ROBOTIC SURGERY HISTORY
The Origins of Robots
The term “robot ” was coined by the Czech playright Karel Capek in 1921 in his play Rossom’s Universal Robots. The word “robot” is from the check word robota which means forced labor. Since that time, robots have developed from primitive machines that could perform a variety of menial tasks to today where they can perform very complex tasks. Robots are used in computers, in research, and in manufacturing. Robots have only recently entered the medicine. Industrial robots are now used for a variety of surgical techniques, are FDA approved, and are marketed. (18.3)
Photograph of Puma560 robot (18.6)
Robots in Medicine
Robots were first introduced in 1987 with the first laparoscopic surgery, a cholescystecotomy. Since then, numerous procedures have been performed laparoscopically as technology and the skills of the surgeons have developed. This surgery is known as minimally invasive as incisions are smaller, there is less risk of infection, hospital stays are shorter, and recuperation is reduced. However, there are also drawbacks to minimally invasive surgery. The equipment requires a surgeon to move the instruments while watching a video monitor. The surgeon must move in the opposite direction from the target on the monitor to interact with the correct area on the patient so hand-eye coordination, tactile and force feedback, and dexterity aren’t compromised. Other drawbacks of laparoscopic surgery include restricted degrees of motion, decreased sense of touch, increased sensitivity to hand movement. (18.3, 18.4, 18.5)
The first non-laparoscopic robot was the Puma 560, usedby Kwoh et al to perform neurosurgical biopsies with greater precision in 1985. Three years later, Davies et al performed a transurethral resection using the same machine. This system developed in the PROBOT, a robotic system specifically designed for transurethral resection. Next, ROBODOC was developed by Integreated Surgical Supplies of Sacramento, CA which was designed to move the femur during hip replacement surgeries. This became the first robot approved by the FDA. (18.3)
Involvement of NASA and the U.S. Army
As robots developed in the medical field, researchers at the NASA (National Air and Space Administration) Ames Research Center began working on a concept called teleprescence surgery (telesurgery) which combined virtual reality, robots, and medicine. In the early 1990’s, the scientists from the NASA-Ames team joined the Stanford Research Institute (SRA) to develop a telemanipulator for hand surgery. Eventually, surgeons and endoscopists joined the development team to give their project a full spectrum of experts.
The U.S. Army also became interested because through robots they hoped to decrease wartime mortality by bringing the surgery to the soldier. The system that was developed for the army is known as MASH (Mobile Advanced Surgical Hospital) where a soldier could be loaded into a vehicle with robotic surgical equipment and could be operated on by a surgeon in the mobile unit. It has not yet been tested or approved for the army. (18.3)
Overview of Major Surgical Robotic Systems and Companies
A variety of commercial companies have been developed to create surgical robotic systems for the general community.
Computer Motion, Inc. developed the AESOP® Endoscope Positioner: a voice-activated robotic system for endoscopic surgery. In 1993, this became the first robot approved by the FDA for surgery.
The HERMES® Control Center was also developed by Computer Motion, Inc. and brought a centralized voice command and recognition sytem to the robotic medical devices.
Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist®. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery, and is also presently involved in a cardiac clinical trial in the United States for totally endoscopic coronary artery bypass graft surgery. There are over 210 da Vinci Systems in use throughout the United States, Europe and Japan.
In 2001, SOCRATES™ Robotic Telecollaboration System was created by Computer Motion, Inc.. It includes integrated telecommunication equipment along with the robotic devices in order to provide remote surgical telecollaboration. This system was used for the first-ever transatlantic telesurgery performed.
Computer Motion merged with Intuitive Surgical, Inc., in June of 2003.
They introduced the ZEUS® Surgical System in 1998. This system consists of a surgeon control center and three table-mounted robotic arms for endoscopic surgery. Zeus was the system used to perform the first fully endoscopic robotic surgery and the initial beating-heart, totally endoscopic coronary bypass procedure.
Many more robots and robot instruments and programs are being researched and developed in the United States and around the world. With a competitive healthcare market in the United States, having cutting edge equipment, the newest technologies, and the newest testing modalities are important to the success of the organization. Robotics in medicine is a fairly new, yet advancing field. (18.3, 18.4, 18.5, 18.6, 18.9, 18.10)