The document discusses the history and development of robotic surgery. It describes how the first robotic surgery device, the PUMA 560, was used in 1985 for brain biopsies. Later systems like PROBOT and ROBODOC were developed in the late 1980s and early 1990s. The da Vinci surgical system was approved by the FDA in 2000 and is now commonly used for procedures like prostatectomies and cardiac/gynecological surgeries. The da Vinci allows surgeons to operate remotely through small incisions while magnifying their hand movements. Robotic surgery provides benefits like shorter recovery times but drawbacks include the high costs of equipment and training. New innovations continue to advance the field.

1. INDEX
S.no. Contents
01. Introduction to robotic surgery
02. History of robotic surgery
03. Surgery robots
04. DA VINCI ROBOT
05. Working of DA VINCI ROBOT
06. Benefits of robotic surgery
07. Applications of robotic surgery
08. Drawbacks of robotic surgery
09. Facts about robotic surgery
10. Revolution in robotic surgery
11. Future development in robotic surgery
12. Conclusion

2. Introduction
Surgery is a technology consisting of a physical intervention on tissues. A procedure
is considered surgical when it involves cutting of a patient's tissues or closure of a
previously sustained wound. The first revolution of surgery began with introduction
to anesthesia. Anesthesia is a type of chemical compounds which while injected the
body or a particular part of the body becomes paralysed. This has now even lead to
organ transplantation.
The second revolution of surgery happened with the introduction of robotic surgery.
Here the robotic movements are replicated by hand movements of the surgeon. The
robot may be a hydraulically, electrically, pneumatically powered.

3. History
The surgical thinking in humans began in ten thousand years ago. The skull
which is shown below gives you an example that surgery has been performed by
people centuries ago.
The first surgical robot, PUMA 560, was used in 1985 in a stereotaxic
operation, in which computed tomography was used to guide the robot as it inserted
a needle into the brain for biopsy, a procedure previously subject to error from hand
tremors during needle placement
In 1988 PROBOT, developed at Imperial College London, was used to
perform transurethral prostate surgery, a procedure that required numerous
repetitive cutting motions. Also in 1992 ROBODOC, developed by the American
companies Integrated Surgical Systems, Inc. (ISS), and IBM, was used to
successfully prepare a cavity in the femur for hip replacement in human patients
The ROBODOC Surgical System includes two leading-edge components:
ORTHODOC, a 3-dimensional workstation for preoperative surgical planning, and
the ROBODOC Surgical Assistant, a computer-controlled surgical robot used for
hip replacement surgeries. In traditional manual techniques, the removal of bone is
done using handheld surgical instruments. However, even the most skilled surgeons
lack a degree of precision due to the limitations of the surgical instruments. With the
ROBODOC Surgical System, the combination of the preoperative planning with the
execution of the ROBODOC robot assisted technique can lead to a more precise
removal of the bone and implant placement
 In May 2006,The first unmanned robotic surgery took place in Italy.
 In August 2007: DR. SIJO PAREKATTIL of the Robotics Institute and
Centre for Urology (Winter Haven Hospital and University of Florida)
performed the first robotic assisted microsurgery procedure denervation of
the spermatic cord for chronic testicular pain.

4. Surgery robots
In the case of robotically-assisted minimally-invasive surgery,
instead of directly moving the instruments, the surgeon uses one of two methods to
control the instruments; either a direct tele-manipulator or through computer control.
A tele-manipulator is a remote manipulator that allows the surgeon to perform the
normal movements associated with the surgery whilst the robotic arms carry out
those movements using end-effectors and manipulators to perform the actual
surgery on the patient. In computer-controlled systems the surgeon uses a computer
to control the robotic arms and its end-effectors, though these systems can also still
use tele-manipulators for their input. One advantage of using the computerised
method is that the surgeon does not have to be present, but can be anywhere in the
world, leading to the possibility for remote surgery. In the case of enhanced open
surgery, autonomous instruments (in familiar configurations) replace traditional
steel tools, performing certain actions (such as rib spreading) with much smoother,
feedback-controlled motions than could be achieved by a human hand. The main
object of such smart instruments is to reduce or eliminate the tissue trauma
traditionally associated with open surgery without requiring more than a few
minutes' training on the part of surgeons. This approach seeks to improve open
surgeries, particularly cardio-thoracic, that have so far not benefited from minimally-
invasive techniques.
Robotic surgery has been criticized for its expense, by one estimate costing $1,500
to $2000 more per patient

5. Da Vinci robot
Components of the da Vinci Surgical System
1. Surgeon Console
• Using the da Vinci Surgical System, the surgeon operates seated comfortably at a
console while viewing a high definition, 3D image inside the patient's body.
• The surgeon's fingers grasp the master controls below the display with hands and
wrists naturally positioned relative to his or her eyes.
• The system seamlessly translates the surgeon's hand, wrist and finger movements
into precise, real-time movements of surgical instruments
2. Patient-side Cart
• The patient-side cart is where the patient is positioned during surgery. It includes
either three or four robotic arms that carry out the surgeon's commands.
• The robotic arms move around fixed pivot points.
• The system requires that every surgical maneuver be under the direct control of
the surgeon. Repeated safety checks prevent any independent movement of the
instruments or robotic arms.

