magnification
of
inside
the
human

body.

Fiber
Optics:
A
telecommunications
method
involving
thin,
transparent
wires
to

transmit
light
over
great
distances
at
great
speed.

Haptics:
Feed
back
of
tactile,
if
not
other
perceptive,
information.

Kinesthesia:
Perception
of
body
position,
movement,
and
muscular
tensions25

Laparoscopy:
A
fundamental
facet
of
endoscopy,
more
commonly
known
as

minimally
invasive
surgery,
which
does
as
it
suggests.

Latency:
The
concept
of
a
time
lapse
between
the
input
of
surgical
command
and
the

output
of
robotic
biomimicry.

Master-‐slave
system:
A
type
of
robotic
surgical
system
involving
little
to
no
artificial

intelligence,
where
the
robot
only
performs
exactly
what
the
surgeon
manipulates
it

to
through
a
console.

Minimally
invasive:
Any
surgery
with
minimal
incisions,
typically
involving

technology
to
compensate
for
a
surgeons
lack
of
sight
or
room
to
maneuver.

Port
Site
Pain:
Pain
felt
in
the
area
of
incision
post
operation.

Protected
Network:
A
secure,
private
wireless
network
for
telecommunication

25
"Robot-‐Assisted
Surgery:
Glossary."
Robot-‐Assisted
Surgery:
Glossary.
Brown
University,
n.d.
Web.

12
Aug.
2013.
<http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/glossary.html>

000782-‐0151

28

Satellite
Uplink:
Use
of
a
communications
satellite
to
relay
information
between
a

transmitting
and
receiving
station
on
earth.

Stereoscopic:
use
of
binoculars
for
observing
the
surgical
field
and
providing
depth

Telesurgery:
Remote,
wireless
surgery,
no
matter
the
distance.

000782-‐0151

29

9.
Works
Cited

"Access
to
Medicines."
WHO.
N.p.,
n.d.
Web.
12
Aug.
2013.

<http://www.who.int/mediacentre/news/statements/2009/access-‐medicines-‐
20090313/en/>.

"All
About
Robotic
Surgery."
Q&A
about
Robotic
Surgery.
World
Wide
Information

Center
for
Minimally
Invasive
Robotic
Surgery,
2011.
Web.
31
July
2013.


Aston,
Geri.
"Hospitals
and
Health
Network
Magazine."
Hospitals
and
Health

Network
Magazine.
Hospitals
&
Health
Networks,
Apr.
2012.
Web.
13
Aug.
2013.

<http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Arti
cle/data/04APR2012/0412HHN_FEA_clinicalmanagement>.

Bell,
Kay.
"Comparison
of
DSL,
Cable
&
Fiber
Optic."
Science.

OpposingViews.com,
n.d.
Web.
09
Aug.
2013.


Bonsor,
Kevin,
and
Jonathan
Strickland.
"How
Robotic
Surgery
Will

HowStuffWorks,
30
Oct.
2000.
Web.
08
Aug.
2013.

<http://science.howstuffworks.com/life/human-‐biology/robotic-‐surgery1.htm>.

"Da
Vinci®
Skills
Simulator™."
Intuitive
Surgical.
Intuitive
Surgical,
Oct.
2010.

Web.
07
Aug.
2013.


"Da
Vinci®
Surgical
System."
Robot-‐Assisted
Surgery:
Da
Vinci.
Brown

University,
2005.
Web.
9
Aug.
2013.


000782-‐0151

30

Da
Vinci
Surgical
System
Overview
Video."
Intuitive
Surgical.
Intuitive

Surgical,
Oct.
2010.
Web.
08
Aug.
2013.

<http://www.intuitivesurgical.com/products/davinci_surgical_system/overview_vi
deo.html>.

"EndoWrist®
Instruments."
Intuitive
Surgical.
Intuitive,
2012.
Web.
05
Aug.

