History of Robotic Surgery
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 procedure and the potential for greater precision when used in minimally invasive surgeries, such as laparoscopies which typically utilize flexible fiber optic cameras. The 1985 procedure lead to the first laparoscopic procedure involving a robotic system, a cholecystecotomy, in 1987. The following year the same PUMA system was used to perform a 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 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 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 system has been able to remove the need to use the sides of the incision walls for leverage. This advancement allows for less contact between exposed interior tissue and the surgical device, which greatly reduces 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 procedures in the following areas:
- Urological surgeries
- General laparoscopic surgeries
- General non-cardiovascular thoracosopic surgeries
- Thoracoscopically-assisted cardiotomy procedures
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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 system, have released upgrades in the number of operating arms, eliminating the need for one surgical assistant, which may expand its clinical applications.
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 surgical 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 systems capable of functioning at greater distances between surgeons control console and the patient side table robotics. This would allow surgeries to be conducted with patients in a near by “clean room”, reducing or eliminating infection intra-operatively. It is possible for next generation medical robotics to conduct surgical prep work remotely as well.
Advancements in making robotic 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 loosing the sensory information helpful in making judgment calls.
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