Robotic Surgical Applications

Surgical robotics was pioneered in the 1980s in the field of neurosurgery and later in the field of orthopedics (4,5). Robotic "registration," the ability of the robot to be oriented with respect to the anatomy of the patient, and to transform coordinates from one system, such as an imaging study, to the actual "coordinates" of a patient with perfect alignment is one of the challenges of robotic surgery. Registration is somewhat simplified in neurosurgery and orthopedics because of the relatively fixed anatomic landmarks and bony structures available.

Robots have been employed in the field of neurosurgery to facilitate such procedures as brain biopsy, tumor resection, and stereotactic surgery. For example, in 1985, Kwoh et al. employed the PUMA 560 robota to perform neurosurgical biopsies with greater precision (6). Similarly, another robot, the Neuromate™, has a well-established track record in stereotactic functional neurosurgery. In the field of orthopedic surgery, robots have a growing role in such procedures as hip and knee arthroplasty. The ROBODOC® surgical systemb is a modified industrial robot, which is used for several of orthopedic procedures. Designed to address potential human errors in performing cementless total-hip replacement, the ROBODOC surgical system employs a motorized arm with the capacity to drill a precise hole in the femur during hip-replacement surgery (7).

Additional pioneering work in the development of robotic-assisted surgery was the result of a joint collaboration in the United States between the National Aeronautics and Space Administration , the Jet Propulsion Laboratory, and MicroDexterity Systems, a private interest. As part of the Jet Propulsion Laboratory's Telerobotics Program, these interests formed the Robot-Assisted MicroSurgery project in the early 1990s. The purpose of this program was to build the technology and workstations necessary to improve robotic dexterity and enable microsurgical procedures to advance to the point where they could be applied to procedures of the eyes, ear, nose, throat, face, hand, and brain. By 1994, the Robot-Assisted MicroSurgery project had successfully developed a robotic arm measuring 2.5 cm in diameter and 25 cm in length, which was capable of six degrees of motion. In the following year, a system of kinematics and high-level control, which included an electronic safety system, was added. This technology was successfully tested at the Cleveland Clinic Foundation in the late 1990s during a simulated-eye microsurgery. Subsequent work produced a dual-arm telerobotic microsurgery workstation capable of microsurgical suturing.

The United States Army became interested in the possibility of "bringing the surgeon to the wounded soldier—through telepresence" (7). A system was thus devised whereby a wounded soldier could be transferred to the nearest Mobile-Activated Surgical Hospital, a vehicle with robotic surgical equipment, within which a wounded soldier could be operated on remotely by a surgeon. Although successfully tested in animal models, this system has yet to be implemented in an actual battlefield setting.

Robots designed to hold and manipulate instruments, such as cameras or retractors, have been a tremendous success. In 1994, Computer Motion, Inc.c developed the automated endoscopic system for optimal positioning (AESOP 1000). The AESOP 3000, which features a voice-activated robotic arm that holds the camera and endoscope assembly for the surgeon during an endoscopic procedure and moves it with seven degrees of freedom, was introduced in 1998.

Intuitive Surgical®d made an important advancement in robotic surgical instrumentation with the introduction of the da Vinci™ Surgical System, which received Food and Drug Administration approval in July 2000. Based on the same concept, Computer Motion, Inc. introduced the Zeus® surgical system soon after the da Vinci system. In both systems, the surgeon sits comfortably at a master console and controls the "slave" robotic instruments using a pair of master manipulators resembling joysticks. Separately, cameras are inserted into the patient's body to give a three-dimensional view of the body interior. Multiple specialties have employed these systems for a wide variety of operations.

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