Brief history of robotics and robotic surgery

ROBOT Y SU INSTRUMENTAL DR SAID CASTRO ZAZUETA
https://www.urology-center.com.mx/

HISTORIA BREVE DE LA ROBÓTICA
1985 1988 1992 1994 1998 1999
PUMA 560
-Kwoh et al
Biopsia cerebral.
PROBOT
Integrated Surgical
Supplies.
Cirugía Prostática.
ROBODOC
Integral Surgical
System.
Primer robot
aprovado por FDA
Reemplazo de
cadera.
ZEUS
Computer Motion
Telerrobótica
Consola 3D a
distancia.
Gran tamaño –
Colisiones..
AESOP
Computer Motion.
Sistema
Endoscópico para
posicionamiento
óptimo.
1er Aprobado FDA
para cirugia
abdominal.
Sistema da Vinci
Intuitive Surgical
Kalan S, Chauhan S, Coelho R, Orvieto M, Camacho I, Palmer K, et al. History of robotics surgery. J Robotic Surg. 2010;4:141-7.

Database Intuitive Surgical, Inc. 2017

2017:
•E.U. 2770
•EUROPA 719
•ASIA. 561
•RESTO 221
•MEXICO 10
Database Intuitive Surgical, Inc. 2017https://www.urology-center.com.mx/

-2006 Hospital San José Tec, MTY NL
-2010 Hospital Puerta de Hierro GDL, JAL
-2012 Hospital Manuel Gea González, CDMX
-2013 Hospital Angeles del Pedregal, CDMX
-2013 Hospital de Alta Especialidad, Zumpango EDOMEX
-2014 Hospital Central Militar, CDMX
-2015 Hospital 20 Noviembre ISSSTE, CDMX
-2016 Hospital Angeles Interlomas, CDMX
-2016 Hospital Angeles Valle Oriente, MTY NL
-2017 Centro Médico ABC Observatorio, CDMX
-2017 Hospital General Naval de Alta Especialidad, CDMX

Crecimiento de Cirugías Realizadas en México 2012- 2017
Database Cyberrobotics, Inc. 2017
1198
63 74
249
640
859

COMPONENTES.
CONSOLA DE MANDO.
• Binocular. Visión en 3D.
• Dos mandos ajustables.
• Sistema de pedales. Endocamara y coagulación y
tercer brazo.
• Pantalla táctil.
• Control ergonómico

COMPONENTES.
CARRO PACIENTE.
• Base con cuatro brazos.
• 3 para instrumentos en puertos de 8 mm.
• 1 para Endocamara de 12 mm.
• Brazo humano 29° (594,823,321 movimientos).
• Robot 7° (117,649 movimientos).
• Laparoscopía 4° (729 movimientos).

COMPONENTES.
TORRE DE VISION.
• Fuente de Luz.
• Insuflador.
• Unidad de Energía.
• Videograbador.
•Pantalla táctil.

EndoWrist - Instrument Cannulae and Obturators
~16 cm ~11 cm
8 mm
cannulae
5 mm
cannula
5 mm
obturator
8 mm
obturators

Instrument diameters
o 5 mm
o 8 mm
Instrument Lives
o 8 mm: 10 lives
o Most 5 mm: 20 lives
o Training: 30 Lives
o Clip appliers: 100 Fires
EndoWrist – Diameters & Lives

8mm Instrument
5mm Instrument
Tip Release
Levers
Shaft or
Main Tube
Instrument
Housing
Snake Wrist
Architecture
EndoWrist - Components
Tine
Wrist

Dissector:
o Precise dissection and
tissue spreading, fine tip
Grasper:
o Large profile used to hold
onto tissue
Maryland Bipolar Forceps
EndoWrist - Grasping Instruments
Double Fenestrated Grasper

Retractor:
o Long jaw profile for
holding/lifting structures
Needle Driver :
o Very strong grasping for
pushing needles through
tissue
Graptor
Large Needle Driver

Prograsp™ Forceps
Low closing force, ideal for
soft tissue grasping
Triangular tooth geometry for
tissue grasping capability
Large jaw profile allows for
use as grasper or retractor
Round tip limits dissection
capabilities
High closing force and
fenestrated, wide jaw
profile enable secure
grasping, manipulation and
retraction
Recommended for use on
fibrous tissue or tissue to
be removed
Traumatic Instrument
Cadiere Forceps

Large/Small Graptor™ Double Fenestrated Forceps
Double fenestrated 35
mm jaw with rounded
triangular teeth and
very low force
Allows complete, firm
yet atraumatic grasp
of delicate structures
such as bowel
Atraumatic large,
secure tissue purchase
Very low force
grasping of delicate
tissue like bowel

