Page 33 - Laparoscopic Surgery Online Journal

WJOLS

Robotic Gynecological Surgery: A Clinical Approach

surgeons both inside and outside of the operating room. The BASIC SETUP
computer’s ability to enhance, modify or transform
Today, many robots and robot enhancements are being
electronic data is changing patient management before,
researched and developed. Schurr et al at Eberhard Karls
during and after surgery. However, these technologic
University’s section for MIS have developed a master-slave
advancements are having a great influence on the planning
manipulator system that they call ARTEMIS. This system
and performance of the surgery. Although robots are still consists of two robotic arms that are controlled by a surgeon
unintelligent machines, great steps have been made in at a control console. Dario et al at the MiTech laboratory of
expanding their use. Today robots are used to perform highly Scuola Superiore Sant’Anna in Italy have developed a
specific, highly precise, and dangerous tasks in industry and prototype miniature robotic system for computer-enhanced
research which not possible with a human work force. colonoscopy. This system provides the same functions as
Robotics, however, has been slow entered the field of conventional colonoscopy systems but it does an inchworm-
medicine. The lack of fusion between industrial robotics like movement using vacuum suction. Because this system
and medicine, particularly surgery, is ended nowadays. allows the endoscopist to teleoperate or directly supervise
Voice-activated robotic arms routinely produce endoscopic this endoscope, the surgeons believe that this system is not
cameras, and complex master slave robotic systems are only suitable but may expand the applications of
currently approved, marketed, and used for a variety of endoluminal diagnosis and surgery. 9 In 1998, Computer
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procedures. The beginning of surgical robots have entered Motion which already had manufactured the AESOP
the field of endoscopic surgery to overcome the capabilities developed the ZEUS surgical robot with a 2D imaging
of human surgeons beyond the limits of conventional system similar to that of standard laparoscopy. On the other
laparoscopy. The history of robotics in surgery begins with hand, the Da Vinci surgical system was introduced which
the Puma 560, a robot used in 1985 by Kwoh et al to perform has four robotic arms and obtained US Food and Drug
neurosurgical biopsies with greater precision. Three years Administration (FDA) approval in 2001, and become the
most common robotic system used in the world. The
later, Davies et al performed a transurethral resection of the
competition between the ZEUS and the Da Vinci surgical
prostate using the Puma 560. This system eventually lead
systems ended when Computer Motion was introduce into
to the development of Probot, a robot designed specifically
robotic surgery in 2003. 10
for transurethral resection of the prostate. While Probot was
The Zeus system is composed of a surgeon control
being developed, Integrated Surgical Supplies Ltd. of
console and three table-mounted robotic arms. The right
Sacramento, CA, was developing ROBODOC, a robotic
and left robotic arms replicate the arms of the surgeon, and
system designed to cut the femur in hip replacement
the third arm is an AESOP voice-controlled robotic
surgeries. ROBODOC was the first surgical robot approved
endoscope for visualization. In the Zeus system, the surgeon
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by the FDA. Also in the mid-to-late 1980s a group of
is seated comfortably upright with the video monitor and
researchers at the National Air and Space Administration
instrument handles positioned to maximize dexterity and
(NASA) Ames became interested in using this information
allow complete visualization of the surgical field. The system
to develop telepresence surgery. This concept of telesurgery
uses both straight shafted endoscopic instruments similar
became one of the main forces behind the development of
to conventional endoscopic instruments and jointed
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surgical robots. While these robots were being developed,
instruments with articulating end-effectors and 7º of
general surgeons and endoscopists joined the development 11
freedom. The Da Vinci robotic system consists of three
team and accept it to overcome the limitations of conventional
main components: The robotic cart, the vision cart, and the
laparoscopic surgery.
operating console. Four robotic arms are mounted on the
Initial clinical trials using robotics in the operating room
robotic cart which can be placed freely next to the patient.
have shown the ability of the system to enhance the skill of
The robotic cart connects to the laparoscopic trocars on the
the surgeon to perform technically delicate suturing and
patient’s abdomen which connected to the operating console
dissection. By enhancing the skill of the surgeon, the robot through a cable. The Da Vinci surgical system is equipped
has aided in the development of microsurgical procedures, with a 3D vision system in which double endoscopes
such as those used in cardiac and infertility surgery, and generate two images resulting in the perception of a 3D
their advance into the field of endoscopic surgery. The image. In addition, robotic arms with surgical instruments
computer interface helps the surgeon perform the have three or four joint which reproduce the range of motion
microanastomoses using a minimally invasive approach and dexterity of the surgeon’s hand. The surgeon sits at the
beside the advantages to the patient of such techniques, surgical console and performs the surgery by manipulating
including reduced recovery time and better cosmoses. 8 the controller in it. The movement is translated from the
World Journal of Laparoscopic Surgery, September-December 2013;6(3):156-162 157