6. 3. Endo-wrist Instruments
• A full range of Endo-wrist instruments is available to the surgeon while
operating.
• The instruments are designed with seven degrees of motion - a range of motion
even greater than the human wrist
• Each instrument has a specific surgical mission such as clamping, suturing and
tissue manipulation.
• Quick-release levers speed instrument changes during surgery.
Note: Endo-Wrist Instrumentation & Intuitive Motion
Wristed instruments bend and rotate far beyond the human hand. Tremor filtration
and Intuitive®
Motion technologies allow the surgeon to operate with steady,
natural motion.
4. Vision System
• The vision system is equipped with a high-definition, 3D endoscope
(flexible tube with a camera and light at the tip) and image processing equipment
that provides true-to-life images of the patient's anatomy.
• A view of the operating field is available to the entire OR team on a
large viewing monitor (vision cart). This widescreen view provides the surgical

7. assistant at the patient's side with a broad perspective and visualization of the
procedure
5. Magnified 3D HD Vision
Highly-magnified 3D HD Vision ensures that surgeons can see the surgical site
with true depth perception and crystal-clear vision.
Visualizing anatomy in highly magnified 3D HD is a hallmark of performing
surgery with the da Vinci Surgical System.
The da Vinci vision system delivers 3D high definition video into the viewer located
at the surgeon console. Optics mounted at the tip of the scope allow the surgeon to
see anatomical structures
6. Enhanced Ergonomics
Whether it is the first or last case of the day, the ergonomically-
adjustable surgeon console makes performing surgery with the da Vinci Surgical
System feel comfortable and natural with crystal clear definition and natural
colour.

8. Working of Da Vinci robot
The da Vinci Surgical System is a robotic surgical system is
made by the American company Intuitive Surgical. Approved by the Food and Drug
Administration (FDA) in 2000, it is designed to facilitate complex surgery using
a minimally invasive approach, and is controlled by a surgeon from a console. The
system is commonly used for prostatectomies, and increasingly for cardiac
valve repair and gynecological surgery procedures. All surgery presents risk,
including da Vinci Surgery and other minimally invasive procedures. Serious
complications may occur in any surgery, up to and including death. Examples of
serious or life-threatening complications which may require hospitalization include
injury to tissues or organs, bleeding, infection or internal scarring that can cause

9. long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to
the inverted position often used during abdominal and pelvic surgery. Risks of
surgery also include potential for equipment failure and human error. Risks specific
to minimally invasive surgery may include: A long operation and time under
anesthesia, conversion to another technique or the need for additional or larger
incisions. If your surgeon needs to convert the procedure, it could mean a long
operative time with additional time under anesthesia and increased complications.
Temporary pain or discomfort may result from pneumoperitoneum, the presence of
air or gas in the abdominal cavity used by surgeons in minimally invasive surgery.
Research suggests that there could be an increased risk of incision-site hernia with
single-incision surgery. Results, including cosmetic results, may vary. Patients who
bleed easily, who have abnormal blood clotting, are pregnant or morbidly obese are
typically not candidates for minimally invasive surgery, including da Vinci Surgery.
1. The surgeon works from a computer console in the operating room,
controlling miniaturized instruments mounted on three robotic arms to
make tiny incisions in the patient.
2. The surgeon looks through a 3-D camera attached to a fourth robotic
arm, which magnifies the surgical site.
3. The surgeon’s hand, wrist and finger movements are transmitted
through the computer console to the instruments attached to the robot’s
arms. The mimicked movements have the same range of motion as the
surgeon allowing maximum control.
4. The surgical team supervises the robot at the patient’s bedside.

