Robotic surgery uses robotic systems to assist surgeons with complex procedures. Some key points: - Early systems included ROBODOC in 1985 for hip replacements and AESOP in 1994 for positioning the endoscope. The Da Vinci system, introduced in 2000, is now the most widely used system. - Systems can be tele-surgical like Da Vinci where the surgeon controls the robot remotely, shared-control where the robot provides feedback, or supervisory where the robot executes pre-planned motions autonomously under surgeon oversight. - The Da Vinci system allows the surgeon to sit at a console several feet from the patient with magnified 3D HD vision and wristed instruments that mimic hand movements with

1. Principles of Robotic Surgery
- Abhishek Pandey

2. Introduction
• Robot – Programmable device doing complex actions
automatically with speed & precision.
• Robotic Surgery → Robot Assisted Surgery – Surgeon
in control.

3. History
1985: The PUMA 560 (Unimation Inc.) – robot
placed needle for CT-guided brain biopsy
1988: The ROBODOC (Integrated Surgical Systems) – robot
used in Hip replacement to core femoral shaft

4. 1992: The PROBOT (Imperial
College London) – robotic TURP
1994: The AESOP (Automated
Endoscopic System for Optimal
Positioning) (Computer Motion Inc.)

5. The Zeus System (Computer Motion Inc.)

6. The Da Vinci System (Intuitive Surgical Inc.)
• 2003 – Intuitive Surgical Inc. bought Computer Motion Inc.
and everything else became history
Surgeon’s Console Vision Cart Patient Cart

7. Classification
Based on the level of Autonomy
1. Tele-surgical system – The Da Vinci System
2. Shared-control system – The ACROBOT
3. Supervisory-controlled systems – The RoboDoc, The
PROBOT, The Cyberknife
4. Total Autonomy – N.A.

8. Tele-Surgical System
• Surgeon in complete control.
• Surgeon sits at user control console with joysticks &
camera feed to remotely operate the tools
• Robot directly follows instruction
• The Da Vinci surgical system, The Trauma Pod
• Da Vinci system is capable but is currently not
approved for autonomous motions.

9. Shared-Control System
• Robot can decide to resist the surgeons’ intended
movement
• The work space is split into several segments – Safe,
Close, Boundary, or Forbidden Classification
• If surgeon moves cutting tool towards tissue that
should not be damaged, the robot will apply the
force haptic feedback
• The ACROBOT

10. Supervisory-Controlled Systems
• Human oversees the operation and issues high-level
commands (decision-making).
• Robot executes the motions autonomously.
• The RoboDoc – Orthopedic – bone milling.
• The PROBOT - Positioning of system by surgeon →
autonomous TURP (Surgeon control emergency stop)
• The Cyberknife – Radiosurgery.

11. Autonomy – Pros & cons
• Ethical issues with Autonomy
– Patient safety
– Culpability

12. Approaches to Automation
• Predefining Motions or Constraints – execution of
steps without ability to adapt to environment will fail
in real surgical situations if there is movement.
Automated
suturing using
EndoBot
system on
simulated
tissue.

13. • Visual Tracking and Servoing –
– Visual servoing – use of images in a feedback loop to
automate the robotic system.
– autonomous endoscopic camera movement – tracking
surgeon’s intent via instrument/eye movements
• Learning by observation (LBO)

14. The Da Vinci Surgical System
1. The Patient-side Cart – Four patient-side
manipulators or arms
2. The Surgeon Console – High resolution stereo-
viewer – 3D vision & Joystick control
3. The Vision Cart – Computerized Control system –
relay of Input and Output with Processing

15. The Da Vinci System (Intuitive Surgical Inc.)
Surgeon’s Console Vision Cart Patient Cart

16. Robotic Arm – Basic Design
• Mimics human arm design
• Motors / Actuators – function as muscles
• Joints – Increasing joints increases DOF
– Prismatic – Translational DOF
– Revolute – Rotational DOF
• End effectors – Grasping or other tools
• New – Gantry design of patient-side cart to ease
docking of robotic arms

18. Endoscopy – Limits DOF

19. 7 Degrees of Freedom
• Proprietary Endowrist design – da Vinci system
• 3 Translational DOF
• 3 Rotational DOF
• 1 Grasping

20. Processing
• Movement scaled down
• Tremors filtered
• Image Magnified with 3D effect
• Crosschecking and Spatial correlation between
surgeon’s movement & end effector movement.
• Gravity compensation – the actuator power required
to resist joint torque caused by weight of robot

21. SOP
• Preparing & Draping system
• Roll-up – Positioning patient-cart next to patient bed
• Deployment – adjusting angles of robotic arms to
ensure clearance between arms & patient
• Docking – Securing connection b/w arm & patient
• Undocking → Undraping → Cleaning
• Stowing arms to minimize storage space required

22. Challenges
• Ethical Issues
• Learning Curve
• Cost
• Tele-Surgical Latencies
• Full autonomy far-fetched
• Superiority could not be demonstrated

23. Current Benefits
• Better accuracy, precision, dexterity
• Tremor corrections
• Scaled motion
• Haptic corrective feedback.
• End-effectors much smaller
• Tele-Surgery

24. THANK YOU