Origins of Robotic Surgery
The first documented use of a robot-assisted surgical procedure occurred in 1985 when the PUMA 560 robotic surgical arm was used in a delicate neurosurgical biopsy, a non-laparoscopic surgery. The robotic system allowed for a successful robotic surgery and the potential for greater precision when used in minimally invasive surgeries, such as laparoscopies which typically utilize flexible fiber optic cameras. The 1985 robotic surgery lead to the first laparoscopic procedure involving a robotic system, a cholecystectomy, in 1987. The following year the same PUMA system was used to perform a robotic surgery transurethral resection. In 1990 the AESOP system produced by Computer Motion became the first system approved by the Food and Drug Administration (FDA) for its endoscopic surgical procedure.
In 2000, the da Vinci Surgery System broke new ground by becoming the first robotic surgery system approved by the FDA for general laparoscopic surgery. This was the first time the FDA approved an all-encompassing system of surgical instruments and camera/scopic utensils. Its predecessors relied upon the use of endoscopes and numerous surgical assistants to perform surgery. The da Vinci robotic surgery system’s three-dimensional magnification screen allows the surgeon to view the operative area with the clarity of high resolution. The one-centimeter diameter surgical arms represent a significant advancement in robotic surgery from the early, large-armed systems such as the PUMA 560. With such miniaturized operating arms, the da Vinci robotic surgery system removes the need to leverage the sides of the incision walls. This advancement allows for less contact between exposed interior tissue and the surgical device, greatly reducing the risk of infection. The “Endo-wrist” features of the operating arms precisely replicate the skilled movements of the surgeon at the controls, improving accuracy in small operating spaces.
The da Vinci system has been approved by the FDA for use in both adult and pediatric robotic surgery procedures in the following areas:
- Urological surgeries
- General laparoscopic surgeries
- General non-cardiovascular thoracoscopic surgeries
- Thoracoscopically-assisted cardiotomy procedures
Applications for Robotic Surgery
Because robotic surgery is at the cutting edge of precision and miniaturization in the realm of surgery, the possible applications are as extensive as the uses of minimally invasive surgery. Robotic surgery has already become a successful option in neurological, urological, gynecological, cardiothoracic, and numerous general surgical procedures. Intuitive Surgical, makers of the da Vinci robotic surgery system, have released upgrades in the number of operating arms, eliminating the need for one surgical assistant, which may expand its clinical applications.
Robotic surgery procedures performed in Europe, particularly those done by German surgeons, have advanced the field of robotic medicine greatly. Smith & Nephews, in conjunction with URS Orthopedic Systems, have created software to be used with robotic surgical systems such as da Vinci and is exploring its orthopedic applications in hospital clinical tests throughout Germany.
The Future of Robotic Surgery
The future of robotic surgery is nearly as promising as the human will to invent better ways of accomplishing delicate medical procedures. It is reasonable to assume that the current advantages of robotic surgery systems will be expanded upon in the next generation of medical robotics. Removing human contact during surgery may be taken to the next level with robotic surgery systems capable of functioning at greater distances between surgeons control console and the patient side table robotics. This would allow robotic surgery to be conducted with patients in a nearby “clean room,” reducing or eliminating the intraoperative infection. It is possible for next-generation medical robotics and robotic surgery to conduct surgical prep work remotely as well.
Advancements in making robotic surgery systems more capable of replicating the tactile feel and sensation a surgeon experiences during more invasive traditional procedures would give the surgeon the best of both worlds. The surgeon would gain the precision and advantages of minimally invasive procedures without losing the sensory information helpful in making judgment calls during robotic surgery.