Advantages of Robotic Surgery

Robots in the field of surgery have dramatically changed the procedures for the better. The most significant advantage to Robotic Surgery to the patient is the decrease in pain and scaring. By using cameras and enhanced visual effects, doctors can make the tinniest of incisions. The da Vinci and Zeus system each use arms to operate. In order for these arms to get inside the body and operate, they only need a few centimeters for an incision. In fact The San Matteo Hospital in Pavia, Italy performed a Cardiac Bypass surgery that included three incisions, each about one centimeter in length. Typically in that type of surgery the incision is about 30 centimeters in length. The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Due to the small and precise cuttings, the patents hospital stay is greatly reduced. A person needs far less recovery time when they have 3-centimeter scars then when they have a scar almost 10 times as large. Also, the risk of infection or complications decreases as the incision size does. The patient mentioned earlier with the Closed Heart Bypass surgery is a terrific example. After his surgery, he was cleared by his surgeon Dr. Mauro Rinaldi and released from the hospital after only 12 hours of recovery. The next week he was actually able to join his family on a vacation. Besides the obvious rewards to the patient, Robotic Surgery is also very advantageous to the surgeon and hospital. In the ZEUS Surgical System, an arm on the machine is dedicated to the Automated Endoscopic System for Optimal Positioning (AESOP). AESOP is a 3D camera used in robotic surgery. It can be zoomed in by either voice activation or pedals located at the surgeons foot. Doctors who have used this actually argue that AESOP gives a better image than in real life. This is particularly true with surgeons that have poor vision or in microscopic surgerys that deal with nerves. Also, by using the hand controls the surgeons can reach places in the body that are normally unreachable by the human hand. Finally, the most clear advantage to using robots in surgery is in long operations, particularly ones that deal with nerve or tissue reconstruction. Surgeons often tire easily after performing microscopic surgerys that last hours. However, by having the ability to be seated and have less strain on the eyes, doctors can control their natural flinching or nerves more efficiently

Post-Surgery Less scarring Faster recovery time Tiny incisions 0% Transfusion rate

Shorter catheter time 5 vs. 14 days Immediate urinary control Significantly shorter return to normal activities ( 1-2 weeks ) Equal Cancer Cure Rate Less post operative pain

In-Surgery Surgeons have enhanced view Easier to attach nerve endings Surgeons tire less easily Fewer doctors required in operating rooms In turn, cheaper for hospitals. Smaller risk of infection Less anesthesia required Less loss of blood

The Cost
The Robots that perform the surgeries cost around $750,000 to over $1 million. This is because they use extremely sensitive and experimental equipment that costs a lot of money. In addition to the cost of the machines the training that is needed for surgeons to learn how to use the systems is also very expensive. Because of the extreme cost of the machines at this point in time the

procedures are slightly more expensive than a regular operation, but it does have its advantages. Many people in the medical field however believe that these surgeries will soon become more common and less expensive.

Disadvantages of Robotic Surgery

THE QUESTION OF SAFETY

In comparison to robots used in the industrial sector, medical robots present designers with much more complicated safety problems. Some of the most important factors which lead to such complexity are described below: Human presence: In an industrial situation, there are no humans present in the application environment. Should that be necessary, safety regulations specify that the robot be deactivated while humans are in the vicinity. This greatly simplifies the safety requirements and their satisfaction. In the medical sector, however, robots are required to assist rather than to replace humans. In that respect, they must be able to work in close proximity to humans and perform well in a chaotic, time-varying environment. This requires medical robots to have rich sensory and reasoning capabilities concerning their environment, something that both pushes the current technology to the limits and presents robot designers with insurmountable obstacles.

Fault consequences: This is closely related not only to the presence of humans near the robot, but also to the nature of the task of the robot, which typically involves a human patient. In the industrial sector, a fault can mean at most some loss of physical equipment. In the medical sector, where lives are at stake, the implications are of profound importance.

Non-generic task: In the industrial sector, the robot is required to perform a series of movements in some pre-defined order. The object it is operating on, be it as simple as a metal pipe or as complex as a car, is not distinguished in any way, that is, the robot is not required to take account of differences on an object-by-object basis, but treats them all as being equal. When dealing with patients, however, this is not possible. Each patient has

their own distinguishing characteristics, making a uniform approach inappropriate. In safety terms, this requires testing, or at least reasoning about infinitely many scenarios. Possible reasons that can lead to unsafe operation of a medical unit include flawed design, malfunction of hardware and software components, misinterpretation and incorrect or inadequate specification. As in many other applications, improving some of these parameters results in a degraded performance in other areas, while an overall increased level of safety is accompanied by an increase in cost, complexity, or both.