2013.
<http://www.intuitivesurgical.com/products/instruments.html>

Herron,
Daniel
M.
"A
Consensus
Document
on
Robotic
Surgery."
Society
of

American
Gastrointestinal
and
Endoscopic
Surgeons.
SAGES,
Nov.
2007.
Web.
03
Aug.

2013.
<http://www.sages.org/publications/guidelines/consensus-‐document-‐
robotic-‐surgery/>.

Lawson,
Elise
H.,
Myriam
J.
Curet,
Barry
R.
Sanchez,
Rob
Schuster,
and
Ramon

Berguer.
"Postural
Ergonomics
during
Robotic
and
Laparoscopic
Gastric
Bypass

Surgery:
A
Pilot
Project."
Journal
of
Robotic
Surgery
1.1
(2007):
61-‐67.
Print.

Leddy,
Laura
S.,
Thomas
S.
Lendvay,
and
Richard
M.
Satava.
"Robotic
Surgery:

Applications
and
Cost
Effectiveness."
Robotic
Surgery:
Applications
and
Cost

Effectiveness.
Dove
Press,
2
Sept.
2012.
Web.
11
Aug.
2013.

http://www.dovepress.com/robotic-‐surgery-‐applications-‐and-‐cost-‐effectiveness-‐
peer-‐reviewed-‐article-‐OAS

Nightdale,
C.
J.
"What
Can
Be
Expected
from
Magnification
Endoscopy?"
What

Can
Be
Expected
from
Magnification
Endoscopy?
Oeso
Knowledge,
May
1998.
Web.

08
Aug.
2013.


000782-‐0151

31

Park,
J.
"A
Haptic
Teleoperation
Approach
Based
on
Contact
Force

Control."
The
International
Journal
of
Robotics
Research
25.5-‐6
(2006):
575-‐91.

Print.

"Parkridge
East
Hospital."
The
Center
for
Robotic
Surgery.
Brigham
and

Women's
Hospital,
16
Oct.
2012.
Web.
12
Aug.
2013.

<http://parkridgeeasthospital.com/service/the-‐center-‐for-‐robotic-‐surgery>.

"Remote
Gallbladder
Operation
Spans
3,800
Miles."
The
New
York
Times.
The

New
York
Times,
20
Sept.
2001.
Web.
10
Aug.
2013.

<http://www.nytimes.com/2001/09/20/world/remote-‐gallbladder-‐operation-‐
spans-‐3800-‐miles.html>.

"Robot-‐Assisted
Surgery:
Glossary."
Robot-‐Assisted
Surgery:
Glossary.
Brown

University,
n.d.
Web.
12
Aug.
2013.

<http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/glossary.html
>

"Robotics:
The
Future
of
Minimally
Invasive
Heart
Surgery."
Robotics:
The

Future
of
Minimally
Invasive
Heart
Surgery.
Brown
University,
5
Mar.
2000.
Web.
21

July
2013.

<http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/R
obotics.html>.

Rosen,
Jacob,
Blake
Hannaford,
and
Richard
M.
Satava.
Surgical
Robotics:

Systems,
Applications,
and
Visions.
New
York:
Springer,
2011.Print.

000782-‐0151

32

10.
Appendices

8/24/13 Robotic Surgery Survey
https://docs.google.com/forms/d/1vvuAk7deQSJsxEo6g4FkMfh0Wd03-Mh7manscNGvuBI/viewform#start=publishanalytics 1/3
Edit this form
Robotic Surgery Survey
This survey is intended for use in an academic research paper objectively involving the use of
robotic telesurgery. You will only be reported as surgeons, and your responses shall be kept
anonymous.
* Required
What age group do you belong?
Select one.
<30
30-40
41-50
51-60
>60
I have performed both traditional laparoscopic surgery and robotic surgery. *
Select one.
Yes
No
Approximately how many hours of training were required to become proficient in robotic
surgery methods? *
Fill in.
Please estimate the answers to the following questions.
Prior to your training in robotic surgery, approximately how many laparoscopic procedures
were you performing a year?
Approximately what percentage of these cases are you now performing robotically?
Please answer the following statements with a rating of to
what degree you agree with the following statements.
Robotic Surgery offers a technical advantage over laparoscopic surgery.
Select one.

