• In 1985 a robot, The PUMA 560, was used to place a needle for a brain biopsy using CT guidance. Three years later the same machine was used to perform a transurethral resection.
• In 1987 robotics was used in the first Laparoscopic surgery, a cholescystecotomy.
• In 1988, The PROBOT, developed at Imperial College London, was used to perform prostatic surgery.
• The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.
• Further development of robotic systems was carried out by Computer Motion with the AESOP and ZEUS Robotic Surgical Systems and Intuitive Surgical with the introduction of The da Vinci Surgical System.
Benefits: The goal of using robots in medicine is to provide improved diagnostic abilities, a less invasive and more comfortable experience for the patient, and the ability to do smaller and more precise interventions.
Robots are currently used not just for prostate surgery, but for hysterectomies, the removal of fibroids, joint replacements, open-heart surgery and kidney surgeries. They can be used along with MRIs to provide organ biopsies. Since the physician can see images of the patient and control the robot through a computer, he/she does not need to be in the room, or even at the same location as the patient.
This means that a specialist can operate on a patient who is very far away without either of them having to travel. It can also provide a better work environment for the physician by reducing strain and fatigue. Surgeries that last for hours can cause even the best surgeons to experience hand fatigue and tremors, whereas robots are much steadier and smoother.
Along with improved patient care, another aim of making medical robotics mainstream is to cut down on medical costs. However, this is not always the case. Some robotic surgery systems cost more than $1 million to purchase and $100,000 a year or more to maintain.
This means that hospitals must evaluate the cost of the machine vs. the cost of traditional care. If robotic surgery cuts down on the trauma and healing time, there is money saved in terms of the number of days the patient stays in the hospital. There is also a reduction in the amount of personnel needed in the operating room during surgery.
In contrast, extensive training time is required for physicians to learn to program and operate the machines. Another concern is that there are very few manufacturers of medical robotics. With very little competition, the few manufacturers that exist can set their own prices.
Medical robotics is still a very new idea, and there is much more work to be done. It is still very expensive, which can make it prohibitive for many hospitals and health-care centers.
There are also still issues with latency. This refers to the time lapse between the moments when the physician moves the controls and when the robot responds. Also, there is still a chance for human error if the physician incorrectly programs the robot prior to surgery. Computer programs cannot change course during surgery, whereas a human surgeon can make needed adjustments.
As surgeons become more familiar with using robots for surgery, and as more companies provide medical robots, there will come a day when robots are used in almost every hospital. However, this is still far off in the future.
Click on each picture to be linked to matching website.
The Puma 560.
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance.
The history of robotics in surgery
begins with the Puma 560, a robotic arm used in 1985 by Kwoh et al to perform neurosurgical biopsies with greater precision.
Three years later, Davies et al performed a transurethral resection of the prostate using the Puma 560. It did not become a treatment of choice for TURP due to poor ultrasound imaging capabilities of the prostate.
This system eventually led to the development of;
In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery.
a robot developed at Imperial College London was designed specifically to aid in the resection of prostatic tissue. The system is image guided, model based, with simulation and online video monitoring. The development and trial of the system have not only demonstrated the successful robotic imaging and resection of the prostate, but have also shown that soft tissue robotic surgery in general, can be successful.
While PROBOT was being developed, Integrated Surgical Supplies Ltd. of Sacramento, CA, was developing;
The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.
a robotic system, previously marketed by Integrated Surgical Systems (ISS), made medical history in 1992 as the first robot assisting in a human Total Hip Arthroplasty (THA). Since then, it has been used in over 24,000 surgical procedures around the world.
Designed to machine the femur with greater precision in hip replacement surgeries,The ROBODOC® Surgical System has been cleared by the U.S. Food and Drug Administration (FDA) for Total Hip Arthroplasty proceudres; making it the only active robotic system cleared by the FDA for orthopaedic surgery.
CUREXO Technology Corporation, is a pioneer in medical robotics and world leader in image-directed robotic products for orthopaedic applications. The Company’s ROBODOC® Surgical System allows surgeons to pre-operatively plan their surgery in a 3-D virtual space and then execute the surgery exactly as planned in the operating theatre. The System includes two components; ORTHODOC®, a computer workstation equipped with proprietary software for 3-D preoperative surgical planning, and the ROBODOC® Surgical Assistant, a computer-controlled surgical robot utilized for precise cavity and surface preparation for hip and knee replacement surgeries. The ORTHODOC® Preoperative Planning Workstation (ORTHODOC) provides the surgeon with 3D information and easy point-and-click control.
The ORTHODOC converts the CT scan of the patient's joint into a 3-dimensional bone image, which can be manipulated by the surgeon to view bone and joint characteristics. This enables the surgeon to use the ORTHODOC tool in a simulated surgery using CT scanned images of the patient’s anatomy.
A prosthetic image is selected from the ORTHODOC’s extensive digital library. The surgeon is able to manipulate the three-dimensional model against the CT bone image, allowing for optimal prosthetic selection and accurate alignment.
This virtual surgery creates a precise preoperative plan customized for each patient. In the case of a primary Total Hip Arthroplasty (THA) procedure, the surgeon plans the femoral cavity preparation on the ORTHODOC. The surgeon can determine the specific brand, size, type (anatomical or straight stem) of the femoral stem prosthesis and can precisely define the optimal fit and alignment of the femoral stem. This precision is used in determining optimal anteversion,leg length, etc.
Studies have shown that preoperatively selected prostheses can be planned to achieve optimal fit, resulting in better than 95% contact with the bone. The fit, fill and alignment will be accomplished, precisely as planned, using the ROBODOC system.
History of the development of Orthopilot:
In 1994 the experimentation with kinematic navigation began. This spurred the development of Image Guided Orthopedic Surgery (IGOS) in the European Union from 1996-1999. 1997 marked the first clinical use of IGOS, in a total knee replacement surgery.
In 1999 Orthopilot was developed and received a CE marking (stating that the product had met European standards); at this time it was introduced to the market with programming capable of performing total knee arthroplastys.
In 2001 Orthopilot received FDA approval and became the first CT-free navigation system in the U.S. Since then there has been much development and advancements in the software used for THA, TKA, ACL reconstruction, and HTO procedures. As of today there have been over 80,000 surgeries performed using the Orthopilot navigation system.
The Orthopilot system is used to provide doctors with a way to accurately execute large joint replacement/corrective surgeries. The procedures vary depending on the type of surgery, however the general methodology of the surgery is as follows: The surgeon fixes sensors to the part of the patient being operated on, and then moves the patient in specific natural motions so that the camera receives the data and uses it to form a model on the screen. The representations on the monitor allow the surgeon to perform the surgery with greater accuracy, as the Orthopilot system will be able judge when the joint is properly aligned.
Orthopilot has a number of well documented applications in the realm of large joint replacement and repair. The most common include:
•Total Knee Arthoplasty
•Unicondylar Knee Arthoplasty
•Total Hip Arthoplasty
•Cartilage Defect Management
•Anterior Cruciate Ligament (ACL) Reconstruction
•High Tibial Osteotomy (HTO)
Prior to Orthopilot (and computer assist devices similar to it), it was not always certain that an implant would be placed in the optimal position.
Prior to Orthopilot (and computer assist devices similar to it), it was not always certain that an implant would be placed in the optimal position. With the navigation system the implant can be placed within 3 degrees of perfect position at almost every surgery. The navigation also allows minimally invasive surgery to be performed easily because of the display, thereby increasing recovery time and decreasing post operative pain. Also, once a surgeon becomes familiar with the navigation system, surgery time will decrease, which is an important clinical and economic factor.
As with most computer assist devices, the major disadvantages are due to the fact that the machines are very expensive, the surgeon must undergo new training to learn how to use the device, and initially the surgeries will take much longer as the surgeon is becoming familiar with the new procedure.
Improving the speed, accuracy and reproducibility of joint replacement, ensuring maximum benefit for the surgeon and the patient Acrobot provides precision surgical systems for computer-assisted 3D planning, surgical navigation and surgeon-controlled robotic surgery.