The Future of Robotic Surgery

The future of robotic surgery is hard to believe but ....it is now. If you haven't noticed, robotic surgery has come long ways and it was only a dream for doctors and engineers to have something that you no longer had to make big, hideous scars that would mess up somebody's body for the rest of their lives. Doctors, before robotic surgery, worked on making minimally invasive surgery that would take hours of surgery time. Now, surgery is still made in hours, but shorter hours are now in check with the robotic surgery. So you can't really say there is a future of robotic surgery, but you can say that this has been the future for doctors long ago so all you can say is...the future is now!! Robotic Surgery: The Future Is Now The field of surgery is entering a time of great change, spurred on by remarkable recent advances in surgical and computer technology. Computer-controlled diagnostic instruments have been used in the operating room for years to help provide vital information through ultrasound, computer-aided tomography (CAT), and other imaging technologies. Only recently have robotic systems made their way into the operating room as dexterity-enhancing surgical assistants and surgical planners, in answer to surgeons' demands for ways to overcome the surgical limitations of minimally invasive laparoscopic surgery, a technique developed in the 1980s. On July 11, 2000, FDA approved the first completely robotic surgery device, the daVinci surgical system from Intuitive Surgical (Mountain View, CA). The system enables surgeons to remove gallbladders and perform other general surgical procedures while seated at a computer console and 3-D video imaging system across the room from the patient. The surgeons operate controls with their hands and fingers to direct a robotically controlled laparoscope. At the end of the laparoscope are advanced, articulating surgical instruments and miniature cameras that allow surgeons to peer into the body and perform the procedures. This system and other robotic devices developed or under development by companies such as Computer Motion (Santa Barbara, CA) and Integrated Surgical Systems (Davis, CA) have the

potential to revolutionize surgery and the operating room. They provide surgeons with the precision and dexterity necessary to perform complex, minimally invasive surgical (MIS) procedures, such as beating-heart single- or double-vessel bypass and neurological, orthopedic, and plastic surgery, among many other future applications. Manufacturers believe that their products will broaden the scope and increase the effectiveness of MIS; improve patient outcomes; and create a safer, more efficient, and more cost-effective operating room. It is the vision of these companies that robotic systems will one day be applicable to all surgical specialties, although it is too early to tell the full extent to which they'll be used. Surgical robotics manufacturers working toward FDA approval of their devices are encouraged by Intuitive Surgical's recent FDA approval. "The future looks bright," says Yulun Wang, MD, founder and chief technical officer of Computer Motion. "This approval sends a positive signal to industry, and there are tremendous opportunities." According to Wang, "The goal of robotic surgery is to offer superior quality and reduced trauma to the patient. Today, the skeptical surgeon would say that's not proven yet, but the progressive surgeon would say that these goals are achievable. Thus far, the results have been phenomenal." And many researchers and industry participants in the field say that the capabilities of firstgeneration systems are just the beginning. According to Richard E. Wood, MD, chief of cardiothoracic surgery at Baylor University Medical Center (Dallas), robotic surgery systems "will certainly make it easier to perform major surgeries, but these systems still need to evolve. They're not for every patient, but with time we will gain more experience and do more procedures, and the instruments will evolve from this first generation." Currently, the three principal device manufacturers in this area are Intuitive Surgical, Computer Motion, and Integrated Surgical Systems. Their systems are described below. Future Outlook Surgeons and device executives agree that first-generation robotics systems have already displayed many advantages over traditional laparoscopic surgery and open surgery, especially in terms of speedier patient recovery and reduced pain. But they also insist that the technology is still evolving and will become more capable with time. "We're on the cusp of redirecting and improving surgical capability, but we are in the first generation of this process," says San Ramon's Gardiner. "The technology will be applied selectively early on, but as patients begin to insist on the new technology, it will become state-ofthe-art and the standard of care for selected procedures." In Gardiner's opinion, as a general surgeon, "basically, the most promising applications for these systems will be in any surgery in which suturing is an important feature." Continued evolution of robotic surgical systems is inevitable, says Gardiner. "Down the road, as with PCs, the systems will become smaller, lighter, faster, and easier to set up, and this will

