ROBOTIC SURGERY INTRODUCTION Robotassisted surgery is the latest

ROBOTIC SURGERY

INTRODUCTION Robot-assisted surgery is the latest development in the larger movement of endoscopy, a type of minimally invasive surgery, the idea being that less invasive procedures translated into less trauma and pain for patients. Surgery through smaller incisions typically results in less scarring and faster recovery. It's not that robots are changing the basics of surgery. Surgeons are still cutting and sewing like they have been for decades. Robots represent a new computer-assisted tool that provides another way for surgeons to work.

HISTORY Ø Ø In 1985 a robot , the PUMA 560, was used to place a needle for brain biopsy using CT guidance. In 1988, the PROBOT , developed at Imperial College London, was used to perform prostate surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical , with the introduction of the da Vinci surgical system and Computer Motion with the AESOP and the ZEUS robotic surgical system.

CURRENT ROBOTIC SURGICAL SYSTEMS � � Artemis da Vinci and Zeus

ARTEMIS Schurr et al at Eberhard Karls university’s section for minimally invasive surgery have developed a master-slave manipulator system that they call ARTEMIS. This system consists of two robotic arms that are controlled by a surgeon at a control console. Dario et al at the Mi. Tech laboratory of Scuola Superior Sant’ Anna in Italy have developed a prototype miniature robotic system for computer-enhanced colonoscopy.

Da Vinci and Zeus They are comprehensive master- slave surgical robotic system In the da Vinci system, there are essentially 3 components: � a vision cart that holds a dual light source and dual 3 chip cameras, � a master console where the operating surgeon sits, and � a movable cart, where 2 instrument arms and the camera arm are mounted.

i. ZEUS SYSTEM The ZEUS surgical system is made of an ergonomic surgeon console and three table-mounted robotic arms, which perform surgical tasks and provide visualization during endoscope surgery. Seated at an ergonomic console with an unobstructed view of the OR, the surgeon controls the right and left arms of ZEUS, which translate to real-time articulation of the surgical instruments. A third arm incorporates the AESOP endoscope positioner technology, which provides the surgeon with magnified, rock-steady visualization of the internal operative field. Fig: Zeus system

Surgeon console � � � Fig: surgeon console Touch screen monitor Support arms and surgeon handles Mounting areas : for speakers Access to controller front panels Mounting shelves for housing control units

Features of Zeus system � � � � Industry standard mechanism-easy sterilization Instrument reusability Quick instrument changes Rapid setup Visualization Six degrees of freedom Seating accommodation

ii. DA VINCI SYSTEM � System overview . surgeon console. patient side cart. insite vision camera with endoscope

Fail safe mechanisms Safety concerns remain the centre of focus. To start the procedure, the surgeon’s head must be placed in the viewer. Otherwise the system will lock and remain motionless until it detects the presence of the surgeons head once again. Included in the power source is a backup battery that allows the system to run for twenty minutes, giving the hospital enough time to re-establish power. Each instrument has a chip that prevents the use of any instrument other than those made by Intuitive Surgical. These chips also store information about each instrument for more precise control and keep track of instrument usage to determine when it must be replaced.

PROS � Precision. � Miniaturization. � Smaller incisions. � Decreased blood loss. � Less pain. � Quicker healing time. � Articulation beyond normal manipulation. � Three- dimensional magnification

CONS � efficiency has not yet been well established � High cost(price tag of million dollars) � Cubersome robotic arms(miniaturization required) � lack of compatible instruments and equipment

APPLICATIONS � � � � General surgery Cardiothoracic surgery Cardiology and electrophysiology Gastrointestinal surgery Neurosurgery Orthopedics Pediatrics

FUTURE ENHANCEMENTS Robotic surgery is in its infancy. Many obstacles and disadvantages will be resolved in time and no doubt many other questions will arise. Many of the current advantages in robotic surgery ensure its continued development and expansion. Although these systems have greatly improved dexterity, they have yet to develop the full potential in instrumentation or to incorporate the full range of sensory input. More standard mechanical tools and more energy directed tools need to be developed. Some authors also believe that robotic surgery can be extended into the realm of advanced diagnostic testing with the development and use of improved equipment. The possibilities for improvement and advancement are only limited by imagination and cost.

CONCLUSION Although still in its infancy, robot assisted surgery has already proven itself to be of great value, particularly in areas inaccessible to conventional laparoscopic procedures. It remains to be seen, however, if robotic systems will replace conventional laparoscopic instruments in less technically demanding procedures. It has the potential to expand surgical treatment beyond the limits of human ability. Whether or not the benefit of its usage overcomes the cost to implement it remains to be seen and much remains to be worked out. Further research must evaluate cost effectiveness or a true benefit over conventional therapy for robotic surgery to take full root.

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