The overall goal of Acrobot’s technologies is to provide: •Speed •Accuracy •Reproducibility
In order to enhance clinical outcomes, augment (but not replacing) surgeon skills, facilitate bone conservation and increase productivity.
When joint replacement components are implanted accurately and successfully, the patient’s post-operative recovery time can be reduced and discomfort and complications can be minimised, which should then lead to improved quality of life for the patient.
Acrobot precision surgical system consists out of four components:
1: Acrobot Modeller: Modeller takes CT scan data and generates an accurate 3D representation of the patient’s anatomy. 2: Acrobot Planner: Planner allows the surgeon to determine the optimum size required and the exact position to place the components of the joint replacement by creating a patient specific ‘Patient Plan’. 3: Acrobot Navigator: Navigator is a unique non-optical / non-electromagnetic navigation system, which uses two digital arms to track the patient. One arm tracks the bone and the other the instrument. The previously created ‘Patient Plan’ is loaded into Navigator which with its unique tracking system provides pin-point accuracy in the optimum placement of the implant 4: Acrobot Sculptor: Sculptor allows the surgeon to accurately sculpt bone away to create the recesses required for component implantation. The ‘Patient Plan’ is uploaded into Sculptor and using Acrobot’s patent protected ‘Active Constraint’ technology a high speed burr allows precise targeted bone removal in a safe and controlled manner. Products are currently NOT available in the US
The RIO™ Robotic Arm Interactive Orthopedic System.
RIO™ Robotic arm interactive orthopedic system
The MAKOplasty® Procedure Based on more than 200 licensed or owned patent applications and patents, MAKOplasty enables orthopedic surgeons to treat patient-specific, early- to mid-stage osteoarthritic knee disease with consistent, reproducible precision. The procedure employs the MAKO Tactile Guidance SystemTM (TGSTM), a proprietary, surgeon-interactive robotic arm system that controls surgeons' movements through the use of tactile resistance technology. Computer-generated virtual surfaces guide surgeons and the robotic arm along their planned path and focus cutting on patient-specific 3D visualizations, based on pre-operative imaging. The surgeon can confidently make complex tissue-sparing and bone-conserving cuts. Any necessary adjustments can be made during the operation, and patients stand to recover faster.
The RIO™ empowers surgeons and hospitals to address the needs of a large and growing, yet currently underserved patient population suffering from early to mid-stage osteoarthritis of the knee. Patients who desire a restoration of lifestyle, minimized surgery, reduced pain and rapid recovery may benefit from MAKOplasty®.
"The implants and instruments benefit from SolidWorks' rapidly improving surfacing capabilities, and the TGS design benefits from SolidWorks' large assembly and motion simulation capabilities," said MAKO CTO, Senior Vice-President and Co-founder Rony Abovitz. "We also use SolidWorks to design the virtual volumes - the safe cutting zones, if you will - that guide the surgeon in reshaping patients' bone surfaces prior to implanting. SolidWorks handles all of these jobs well, and the software is easy for our engineers to learn no matter what platform they've learned on."
The MAKOplasty design effort has been under way since 1997, tracing its surgical navigation and medical robotics roots to a wide range of licensed and internally developed technologies, notably the MIT Artificial Intelligence (AI) Lab, Northwestern University's Lab for Intelligent Machines, and The Cleveland Clinic. One of the original seats of SolidWorks was used by William Townsend, CEO of Barrett Technology and the co-inventor of core cable-drive robot technologies (WAMTM arm) at the MIT AI Lab.
MAKO Surgical Corp.
is a medical device company based out of Fort Lauderdale, Florida that markets its advanced robotic solution and implants for minimally invasive orthopedic knee procedures.
MAKO's Tactile Guidance System ™ includes an interactive robotic arm platform that utilizes tactile-resistance and patient-specific visualization to prepare the knee joint for the insertion and alignment of resurfacing implants through a keyhole incision.
MAKO has an intellectual property portfolio of more than two hundred licensed or owned patent applications relating to the areas of computer assisted surgery, haptics, robotics, and implants.
Cool Haptic Implementations for Medical Applications
Within the past 10 years, robotic surgical systems have revolutionized the way surgeons’ approach minimally invasive surgery especially laparoscopic and arthroscopic procedures. However, one of the deficiencies of most robotic surgical systems today is the lack of the sensation of touch for the surgeon.
Implementation of haptic feedback into robotic surgical systems can transform the physician’s user experience by enabling identification of different tissue structures, preventing tissue damage, insuring correct suture placement and decreasing task completion time.
Click on Image to read about the Laerdal Virtual I.V. Simulator
The EndoscopyVR simulator is a surgical platform that supplies a realistic training environment for both gastrointestinal and bronchoscopy procedures
CAE EndoscopyVR Surgical Simulator
Most accurate physiology, better haptics, most advanced bronchoscopy content
Leading and up-and-coming medical brands use haptics to great advantage. Their products are winning awards, receiving acclaim, and delighting customers with extraordinary user experiences.
The EndoscopyVR simulator is a surgical platform that supplies a realistic training environment for both gastrointestinal and bronchoscopy procedures. A modular approach to learning allows students to practice skills and gain confidence in a safe environment prior to advancing to more difficult procedures. The EndoscopyVR simulator offers superior force feedback sensation, physiological and anatomically correct simulation, extensive didactic aids, thorough metrics reports, vital signs and ability to administer drugs.
Two robotic surgical systems have received FDA clearance to be marketed in the United States
FDA Consumer magazine May-June 2002
The da Vinci Surgical System, made by Intuitive Surgical,Inc. of Sunnyvale, Calif., is cleared to perform surgery under the direction of a surgeon.
The ZEUS Robotic Surgical System, made by Computer Motion,Inc. of Goleta, Calif., has been cleared by the FDA to assist surgeons.
"[The] da Vinci is cleared to assist in advanced surgical techniques such as cutting and suturing [sewing]," says Neil Ogden, chief of the FDA's General Surgery Devices Branch in the Center for Devices and Radiological Health.
"ZEUS is cleared to assist in grasping, holding, and moving things out of the way, but isn't cleared for cutting or suturing." Clinical trials on ZEUS are underway with the goal of obtaining FDA clearance to assist in the performance of advanced surgical tasks in the United States, according to Paul Nolan, senior director of customer training and education at Computer Motion.
Multiple types of procedures have been performed with either the Zeus or da Vinci robot systems, including bariatric surgery.
Here's a profile of each system
The da Vinci Surgical Systems by Intuitive Surgical
In1995, a physician with a keen business sense saw the commercial value of the emerging robotic technology. Frederic H. Moll, MD, acquired the license to the telepresence robotic surgical system developed by the NASA-SRI teams, and started a company called Intuitive Surgical Inc.® (Intuitive Surgical Inc., 2005; Satava, 2003). Intuitive Surgical Inc. used the telepresence robotic technology pioneered by the NASA-SRI team to develop a master-slave telepresence robotic surgical system they named daVinci®.
According to the manufacturer, the da Vinci System is called “da Vinci” in part because Leonardo da Vinci invented the first robot. The artist Leonardo also used anatomical accuracy and three-dimensional details to bring his works to life.
In July 2000, the FDA cleared da Vinci as an endoscopic instrument control system for use in laparo-scopic (abdominal) surgical procedures such as removal of the gallbladder and surgery for severe heartburn. In March 2001, the FDA cleared da Vinci for use in general non-cardiac thoracoscopic (inside the chest) surgical procedures--surgeries involving the lungs, esophagus, and the internal thoracic artery. This is also known as the internal mammary artery, a blood vessel inside the chest cavity. In coronary bypass surgery, surgeons detach the internal mammary artery and reroute it to a coronary artery. In June 2001, the FDA cleared da Vinci for use during laparascopic removal of the prostate (radical prostatectomy).
The da Vinci is intended to assist in the control of several endoscopic instruments, including rigid endoscopes, blunt and sharp dissectors, scissors, scalpels, and forceps. The system is cleared by the FDA to manipulate tissue by grasping, cutting, dissecting and suturing.
The da Vinci system consists of three components: the vision system, the patient-side cart, and the surgeon console.