increase their applications. As with CT scans, you will find uses and needs for the technology in excess of what the projections were, and surgeons will want and need these devices. The surgeon actually does a better, more precise, elegant, dexterous, controlled procedure with robotics, with less tissue damage, which leads to a better outcome." "In the next five to seven years, almost all ORs worldwide will have robotic assistance of some kind for major surgeries," says ISS's Trivedi. "We will never, ever, replace the surgeon, but robotics will take over a lot of the things they do by hand, with more precision and accuracy." UCLA's Schulam, who has been using robotic surgical systems since 1995, when the first products were being developed, says that the elaboration of such systems may change the relationships between surgeons and industry. "Robotics are here to stay. However, it will take time for these devices to revolutionize the way surgery is done, and educational programs are the key to their success. "We need to change how industry and surgeons interact," he continues. "In the past, surgeons have had a consumerlike relationship with the device industry, where the consumer buys the product and is off. But now, what will be required is a much more collaborative relationship, in order to get surgeons to change the way they're used to doing things." Baylor's Wood is even interested in forming a robotic surgery institute, perhaps within the next year, where surgeons from many specialties can meet and discuss how to bring robotics technology to the next level. According to surgeons, patients have been asking about robotic surgery, and their feedback has been very positive. This demand is another key to the success of the robotics industry. "People are very informed today, because of the Internet," says Wood. "About 8% of my patients have asked about robotic surgery." "Frankly, I was very surprised," says Gardiner. "I thought patients would feel robotics is too impersonal, but I have found that not one patient has not wanted it."

Robotic Telesurgery
Long Distance Robotic Surgery- During the recent 86th Annual Clinical Congress of the American College of Surgeons, a live robotic Telesurgery session was organized between the convention hall at McCormick Place in Chicago, Illinois, and the Johns Hopkins Bayview Medical Center in

Baltimore, Maryland. The male patient underwent a successful remote-controlled and computerassisted minimally invasive operation to treat chronic groin pain. The telerobotic system which was utilized, has been developed by the Johns Hopkins School of Medicine, Applied Physics Laboratory, and ICE Communications Inc. in 1993 to serve initially as a remote surgical training system for laparoscopic procedures.

Leaders in Robotic Telesurgery

Dr. Louis Kavoussi, a Johns Hopkins urologist, who has done a great deal of scientific research on the accuracy and use of robotic surgical arms compared to human surgical assistants during urological laparoscopic surgery, operated the computer console and video screen which graphically displayed the patient's abdomen before the congress audience at the Chicago site. At a distance of some 850 kilometers, his colleague, Dr. Thomas Jarrett from the Johns Hopkins Bayview Medical Center assisted him. With a simple mouse-click, Dr. Louis Kavoussi directed a tiny camera attached to a slender robotic arm as to control the rate of gas injected into the abdomen to create a workspace for the minimally invasive operation.

Both Dr. Kavoussi and Dr. Jarrett were able to view the nerve that caused the chronic groin pain. Dr. Jarrett cut the nerve while Dr. Kavoussi, using the robotic arm, cauterized the area to stop bleeding. A microphone allowed the two physicians to constantly communicate with each other during the entire intervention. The telerobotic system has originally been designed to be interactive and provide coordinated co-operation between the remote expert and the local surgeon to assure optimal results of the operative procedure. To accomplish this, the system includes real time video display from either the laparoscope for internal body view or an externally mounted camera for overview of the operating room, and full two-way audio communication.
Telesurgical assisted surgery is bound to produce a new frontier in medicine. Dr. Kavoussi is one of the few physicians in the United States who has done long-distance robotic surgery. Since his first procedure about four years ago, Dr. Kavoussi has performed remote procedures from Baltimore to Bangkok, Thailand; Innsbruck, Austria; Rome, Italy; and Singapore. Last September, from the library of his Maryland home, he assisted in a robotic varicose vein surgery on a patient in Brazil. Dr. Kavoussi's long experience and research has demonstrated that a robotic device can more effectively manipulate and more accurately control the video endoscope than a human assistant during laparoscopic procedures do. As a result, any novel operative procedure could be performed anywhere in the world with the same standards as those at the institution in which the procedure was developed. This system is the platform for future Telesurgical interventions. As robotic devices are developed for the operating room, the data features of this system will eventually allow for complete Telesurgical intervention. This is 21st century telemedicine, the latest advance in a field which doctors claim someday may allow a surgeon on earth to operate on astronauts in space. Dr. W. Randolph Chitwood, Jr., head of the cardiac team at East Carolina University in Greenville, North Carolina, already consulted with NASA about potential earth-to-space operations. His team has completed the first robotic mistral valve cardiac surgery trials with the da Vinci Surgical System. While witnessing the Telesurgical demonstration in Chicago, Dr. Chitwood stated that a robot performing the bulk of an operation is perhaps less than a decade away. Astronauts with a medical emergency in space need months to travel back to earth. With use of telerobotic technology, surgeons may be able to direct surgery over millions of miles by telemanipulation, according to Dr. Chitwood.

