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Robotics in Surgery

By Leslie B.


“Robot-assisted techniques are the next generation in minimally invasive surgery” (“Breakthrough”). This quote from the Harvard Women’s Health Watch predicts that robots are the future of medical surgeries. Using robots in surgery as opposed to the traditional human method has dramatically altered the surgical options of both men and women for the better. This option has become increasingly popular in the last decade because of its recent advances. This paper will look into those recent advances, including three commonly used robotic systems, and determine what advantages and disadvantages surface by using robots and what the future holds for robotics in surgery.

Although robots are often used in different areas of science, they were originally created as a form of entertainment (Najarian). The term “robot” has many different definitions but is commonly defined as ‘a reprogrammable, multifunctional manipulator designed to move materials, parts, tools, or specialized devices through various programmed motions for the performance of a variety of tasks’ (Najarian). Robots are used in industry as well as computers, but most notably in medical surgeries (Najarian). Robotics in surgery have come a long way in the past 20 years, they have redefined how medical procedures are conducted.

The first robot appeared in the operating room about 20 years ago as a way to minimize invasiveness of surgeries (Camarillo). Minimally invasive surgeries meant it was no longer necessary that the surgeons placed their hands inside the patient’s body to perform surgery because instruments and scopes could be placed inside the body through small incisions (Camarillo). According to Camarillo, some disadvantages of the traditional human surgery method included “Loss of wrist articulation, poor touch feedback, the fulcrum effect, loss of 3-dimensional vision, and poor ergonomics of the tools mean that only relatively simple procedures are truly widespread.” It was believed that the use of robots in surgery would eliminate these disadvantages, but robots had both advantages and disadvantages as well. Some advantages of using robots were its accuracy of surgeries, its repeatability, reduced trauma due to the small incision size and quicker patient recovery times (Camarillo). Additional advantages include “3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon” (Jung). Camarillo states some of its disadvantages to be “substantial loss of force feedback and a lack of adaptability.” Another concerning point is the potential error behind using machines. Perhaps something goes wrong in the surgery, is it the doctor’s fault or that of the machine? Both sides could be argued because the doctor was operating the robot, but what if the robot malfunctions? As of 20 years ago, robots were a new development in the advancement of surgeries. The technology was new and robots were sparsely found in operating rooms across the world.

A company called Intuitive Surgical created what is now the most commonly used surgical robot in the world, the da Vinci Surgical System. The da Vinci robot is directed by humans and allows surgeons to get a closer look at the site of surgery than the human eye will allow (Singh). This new technology is used to “enhance the surgeon’s ability to carry out various surgical procedures” (Najarian). This 1.5 million dollar robot consists of two parts: the surgical arm unit with four arms (most models), and the viewing and control console (Singh). Three of the four arms act as a scalpel, scissors, or other instrument, while the fourth arm houses a camera with two lenses that allow a 3D view of the process; the arms are controlled by two foot pedals and two hand controllers. The procedure starts by first making four incisions in the patient’s abdomen, each about 1 cm long, then four rods are inserted. According to Singh, three arms hold the rods in place, while a camera is located in the fourth rod that allows sight inside the body. The da Vinci robot method is different from the human surgical method because the surgeon isn’t actually holding the instruments directly; the surgeon operates the instruments through the robot. The operating surgeon controls the arms of the robot from a couple feet away by looking through a viewfinder to observe the 3D images of the body. Singh states that the surgeon operates a joystick that then sends signals to the robot telling it what to do. The da Vinci surgical robot is capable of performing various surgeries including: hysterectomies, prostatectomies, gynecological surgeries and thoracic surgeries by the FDA (Singh). According to Singh, “Surgeons are beginning to employ the da Vinci System to remove tumors on the liver and pancreas, on account of the delicacy of the procedure, the number of blood vessels that the surgeon must deal with, and the single location of the operation.”