The vision system includes the endoscope, the cameras, and other equipment to produce a 3D image of the operating field.
The patient-side cart has three robotic arms and an optional fourth arm. One arm holds the endoscope, while the other arms hold interchangeable surgical instruments. The da Vinci system uses EndoWrist surgical instruments, which mimic the movements of the human hand and wrist.
The Surgeon Console In use, a surgeon sits at a console ("Surgeon's Console") several feet away from the operating table and manipulates the robot's surgical instruments. The robot has three hands attached to a free-standing cart. One arm holds a camera (endoscope) that has been passed into the patient through small openings. The surgeon operates the other two hands by inserting fingers into rings.
The arms use a technology called EndoWrist--flexible wrists that surgeons can bend and twist like human wrists. The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms. The da Vinci has a three-dimensional lens system, which magnifies the surgical field up to 15 times. Another surgeon stays beside the patient, adjusting the camera and instruments if needed.
There are 89 da Vinci systems placed; 50 in U.S. medical centers, 34 placed in Europe and five placed in Asia.
* Update: as of May 2012 more than 1,840 da Vinci Systems are installed in over 1,450 hospitals worldwide.
The da Vinci robot is commonly used to remove the prostate gland for cancer, repair obstructed kidneys, repair bladder abnormalities and remove diseased kidneys.
The da Vinci Surgical System
provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting a surgeons hands at the controls of a state-of-the-art robotic platform. The da Vinci System enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision.
The da Vinci S HD Surgical System integrates 3D HD endoscopy and state-of-the-art robotic technology to virtually extend the surgeon’s eyes and hands into the surgical field.
A newer model called the da Vinci S Surgical System is now available, and offers high definition imaging and other improvements.
The da Vinci S HD Surgical System integrates 3D HD endoscopy and state-of-the-art robotic technology to virtually extend the surgeon’s eyes and hands into the surgical field. Only the da Vinci System enables new, minimally invasive options for complex surgical procedures.
• Fast foolproof setup • Rapid instrument exchange • Multi-quadrant access • Interactive video displays
Unparalleled 3D HD Visualization • World’s first robotic surgical system with 3D HD vision • Twice the effective viewing resolution provides improved clarity and detail of tissue planes and critical anatomy • Panoramic 16:9 aspect ratio is 30% wider, providing 20% more viewing area • Digital zoom reduces interference between endoscope and instruments • 0° and 30° stereo endoscopes
Enhanced Dexterity, Precision & Control • Precise fingertip control of fully articulating EndoWrist® Instruments • Motion scaling & tremor reduction • Patented Intuitive® Movement • Large range of motion robotic arms and extended length instruments enable multi-quadrant access • Slim, telescoping instrument arms provide better patient access and optimal port placement • Broad selection of 8mm and 5mm EndoWrist instruments
Fast, Foolproof Setup • Motorized Patient Cart • Quick-click cannula mounts for simplified patient docking • Integrated 4th arm for rapid deployment • Touchscreen scope configuration • Single high-speed fiber-optic connection • Single-use sterile adaptors with integrated drapes
Streamlined Interface • Integrated touchscreen monitor • Telestration for improved proctoring and team communication • TilePro multi-input display allows an integrated view of patient critical information • Intuitive status LEDs & icons
The newly refined da Vinci Si Surgical System is the latest addition to the da Vinci® product line.
The da Vinci Si HD System
was launched in April 2009, the da Vinci Si introduces several enabling features, including:
•Enhanced high-definition 3D vision for superior clinical capability •An updated user interface for streamlined setup and OR turnover •Extensibility for digital OR integration •Dual-console capability to support training and collaboration during minimally invasive surgery.
The da Vinci Si System retains and builds on the core technology at the heart of the existing da Vinci and da Vinci S™ Systems:
•Advanced 3D HD visualization with up to 10x magnification and an immersive view of the operative field •EndoWrist® instrumentation with dexterity and range of motion far greater than even the human hand •Intuitive® motion technology, which replicates the experience of open surgery by preserving natural eye-hand-instrument alignment and intuitive instrument control
Together, these technological advancements provide da Vinci surgeons with unparalleled precision, dexterity and control that enable a minimally invasive approach to many complex surgical procedures.
To read more about da Vinci Si HD Extended Features & Benefits Click here
the latest-generation da Vinci Si dual console surgical robotics system
The da Vinci Si dual console surgical robotics system
allows two surgeons to simultaneously collaborate during surgery – meaning two sets of eyes, hands and skills are involved in the surgery. With the older robotics system, surgeons worked independently, even on complex cases where two surgeons would normally collaborate in open or even laparoscopic surgery.
The dual console also allows for surgeons from different specialties to work together on the same patient. For example, a patient undergoing gynaecological and urological procedures can be robotically operated on at the same time, allowing both surgeons to work together and reducing the risks of complications for the patient.
The most obvious advantage of the dual console is the ability to train new robotics surgeons. Instead of the mentoring surgeon and mentoree trading places back and forth throughout the surgery, both surgeons can now work in tandem. The efficiency of having two surgeons working at the same time could easily accelerate the learning curve as both surgeons are seeing the same anatomy and sharing the same instruments, just like the learning process in open surgery. The accelerated learning curve for the surgeons means more cases can be performed; allowing even more patients to benefit from robotics surgery.
INTRODUCING The da Vinci Xi®
The da Vinci Xi®
is the next frontier for minimally invasive surgery. With this addition, Intuitive Surgical® can now offer a full range of da Vinci Systems optimized for highly complex, multi-quadrant surgery and simpler, single-quadrant surgery.
Skills Practice in an Immersive Virtual Environment
Portable. Practical. Powerful. The da Vinci Skills Simulator contains a variety of exercises and scenarios specifically designed to give users the opportunity to improve their proficiency with the da Vincisurgeon console controls. The sleek case seamlessly integrates with an existing da VinciSi or Si-e surgeon console* turning it into a novel practice platform that can be used in or outside the operating room. No additional system components are required.
The straightforward set-up allows users to practice unassisted or with supervision, according to their preference.
Built-in metrics enable users to assess skills, receive real-time feedback and track progress.
Administrative tools let users structure their own curriculum to fit with other learning activities in their institution.
The open architecture of the system software allows for the future development and incorporation of additional practice modules....read more
Each exercise covers at least one of the following skill categories:
EndoWrist® Manipulation - EndoWrist instruments are designed to provide surgeons with natural dexterity and a range of motion far greater than even the human hand. These exercises are designed to help users gain familiarity with the movement of these instruments.
Camera and Clutching – The three-dimensional, enhanced high-definition vision of the da Vinci System offers a key clinical advantage in surgery, and these exercises help users improve camera control and learn to use the clutch effectively.
Fourth Arm Integration – For more advanced instrument control skills, some exercises include a fourth instrument arm that must be used. This is designed to promote instrument skill, and encourages users to think strategically about instrument placement during tasks.
System Settings – The surgeon console features a comprehensive set of controls for user settings. Quiz exercises on the simulator focus on basic setting topics such as icons, ergonomics and instrument scaling.
Needle Control and Driving – These scenarios are designed to help users develop skill when manipulating needles, including a focus on how to effectively hand off and position needles while practicing with a range of geometries.
Energy and Dissection – The footswitch panel enables users to perform a range of tasks such as swapping between different types of energy instruments. These exercises allow users to gain familiarity with the footswitch panel by letting them practice applying monopolar and bipolar energy while working on dissection tasks.
Detachable Instruments (Endowrist® Instruments and Intuitive® Masters).