One obstacle to overcome would be the time delay that has to be bridged at very long distances for the robot to respond. Parallel studies by Dr. Kavoussi have proven that the effect of time delay on physician performance may not exceed 700 ms because this would result in a significant deterioration in the remote specialist's efficacy. This data is crucial in tailoring the requirements for telecommunication between two sites based on distance, bandwidth, and cost. At present, long-distance surgery between remote sites on earth alone is still experimental. Dr. Jarrett explained that patients therefore have been billed only for costs associated with procedures done on-site. Up till now, private funding has paid for all the long-distance costs, including the remote surgeons fees.

Telecollaborative Surgery

SANTA BARBARA, Calif. -- Computer Motion Inc. (NASDAQ: RBOT), the leader and pioneer in medical robotics, announced that a London Health Sciences Center (LHSC) team of surgeons in London, Ontario, Canada performed the world's first series of Telecollaborative surgeries using Computer Motion's SOCRATES Telecollaborative System.

To date a total of six robotically assisted procedures have been completed with the surgical mentor telecollaborating from the University Campus and the operative surgeon performing the procedure at the Westminster Campus, some 15 miles away:
Drs. Douglas Boyd, Alan Menkis and Reiza Rayman completed a mitral valve repair and two heart bypass surgeries; Drs. Brian Taylor and Winston Hewitt performed an appendectomy procedure; and Drs. Richard Inculet and Richard Malthaner completed a lung biopsy and a lung resection procedure. The medical community agrees that one of the most effective ways for surgeons to learn new procedures is directly from another surgeon. As a result, surgeon champions are routinely called upon to lend their clinical expertise and direction to surgeons who are still gaining expertise in advanced or complex procedures. Often, there are travel costs and scheduling challenges associated with this method.
There has been a growing interest in finding a better way to economically and effectively augment minimally invasive and conventional "open" surgical training. Standard teleconferencing systems are proving to be inadequate to the task of transmitting a clear, steady, non-pixilated operative image for the remote surgeon.

The Computer Motion SOCRATES system eliminates these and other problems. SOCRATES provides the remote surgeon access to a precise and stable image via Computer Motion's AESOP(R) Endoscope Positioned plus much more. Yulun Wang, Ph.D., founder and chief technical officer of Computer Motion, commented, "Computer Motion has taken telecommunications one important step further by developing the SOCRATES system to eliminate the distance barrier for physical interaction, enabling a new class of training and education required for the advancement of open and endoscopic surgical techniques. In the late 1980s and early 1990s when the medical community realized the full significance of laparopscopy for patients, thousands of surgeons had to learn new surgical techniques. This situation is repeating itself as emerging technology is enabling new advanced surgical procedures that yield improved patient outcomes across a broad range of surgical disciplines. We now sit on the threshold of another training and education opportunity, and Computer Motion is uniquely positioned to facilitate the necessary transfer of knowledge with our SOCRATES, AESOP and HERMES technologies." "SOCRATES is a huge step beyond just sharing audio and video feedback via teleconference," said Dr. Ken Harris, chief of surgery at LHSC. "For the first time, the mentoring surgeon is able to actively participate in a `hands-on' manner from a remote location. This translates to a very economical and effective method to shorten the learning curve for surgeons applying new surgical techniques to their practice. SOCRATES also facilitates the expansion of minimally invasive surgery into areas that may not currently have access to or the budget for surgical experts. This is something that patients around the world will benefit from." LHSC is comprised of three separate sites across the city of London, Ontario. "This is a splendid example of the innovative spirit at this hospital," said Tony Dagnone, president and CEO of LHSC. "The positive impacts to patient care delivery as a result of the telementoring approach are astounding. We believe the SOCRATES technology will someday mean patients will be able to access the care they need closer to home in their community hospitals. Beyond our region, this technology will also allow us to share with and learn from other world-class healthcare providers. LHSC is committed to pursuing robotically assisted surgeries because we believe it is in the best interest of patients for improved outcomes and quality of life," Dagnone added. Early development work on Computer Motion's telerobotic systems began in 1996 when Johns Hopkins University, under the direction of Dr. Louis Kavoussi, pioneered the development of telerobotics with Computer Motion's first telerobotic system, the AESOP(R) 1000 TS. Johns Hopkins was the first institution to use Computer Motion's telerobotic system in multi-center U.S. and transcontinental clinical trials. Dr. Kavoussi and a number of notable surgeons, including Dr. Peter Schulam of University of California, Los Angeles Medical Center, published their initial telerobotic experience and continue to work with the technology today. Several other world-class institutes, including the Medical College of Virginia and the Medical University of South Carolina, have partnered with Computer

