Robots are machines that perform the same tasks with
precision. The definition of a robot most relevant to
surgery is by Davies: "A powered computer controlled
manipulator with artificial sensing that can be programmed
to move and position tools to carry out a range of surgical
tasks."
Robotic Surgery is the use of Robots to perform surgical
procedures. The robot's role is not to replace the surgeon
but to enhance the surgeon's innate abilities while
under close supervision. This should be reassuring to
the public with regard to safety and standard of care,
plus the surgeons and other healthcare professionals.
Robots can even improve surgical outcomes. Robotic systems
are best described as ‘‘extending human capabilities’’
rather than ‘‘replacing human surgeons.’’
Surgery now uses robotic and image processing systems
in order to interactively assist the medical team, both
in planning the surgical intervention, and in its execution.
The objective of this new technique is to enhance the
quality of surgical procedures by minimizing their side
effects (smaller incisions, lesser trauma, more precision),
thus increasing patient benefit while decreasing the
surgical cost. These techniques are being successfully
introduced in several areas of surgery: neurosurgery,
orthopedics, micro-surgery, cardiovascular and general
surgery etc.
Classification:
Today, there are three types of surgical operation
techniques. The first one is the traditional data flow
model, in which surgeon directly contacts with the patient
and sensorial inputs are synchronized. The second type,
called “laparoscopic surgery” or “keyhole
surgery”, is performed through ports which enable
to view the operative area in a video screen. A camera,
that passes though one port, should be held by a surgeon
or a robotic arm. This arm is controlled by the operating
surgeon for visualization. In the last one, the surgeon
is outside the operating room. Patients’ inputs
and surgeon’s outputs are all electronically conducted
by the help of robotics technology.
Surgical robots can be classified into active or passive.
A passive robot would be used to position a fixture
appropriately and then be switched off, to be followed
by the surgeon inserting his instruments. An example
of this would be a robot to help position a device for
guiding neurosurgical biopsy needles. By contrast, an
active robot would actually move the tools. These include
laparoscopic camera holders, tele-manipulators, and
robots used for burring out tissue.
Tele-surgery is an application of telemedicine in which
a surgeon at distance performs the operation by manipulating
the hands of a robot by consulting a surgeon at the
operating site.
Different Phases:
Three main steps can be pointed out in a general robotic
surgery intervention: data acquisition and subsequent
planning, intra operative assistance, and post-operative
patient control. In the pre-operative phase, a patient
dependent model of the rigid (ex: bones), and de-formable
(ex: the heart) anatomical entities involved in the
surgical act have to be built. For this, several medical
imagery techniques (MRI, Scanner, Ultrasonic etc.) are
used, where the anatomical structures are detected,
located and modeled. In the same time, the mechanical
model of the robotic system is fused in an overall geometric
model. This will be used to describe and simulate the
different potential problems that may occur during the
intervention.
The results obtained in the planning phase are then
calibrated and put in correspondence with patient in
intra-operative situation. As a consequence, the
robotic system is able to provide interactive assistance/guidance
and to constrain the movements of the surgeon in order
to perform, with the desired precision, the possibly
pre-defined procedure (ex: neurosurgical biopsy). In
some cases, the robot may have an autonomous behavior
in order to realize a dedicated and fixed part of the
procedure (ex: thighbone drilling for artificial hip
installation).
Technology and Issues:
One reason surgical applications are progressing quickly
is the large technology base that has been developed
in robotics research in the past three decades. Results
in mechanical design, kinematics, control algorithms,
and programming that were developed for industrial robots
are directly applicable to many surgical applications.
Robotics researchers have also worked to enhance robotic
capabilities through adaptability (the use of sensory
information to respond to changing conditions) and autonomy
(the ability to carry out tasks without human supervision).
The resulting sensing and interpretation techniques
that are proving useful in surgery include methods for
image processing, spatial reasoning and planning, and
real-time sensing and control.
Fundamental research areas of robotics surgery are:
the modeling of de-formable organs, planning and simulation
of robotics procedures, safe & real-time integration
with augmented reality.
As for tele-operated robots, the surgeon through a
master console benefits from an enhanced (sometimes
3D) vision of the organs. In addition, augmented reality
would allow the overlay, in real-time, of the pre-operative
data of the patient during the intervention. The surgeon
movements may be reduced to increase precision, and
smoothed to avoid hand tremor by virtue of a decoupled
master/slave unit.
Robotic tele-surgery is now a reality, performed with
the surgeon in the United States and the patient in
France. High speed linkups via telephone or satellite
are required to reduce the delay of data
transmission to less than 300 milliseconds, and an
assistant surgeon still needs to be present with the
patient in order to make the incisions and insert the
robot arms.
The world's first transoceanic surgery performed in
2001, September 7 by Gagner, who was assisted by French
surgeon Jacques Marescaux. The operation was named Operation
Lindbergh, took 55 minutes.
The public need to be made aware of the various aspects
and applications of these systems. Safety features are
built in, for example when the camera is moved by the
surgeon, or when the surgeon takes his head away from
the console (for example, to have a sip of coffee),
the instruments freeze, and the system enters a standby
mode.
Major concern is having safe and robust software. Several
efforts in computer science have been devoted to develop
modular and safe control mechanisms of software components
used in robotic systems.
Pressed by incentives to cut costs, and marketplace
competition to make surgery easier on patients, medical
and biotech companies are focusing on new tools for
"non-invasive" surgery. In some cases, technology
developed for space exploration and military use is
transported to the medical world.
Robots are expected to make surgery safer, cheaper
and recovery much faster. Robots may also eliminate
some operating room personnel with the goal being to
allow "solo surgery" - a doctor operating
with only an anesthesiologist and nurse on operations
that now require two or three doctors and several nurses.
But mostly the idea is to do surgery with the smallest
incision possible.
Conventional bypass heart surgeries will require stopping
the patient's heart. But researchers expect to put computer
robotics to work to be able to operate on the moving,
beating heart. Improvements in visual and motor synchronization
of tele-manipulators will ensure that surgery can be
performed on the beating heart. The robot arms will
move relative to the
variable beats of the heart, so that the image that
is fed to the surgeon is still, consequently eliminating
cardiopulmonary bypass. Other advances will occur in
imaging, virtual reality integration, haptic sensation
feedback, and superior data transfer, allowing "tele-mentoring"
to occur.
Conclusion:
The use of information and robotics technologies provided
many advances in the field of surgery. Today surgery
has the
capability of realizing our dreams. Still robotic systems
are only at the beginning
of their lifecycle. All these show the use of robotics
technologies is only limited by surgeons’ imagination
and engineers’ skills.
Contributor: Satish kumar TVA is working with
ITMagic Company Ltd, Seoul, South Korea as project manager.