The Endowrist detachable instruments allow the robotic arms to maneuver in ways that simulate fine human movements
The Endowrist detachable instruments allow the robotic arms to maneuver in ways that simulate fine human movements
The Endowrist detachable instruments
allow the robotic arms to maneuver in ways that simulate fine human movements. Each instrument has its own function from suturing to clamping, and is switched from one to the other using quick-release levers on each robotic arm. The device memorizes the position of the robotic arm before the instrument is replaced so that the second one can be reset to the exact same position as the first. The instruments’ abilities to rotate in full circles provide an advantage over non-robotic arms. The seven degrees of freedom (meaning the number of independent movements the robot can perform) offers considerable choice in rotation and pivoting. Moreover, the surgeon is also able to control the amount of force applied, which varies from a fraction of an ounce to several pounds. The Intuitive Masters technology also has the ability to filter out hand tremors and scale movements. As a result, the surgeon’s large hand movements can be translated into smaller ones by the robotic device. Carbon dioxide is usually pumped into the body cavity to make more room for the robotic arms to maneuver. For more information Click here
3-D Vision System (Insite® Vision and Navigator Camera Control)
The camera unit or endoscope arm provides enhanced three-dimensional images. This high-resolution real-time magnification showing the inside of the patient allows the surgeon to have a considerable advantage over regular surgery. The system provides over a thousand frames of the instrument position per second and filters each image through a video processor that eliminates background noise. The endoscope is programmed to regulate the temperature of the endoscope tip automatically to prevent fogging during the operation. Unlike The Navigator Control, it also enables the surgeon to quickly switch views through the use of a simple foot pedal. For more information Click here
da Vinci surgical system in a general procedure setting
Advantages and Disadvantages.
The da Vinci Surgical System
Hospital stays can be reduced by about half, reducing hospital cost by about 33%.
These fewer days in the intensive care unit are a result of less pain and quicker recovery.
Though the size of the device is still not small enough for heart procedures in children, the minimally invasive nature of da Vinci does not leave a large surgical scar and still has some limited applications in children for the time being. Moreover, according to Intuitive Surgical, only 80,000 out of 230,000 new cases of prostate cancer undergo surgery because of the high risk invasive surgery carries, implying that more people may undergo surgery with this evolving technology.
The main drawbacks to this technology are the steep learning curve and high cost of the device. Though Intuitive Surgical does provide a training program, it took surgeons about 12-18 patients before they felt comfortable performing the procedure.
One of the greatest challenges facing surgeons who were training on this device was that they felt hindered by the loss of tactile, or haptic, sensation (ability to “feel” the tissue).
The large floor-mounted patient-side cart limits the assistant surgeon’s access to the patient. However, there are also many who are unable to access the da Vinci based on the steep price.
In a paper published by The American Journal of Surgery, 75% of surgeons claimed that they felt financially limited by any system that cost more than $500,000. As of now, surgery with the da Vinci Surgical System takes 40-50 minutes longer, but the FDA considered this a learning curve variable and expects time to improve with more use of the system. Click here
Fail Safe Mechanisms
Safety concerns remain the center of focus for Intuitive Surgical. To start the procedure, the surgeon’s head must be placed in the viewer. Otherwise, the system will lock and remain motionless until it detects the presence of the surgeon’s head once again. During the procedure, a zero-point movement system prevents the robotic arms from pivoting above or at the one-inch entry incision, which could otherwise be unintentionally torn. Included in the power source is a backup battery that allows the system to run for twenty minutes, giving the hospital enough time to reestablish power. Each instrument contains a chip that prevents the use of any instrument other than those made by Intuitive Surgical. These chips also store information about each instrument for more precise control and keep track of instrument usage to determine when it must be replaced.
Besides the cost, the da Vinci Surgical System still has many obstacles that it must overcome before it can be fully integrated into the existing healthcare system. From the lack of tactile feedback to the large size, the current da Vinci Surgical System is merely a rough preview of what is to come. Spending around $16.2 million in 2003 alone, Intuitive Surgical has a first-mover advantage over its competitors and continues to lead on as it receives more and more FDA approvals. More improvements in size, tactile sensation, cost, and telesurgery are expected for the future Click here
Estimate of Initial Investment and Cost Savings per Heart-Valve Surgery for da Vinci® Market Price
Maintenance/year Physician Training
$1 million $100,000 $250,000
Cost of one inpatient hospital day
Reduced inpatient hospital days for heart procedures
Cost saving per heart procedure due to reduced hospital stay
$9,000 per heart valve
Extra procedure cost
$2000 more per operation
$175,000 for fourth arm (Compared to $80,610 per year for extra OR nurse)
Sources: Table 2 from Journal of Healthcare Management 46:4 July/August 2003 Salary Survey 2004. Nursing Management 35: 7 July 2004 Pages 28-32 American Heart Association's Scientific Sessions 2002 Click here
Costs and Reimbursement.
Costs: Though Intuitive Surgical has faced some setbacks during its legal battles with Computer Motion, it has recovered quickly and has been growing at an unprecedented rate since the merger. The total sale for the first year of 2004 was $138.8 million (a 51% increase from the previous year) with a total of $60 million in revenue. This includes recurring revenue from instruments, disposable accessories, and services, which have also increased accordingly in response to the larger number of systems installed and greater usage in hospitals. In 2004 alone, 76 da Vinci Systems, each costing about $1.5 million, were sold.
Reimbursement: Medical reimbursement by insurance companies is specific to each respective company. However, Medicare reimbursement is available for laparoscopic and thoracoscopic procedures since the da Vinci Surgical System has been FDA approved for commercial distribution in the United States. Click here
Zeus Robotic Surgical System.
The Zeus surgical system with its table-mounted arms (left) and the surgeon’s console (right)
ZEUS Robotic Surgical System
In 1989, Yulun Wang, PhD, a graduate engineer and acquaintance of Dr. Satava, founded his own medical robotics company with funding from the U.S. government and private industry. His company, Computer Motion, Inc.®, launched AESOP® (Automated Endoscopic System for Optimal Positioning), a robotic telescope manipulator, and the robotic surgical system ZEUS® (Marescaux & Rubino, 2003; Satava, 2003). AESOP was FDA approved for use in 1994, and is currently marketed in the United States (Marescaux & Rubino, 2003).
Computer Motion, Inc. received FDA approval to market ZEUS in 2001 (Marescaux & Rubino, 2003). The FDA cleared ZEUS in October 2001 to assist in the control of blunt dissectors, retractors, graspers, and stabilizers during laparoscopic and thoracoscopic surgeries.
ZEUS has three robotic arms that are mounted on the operating table. One robotic arm is called the Automated Endoscopic System for Optimal Positioning Robotic System (AESOP). AESOP is a voice-activated robot used to hold the endoscope. The FDA cleared AESOP to hold and position endoscopes in 1994, and voice activation was added later.
ZEUS differs from the da Vinci system in that the AESOP part of ZEUS responds to voice commands. For example, a surgeon might say: "AESOP move right." The positioning arm then would move right until the "stop" command was given.
Like the da Vinci system, the other two arms of ZEUS are the extension of the left and right arms of the surgeon. Surgeons sit at a console and wear special glasses that create a three-dimensional image. Computer Motion has added a flexible wrist technology called Micro-Wrist, which is now included in FDA-approved clinical trials, Nolan says.
There are currently more than 30 ZEUS units installed in North America, 15 units installed in Europe and the Middle East, and five units installed in Asia.
Click here for more about the Zeus surgical robot system.
da Vinci vs Zeus; Historical Intuitive Surgical / Computer Motion patent infringement lawsuit
ZEUS Surgical Robot
Back in 2002,
competition between Intuitive Surgical Inc. and Computer Motion Inc. began to mount fiercely, as the market became ready to embrace surgical robotic technology. Those days, the sales numbers were still very low. (Zeus: 30 units sold in the USA, 15 in Europe, 5 in Asia; da Vinci: 50, 34, 5, respectively.)
First, Computer Motion sued Intuitive Surgical for infringement of nine patents. Then, Intuitive and IBM filed the patent infringement suit against Computer Motion in reference to the voice-controlled technology. In 2002, the District Court for the Central District of California ruled that the da Vinci Surgical System literally infringed Computer Motion's 6,244,809 patent. Then, a federal jury in 2003 issued a ruling requiring Computer Motion to pay Intuitive and IBM $4.4 million for infringing a patent covering aspects of Intuitive's system.