Motion in the development and testing of SOCRATES. The new system is currently under FDA regulatory review.

Robotic Surgical Technology

Robotic Surgery is innovative and frightening to most people because it uses machines, or robots. These robots are complex and require a good deal of training. The main operating machines, the da Vinci System and the ZEUS Surgical System use three surgical arms. The ZEUS System has two main operating arms, which contain tools for incisions and for the surgery. For example, small cutters are used in Gallbladder surgery to cut the Gallbladder out. The other arm on the ZEUS is a digital high quality 3D camera. The camera and video system that the surgeon operates on have to be within .2 seconds of each other. If the video is not streamed in real time, then the error percentage increases dramatically.

Current Available Systems

There are no more than five major robotic surgical system. ZEUS AESOP da Vinci Hermes Socrates They range in prices from $750,000 to over $1,000,000. The ZEUS was the first machine approved by the FDA but shares the limelight with the da Vinci Surgical System.

The Zeus System ZEUS Surgical System The ZEUS Surgical System is made up of an ergonomic surgeon control console and three table-mounted robotic arms, which perform surgical tasks and provide visualization during endoscopic 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.

Peerless voice control capabilities allow the surgeon to precisely guide the movements of the endoscope with simple spoken commands, freeing the surgeon's hands to manipulate the robotic surgical instrument handles. ZEUS custom scales the movement of these handles and filters out hand tremor, enabling surgeons with greater capability to perform complex micro-surgical tasks.

In 1999, ZEUS made history in the world's first robotic-assisted beating-heart bypass surgery, by Douglas Boyd, MD. The event ushered in a new era in Minimally Invasive Surgery, as promising and inspiring for patients as it is for surgeons and hospitals. Today ZEUS is being integrated into a broad range of procedures encompasing cardiac, bariatrics, general surgery, urology, and neurology.**

ZEUS Surgical SystemFeatures

The ZEUS Surgical System features the following components: Video Console Primary Video Monitor up to 23"W x 23"D Flat Panel Monitor: with support for an additional flat panel monitor Surgeon Control Console Touch Screen Monitor Support Arms and Surgeon Handles Mounting Areas: for speakers; access to controller front panels; access to PC and HERMES Control Center; mounting shelves for housing Control Units Industry Standard Mechanism - Easy Sterilization Incorporates mechanism design based on standard flushing port and push-pull rod technology, the same makeup as industry-standard endoscopic equipment. Provides easy sterilization. Instrument Reusabilty Uses robust, reusable instruments, built to withstand the rigorous OR environment. Instrument and Port Size Offers unparalleled precision through 3.5 to 5-mm instrument and endoscope accommodation. Wide Array of Instruments Offers a suite of more than 40 ZEUS-compatible instruments, available in a variety of shaft diameters, from industry leaders Scanlan, Storz and US Surgical. Quick Instrument Changes Incorporates a quick-change mechanism to seamlessly swap instruments and safely guide the placement of the instrument tips. Console Placement Provides total flexibility in overall console placement, easily converting from setup directly at the operating table to setup as a physically removed console.

