Page 6 - Journal of Laparoscopic Surgery

10.5005/jp-journals-10007-1130
Muhammad Nurhadi Rahman, RK Mishra
REVIEW ARTICLE
The Camera-holding Robotic Device in

Laparoscopy Surgery

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1 Muhammad Nurhadi Rahman, RK Mishra
1 Urogynecology Division, Department of Obstetrics and Gynecology, Sardjito Hospital, Faculty of Medicine
Gadjah Mada University, Yogyakarta, Indonesia
2 Chairman and Director, World Laparoscopic Hospital Pvt Ltd, DLF Cyber City, Gurgaon, Haryana, India

ABSTRACT

Background: The inconvenience of laparoscopic operations lies mainly in the difficulties in mutual understanding between the surgeon
and the camera assistant who maneuvers the laparoscope according to the surgeon’s instructions. Another problem arises when the
operation has to be performed for many hours. In this case, the camera image tends to become unsteady due to fatigue of the camera
assistant. The self camera-control by the surgeon gives more stability of the laparoscopic image. A robotic camera assistant, directly
under surgeon’s control, can help the surgeon control the view better. This review is limited only in the robotic camera holder to replace
the assistant camera holder in laparoscopy surgery.
Materials and methods: Several types of the camera-holding robotic devices, such as the AESOP, EndoAssist, PMAT and PARAMIS
were reviewed respectively.
Discussion: Most of the camera-holding robotic devices have the advantages, such as elimination of the fatigue of the assistant who
holds the camera, elimination of fine motor tremor and small inaccurate movements, delivery of a steady and tremor-free image,

nondependency on camera operator, reduced cost of surgery and reduced number of highly skilled staff. Some of them have additional
advantages and disadvantages depend on their uniqueness.
Conclusion: There is no fundamental difference between the operation performed with and without the devices, but the machines do
contribute to certain aspects of the operations and may help to overcome some of the difficulties encountered in these complex
laparoscopy procedures. Unavailability and variability in quality of human camera-holders should not be an obstacle to performing
satisfactory laparoscopic surgery. Therefore, some form of standardization of assistance is required and laparoscope-holding systems
are a first step in this direction.
Keywords: Camera-holding robotic device, Robotic camera assistant, Camera holder, Laparoscopy surgery, AESOP, EndoAssist,
PMAT, PARAMIS.

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BACKGROUND Surgical System classified as a master-slave surgical system.
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It uses true 3D visualization and EndoWrist . It was approved
Robotic surgical devices have developed beyond the
investigational stage and are now routinely used in minimally by FDA in July 2000 for general laparoscopic surgery, in
invasive general surgery, pediatric surgery, gynecology, November 2002 for mitral valve repair surgery. The da Vinci
urology, cardiothoracic surgery and otorhinolaryngology. robot is currently being used in various fields, such as urology,
Robotic devices continue to evolve and as they become less general surgery, gynecology, cardiothoracic, pediatric and ENT
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expensive and more widely disseminated. But not every surgery. It provides several advantages to conventional
country, especially, the developing countries ready for this. In laparoscopy, such as 3D vision, motion scaling, intuitive
the developing countries, the conventional laparoscopy movements, visual immersion and tremor filtration. The advent
surgery is just about to grow. of robotics has increased the use of minimally invasive surgery
The term ‘robot’ was coined by the Czech playright Karel among laparoscopically naïve surgeons and expanded the
Capek in 1921 at Rossom’s Universal Robots. The word ‘robot’ repertoire of experienced surgeons to include more advanced
is from the ‘Czech’ word robota which means forced labor. The and complex reconstructions. 2
era of robots in surgery began in 1994 when the first AESOP Manipulation of instruments is what makes the difference
(voice, controlled camera-holder) prototype robot was used between laparoscope holders and fully operational robots, such
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clinically in 1993 and then marketed as the first surgical robot as the da Vinci . These robots allow the surgeon to perform
ever in 1994 by the US FDA. Since then, many robot prototypes meticulous dissections and microsutures in restricted and
like the EndoAssist (Armstrong Healthcare Ltd, High Wycombe, difficult-to-reach areas. However, their exorbitant price, their
Buck, UK), FIPS endoarm (Karlsruhe Research Center, volume, their technological complexity and long setup time mean
Karlsruhe, Germany) have been developed to add to the they have not yet entirely won over the surgical community
functions of the robot and try and increase its utility. Integrated and their cost-effectiveness still needs to be evaluated. It should
surgical systems (now Intuitive Surgery, Inc.) redesigned the be made perfectly clear that the rationale for fully operational
SRI Green Telepresence Surgery System and created the daVinci robots and laparoscope holders is different; robots are not meant

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