While the da Vinci Surgical System is the most commonly used robot in the operating room throughout the world, another commonly used robot is the ZEUS Robotic Surgical System. Singh states “The ZEUS Surgical System is made up of an ergonomic surgeon control console and three table-mounted robotic arms, which perform surgical tasks and provide visualization during endoscopic surgery.” The surgeon controls two of the arms while the third arm provides a steady visual inside the body. The surgeon uses voice commands to control the endoscopic scope allowing his hands to operate the arms and therefore the instruments. One main advantage of the Zeus Surgical System is that the robot eliminates hand tremors and provides a more efficient way of operating microsurgical procedures. Using this robot, or a machine similar to this one allows ease of sterilization, instrument reusability, quick swapping of instruments, fast setup, better visualization, and more accurate wrist and hand controls (Singh).

Another commonly used robot is the AESOP Robotic System. According to Singh, “The AESOP system employs the assistance of the Automated Endoscopic System for optical position.” This robot has historical significance because it was the first one to be approved by the FDA for assisting a surgeon in the operating room. This robot has a more specific function, compared to the da Vinci and Zeus Surgical Systems, because it’s mainly used to insert the endoscopic camera inside the patient. This robot is also controlled by voice commands, thus leaving the surgeon’s hands free (Singh). The AESOP is only used for imaging purposes though, which when medically concerned is considered noninvasive and low risk (Camarillo).

The future of robotics in surgery is categorized into two main fields: imaging and manipulation, but between these two fields there are many possibilities (Camarillo). Imagine a future where robots could operate on your heart through a minimally invasive, closed chest procedure through a small incision site. Not only would this provide a more efficient way of operating, but it would be much safer and easier on the patient (Bishop). Performing a minimally invasive surgery on what would be a very complex procedure if done by a human surgeon would be an incredible advancement. This would drastically reduce hospital stays to a couple nights rather than weeks, reduce amount of pain the patient felt after surgery, reduce period of time needed to get back to a “normal” life, reduce chances of the immune system to be compromised, and also reduce the chances of damaging the surrounding tissues (Park). Some main points of focus for future surgeries include taking advantage of the natural orifices, like the nostrils, and performing capable surgeries from there, thus removing the need to make an incision at all. A few of these procedures are being done now, but what if we could avoid an incision altogether? Perhaps at some point in the not too distant future we would be operated on entirely by robots and only robots.

Robotics in surgery has come a long way in the last 20 years. It all started with a mere idea of using robotics to perform surgeries to completing surgeries start to finish without having to touch the patient. There are many advantages to using robots, including: three-dimensional view of the patient and the operation area, allowing the surgeon to perform more intense operative controls, more precise and accurate movements, and of course greater range of motion (Singh). Although with advantages come disadvantages, including: high costs of the robots, performance validation, safety, and acceptance from patients to be operated on by a robot (Howe). Even though there are pros and cons to switching over from traditional human methods of surgery to completely robot-operated surgeries, I believe we are heading in the right direction.


Bibliography

Bishop, K. “Robotic-assisted surgery offers women new option.” The Blade. 25 December 2012. Web. 1 April 2013.

“Breakthrough: Robotic surgery.” Harvard Women’s Health Watch, 20.3 (2012): 7. Web.

Camarillo, D. B., T. M. Krummel, and K. Salisbury. “Robotic technology in surgery: past, present, and future.” The American Journal of Surgery, 188 (2004): 2-15. Web.

Howe, R. D., and Y. Matsuoka. “Robotics for Surgery.” Annual Review Biomed, 1 (1999): 211-240. Web.

Jung, Y. W., S. W. Kim, and Y. T. Kim. “Recent advances of robotic surgery and single port laparoscopy in gynecological oncology.” Gynecol Oncol, 20.3 (2009): 137-144. Web.

Najarian, S., M. Fallahnezhad, and E. Afshari. “Advances in medical robotic systems with specific applications in surgery – a review.” Journal of Medical Engineering & Technology, 35.1 (2011): 19-33. Web.

Park, Y. M., W. S. Kim, H. K. Byeon, A. D. Virgilio, S. Y. Lee, and S. H. Kim. “Clinical Outcomes of Transoral Robotic Surgery for Head and Neck Tumors.” Annals of Otology, Rhinology & Laryngology, 122.2 (2013): 73-84. Web.

Singh, K. “Robotics in Surgery.” Division of Computer Engineering, (2010): 1-41. Web.

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