Long-tip jaw with increased
jaw spacing
Doubles as a Needle Driver;
able to loop while making
knots
Precise and delicate
tissue handling
Slender jaw profile
with fine tooth pattern
Closes at the tip first
Long Tip Forceps Fine Tissue Forceps

Secure grasp of dense
tissue with 4 x 2
interlocking teeth
Greater tissue purchase
with 60-degree wide angle
jaw opening
Not for use in cancer cases
Piercing distal tips allow
for excellent tissue
purchase
Useful to manipulate
large uterine fibroids
Not for use in cancer
cases
Cobra Grasper Tenaculum Forceps

Long Tip Forceps
Double
Fenestrated
Grasper
Less Force More Force
LessTraumaticMoreTraumatic
Grasping Force
GraspingProfile
Grasping Comparison Chart
Thisisarelativenotanabsolutecomparison
Grasping Comparison Chart
Large Needle
Driver
Mega™ Needle
Driver
Fenestrated Bipolar
Cadiere Forceps
ProGrasp™*
Cobra
Tenaculum
Small GraptorGraptor™
PK™
Maryland
Curved Bipolar
Dissector
* ProGrasp Force varies with the angle of the jaw
Precise Bipolar

EndoWrist Families and Applications:
Needle Drivers

Strong grasping force and
wide jaw profile enable
enhanced grip force to
drive needles through tough
tissue
Recommended for medium-
sized needles
(RB-1 or equivalent)
Needle driver with
integrated scissor blades
Reduces instrument
exchanges and length of
procedures
Recommend dry-run
practice of Suture Cut
technique before the first
case
Large Needle Driver Large SutureCut™ Needle Driver
EndoWrist - Needle Drivers

Strong grasping force and
wide jaw profile enable
enhanced grip force to
drive needles through tough
tissue
Secure grasp of large
needles such as CT-1 and
CT-2
Sliding knot technique
Needle driver with
integrated scissor blades
Reduces instrument
exchanges and length of
procedure
Recommend dry-run
practice before the first
case
Mega™ Needle Driver Mega SutureCut™ Needle Driver

Precise needle handling
Unobstructed view of
anatomy
Recommended for
Cardiovascular procedures
Recommended for small
needles BV or smaller
Black Diamond Micro Forceps

Cutting

Curved Scissors Potts Scissors Round Tip Scissors
Curved jaw enhances
visualization and
enables access to
difficult tissue planes
by "reaching around"
tissue
Thin, sharp blades
allow precise cutting
of delicate tissue
Sharp, pointed cutting
profile enables
precision
Recommended for
Cardiovascular
procedures
Straight scissors with
stronger closing force
than curved scissors
EndoWrist - Cutting

Energy

Permanent Cautery Hook Permanent Cautery Spatula
Monopolar instrument
for dissection and
coagulation
Used for skeletonizing
vessels
Often used in a pulling
fashion
Monopolar instrument
for dissection and
coagulation
Thin, blade-like profile
allows precise cutting
Resembles an
electrified scalpel
Thermal Ligation - Monopolar Instruments

Multifunctional use as a
hot or cold hook, spatula,
and scissor
Curved and tapered
blades for precise, clean
tissue cutting, and blunt
dissection
Requires a tip cover
Thermal Ligation - Monopolar Instruments
Monopolar Hot Shears™
Old Tip Cover New Tip Cover

Fenestrated Bipolar Forceps Maryland Bipolar Forceps
Curved and tapered jaws allow
localized coagulation
Delicate tissue grasping and fine
dissection
Strongest grasping force of all bipolar
instruments
Fenestration minimizes charring and
enables larger overall tissue purchase
Used for atraumatic grasping,
dissection and coagulation
Localized coagulation
Wide fenestrated jaw profile
enables secure grasping and
tissue handling without tearing
Thermal Ligation - Bipolar

PreCise™ Bipolar Forceps Micro Bipolar Forceps
Fine tissue grasping and
coagulation; Minimal thermal
spread and hemostasis control
Tip-closing design enables
precise tissue handling
Precise, localized coagulation
with minimal thermal spread
Triangular fenestrated jaw
profile enables secure yet
precise tissue grasping and
manipulation
Thermal Ligation - Bipolar

PK® Dissecting Forceps
70° Jaw Opening
Audible tone prevents
excessive delivery of energy
Minimizes thermal spread,
sticking, eschar, and smoke
Precise control of energy
and pressure
Reduced variability of tissue effect
Used for grasping, dissecting
and coagulating
Thermal Ligation - Advanced Bipolar Energy