Rapid Setup Takes less than 15 minutes to set up. Visualation Designed to adapt to individual surgeon preferences in viewing modes, permits both 2D and 3D visualization and accommodates a wide variety of endoscopes and monitor setups. Secondary Monitors Secondary flatscreen video monitors mount parallel to the main monitor to provide additional patient data including vitals, image guidance reference display and a redundant view of the operative field for use with SOCRATES. Profile Built lightweight for easy installation and flexible adjustment, ZEUS maintains a low profile. Its twin instrument positioning arms adhere equally to this design imperative, allowing assistant to retract, suction and irrigate during surgery. Operation A user-friendly, single foot pedal provides device engagement and disengagement. When engaged, specific controls are easily accessed using voice control and touch screen interfaces. Microwrist Hand Controls MicroWrist form-fitting hand controls translate the surgeon's movements with precise scaling and hand tremor filtering. Six Degrees of Freedom 4 Motorized Up and Down In and Out Shoulder: Back and Forth Elbow: back and forth 2 Floating Forearm: back and forth - safety function: float away to avoid ramming something Wrist 1 Fixed change in angle Elbow Tilt (+/- 3 degrees)

Scaling Offers infinite motion scaling, without limitation to arbitrarily defined increments. Scaling adjustment can be accomplished using either touchscreen or voice command. Seating Accomodation Ergonomic console and seat provides optimal surgeon comfort for long procedures Repositioning During surgery, endoscopic and instrument positioning arms tilt with the operating table; this flexible design eliminates the need to readjust or recalibrate the arms. Re-Indexing At any time, the foot pedal releases the clutch, allowing surgeons to relax and reposition (center and re-index) their hands and arms. Endiscopic Position Saving Provides the powerful capability to save 3 different endoscopic positions, retaining x-y-x axis coordinates that can be quickly and easily returned to at any time. Voice Control Voice control components leverage the advantages of a sophisticated overall communications paradigm: individual surgeon voice modeling; context sensitive tree command structure; limited vocabulary for error avoidance; voice and visual feedback on command success; compensation for ambient OR noise. Pendant Control Device control and communications options are embedded also in ZEUS' portable pendant device, allowing flexible, duplicate control options that transcend the OR's sterile boundary. Mirror Redundancy Uses mirror redundancy technology at a rate of up to 1000 times per second to ensure patient safety. http://www.computermotion.com

The Da Vinci System

The da Vinci Surgical System offers the InSite Vision System with true 3-D visualization, as well as a comprehensive suite of EndoWrist Instruments. The System is the first totally "intuitive" laparoscopic surgical robot in existence. As of today, the FDA has cleared the System for use in performing many surgical procedures including general laparoscopic surgery, thoracoscopic (chest) surgery, laparoscopic radical prostatectomies and thoracoscopically assisted cardiotomy procedures. Additionally, the da Vinci System is also presently involved in a cardiac clinical trial in the United States for totally endoscopic coronary artery bypass graft surgery. Already more than 177 da Vinci Systems are in use in major hospitals and surgical facilities throughout the United States, Europe and Japan. The da Vinci Surgical System is changing surgical procedures in three basic ways, which may improve both the patient's experience and surgeons' success: Simplifies many existing MIS surgeries. Surgical procedures routinely performed today using MIS techniques may be performed more quickly and easily with the da Vinci Surgical System. The System looks and feels like open surgery to the surgeon. Makes difficult MIS operations routine. Some procedures have been adapted for port-based techniques but are extremely difficult and are rarely performed and are performed if at all by only a select number of highly skilled surgeons. The da Vinci Surgical System enables more surgeons at additional institutions to perform these procedures routinely with confidence. Makes new MIS procedures possible in most surgical specialties. A number of surgeries that cannot be performed minimally invasively today may be performed through 1-cm ports by surgeons using the da Vinci Surgical System. The intuitive motion, enhanced 3-D Vision system and a comprehensive suite of EndoWrist Instruments enable new breakthroughs in surgical techniques.