On March 7. 2003 the two companies announced that "they are merging into one company combining their strengths in operative surgical robotics, telesurgery, and operating room integration, to better serve hospitals, doctors and patients." This meant a goodbye to Computer Motion. "The reason that Intuitive paid a premium price for CMI is that they believed that they would lose one of the patent infringement cases that CMI was pursuing. The reason that CMI agreed to the acquisition, is that (while they believed they would ultimately prevail in the patent infringement case) they simply didn't have the financial resources to sustain them over the period that IBM's deep pockets would allow Intuitive to keep the litigation going."
Robert Duggan served as Chairman of the Board of Directors of Computer Motion, Inc. from 1990 to 2003. While serving on the Board at Computer Motion, he was named Chief Executive Officer in 1997. Mr. Duggan negotiated the merger with Intuitive Surgical on a 1/3 – 2/3 bases in June 2003 with Computer Motion receiving 1/3 interest. At the time of merger, Computer Motion was generating $25 million annually in revenues. At the mergers' completion Mr. Duggan became a member of the Board of Directors of Intuitive Surgical, Inc., listed on the NASDAQ as ISRG. Bob Duggan only recently resigned from the ISRG board.
After the merger, the Zeus Robotic Surgical System was discontinued, the support for the product decreased and many of the engineers were fired, as they did not want to leave Santa Barbara for Mountain View.
SRI International to demonstrate M7 Dexterous Telesurgical Robot during national robotics week
supports National Robotics Week and believes it is an important opportunity to highlight developments in robotics technology and to inspire students to pursue careers in robotics and other STEM-related fields," said Thomas Low, director of SRI’s Medical Systems and Telerobotics program. "The dexterous telemanipulation capability embodied in SRI’s M7 robot is now making its way into applications where remote handling is necessary for operator safety, such as bomb disposal and biohazard handling and inspection."
SRI has a long history in the field of medical robotics, in particular through its pioneering telepresence technologies. In 1995, SRI spun off Intuitive Surgical, Inc. to commercialize its revolutionary robotic surgical technology. More recently, SRI’s M7 telesurgical robot conducted the first robotic surgery demonstration in a simulated zero-gravity environment, and was part of an experiment last year involving multiple biomedical robots manipulated from different locations.
The SRI M7 represents the next generation of telesurgical capabilities from SRI that leverage the organization’s comprehensive portfolio of expertise, which includes stereo imaging, telerobotics, sensory devices, video, speech recognition, and telecommunications, to perform monitoring, actual operations, and assistance-related activities from remote locations in real time.
For more information about SRI’s medical robots and telepresence technologies Click here
When the FDA cleared Aesop in 1994
it became the first robot to assist surgeons in the operating room. With its use in over 70,000 procedures (heart and all others) performed since that point, Aesop has become a reliable and often indispensable aid in the operating room.
Aesop's function is quite simple merely to maneuver a tiny video camera inside the patient according to voice controls provided by the surgeon. By doing so, Aesop has eliminated the need for a member of the surgical team to hold the endoscope in order for a surgeon to view his operative field in a closed chest procedure. This advance marked a major development in closed chest or port-access bypass techniques, as surgeons could now directly and precisely control their operative field of view.
Today about 1/3 of all minimally invasive procedures use Aesop to control an endoscope. Considering each Aesop machine can handle 240 cases a year, only 17,000 machines are needed to handle all minimally invasive procedures a relatively small number considering the benefits of this technology. Aesop costs around $65,000 and has performed well in all the clinical trials that it has undergone. Ultimately, Aesop has the potential to dominate the minimally invasive market.
Hermes Control Center.
Unlike Aesop and Zeus,
Hermes does not use robot arms to make the Operating Room more efficient. Rather Hermes is a platform designed to network the OR, integrating surgical devices, which can be controlled by simple voice commands.
Many pieces of surgical equipment are outside the range of sterility for the surgeon and must be manipulated by a surgical staff while Hermes enables all needed equipment to be directly under the surgeon's control.
Hermes can integrate tables, lights, video cameras and surgical equipment decreasing the time and cost of surgery. Ultimately Hermes decreases the need for a large surgical staff and facilitates the establishment of a networked, highly organized OR. Ultimately Computer Motion is working to bring Hermes into 84,000 operating rooms worldwide
SOCRATES Robotic Telecollaboration System.
Cleared by FDA in October 2001 as the first product in the new category of robotic telemedicine devices, the Socrates telecollaboration system enables a remote surgeon to mentor a surgeon as if locally
The Socrates Robotic Telecollaboration system
enables a surgeon located at a remote site to interact with another surgeon located in an operating room anywhere in the world. Through Socrates, the remote surgeon is able to converse with the operative surgeon as well as view video images generated by an overhead camera or endoscope utilized at the operative site
Yulun Wang, Ph.D., founder and chief technical officer of Computer Motion stated, "Our commitment to advancing the adoption of less-invasive surgical procedures necessarily requires providing effective training solutions. SOCRATES is the first of many initiatives in Telemedicine that the company intends to pursue." Dr. Wang continued, "In the future, we envision extended networks connecting mentors and training surgeons at facilities around the world."
Computer Motion SOCRATES Robotic Telecollaboration System Receives FDA Regulatory Approval SANTA BARBARA, Calif.--(BW HealthWire)--Oct. 8, 2001
Computer Motion, Inc. (Nasdaq:RBOT) today announced regulatory clearance granted by the Food and Drug Administration
In reviewing SOCRATES, the FDA created a new classification of medical devices, titled "Robotic Telemedicine Device." SOCRATES is the first and only device in this classification to be approved by the FDA for clinical use.
Computer Motion expects the SOCRATES system to be used in coordination with the company's system of products to create exciting new training and mentoring opportunities for surgeons in a wide variety of disciplines.
Dr. Peter Schulam, chief of the Division of Endourology and Laparoscopic Surgery in the Department of Urology at UCLA Medical Center said, "Inadequate mentoring following educational courses has dampened the dissemination of laparoscopic surgery. Socrates may greatly impact surgical training and education by providing global access to specialists. Telesurgical mentoring may be both cost and time effective for the surgeon." Dr. Schulam continued, "The potential benefits to the patient include expanded availability to novel surgical procedures and decreased likelihood of complications.
Socrates will offer support to surgeons during the learning curve of new procedures thereby providing a safer environment to the patients during this transition."
In February 2001, surgeons at London Health Sciences Centre (LHSC) performed the world’s first robotic-assisted surgery using the Socrates Robotic Telecollaboration system.
Canadian Surgical Technologies and Advanced Robotics (CSTAR)'s Dr. Reiza Rayman telementored Dr. Richard Malthaner, LHSC Thoracic Surgeon, who was 200 kilometres away in London performing a lung biopsy. Dr. Rayman also demonstrated the use of Telestration.
Telementoring—Using video-conferencing technology, an expert surgeon at a remote site can teach robotic and other procedures to second surgeon in an operating room. Telesurgery—Surgery performed by an operating surgeon sitting at a console in a remote location. The remote location can be several feet, or several miles, away from the operating room.
Telestration—An illustrative technique which allows the remote mentoring surgeon to use a drawing tablet to make marks on the local surgeon's video monitor. The mentoring surgeon can show where to make an incision or can highlight a tumour mass, for example.
DLR MIRO – A Robot for Medical Applications.
June 2008 First presentation of the new generation MIRO on the AUTOMATICA 2008 in Munich
The DLR MIRO wins the iF product design award 2009 in the category "advanced studies".
The DLR MIRO
is the second generation of versatile robot arms for surgical applications, developed at the Institute for Robotics and Mechatronics. With its low weight of 10 kg and dimensions similar to those of the human arm, the MIRO robot can assist the surgeon directly at the operating table where space is sparse. The planned scope of applications of this robot arm ranges from guiding a laser unit for the precise separation of bone tissue in orthopaedics to setting holes for bone screws, robot-assisted endoscope guidance and on to the multi-robot concept for (endoscopic) minimal invasive surgery.
The DLR MIRO wins the iF product design award 2009 in the category "advanced studies". The design of the DLR MIRO has been created in cooperation with Tilo Wüsthoff - Industrial design Munich.