10. Benefits of Robotic Surgery
Robotic surgery offers many benefits to patients compared to open surgery,
including:
 Shorter hospitalization
 Reduced pain and discomfort
 Faster recovery time and return to normal activities
 Smaller incisions, resulting in reduced risk of infection
 Reduced blood loss and transfusions
 Minimal scarring
Major advantages for surgeons using robotic surgery include:
1. Greater visualization
2. Enhanced dexterity

11. 3. Greater precision
Robotic surgery is an advanced form of minimally invasive or laparoscopic (small
incision) surgery where surgeons use a computer-controlled robot to assist them in
certain surgical procedures. The robot’s “hands” have a high degree of dexterity,
allowing surgeons the ability to operate in very tight spaces in the body that would
otherwise only be accessible through open (long incision) surgery.
Compared to open surgery (traditional surgery with incisions), robotic and
minimally invasive surgery results in smaller incisions resulting in less pain and
scarring.
Robotic surgery allows surgeons to perform complex surgical tasks through tiny
incisions using robotic technology. Surgical robots are self-powered, computer-
controlled devices that can be programmed to aid in the positioning and
manipulation of surgical instruments. This provides surgeons with better accuracy,
flexibility and control.

12. Applications of robotic surgery
Robotic surgery has successfully addressed the limitations of
traditional laparoscopic and thoracoscopic surgery, thus allowing completion of
complex and advanced surgical procedures with increased precision in a minimally
invasive approach. In contrast to the awkward positions that are required for
laparoscopic surgery, the surgeon is seated comfortably on the robotic control
console, an arrangement that reduces the surgeon's physical burden. Instead of the
flat, 2-dimensional image that is obtained through the regular laparoscopic camera,
the surgeon receives a 3-dimensional view that enhances depth perception; camera
motion is steady and conveniently controlled by the operating surgeon via voice-
activated or manual master controls. Also, manipulation of robotic arm instruments
improves range of motion compared with traditional laparoscopic instruments, thus
allowing the surgeon to perform more complex surgical movements.
Robotic surgery is useful for many other treatments as well. Few of them are
considered below:
• Cardiac surgery
• Gastrointestinal surgery
• Gynecology
• Neuro surgery
• Orthopedics
• Pediatrics
• Radio surgery
• Urology

13. Drawbacks of robotic surgery
•Cost of the equipment is very high, it is about 1,390,000 dollars.
•Surgeons has to spend several man hours to learn about the Robotic system.
•During training periods, surgery may take even long hours than a normal surgery,
which may also lead to use of longer anesthesia periods. Although rapidly
developing, robotic surgical technology has not achieved its full potential owing to
a few limitations. Cost-effectiveness is a major issue; 2 recent studies comparing
robotic procedures with conventional operations showed that although the absolute
cost for robotic operations was higher, the major part of the increased cost was
attributed to the initial cost of purchasing the robot (estimated at $1,200,000) and
yearly maintenance ($100,000). Both factors are expected to decrease as robotic
systems gain more widespread acceptance. However, it is conceivable that further
technical advances may at first drive prices even higher.[45] Decreasing operative
time and hospital stay will also contribute to the cost-effectiveness of robotic
surgery.
Other drawbacks to robotic surgery include the bulkiness of the robotic equipment
currently in use. Lack of tactile and force feedback to the surgeon is another major
problem, for which haptics (systems that recreate the “feel” of tissues through force
feedback) offers a promising, although as yet un realized, solution.

14. Facts about the Robotic Evolution
The terms robotic surgery, robotically assisted surgery or computer assisted
surgery, all refer to a technological development in the field of surgical
procedures. In quite a number of operating rooms today, you will find robotic
systems aiding colon and rectal surgeons, also know as proctologists, during
surgical procedures. Robotically assisted surgery was developed to help
overcome the limitations associated with minimally invasive surgery. It was
also developed to help enhance the capabilities of surgeons during surgical
procedures.
Surgery is never an easy thing for anyone and the term robotic surgery makes
the whole aspect of surgery seem even more intimidating. However, there is
no need for worry when it comes to robotic surgery. This type of surgery is a
new and innovative type of surgical system performed by a trained surgeon
using the da Vinci ci surgical robotic system. It is designed in such a way that
there are built in safe guards and that the surgical process is safe.
The following are the top 5 surprising facts about robotic surgery:
1. Whenever robotic surgery is performed, it is done by the surgeon. The
robot is the assistant. The da Vinci Si is a special kind of surgical
platform whereby surgeons use small, precise and minimal invasive
tools. This type of surgical platform enables the surgeon to make
movements that are more exact and offers him or her a wide variety of
motions within the small surgical area. Even though robotic surgery
provides a 3D and HD vision system, optimum control and state-of-the
art technology, the surgeon is still 100% in control of any movements.
2. With robotic surgery, there are smaller scars. With the da Vinci Si
surgical system, surgeons only need to make 4 or 5 small incisions in

