Robotic Surgery

First submitted by:
Shawn Tsuda
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Robotic technology in may have broad-based application to many complex laparoscopic procedures. There are more than 400 robotic systems in the USA and over 30,000 robotic procedures have been performed.  There has also been application to cardiac surgery, for which robotics was originally conceived for, and is particularly adapted to urology.

 

Types of Surgical Robots

  • supervisory-controlled robotic system in which the robotic intervention is preplanned and programmed, and carries out is movements autonomously.
  • robotic tele-surgical system in which the robot is manipulated by the surgeon in real-time through remote control through any given distance
  • shared control system in which the surgeon directly controls the movements of the robot as the robot enhances the surgeon’s skills through dexterity enhancement (1)

Early History

In 1985, the PUMA 560 robot was used for a brain biopsy under cat scan guidance.  In 1988, the first robot, PROBOT, was used for prostatic surgery.  AESOP 2000 and ZEUS were introduced in 1996.  A year later, in 1997, the first da Vinci prototype was made.  In 1998, an open cardiac bypass was performed with the da Vinci. In 2001, Marescaux et al performed a laparoscopic cholecystectomy in Strasbourg, France, from New York, with the ZEUS robot.

The da VinciTM Robotic Surgery System

The da VinciTM Robotic Surgery System (dVRS, Intuitive Surgical, Sunnyvale, CA, USA) uses high-resolution 3-D optics, and enhanced degrees of freedom of its instruments. In addtion, a seated position at the operating station alleviates surgeon fatigue. The da Vinci robot has been applied to cardiothoracic, urology, gynecology and general surgery. The da Vinici STM series incorporates an integrated touchscreen, telestration, and adaptation for integratino of specific patient information such as radiographic images superimposed on the operative field.

Robotics and Cardiothoracic Surgery

Over 1500 cardiac robotic surgeries are performed in the United States annually.  These include Robot-assisted Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) and Totally Endoscopic Coronary Artery Bypass (TECAB) surgeries.  Robotic surgery has been used for mitral valve surgery, coronary revascularization, atrial fibrillation surgery, left ventricular lead placement, and aortofemoral bypass,

 

Robotics and General Surgery

Multiple abdominal surgeries have been performed with a robot, including cholecystectomy, esophagectomy, fundoplication, Heller myotomy, gastrectomy, splenectomy, colectomy, Roux-en-Y gastric bypass, pancreatcectomy, and Whipple procedures.

 

Robotics and Urology

Robotic prostatectomy has been the mainstay of robotic urologic surgery.  It has also been applied to nephrectomy, adrenalectomy, and cystectomy.

 

Robotics and Gynecology

The safety and efficacy of robot-assisted approach in hysterectomy, in humans, was first documented by Diaz-Arrastia et al. in 2002.

It has since been applied to tubal anastamosis, myomectomy, hysterectomy, and urogynecology.

 

Robotics and Microsurgery/Hand Surgery

Robot-assisted microsurgical has been applied to corneal surgery, microvascular anastomoses in plastic surgery and urology for vasovasostomy or vaso-epididymostomy.

 

References

1. Nathoo N, Cavusoglu MC, Vogelbaum MA et al. In touch with robotics: neurosurgery for the future. Neurosurgery 2005; 56:421–433.

2. Narazaki K, Oleynikov D, Stergiou N. Robotic surgery training and performance. Surg Endosc 2006; 20:96–103.

3. Perez A, Zinner M, Ashley S, Brooks D, Whang E. What is the value of telerobotic technology in gastrointestinal surgery? Surg Endosc 2003; 17:811–813
4. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr. Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 2002; 16(9):1271–1273.