Surgical robotic systems can be divided into two major groups: specialized and versatile systems. Specialized systems focus either on a dedicated surgical technique or on the treatment of a specific medical disease. In contrast, the design approach of the DLR MIRO and the earlier generation KineMedic aim at a compact, slim and lightweight robot arm as a versatile core component for various existing and future medical robotic procedures.
By adding specialized instruments and modifying the application workflows within the robot control, the MIRO robot can be adapted to many different surgical procedures. This versatility has been achieved by the design of the robotic arm itself and by the flexibility of the robot control architecture.
The key features that distinguish MIRO from the rest are:
dexterous robot arm, with a
payload-to-weight-ratio far better than today’s industrial robots.
Seven torque-controlled joints allow a more flexible operating room (OR) setup and can be used to avoid collisions with other robots or operating room equipment. The joint units integrate both position and torque sensors, so that the robot can be used in impedance-controlled mode, allowing sensitive movements of the robot effected by the surgeon (“hands-on robotics”) and avoiding unintended collisions, as well as very precise manipulation in position-controlled mode. Precision can be further enhanced by external navigation system controlled positioning.
Close interaction with technical systems demand understanding of the system, thus a central design issue of the MIRO robot is an inherent predictability of the system’s actions for the user. To achieve this, a serial kinematics with seven degrees of freedom which resembles those of the human arm has been developed and optimized for medical procedures. The joint morphology groups the MIRO arm in a dedicated shoulder (roll-pitch-yaw), upper arm, elbow (pitch-roll), forearm and wrist (pitch-roll), each group with intersecting axes.
The MIRO robot arm is a highly integrated mechatronic system. Beside motors, gears, and safety brakes the robot arm integrates torque- and position sensors, power electronics, and programmable logic electronics in each joint. The different joint electronics are connected by a high performance communication bus, which allows outsourcing the joint control to the external supply module.
Beside the classical control of the robot by a planned trajectory, the robot offers the possibility of applications in the soft robotics approach. With the integrated torque sensing, the robot can be operated impedance controlled and gravity compensated. This allows the user to directly interact with the robot, because external forces and torques are sensed and used in closed-loop control algorithms.
MIRO / KineMedic
At maximum extended arm position
Capable for single-person carriage
Number of Joints
redundant kinematics, comparable to the human arm
Max. Arm Length
Sensor monitoring, signal generation and transmissions
DLR has developed the light-weight robot MIRO for the application in various surgical procedures. Its low weight and compact dimensions simplify the integration of one or more robot arms into the operating room where space is sparse.
MIRO’s features and performance allow applications in open surgery as well as minimally invasive surgical procedures like endoscopic heart surgery.
DLR integrates three MIRO robots in the presented MIROSURGE project: two robots guide sensor integrated, proprietary forceps for bimanual manipulation with force feedback, while a third one controls a stereo endoscope for 3D-Vision.
The MiroSurge Robotic Surgery System
is part of the team at the Institute of Robotics and Mechatronics of the German Aerospace Centre working on the MiroSurge project, whose goal is to design a new generation of surgery robot for minimally-invasive surgery. Current endoscopic surgery is difficult for surgeons because they must work with long slender instruments that provide little feedback, and have a limited view of the operating area through a single camera. Konietschke and his colleagues' goal with the MiroSurge is to overcome these limitations through robotics.
The MiroSurge robotic surgery system can provide a surgeon with 6 degrees of freedom inside a patient. Two of the robotic arms feature force capture sensors, which provide force feedback to the surgeon, putting him back in contact with the tissue being manipulated. The third robotic arm features a pair of cameras that provide the surgeon with a 3-dimensional view of the interior of the operating area. Konietschke tells us about the ultimate ambition of the MiroSurge project, which is to have a robot that can track a beating heart and compensate for its motion, allowing a surgeon to operate on it without having to stop the heart! He then wraps up the interview by speaking about soft actuators that allow surgeons to move the robot arms around manually with as much effort as moving a feather.
Neuromate was the first robotic system designed to perform stereotactic brain surgery.
was the first robotic system designed to perform stereotactic brain surgery. The system is currently used to aid surgeons in the execution of stereotactic neurosurgical procedures. It was designed by Integrated Surgical Systems Inc. and was designed to performs surgeries using the VoXim™, IVS Software Engineering software system. The image guided, computer controlled device manipulates a 6 jointed robotic arm, allowing for 5 degrees of freedom.The NeuroMate system gained FDA approval in the summer of 1999.
NeuroMate can be used with the patient’s head either placed in a frame or without a frame during surgery; the difference between the two is the accuracy of the imaging displayed, with the frameless method currently less accurate but improving. The robotic and software system interact, providing a 3D view of anatomical structures of the brain using CT or MRI scans. Once a plan is formed the surgeon will control the arm, using the imaging displayed on a PC as to guide the operation.
A wide range of neurosurgical procedures including:
•Removal of brain tumors
•Movement disorder surgery (for disorders such as parkinsons)
•Implantation of devices to stimulate the brain (in order to alleviate the symptoms of epilepsy)
NeuroMate is useful in neurosurgery only
NeuroMate’s PC based planning system was created so that it easily interfaces with other popular planning systems offered by other companies. The machine augments surgical skill and greatly reduces fatigue, making long operations less difficult. The accuracy of the robot also decreases operation time, especially operations involving multiple biopsies.
NeuroMate is useful in neurosurgery only, not a number of different applications like Da Vinci (and other similar products). This device is very expensive and with very few machines being purchased, it is not economically viable for the developer/producer to continue marketing the product. In a similar vein, neurosurgery is less common and less profitable than heart and many other surgeries, therefore it is less attractive for hospitals to spend such a large amount of money on this device......
The major question facing advancements like robotic surgical products is whether or not they make procedures too expensive. Recently, studies like the one completed by J Morgan et al have looked at this issue. Morgan et al’s study found that, unless you include the initial investment cost, there is no significant difference in cardiac surgery cost with or without robotics. Therefore, once hospitals got past the initial cost of purchasing products like the da Vinci Surgical System or the Medtronic StealthStation, there would not be additional costs to face. Total hospitalization costs in the study ranged from $7,000-14,000 with robotic assistance and $4,000-11,000 without assistance, depending on the type of surgery. OR time was found to be a major factor in the difference in cost found in the study. This factor would probably be reduced significantly as surgeons gained more experience using robotics. Therefore, the difference in cost, which is already found to be insignificant, will probably actually be smaller.
While technological advancements in robotic surgery and computer assist devices are impressive and the applications vast, these technologies are expensive and require mastery by the surgeon. Given the complexity in surgical procedures and the high incidence of unexpected complications, we are still far from the day when robots reign in the operating room. For more information Click here
A new view of robotic surgery.
Designed to work with the magnetic-resonance imaging systems already integrated into operating rooms, a new type of robotic system takes a different approach to enhancing surgical vision.
By Dr. Garnette R. Sutherland, Jason W. Motkoski, Catherine O. Sutherland, and Alexander D. Greer.
May 12, 2008, Faculty of Medicine, UCalgary, Alberta: neuroArm procedure a first in the world, performed at Foothills Medical Centre.
Advances in neurosurgery have paralleled technological development–particularly in terms of lesion localization and microsurgical technique–for many years. Incorporating robotic technology into the surgical imaging environment couples the human ability to predict based on past experience with the increased precision and accuracy of machines. It takes surgery “beyond the limits of the human hand,” to quote Intuitive Surgical (Sunnyvale, CA), maker of the endoscopic da Vinci instrument, the most widely used surgical robotic system (with more than 1000 installations).
But while da Vinci has had tremendous success in urologic surgery (particularly for prostate cancer removal) among other areas, such existing systems are not ideal for neurosurgery. Ideally, a neurosurgical robotic system would integrate with installed imaging systems, including the ubiquitous magnetic-resonance (MR) imaging machines that have already been successfully integrated into the operating room.
A different approach to robotic surgery, neuroArm (developed in collaboration between the University of Calgary and MacDonald Dettwiler and Associates)is not an endoscopic system, but rather an image-guided robotic system capable of both stereotaxy (biopsy) and microsurgery. It is MR-compatible–meaning that it operates within an MR imaging machine.