15. order to successfully complete the surgery. This means that things such
as large and more invasive incisions are no longer needed. In addition,
these small incisions tend to heal much quicker and the patient ends-
up with far less scaring on the body.
3. With robotic surgery, there may be less postoperative pain or risk of
infections. Minimally invasive surgery means that surgeons make
smaller incisions. This results in patients feeling much less pain and
having quick recovery times. In addition, there is less exposure of the
internal body tissues because of the smaller incisions. This may help to
reduce the risk of dangerous infections. However, studies evaluating
this are in progress.
4. Patients experience quick recovery periods with robotic
surgery. Again, due to the smaller incisions made by surgeons, patients
tend to recover much quicker after undergoing robotic surgery. With
this kind of surgery, a minimal area of the body is involved, cut or
removed during the procedure. This results in patients recovering
quickly after the surgery. Post-operative stays are shorter than those
in open, traditional operations, and the patients may be able to return
to their lives and routines within just a few days after the procedure.
5. Robotic surgery is also used to treat gynecological conditions. The
following are some of the gynecological conditions that robotic surgery
can help to deal with:
 Hysterectomy: This is the removal of the uterus.
 Hyomectomy: This is the removal of fibroid tumors
 Sacrocolpopexy: This refers to a surgical correction of the vaginal and
uterine prolapse.

16. Revolution in robotic surgery
British scientists have developed the world’s smallest surgical robot which could
transform everyday operations for tens of thousands of patients. A team of 100
scientists and engineers have used low-cost technology originally developed for
mobile phones and space industries to create the first robotic arm specifically
designed to carry out keyhole surgery.
The robot, called VERSIUS, mimics the human arm and can be used to carry out a
wide range of laparoscopic procedures – including hernia repairs, colorectal
operations, and prostate and ear, nose and throat surgery – in which a series of
small incisions are made to circumvent the need for traditional open surgery. This
reduces complications and pain after surgery and speeds up recovery times for
patients. The robot is controlled by a surgeon at a console guided by a 3D screen in
the operating theatre.Although surgical robots already exist, the new creation is
much easier to use, takes up about a third of the space of current machines and will
be no more expensive than non-robotic keyhole surgery, according to its
maker Cambridge Medical Robotics.
“Having robots in the operating theatre is not a new idea,”. “The problem at the
moment is that they are phenomenally expensive – not only do they cost £2m each
to buy but every procedure costs an extra £3,000 using the robot – and they are
very large. Many hospitals have to use the operating theatre around the robot. Their
size can also make them difficult for the surgical team to use.“They are also poorly
utilised; they are only really used for pelvic surgery, and can’t be easily adapted to
other types of surgery. In some hospitals they are only being used once every
other day.”
For robots to revolutionise surgery, they need to be versatile, easy to use and small
so that surgical staff can move them around the operating room or between operating
theatres, or pack them away when they are not being used. “Our robot does all of
this and is the first robotic arm to be designed specifically for laparoscopic surgery,”
The robot will be launched next spring and, once surgeons are trained, it should be
available for procedures on patients by the end of next year.

17. Requirement for future development
On September 7, 2001, Operation Lindbergh culminated in the first
complete remote surgery on a human patient (a 68-year-old female), performed over
a distance of 4300 mi (7000 km). The patient and surgical system were located in
an operating room in Strasbourg, while the surgeon and remote console were
situated in a high-rise building in downtown New York. A team of surgeons
remained at the patient's side to step in if need arose. The procedure performed was
a laparoscopic cholecystectomy (gall bladder removal), considered the standard of
care in minimally invasive surgery. The established time delay during the surgery
was 135 ms remarkable considering that the data travelled a distance of more than
8600 mi (14,000 km) from the surgeon's console to the surgical system and back to
the console. The patient left the hospital within 48 hours—a typical stay following
laparoscopic cholecystectomy—and had an uneventful recovery.

18. At present a surgery can be performed through three or four incisions which
was the limitation, if the surgery has to be conducted on different locations as shown
in the above set of figures. The future development in robotic tube be like this figure,
which can hold the camera, surgical instruments, gripper altogether at one place and
surgery can do through one incision.

19. Conclusion
Rapid increase in today's technology, there is a high chance in development
of miniaturised equipment which can help in performing the surgery with one simple
incision. The increase in utilisation of the robotic surgery may help to educate people
and make its way to use in real world scenario, which is one of the key role for its
implementation. The current global market for surgical robots is worth
approximately $4bn a year but this is expected to grow to $20bn by 2024.key role
at present.