Mechanical vibrations cut tissue via friction
Application
o Dissection and ligation of vessels (≤ 5 mm)
o Grasping and retracting when not activated
Minimal Thermal Spread and Tissue Damage
Non-Wristed
Thermal Ligation - Ultrasonic Energy

Harmonic ACE® Curved Scissors
Curved jaw design allows access to
and visualization of tissue planes
Non-wristed instrument
Requires disposable insert accessory,
generator and hand piece
20 lives Instrument
Single use insert
Thermal Ligation - Harmonic

NUEVAS TECNOLOGIAS E INSTRUMENTAL AVANZADO
Energy
Modality
Energy Type
Ligation
Claim
Waveform
Cut
Function
Impedance
Feedback
Cycle
Completion
Indicator
Thermal
Spread
Claim
Advanced
Bipolar
(PK)
Radio Frequency None Pulsed No Yes
Audible
No Auto-Stop
None
Ultrasonic Mechanical ≤ 5mm Continuous Yes No None < 2mm
Vessel Sealing Radio Frequency ≤ 7mm
Pulsed or
Continuous
Yes Yes
Audible
Auto-Stop
< 2mm
Vessel Sealing: Energy Comparison
Key Points:
• Advanced Bipolar: no ligation claims
• Harmonic: only 5 mm claim
• Vessel Sealers: Impedance detection and auto-stop

EndoWrist® One™ Vessel Sealer
Dissection Tip
Grasping
Feature
Cut Line
16mm Sealing Surface
Dual Hinged Jaw
40° Open Angle
Wristed 50°
Articulation
7mm Vessel
Sealing Claim
Independent
Seal and Cut
Low Thermal
Spread

HERMAL SPREAD
OFILES
st One
of
orcine
y Intuitive
ure profile
cycle for
dy conducted by Intuitive Surgical in a porcine model. Data on file.
n=13) Mesenteric artery (n=13) Renal artery (n=39)
LigaSure™
V EnSeal™
with Std. Tip
EndoWrist One
Vessel Sealer LigaSure™
V Harmonic ACEEnSeal™
VALENT MINIMAL THERMAL SPREAD
hologic assessment of seal samples from EndoWrist One Vessel Sealer, LigaSure V and EnSeal
ed that “Thermal spread to the adjacent nerve bundles and small vascular network, when pre
fined within 1-2 mm perimeter.”
stopathologic study conducted by independent third party on vessel seal samples created by Intuitive Surgical in a
port on file.
EndoWrist One
Vessel Sealer
LigaSure V or
New 5 mm
EnS
St
al-and-cut claim • •
m Hg (3x systolic) burst pressure • •
ateral thermal spread • •
ce. Report on file.
ATCHED CAPABILITY ON SEVERAL KEY ATTRIBUTES

EndoWrist - Athermal Ligation
Athermal ligation for large vessels
Full range of motion
Use with Weck Hem-o-lok polymer or
titanium clips - order from Teleflex Medical
Color coding
Roll wrists to match grips
100 fires per instrument
Use two appliers for rapid fire
Clip Applier
Vessel/Tissue
Bundle Size
Common
Procedures
Material
Small Clip Applier Small vessels dVP, dVPN, dVCRV,
dVLob
Metal
Medium - Large
Clip Applier
3 - 10 mm dVP, dVLAR,
Cholecystectomy,
Other Gen Surgery
Polymer
Large Clip Applier 5 - 13 mm dVP Polymer

EndoWrist One- Suction Irrigator
Surgeon Controlled
for greater autonomy
Suction
Irrigation
• Precision suction and irrigation - clean
surgical field
• Enhanced surgeon autonomy
• 45° articulating wrist with rigid tip
• Excellent for teaching - dual console
• Patient side or surgeon console
activation
• Access difficult to reach anatomy

PN1001332RevB08/14
DA VINCI® SINGLE-SITE™ HYSTERECTOMY
Advancing Minimally Invasive Care for Women

PN1001332RevB08/14
• Existing Si system
& 8.5 mm scope
• New cannulas
• Semi-rigid instruments
• 5-lumen port
˗ 2x da Vinci instruments
˗ Scope
˗ Assist cannula
˗ Insufflation
0
THE TECHNOLOGY

QUE VIENE?

*Se conocen pocos detalles.
*Se espera que el robot quirúrgico de Verb
sea un quinto del tamaño de los robots
quirúrgicos actuales.
*Costo reducido para el servicio.
*Sensación táctil?

GRACIAS POR SU ATENCIÓN!!!

Brief history of robotics and robotic surgery

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