000782-‐0151

33

Robotic Surgery is cost effective for the hospital.
Select one.
Robotic surgery provides overall better patient outcome compared to laparoscopic surgery.
Select one.
Robotic Surgery offers a marketing advantage with patients over laparoscopic surgery.
Select one.
I believe there will no longer be a role for traditional laparoscopic surgery once robotic
surgery becomes more prevalent.
Select one.
Would you consider having an expert assist you robotically from a remote location?
Select one.
Robotic surgery decreases port site pain in patients.
Select one to complete the blank.
Robotic surgery decreases length of stay for patients.
Robotic surgery decreases operating room procedure time.
Would you consider operating on patients remotely in different hospitals?
Select one.
Yes
No
I have found robotic laparoscopic surgery ...
Check all that apply.
Has generally reduced ergonomic stress on my body while performing surgery.
Has improved handling of instruments with 360 degree rotational capabilities.
Has improved the view of the patient with 3D, as compared to 2D, patient imaging.
Offers a significantly more useful zoom capability compared to traditional endoscopes.

000782-‐0151

34

Human
Surgical
Strengths
Robot
Surgical
Strengths

1) More
direct
hand
eye
coordination

2) Tactile
sensation
in
the
patient

3) Faster
Procedure
Time

4) Can
quickly
adjust
to
unexpected
events

5) Easier
for
universities
to
teach

6) Initial
costs
cheaper

7) Has
been
improved
and
developed
for

decades

1) Clean
and
geometric
precision

2) Operational
in
smaller
incisions

3) Filters
surgeon
hand
tremors

4) 3D
HD
1080i
view
of
insides

5) Potential
for
remote
surgery

6) 4
appendages
usable

7) Superior
zoom
capabilities

8) More
degrees
of
rotation

Human
Surgical
Weaknesses
Robot
Surgical
Weaknesses

1) Larger
Incisions

2) Many
angles
of
entry
physiologically

impossible
for
surgeon

3) Humans
degrade
with
age

4) No
depth
perception
with
Endoscope

5) Fatigues
surgeon
faster
(with
hours
of

standing
still)

1) Limited
tactile
sensation

2) Danger
to
ever
roam
out
of
view

3) Only
as
talented
as
the
surgeon

4) Viable
mainly
in
simpler
surgeries

5) Costlier
procedures
to
cover
expenses

6) Reliant
on
a
power
source

7) Lengthier
procedures
on
average

Impairs my tactile sensation inside the patient.
Has decreased my overall dexterity as a surgeon.
Has a noticeable time lapse between when I use the controls and when the robot acts.
Thank you very much for taking the time to take this survey.
Your anonymous responses are appreciated.
Powered by

This content is neither created nor endorsed by Google.
Report Abuse - Terms of Service - Additional Terms
Submit
Never submit passwords through Google Forms.

000782-‐0151

36

8/24/13 EE Survey - Google Drive
https://docs.google.com/forms/d/1vvuAk7deQSJsxEo6g4FkMfh0Wd03-Mh7manscNGvuBI/viewanalytics 2/7
0-50 3 21%
51-100 4 29%
101-150 2 14%
151-200 4 29%
>200 1 7%
0-20% 5 36%
21-40% 4 29%
41-60% 2 14%
61-80% 2 14%
81-100% 1 7%
Strongly Agree 8 57%
Agree 5 36%
Unsure 1 7%
Disagree 0 0%
Strongly Disagree 0 0%
Approximately what percentage of these cases are you now performing
robotically?
Please answer the following statements with a rating of
to what degree you agree with the following statements.
Robotic Surgery offers a technical advantage over laparoscopic surgery.
Robotic Surgery is cost effective for the hospital.