How The Robots Work

Try these videos to see the surgical systems in use. http://www.mallard.uiuc.edu/~reed/mitesaw/gallery/main/isdn.html http://www.mallard.uiuc.edu/~reed/mitesaw/gallery/

Types of Robotic Surgeries

Minimally invasive surgery is particularly useful in certain situations or surgerys. For example, in laparoscopic surgeries, or surgeries in which a laparoscope is used, the arms of the robot are extremely helpful. The most common procedures are gastro-jejunostomy, pyloroplasty, RY gastric bypass for obesity, esophageal myotomy for achalasia, living-related nephrectomy for transplantation and bile duct surgery. Other types of Robotic surgeries are:

General
Adrenalectomy Cholecystectomy Esophagectomy Gastric Bypass

Heller Myotomy Nissen Fundoplication Thoracic

Esophageal surgery Thymectomy Mediastinal Tumor Resection Lobectomy BiVentricular Resynchronization Epicardial Leads

Cardiac
Atrial Septal Defect Repair Mitral Valve Repair

Robotic Heart Surgery

The da Vinci system has probably most affectively influenced the Cardiac aspects of surgery. When dealing with heart surgery. It is very easy to make a costly or deadly mistake. These mistakes are reduced with the development of Minimally Invasive Surgery. The surgeon has a far better view with the da Vinci operating achine and can therefore distinguish between an artery and a vein. Also, in cardiac surgery, the use of robotic surgery is far more beneficial than

traditional methods. The scarring is greatly reduced for the patient, thus the reduction of pain. Robotic Surgery also has helped in one of the fastest growing surgerys, gastric bypass. This surgery has become increasingly safer since its introduction. Minimally invasive surgery has affected many forms of surgery, and is likely going to be used in more and more surgeries in the coming years. Mitral Valve Surgery http://www.devicelink.com/mx/archive/01/03/0103mx024.html
A promising application for surgical robotics systems is minimally invasive mitral valve surgery, which is performed to treat narrowing or leakage of the valve. The traditional open procedure requires an extraordinarily high level of mechanical skill that now, with the marriage of telerobotic and surgical technologies, can be performed through tiny ports less than 1 cm long.

In mid-December 2000, Intuitive Surgical received FDA approval to launch a multicenter clinical trial evaluating the company's daVinci system for minimally invasive mitral valve repair. The company stated that the trial will involve recruitment of about 50 patients at six centers in the United States. The study results should be available by the end of the year, according to Fred Moll, MD, cofounder and medical director of Intuitive Surgical. Initial studies were conducted by the cardiac team at the University Health Systems of Eastern Carolina/Brody School of Medicine at East Carolina University (ECU; Greenville, NC). The multicenter trial will be led by W. Randolph Chitwood Jr., MD, chairman of the department of surgery at the ECU School of Medicine. According to a statement by Chitwood, "The patients in our feasibility study who had their mitral valve repaired using this technology experienced much less pain and trauma, better cosmetic results, and spent less time in the intensive care unit and hospital compared with conventional mitral valve surgery where the patient's breast bone is divided in half." More than 70,000 heart valve repair or replacement surgeries are performed annually in the United States, notes Chitwood. "Although we are in the early stages of developing and applying robotics to cardiac surgery, the future looks promising." Also in mid-December, Intuitive noted that the daVinci system received Category B-1 reimbursement designation from the Health Care Financing Administration, allowing reimbursement for use of the system in FDA-approved clinical investigations. Computer Motion is also investigating mitral valve repair and replacement with its Zeus system. The company has initiated a feasibility clinical trial for this application, and is currently enrolling patients. It is expected that it will take about two to five years for robotic systems to be approved for general cardiac use, according to researchers.

Easier Regulatory Path for Device Makers In July 2000, FDA reclassified robotic surgical devices as Class II instead of Class III products, making them eligible for the 510(k) clearance process instead of the longer premarket approval (PMA) process. Product manufacturers in the robotics industry were thrilled with FDA's decision. "This reclassification was sweet music to our ears," says ISS's Trivedi. "It greatly affects the timing of the market introduction of the Robodoc system in the United States. Now, the biggest market in the world may be accessible in a shorter period of time." Computer Motion's Wang echoes manufacturers' sentiments. "This decision was very fortunate for us, and we feel it was the right decision. It shows that FDA recognizes surgical robotics as next-generation, advanced surgical instruments combined with already proven (less-invasive) technology." Intuitive Surgical's Moll hints that FDA's decision could let loose a stream of pent-up creativity in the robotic surgery marketplace. "This decision was appropriate," he notes. "FDA has gone through a process of determining that these products are safe and efficaciousand now industry can move forward."

