Robotic surgery originated in the 1980s with early conceptions of telepresence surgery using robotic arms controlled by surgeons. The first robot used for surgery was the Puma 560 for neurosurgical biopsies. The Da Vinci system, introduced by Intuitive Surgical, performed the first telesurgical laparoscopic cholecystectomy in 1997. The Da Vinci system allows surgeons to perform minimally invasive procedures with improved 3D visualization, dexterity, precision, and ergonomics compared to traditional laparoscopy. Robotic surgery has been used for a wide variety of procedures in fields such as general surgery, urology, gynecology and cardiac surgery.

2.  Robota : forced labour(Czech) - Karel Capek.
 Scott Fisher (NASA) and Joseph Rosen gave the earliest
conceptions of surgical robotics in 1980's - telepresence
surgery in which surgeon works on computer assisted system
to direct and manipulate robotic arms to perform the
designated function.
 Open surgery Laparoscopic surgery Robotic
 The first robot to be used for surgery : Puma 560, a passive
robot used to perform neurosurgical biopsies with greater
precision.
 Neuromate 1997- steriotactic neuro surgeries.

3.  ROBODOC : first surgical robot approved by the FDA and
also the first robot to perform automated procedure on
humans.
 It was developed for primary/ revision THR, TKR.
 The US Army became interested in the possibility of
decreasing wartime mortality by ―bringing the surgeon to
the wounded soldier—through telepresence.
 Funded computer motion which made AESOP, later they
made Zeus system – 2 robotic arms and endoscope for vision.
 Mountain system introduce Da vinci.

4.  1st telesurgical Lap. Cholecystectomy in humans – 1997 (Da Vinci)

 Da Vinci System
 Master console, Patient cart, Vision cart.
 Master console:
 Place where the surgeon sits comfortably outside sterile field and controls
the EndoWrist instrument movements at the surgical site via hand
manipulators.
 It is the control unit.
 The console is provided with a Stereo Viewer that translates the image of
the surgical site acquired by the endoscope and displays it in front of the
surgeon's eyes in 3d (surgical immersion).

5.  Instrument tips appear to align with the surgeon's hands at the master
controllers as seen in the stereo viewer.
 This design simulates the natural eye, hand and instrument alignment of
open surgery which in turn, helps to optimize hand—eye coordination.
 This means that the robotic platform allows the surgeon to be as dexterous
as in open surgery while operating in a minimally invasive environment.
 Motion scaling and tremor reduction minimizes the impact of natural hand
tremor or inadvertent movement.
 The Surgeon Console operator also has the option to change the view from
full screen mode to a multi-image mode (TiIePro Display)

6.  PATIENT CART:
 It is the operative component and slave unit of the Da Vinci System. It
supports the instrument arms and camera arm.
 Remote center technology is used
 The remote center is a fixed point in space around which the patient cart
arms move. It enables the System to maneuver instruments and
endoscopes in the surgical site while exerting minimal force on the
patient's body wall.
 The assistant surgeon operates the patient cart. He exchanges instruments
and endoscopes, and performs other patient side activities.
 The actions of the assistant surgeon operating the patient cart take
precedence over actions of the Surgeon Console operator.

7.  ENDOWRIST INSTRUMENTS:
 The instrument tips are designed to mimic the dexterity of the human hand
and wrist.
 It allows 7 degrees of freedom and 90 degrees of articulation (5 degrees
freedom in conventional laprascopy are called endowrist function).
 These instruments allows for greater precision when operating,
help in the most rapid and most precise suturing, dissection and
tissue manipulation available with any surgical platform.
 These instruments are multi-use instruments. Available in 8mm and
being developed in 5mm diameters.

8.  VISION CART:
 Vision Cart houses the image processing equipments of the system. It also
Provides for an optional touch screen monitor and ancillary surgical
equipment.
 Available in Standard Definition (SD) vision System and a High
Definition (HD) vision System.

9. LAPAROSCOPIC SURGERY ROBOTIC SURGERY
Well developed technology 3 D visualisation – Dual camera
Affordable & ubiquitous Improved Dexterity - endowrist
Proven Efficacy Seven degrees of freedom
Easy to work in large spaces like
peritoneal cavity
Ergonomic position
Can be done with less
experienced assistant
Shorter learning curve
Elimination of physiologic tremors
Elimination of fulcrum effect
Ability to scale motion
Telesurgical Ability
Micro anastomosis possible

10. LAPAROSCOPIC SURGERY ROBOTIC SURGERY
Loss of touch sensation Absence of touch sensation
Loss of 3 D visualisation Expert assistant required by patient
side
Longer learning curve Requires re-docking if patient position
is changed
Compromised dexterity High start up cost
Limited degrees of freedom Newer technology
The fulcrum effect Increased time for OT set up
Amplification of physiologic tremors Bulky equipment

11.  Utilized in a wide variety of minimally invasive surgical procedures-
general, urological, gynecologic, and cardiothoracic surgery.
 GI : cholecystectomy, Hellers myotomy, Fundoplication, bariatric surgery,
colorectal surgery.
 Urology: There are multiple large series of robotic prostatectomies
published in the literature. Better on comparision to open prostatectomy.
 Shorter hospital stay, less pain, less blood loss and fewer transfusions, and
even better erectile function outcomes than conventional open nerve-
sparing prostatectomy.
 Thoracic surgery: thymectomy, lobectomy, esophagectomy, and resection
of mediastinal tumors.

12.  Cardiac surgery :
 Davinci system was originally designed for use in closed chest cardiac
surgery, but is now mostly used in other areas. Its used in minimally
invasive mitral valve repair and replacement with good results, including a
shorter length of stay and fewer blood transfusions than in open surgery.
 In the future, it is likely that multi-vessel or off-pump totally endoscopic
robotic coronary artery bypass will be possible.
 Gynaecologic Surgery: radical hysterectomy, Tubal anastomosis etc.
 Other departments: Neurosurgery, Transplantation surgeries, Vascular
surgeries (slovania-2000) , orthopedics, paediatric surgery.

13.  In 2006 the first artificial intelligence doctor-conducted unassisted robotic
surgery on a 34y/m to correct heart arryhtymia. The results were rated as
better than an above-average human surgeon.
 The machine had a database of 10,000 similar operations, and so, in the
words of its designers, was "more than qualified to operate on any patient.
 In 2007, Dr. Sijo Parekattil (Florida) performed the first robotic assisted
microsurgery procedure denervation of the spermatic cord for chronic
testicular pain.
 In 2008, Dr. Mohan S. Gundeti (chicago) - the first robotic pediatric
neurogenic bladder reconstruction.
 In 2008, the first image-guided MR-compatible robotic neurosurgical
procedure was performed by Dr. Garnette Sutherland using the neuroarm.
 In June 2008, the german aerospace center (DLR) presented a robotic
system for minimally invasive surgery, the micro surg.
 In September 2010, the einthoven university developed sofie surgical
system, the first surgical robot to employ force feedback.
 In September 2010, the first robotic operation at the femoral
vasculature was performed by a team led by borut gersak

14.  Over 1.5million surgeries performed globally. Over 4 lakh surgeries/yr in
usa.
 Future development:
 Miniaturizing of robotic equipment (RAVEN)
 Remotely present mobile robotic platform-RP7.
 Telesurgery : Space, polar regions, War zone etc. Delay more than 250ms
not acceptible.
 Miniaturizing of robots into peritoneal cavity
 Recently used along with robotic anaesthesia – computer calculates
moment to moment dosing requirement.