000782-‐0151

37

Strongly Agree 0 0%
Agree 3 21%
Unsure 9 64%
Disagree 1 7%
Agree 4 29%
Unsure 8 57%
Disagree 0 0%
Robotic surgery provides overall better patient outcome compared to
laparoscopic surgery.
Robotic Surgery offers a marketing advantage with patients over laparoscopic
surgery.

000782-‐0151

38

Agree 8 57%
Unsure 2 14%
Disagree 1 7%
Strongly Agree 0 0%
Agree 2 14%
Unsure 1 7%
Disagree 6 43%
I believe there will no longer be a role for traditional laparoscopic surgery once
robotic surgery becomes more prevalent.
Would you consider having an expert assist you robotically from a remote
location?

000782-‐0151

39

Strongly Agree 1 7%
Agree 4 29%
Unsure 5 36%
Disagree 4 29%
Strongly Agree 0 0%
Agree 5 36%
Unsure 4 29%
Disagree 4 29%
Robotic surgery decreases port site pain in patients.
Robotic surgery decreases length of stay for patients.

000782-‐0151

40

Agree 4 29%
Unsure 2 14%
Disagree 3 21%
Strongly Agree 0 0%
Agree 4 29%
Unsure 2 14%
Disagree 7 50%
Yes 6 43%
No 8 57%
Robotic surgery decreases operating room procedure time.
Would you consider operating on patients remotely in different hospitals?
I have found robotic laparoscopic surgery ...

000782-‐0151

41

Number
of
Surgeon
Surveyed
Hours
to
Proficiency

1
40

2
25

3
30

4
100

5
50

6
10

7
50

8
50

9
50

10
12

11
20

12
30

13
20

14
25

Arithmetic
Mean
36.57142857

Standard
Deviation
23.15404695

Has generally reduced ergonomic stress on my body while performing surgery. 11 19%
Has improved handling of instruments with 360 degree rotational capabilities. 13 22%
Has improved the view of the patient with 3D, as compared to 2D, patient imaging. 12 20%
Offers a significantly more useful zoom capability compared to traditional endoscopes. 13 22%
Impairs my tactile sensation inside the patient. 9 15%
Has decreased my overall dexterity as a surgeon. 1 2%
Has a noticeable time lapse between when I use the controls and when the robot acts. 0 0%
Thank you very much for taking the time to take this
survey. Your anonymous responses are appreciated.
Number of daily responses

000782-‐0151

42

11.
Bibliography

"Access
to
Medicines."
WHO.
N.p.,
n.d.
Web.
12
Aug.
2013.

<http://www.who.int/mediacentre/news/statements/2009/access-‐medicines-‐
20090313/en/>.

"All
About
Robotic
Surgery."
Q&A
about
Robotic
Surgery.
World
Wide

Information
Center
for
Minimally
Invasive
Robotic
Surgery,
2011.
Web.
31
July

2013.

Aston,
Geri.
"Hospitals
and
Health
Network
Magazine."
Hospitals
and
Health

Network
Magazine.
Hospitals
&
Health
Networks,
Apr.
2012.
Web.
13
Aug.
2013.

<http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Arti
cle/data/04APR2012/0412HHN_FEA_clinicalmanagement>.

Bell,
Kay.
"Comparison
of
DSL,
Cable
&
Fiber
Optic."
Science.

OpposingViews.com,
n.d.
Web.
09
Aug.
2013.


Bonsor,
Kevin,
and
Jonathan
Strickland.
"How
Robotic
Surgery
Will

HowStuffWorks,
30
Oct.
2000.
Web.
08
Aug.
2013.

<http://science.howstuffworks.com/life/human-‐biology/robotic-‐surgery1.htm>.

