Introduction: First robotic Surgery.
First robotic surgery, was not done recently. You will be surprised it was in 1983! In recent years, robotic surgery has become increasingly common as the technology offers many benefits, including a faster recovery time and less scarring. A procedure that used to be performed with large incisions and large instruments can now be performed with microscopic precision with much smaller incisions and much tinier instruments.
Laparoscopic surgery used to be performed using smaller instruments and smaller incisions before robotic surgery. It also included miniature cameras to view the operating field. Added to this technique was robotic surgery, which mimicked the dexterity of a surgeon’s hands in a smaller surgical area using robotic arms.
The first surgical robot was called the Arthrobot and was used by Canadian doctors in 1983. Later on, robots were used for other surgeries, such as eye surgery and prostate surgery. The development of robotic surgery began slowly during the 1980’s. At first, robotic surgery was performed by surgeons with precision while the patient was in the same room as the robot. Modern technology, however, now makes it possible for surgeons to operate on patients located far away. The use of this technique has proven beneficial to doctors who operate on soldiers injured in foreign countries.
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The da Vinci Surgical System is currently one of the most advanced robots in use. It has been used for over ten years and is extremely precise. Surgery performed using this technology typically results in shorter recovery times and less discomfort for the patient.
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The surgical community has embraced robotic surgery in an unprecedented manner. As a result, it has been led in part by rapid advancements in technology and, in part, by the ease with which existing laparoscopic procedures and techniques have been adapted to the new laparoscopic approach. In recent years, robots are becoming an increasingly important part of healthcare. It has been rare for these technological advances in medicine and surgery to be introduced as a result of randomized prospective studies.
No review of the history of robotic surgery would be complete without an introduction to the works of the author Karel Capek, and this brief introduction to the history of robotic surgery will not disappoint. The Czech playwright Capek is best known for his plays. Through his play Rossum’s Universal Robots, the term “robot” was defined for the first time. This word is derived from the Czech word robota , which is a word for forced labor or forced activity. However, over time, the term has taken on the meaning of a machine-oriented repetitive task with little or a lot of artificial intelligence involved. Robots who once performed routine tasks for their human masters try to throw off their subservient roles and take control of their own destiny in the play. In industry, robots – machines that can perform repetitive, precise, and pre-programmed actions – are common, but the medical sector has only relatively recently adopted them to help deliver care more effectively.
Current surgical robotic systems can be divided into three types. Semi-active systems, active systems, and primary-secondary systems. An active system operates autonomously (under the control of the operative surgeon) and performs pre-programmed actions. This is exemplified by the PROBOT and ROBODOC platforms described later. Semi-active systems include surgeon-driven elements that complement the preprogrammed elements of these robots. Formal primary-secondary systems (forerunners of the ZEUS and da Vinci® platforms) lack the pre-programmed capabilities of other systems. A surgeon’s activity is entirely responsible for their actions. Instruments used for laparoscopic surgery faithfully reproduce the surgeon’s hand movements, but inside the patient.
The first robotic procedure of the modern era is often defined differently by different authors. In most cases, the honour goes to Kwoh et al , who used the PUMA 560 robotic system to undertake neurosurgical biopsies more accurately – stereo-tactic brain surgery. Davies et al used the same system to perform a transurethral resection of the prostate (TURP), a precursor to what would ultimately become the PROBOT.
The device was developed by Integrated Surgical Supplies Ltd specifically for TURPs. The PROBOT was designed to direct a rotating blade to complete the process of prostate resection. PROBOT did not gain wide clinical appeal, but a similar concept was being explored elsewhere at the same time.
A parallel development was being made to develop the ROBODOC system (the first of the active robotic systems to receive FDA approval) and a machine designed to improve the precision of hip replacement surgeries. It was adopted in Europe (and subsequently in the US) almost immediately, with the first procedures beginning in 1992. Similarly, a second percutaneous approach (PAKY) was used to access the kidney for stone surgery. All of these systems, however, were not designed to enhance or extend laparoscopic procedures.
Early active robotic systems clearly demonstrated the potential of mechanical devices to enhance surgical interventions, but the primary driving force for further developments to enhance laparoscopic procedures was telepresence, a concept that was developed in collaboration between the Ames Research Center at NASA and researchers from Stanford.
Recognizing that linkage between surgeons (far away from the battlefield) and their patients could reduce death and morbidity among soldiers serving in conflicts, the US military developed a robotic platform to connect surgeons to patients.
Many of the researchers involved with this military interest group later developed their ideas commercially in the public and commercial sectors. The Automated Endoscopic System for Optimal Positioning (AESOP) robotic platform was funded directly by Computer Motion.
By using this system, surgeons could control the positioning of a laparoscopic camera system by voice. After some modifications, the system was relaunched as the ZEUS operating system. The EndoAssist (a more bulky but considerably cheaper alternative) relied on infrared signals directed from a headset worn by the operating surgeon. It was about that time that SRI Green Telepresence, the predecessor to what would become Intuitive Surgical, made its debut. It later underwent a major overhaul to become an early version of today’s da Vinci system.
As two rival robotic systems, ZEUS and da Vinci, they went on to dominate the field of robotic surgery for more than a decade, trading world-firsts and pushing the boundaries of minimally invasive surgery. ZEUS, the three-armed platform, continued to utilize the voice-activated AESOP camera system.
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The camera was held by one of its three arms, and the two other arms were used to hold surgical instruments. In general, the da Vinci platform represented a three- to four-arm system, with a center arm holding a binocular lens (for 3D viewing). Possibly more important, however, was the fact that the remaining arms on the cart were also articulated at the wrist for seven degrees of freedom. It was both a unique selling point and an innovation that ultimately played a pivotal role in the emergence of da Vinci as the leading platform.
There was a ten year battle between these two rival systems, ZEUS and Da Vinci, which dominated the field of robotic surgery for a decade – trading world firsts and pushing the boundaries of minimally invasive surgery.
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In Belgium, the da Vinci platform was the first that was used for a cholecystectomy (Belgium, 1997). Using innovative ‘wristed’ instruments for the first time, Carpentier performed a mitral valve replacement the year following. This was followed by a Fallopian tube reanastomosis using the ZEUS system in 1998.
In the year after, Douglas Boyd and colleagues at the London Health Sciences Center performed the first beating-heart cardiac bypass surgery. A subsequent cardiac revascularization procedure was also conducted with the ZEUS platform by the same team.
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ZEUS was used for a transatlantic cholecystectomy in 2001 (the operative surgeon performed the surgery in New York while the patient was physically in Strasbourg, France).
When Computer Motion and Intuitive Surgical merged in 2003, the ZEUS and da Vinci systems were effectively unified. Therefore, further developments and improvements were centered on the da Vinci platform, which has subsequently dominated robotic surgery for almost a decade.
This rapidly evolving field has only recently seen the emergence of new technology companies that have introduced a significant element of competition and choice.