Robotic surgery comes to prostate removal

Contact: John Easton (773) 702-6241 jeaston@uchospitals.edu Released: June 25, 2003 Surgeons at the University of Chicago Hospitals are using a robotic system to remove cancerous prostate glands with less pain, smaller scars, minimal blood loss and rapid recovery. Patients treated using the da Vinci robotic system leave the operating room with four quarter- to half-inch holes in the belly, and a one-inch incision for specimen removal, instead of the standard six-inch incision from the navel to the pelvic bone. Patients often go home the next day and resume normal activities within a week, compared to nearly six weeks after open surgery. Although laparoscopic--or 'minimally invasive'--surgery has been around for more than a decade, "the first U.S. surgeons that applied this approach to prostate cancer found it too difficult and

complex," said Arieh Shalhav, M.D., associate professor or surgery and a specialist in laparoscopic surgery. These surgeons worried that without the clear access and tactile feedback of open surgery, they might miss cancerous tissue or damage the tiny nerve bundles that cross over the surface of the prostate, resulting in impotence. A few years ago, however, a group of French surgeons began to explore minimally invasive surgery for the prostate and to develop the necessary techniques. "The results from the leading groups are now comparable to open surgery," said Shalhav, who has been performing laparoscopic prostatectomies for about two years, "but it has not yet become common. Most surgeons found it technically challenging and physically exhausting." In standard laparoscopy, surgeons use long, slender instruments inserted through small holes and manipulated outside the body to isolate the prostate and remove it. The process can be slow, painstaking, awkward and uncomfortable for the surgeon. "The operation is hard to learn, hard to perform and hard to teach," said Shalhav. "Your movements are reversed by the instruments, so in the beginning you have to think twice about each action, plus you are looking away from the patient and at a two-dimensional monitor." The $1.2 million robotic system retains the benefits for the patient of laparoscopic surgery and solves some of the problems for the surgeon. Instead of standing for hours with arms raised above the patient, the surgeon sits at a nearby console that provides a magnified, three-dimensional image. His wrists and hands are connected to glove-like sensors, which guide the tools on the robot's arms. Those tools have more degrees of freedom than standard laparoscopic instruments, allowing the surgeon to cut, sew, cauterize, suction and remove tissue with considerable precision. The computer-controlled system can even reduce a surgeon's minute tremors. The robot also provides excellent visualization of the surgical field, said Shalhav. The surgeon sees a magnified view. Twin cameras restore depth perception, which is lost in standard laparoscopy. Plus, there is much less bleeding than in traditional open surgery. There are trade-offs, however. Most important is the loss of tactile sensation. "You can't feel any resistance," said Shalhav. "You can't even feel how tight your knots are. You have to rely on what you see and your experience." Urologists at the University began performing robotic prostatectomies in February and now do about one a week, a number that is steadily increasing, but is still fewer than the four to six open prostatectomies performed at the hospital each week.

But the balance between open and robotic surgery could change quickly, urologists suspect. "This is remarkable technology," said Charles Brendler, M.D., professor of surgery and section chief of urology at the University of Chicago. One of the originators of 'nerve-sparing' surgery, now the standard operation for prostate cancer, Brendler has performed more than 2,000 open procedures with one of the country's best records for tumor control and minimal side effects. He is now learning to perform this operation on the robot. "Otherwise," he said, only half joking, "this could be the end for me." Up to now, robotic surgery has been confined to rare or unusual procedures. Although nearly 150 surgical robots have been placed in hospitals, most centers use them sparingly. Prostate surgery could be the first common procedure taken over by this approach. There will be nearly 221,000 new cases of prostate cancer diagnosed in 2003, according to the American Cancer Society, and almost half of those men will chose surgical removal of he prostate. At the University of Chicago Hospitals, the da Vinci Surgical System is also used for several other urologic applications, such as total or partial kidney removal, some general surgery, including gallbladder removal, and several cardiac and thoracic applications, including thymectomy, atrial septal defect closure, mitral valve repair, vascular ring division and patent ductus arteriosus ligation. http://www.uchospitals.edu/news/2003/20030625-robot.html

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Links
http://www.mos.org/cst/article/1623/

http://www.briefme.com/archive.php/article/28033

http://www.roboticsurgery.com/

http://www.carilion.com/cardiac/html/robotics.html

http://www.computermotion.com/productsandsolutions/products/socrates/ http://www.cts.usc.edu/rsi-benefits.html

http://www.stronghealth.com/services/surgical/davinci.cfm