"Da
Vinci®
Skills
Simulator™."
Intuitive
Surgical.
Intuitive
Surgical,
Oct.
2010.

Web.
07
Aug.
2013.


"Da
Vinci®
Surgical
System."
Robot-‐Assisted
Surgery:
Da
Vinci.
Brown

University,
2005.
Web.
9
Aug.
2013.


000782-‐0151

43

Da
Vinci
Surgical
System
Overview
Video."
Intuitive
Surgical.
Intuitive

Surgical,
Oct.
2010.
Web.
08
Aug.
2013.

<http://www.intuitivesurgical.com/products/davinci_surgical_system/overview_vi
deo.html>.

"EndoWrist®
Instruments."
Intuitive
Surgical.
Intuitive,
2012.
Web.
05
Aug.

2013.
<http://www.intuitivesurgical.com/products/instruments.html>

Herron,
Daniel
M.
"A
Consensus
Document
on
Robotic
Surgery."
Society
of

American
Gastrointestinal
and
Endoscopic
Surgeons.
SAGES,
Nov.
2007.
Web.
03
Aug.

2013.
<http://www.sages.org/publications/guidelines/consensus-‐document-‐
robotic-‐surgery/>.

Lawson,
Elise
H.,
Myriam
J.
Curet,
Barry
R.
Sanchez,
Rob
Schuster,
and
Ramon

Berguer.
"Postural
Ergonomics
during
Robotic
and
Laparoscopic
Gastric
Bypass

Surgery:
A
Pilot
Project."
Journal
of
Robotic
Surgery
1.1
(2007):
Print.

Leddy,
Laura
S.,
Thomas
S.
Lendvay,
and
Richard
M.
Satava.
"Robotic
Surgery:

Applications
and
Cost
Effectiveness."
Robotic
Surgery:
Applications
and
Cost

Effectiveness.
Dove
Press,
2
Sept.
2012.
Web.
11
Aug.
2013.

http://www.dovepress.com/robotic-‐surgery-‐applications-‐and-‐cost-‐effectiveness-‐
peer-‐reviewed-‐article-‐OAS

Nightdale,
C.
J.
"What
Can
Be
Expected
from
Magnification
Endoscopy?"
What

Can
Be
Expected
from
Magnification
Endoscopy?
Oeso
Knowledge,
May
1998.
Web.

08
Aug.
2013.


000782-‐0151

44

Park,
J.
"A
Haptic
Teleoperation
Approach
Based
on
Contact
Force

Control."
The
International
Journal
of
Robotics
Research
25.5-‐6
(2006):
Print.

"Parkridge
East
Hospital."
The
Center
for
Robotic
Surgery.
Brigham
and

Women's
Hospital,
16
Oct.
2012.
Web.
12
Aug.
2013.

<http://parkridgeeasthospital.com/service/the-‐center-‐for-‐robotic-‐surgery>.

"Remote
Gallbladder
Operation
Spans
3,800
Miles."
The
New
York
Times.
The

New
York
Times,
20
Sept.
2001.
Web.
10
Aug.
2013.

<http://www.nytimes.com/2001/09/20/world/remote-‐gallbladder-‐operation-‐
spans-‐3800-‐miles.html>.

"Robot-‐Assisted
Surgery:
Glossary."
Robot-‐Assisted
Surgery:
Glossary.
Brown

University,
n.d.
Web.
12
Aug.
2013.

<http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/glossary.html
>

"Robotics:
The
Future
of
Minimally
Invasive
Heart
Surgery."
Robotics:
The

Future
of
Minimally
Invasive
Heart
Surgery.
Brown
University,
5
Mar.
2000.
Web.
21

July
2013.

<http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/R
obotics.html>.

Rosen,
Jacob,
Blake
Hannaford,
and
Richard
M.
Satava.
Surgical
Robotics:

Systems,
Applications,
and
Visions.
New
York:
Springer,
2011.Print.

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