For microsurgery, it transports MR images of the entire brain to the surgeon, who controls the robot at a workstation. Two high-definition cameras mounted to the surgical microscope provide a three-dimensional (3-D) view of the surgical site, transmitting optical imagery to two miniature monitor displays at the workstation.
For stereotactic procedures or stereotaxy, one arm is mounted on a platform within the magnet. In this configuration, the surgeon working at a workstation is able to obtain the biopsy during MR imaging. This is important because it provides direct confirmation that the sample has been acquired from the correct location and that the biopsy procedure has not resulted in an undesirable event.
Click on image to enlarge
FIGURE 2. The neuroArm mobile base includes attached manipulators, a field camera, and a digitizing arm.
While MR compatibility empowers neurosurgery, it challenges system design, limiting the choice of component materials to those that are not ferromagnetic–for example, titanium, PEEK (polyetheretherkeytone), and Delrin, ceramics, or piezoelectrics. It is vital that MR image acquisition does not affect the robot and that the robot does not affect MR image quality.
The setup includes two manipulators (arms) on a movable base platform, a workstation, and a system-control cabinet (see Fig. 1). A variety of visualization tools tie the system together. The manipulators have seven degrees of freedom (DOF) and are designed to hold a variety of standard surgical tools (see Fig. 2). Ultrasonic piezoelectric motors provide 100 nm resolution and have inherent braking characteristics in case power is lost. Sine/cosine 16-bit absolute encoders allow 0.05-degree accuracy and are used on the input and output of each joint to provide fault detection in the event that one encoder should fail. Antibacklash gears manufactured from titanium and machined to extremely tight tolerances allow smooth motion.
Custom six-axis, force/torque sensors provide feedback of tooltip forces in three translational DOF. Those located directly between the tool and end effector provide high-fidelity haptics to the hand controllers for enhanced surgical dissection. Such force feedback also provides a method by which dissection can be quantified, and thus, an ability to set limits on force exerted by the surgeon.
A standardized tool interface allows for roll and actuation while ensuring that the tool can not be accidentally disengaged. The design permits rapid tool exchange, minimizes disruption of surgical rhythm, decreases chance of tool damage, and allows draping to maintain sterility.
The mobile base serves as the positioning mechanism for the manipulators, the digitizing arm used for manipulator registration, and the surgical field camera. In stereotactic mode, the base is used to transfer one of the manipulators to a platform mounted inside the gradient insert of the magnet (see Fig. 3). Within the magnet, the manipulator and biopsy tool are registered to the MR images. A single camera was not able to capture all of the critical components simultaneously, so the system includes two MR-compatible cameras mounted on the platform that transmit images of the manipulator, surgical tool, and surgical site to the surgeon at the workstation. In this configuration, biopsy can be performed and the sample easily transferred out of the gradient aperture.
A 980 nm contact diode-laser system (Photomedex; Montgomeryville, PA) is currently being integrated with neuroArm. In contact laser surgery, the laser beam is contained within a sapphire tip at the distal end of the fiber, rather than passing directly out of the fiber. The light energy remains within the sapphire tip until contact is made with tissue. Penetration of the laser energy is less than 0.5 mm because the 980 nm wavelength is highly absorbed by the water in tissue, minimizing damage to adjacent structures. This wavelength is also absorbed by proteins, allowing coagulation of vessels up to 0.5 mm. When attached to the neuroArm tool interface, the surgeon is uniquely provided a laser with a sense of touch.
The view from the workstation.
FIGURE 3. Precise stereotactic biopsy and implantation with near-real-time MR image-guidance is facilitated by the NeuroArm manipulator, which is mounted on a platform attached to the 3 Tesla MR system gradient insert. The inset shows a view from the opposite end of the magnet.
FIGURE 4. The neuroArm workstation houses two video and two touch-screen monitors, haptic hand controllers, and acoustic interface to recreate, respectively, the sight, touch, and sound of surgery.
The sensory-immersive workstation is located in a room adjacent to the operating room (see Fig. 4). The workstation comprises two video monitors, two touch-screen computer displays, a stereoscopic display unit, and two force-feedback hand controllers.4 The leftmost monitor displays a 2-D image from the surgical microscope, while the rightmost monitor provides the field camera view. A Leica OH4 surgical microscope (Leica Microsystems (Schweiz); Heerbrugg, Switzerland), was modified to provide stereoscopic video output to the workstation. This microscope provides excellent optics and can be moved in the x, y, and z planes using a footswitch that is remotely located at the workstation.
The two touch-screen displays are located directly to the left and right of the surgeon. Magnetic-resonance images are uploaded onto the left touch-screen display and can be manipulated in either 2-D or 3-D and used for surgical planning. Such a display, together with virtual tool overlay, allows visualization of the lesion in relation to the tools from any chosen angle. This enhances surgical vision by providing knowledge of the location of structures outside the surgical corridor. The other touch-screen display shows a virtual representation of the manipulators, radio-frequency coil, and, when in stereotactic mode, the MR magnet with gradient insert. This display provides interactive rolling of the 3-D image, and includes command settings and robot status.
Two high-definition cameras (Ikegami Tsushinki Co.; Tokyo, Japan) mounted on the surgical microscope are used in microsurgery mode and they are the eyes of the surgeon at the workstation. They transmit to two miniature full-color displays (Rockwell Collins; Cedar Rapids, IA), providing the surgeon with a stereoscopic or 3-D view of the operative site. The two miniature full-color displays are currently being upgraded to high definition. Two PHANTOM haptic hand controllers were altered with a stylus and actuator to better mimic conventional surgeon-tool motion and actuation. The stylus includes a finger-activated lever for tool actuation; has a strain-gauge switch for enabling or disabling the manipulators; and allows six DOF, position, and orientation. Two-way audio communication is supplied between the operating room personnel and surgeon. A microphone positioned adjacent to the surgical field provides the surgeon with the acoustics of surgical dissection. For complete article Click here
Canadian researchers have made history with the launch of their NeuroArm, which is the world's first MRI-guided neurosurgical robot.
NeuroArm: Navigating the Future of Surgery Wednesday, November 7, 2007
Brain surgery has stepped into a bright new era where high-precision robots will do the job, guided by sophisticated imaging systems and a surgeon's skill at a computer. "NeuroArm" -- the world's first MRI-compatible, image-guided surgical robot -- promises to dramatically increase surgical accuracy and safety by liberating it from the constraints of the human hand. Patients should see better surgical outcomes and fewer repeat surgeries for tumours that can grow back if not completely removed.
Unveiled in Calgary in April 2007, NeuroArm is the brainchild of Dr. Garnette Sutherland, professor at the University of Calgary's Faculty of Medicine and neurosurgeon for the Calgary Health Region. In a six-year project that turned concept into reality, Dr. Sutherland guided a multidisciplinary team of Canadian university and industry-based scientists, including NRC biodiagnostics and materials researchers. NeuroArm was built in collaboration with MacDonald, Dettwiler and Associates Ltd., the Ontario-based robotics company that built the two Canadarms used on NASA space shuttles.
"NeuroArm offers enhanced dexterity and accuracy, even at microscopic levels," Dr. Sutherland explains. "Surgeons will no longer have to stand over a patient's head for hours, fighting off tremor or fatigue while executing high-precision work. This new technology allows surgeons to manipulate tools from a computer workstation, leaving the actual surgery to the robotic arm," he says.
NeuroArm came to life through a unique partnership among medical, engineering and physics researchers as well as philanthropists, government organizations and the high-tech sector. Dr. Sutherland credits NRC and its spin-off company, IMRIS, for one of the major attributes of neuroArm: its capacity to integrate high-resolution real-time imaging of the brain during an operation.
Dr. Boguslaw Tomanek leads NRC's magnetic resonance (MR) team in Calgary. Several years ago, he and Dr. Scott King, who manages NRC's magnetic resonance prototyping facility in Winnipeg, began working with Dr. Sutherland on ways to combine MR imaging with robotics. He remembers early conversations with the visionary Dr. Sutherland who wondered whether surgeons -- connected to a space mission by computer -- could one day guide a surgical robot to operate on a sick astronaut orbiting in space. "Dr. Sutherland was extremely curious about technology, and was very open to new ideas," recalls Dr. Tomanek.
NRC's expertise in magnetic resonance imaging played a significant role in developing neuroArm. "Several years ago, we designed and made the prototype of the intraoperative MRI system now installed at Calgary's Foothills Hospital," says Dr. Tomanek. "That basic technology was commercialized by IMRIS, and many surgeons were trained to use it. The work to create the MRI-compatible robotic arm came out of this earlier work on imaging systems."
In the field of magnetic resonance imaging, NRC is known for its expertise in radio-frequency (RF) coils. "The coil creates the radio frequency field needed to image internal organs. Correct positioning, high image quality and orientation of the coil are critical as the magnet moves over the patient's brain, yet the coil cannot get in the way of the robotic arm," says Dr. Tomanek. "We had to design a dedicated RF coil to accommodate the robot's access to the brain."
In addition to designing a unique RF coil with access portals, NRC also guided research on the innovative materials required to make the robotic arm compatible with MRI scanning during surgery. "We performed a great deal of computational work to come up with an RF coil design and materials that would work properly together," says Dr. Tomanek. "And, given the requirements of the operating theatre, the coil had to be made of materials that could be regularly cleaned and sterilized." For more information on NeuroArm
NeuroArm Neurosurgery Robot makes Medical History
The neuroArm medical robot made it into history’s books after successfully assisting doctors perform delicate brain surgery to remove an egg-sized cancer tumour. May 16, 2008
21-year old Paige Nickason who is recovering after having a tumour removed from her brain with the assistance of neuroArm, a surgical robotic system developed by a team led by Dr. Garnette Sutherland, a Calgary Health Region neurosurgeon and professor of neurosurgery in the University of Calgary Faculty of Medicine.
"I had to have the tumour removed anyway so I was happy to help by being a part of this historical surgery,” says Nickason.
neuroArm is the world’s first MRI-compatible surgical robot capable of both microsurgery and image guided biopsy. The surgical robotic system is controlled by a surgeon from a computer workstation, working in conjunction with intraoperative MR (magnetic resonance) imaging.
Dr. Sutherland developed the intraoperative MRI machine with Winnipeg-based IMRIS Inc. The technology allows a high field MRI scanner to move in to the operating room on demand, providing imaging during the surgical procedure without compromising patient safety.....read full Press Release
Since Pages' succesful surgery the neuroArm has been used to successfully treat dozens more patients. A private publicly traded medical device manufacturer based in Winnipeg, Manitoba, IMRIS purchased the neuroArm technology.
Further developments are to be expected as MDA and IMRIS are now in the process of producing a two-arm commercial version of the system that will allow surgeons to see detailed three-dimensional images of the brain, as well as surgical tools and hand controllers for use of surgeons to feel tissue and apply pressure when doing an operation.
Dr. Sutherland is currently conducting a clinic trial at Calgary's Foothills hospital using the first generation of the robot. IMRIS anticipates being in a position to seek regulatory approval for the robot as early as 2012.
Meanwhile, the MDA is pursuing to apply its space technologies and know-how to medical solutions for life on Earth, partnering with the Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, to collaborate on the design and development of an advanced technology solution for pediatric surgery.
Dubbed KidsArm, the sophisticated tele-operated surgical system's design is for operations on small children and babies, particularly in conjunction with a high precision real-time imaging technology, to reconnect delicate vessels such as veins, arteries, or intestines., the Canadian Space Agency report said.
CALGARY – When Harvey Cushing and William Bovie introduced electrocautery (which uses a high-frequency current to seal blood vessels or make incisions) in 1926, their innovation transformed neurosurgery. Given the precision required to operate on an organ as delicate as the brain, the convergence of mechanical technologies with the art of surgery catalyzed progress in the field........read more
The StealthStation, a product of Medtronic Surgical Navigation Technologies, is a three-dimensional imaging system that allows surgeons to navigate through the body
a product of Medtronic Surgical Navigation Technologies, is a three-dimensional imaging system that allows surgeons to navigate through the body. It is a next generation product that combines images from a variety of traditional sources. Some of these include X-ray, computerized tomography(CT), magnetic resonance imaging(MRI), and ultrasound. By combining such a variety of imaging techniques, the StealthStation allows for more precise three-dimensional images so the surgeon can focus on the exact location desired.
The StealthStation analyzes pre-operative diagnostic scans to create three-dimensional images used by the surgeon to map out the safest and least invasive surgical path. Real time images are continually produced throughout the surgery. By merging images from multiple sources, the StealthStation allows surgeons to view their targets from any angle. Lastly, images of instruments are incorporated into images of the patient’s anatomy allowing the surgeon to see the exact location of the instrument in three-dimensions and in real time.
Orthopedic Joints/Trauma – total knee replacement, total hip replacement, trauma
Ear, Nose & Throat – functional endoscopic sinus surgery, laterl and anterior skull base surgery
By providing advanced three-dimensional imaging the StealthStation allows surgeons to pinpoint exact locations and targets without damaging nearby tissue by offering views from normally impossible angles and by including the instrumentation in the images. Due to the fact that surgeries are minimally invasive, pain, scarring, and recovery time are all reduced. The wide variety of surgeries that can make use of this product is also an advantage. Proper positioning can still be found even when the patient’s anatomy is atypical. Specifically, when using the StealthStation in spinal surgery, the patient is subjected to a reduced amount of radiation exposure.
Just like the da Vinci System, the major drawbacks to using the Medtronic StealthStation are its large initial investment cost and the inherent learning curve present when surgeons must use a new system they aren’t used to. For more information Click here
Sofie Surgical Robot
TU/e researcher Linda van den Bedem
Better surgery with new surgical robot with force feedback Published on: 28 September, 2010
TU/e researcher Linda van den Bedem developed a compact surgical robot, which uses 'force feedback' to allow the surgeon to feel what he/she is doing. Van den Bedem intends to market
The workstation from which the surgeon controls the robotic arms and surgical tools
Like several of the previous generations of surgical robot, Sofie is a master-slave design. The two components (master and slave) are completely separated from each other, however, with all communication between the two taking place over data cables arranged in an overhead wiring boom.
The master, or control console, is a workstation from which the surgeon controls the robotic arms and surgical tools. The workstation consists of a monitor on which an image of the work area is shown, plus a number of force-feedback joysticks. The console was designed to be a separate module from the slave, which allows it to be placed at some distance from the surgical table; this means that personnel working at the table will not be hampered in their movement by a large control console in the vicinity of the table. The master console was developed by ir. Ron Hendrix.
The slave is a robotic arm frame which can accommodate three independent manipulators
The slave (the actual subject of dr.ir. Van den Bedem's thesis) is a robotic arm frame which can accommodate three independent manipulators (two for surgical tools, one for a camera). The frame for the manipulators is of the type used for pick-and-place robots, allowing the manipulators full freedom of motion in space. This means that the surgeon can also choose the optimal direction of approach for any organ, rather than having to move the patient to suit the machine. Of course the manipulators also provide force feedback through the overhead cable boom.
In addition to having a large degree of freedom, the Sofie slave is also quite compact when compared to the generation of surgical robots in current use. Whereas the current generation requires a large robot arm installation next to the surgical table, the slave is small enough to be clamped onto the surgical bed itself. This means that the slave moves with the bed when the surgical table is moved or adjusted and doesn't have to be adjusted separately for the new position of the table in the operating room.
Commercial advantages and exploitation
Another advantage to the design of Sofie is that its construction is cheaper than that of the previous generation of robot. Although there is no notion yet of what a Sofie-like robot would cost in a commercial offering, it is already clear that the design allows for a robot that costs substantially less than the €1,000,000 average of the da Vinci Surgical System.
As of October 2010, dr.ir. Van den Bedem is investigating the possibilities for commercial exploitation of the basic design. The expectation however, is that any robot could only be available in the market by 2016 at the earliest.
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