A Brief History

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.

Considerations:

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.

Warning:

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.

ZEUS Robotic Surgical System

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 the;

In 1985 the PUMA 560 was used to place a needle for a brain biopsy using CT guidance.

PROBOT,

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;

In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery.


THE ROBODOC,

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.

Orthopilot

Operation

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.

Applications:

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)

Advantages

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.

Disadvantages

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.

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.

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.

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.

Acrobot Precision Surgical Systems

The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.

Endoscopy Simulator

The EndoscopyVR simulator, manufactured by CAE Healthcare, 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 force feedback sensation, physiological and anatomically correct simulation, didactic aids, metrics reports, vital signs and ability to administer drugs.

Key Features include:

  • Dynamic force feedback
  • Appropriate physiological response and tool behavior
  • Normal and pathological anatomical variations derived from actual patient data
  • Extensive bronchoscopy didactic content, including EBUS-TBNA module
  • Easy course planning and setup for individuals and groups
  • Virtual aids assist in better understanding of anatomy
  • Comprehensive metrics for evaluation of performance

Bronchoscopy modules:

  • Bronchoalveolar Lavage
  • Endobronchial Sampling
  • Transbronchial Needle Aspiration (TBNA)
  • Pediatric Difficult Airways
  • Endobronchial Ultrasound (EBUS)

Gastrointestinal Endoscopy modules:

  • EGD
  • ERCP
  • Flexible Sigmoidoscopy
  • Colonoscopy - Biopsy - Polypectomy

Visit Atrium Health for more information

da Vinci Surgical System & Zeus Surgical System.

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

In 1995, 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 latest Intuitive Surgical numbers

  • 23 Years driving minimally invasive innovation
  • 5M+ MIS surgeries completed by 2017
  • 43,000+ Da Vinci trained surgeons globally
  • 4,400+ Da Vinci systems in 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.

Learn about the latest da Vinci© Systems

The da Vinci X®

the da Vinci SP®

The da Vinci Xi®

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.

da Vinci vs Zeus; Historical Intuitive Surgical / Computer Motion patent infringement lawsuit

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.

Yulun Wang, founder of Computer Motion became the CEO of inTouch Health, which developed the RP -7 Robot

M7 Surgical Robot

SRI’s telerobotic surgical system, M7, expands the reach of surgical intervention by enhancing the precision of minimally invasive procedures and enabling surgeons to operate from afar. 

SRI pioneered telepresence surgery during the 1980s under contract to the U.S. Army. The goal: to develop a battlefield-based trauma surgery system that could be operated remotely by a surgeon. In the 1990s, further technology improvements were made with funding from the National Institutes of Health.

SRI began development of the M7 in 1998, under contract to the Telemedicine and Advanced Technology Research Center. The advanced version of SRI’s original telepresence system features several advantages:

  • Two anthropomorphic robotic arms cover a large workspace and move through seven degrees of freedom
  • Auditory, visual, and tactile sensations, including the force or pressure felt while making an incision, are communicated directly to the surgeon performing the operation
  • Tremor is virtually eliminated, and SRI-developed software compensates for jarring or turbulence that may occur on a moving platform, such as a space vehicle or aircraft
  • Conventional surgical tools can be swapped rapidly by a technician
  • Optics and stereo video processing technology were upgraded

In 2006, SRI successfully demonstrated a remote robotic surgical system as part of the ninth NASA Extreme Environment Mission Operations (NEEMO) in the Aquarius Underwater Laboratory, located 60 feet underwater off the coast of Key Largo, Florida.

For the mission, SRI’s robot electronics were redesigned to permit long-distance operation over IP networks. NEEMO 9 marked the first time an entire robotic surgical system was transported to an extreme environment and manipulated successfully from afar.

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.

                                                                                                                                                                                                                                        Aesop 3000.

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.

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."

Cleared by the 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

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.

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.

Definitions

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.

MIRO - Versatile Robot Arm for Surgical Applications


The DLR MIRO is after the KineMedic the second generation of versatile robot arms for surgical applications, developed at the Institute of 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 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 minimal invasive surgery.

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 its antecessor 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.

DLR MIRO attached to the surgical table

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.

Operation

NeuroMate can be used with the patients 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.

NeuroMate/Then

NeuroMate/Now

The neuromate stereotactic robot provides a platform solution for a broad range of functional neurosurgical procedures. It has been used in thousands of electrode implantation procedures for deep brain stimulation (DBS), and stereoelectroencephalography (SEEG), as well as stereotactic applications in neuroendoscopy, biopsy, and many other research applications.

Benefits of robotic neurosurgery

  • The neuromate robot provides consistent, rapid and precise targeting in stereotactic procedures.
  • The neuromate system is routinely used in most centres where it is in operation and has pride of place as the cornerstone of functional and stereotactic procedures.
  • The neuromate robot can be used with a stereotactic frame, or in frameless mode for reduced patient trauma. It is also compatible with procedures using both general and local anaesthesia...

NeuroArm.

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.

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.

May 12, 2008, Faculty of Medicine, UCalgary, Alberta: neuroArm procedure a first in the world, performed at Foothills Medical Centre.

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.

System components.

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.

FIGURE 1. The complete neuroArm system setup includes the manipulators, main system controllers, workstation cabinet, and the workstation replete with imaging tools and controls. Intraoperative Magnetic Resonance Imaging provides updated assessment of the procedure.

FIGURE 2. The neuroArm mobile base includes attached manipulators, a field camera, and a digitizing arm.

The view from the workstation

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.

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.

NeuroArm Neurosurgery Robot makes Medical History

Dr Garnette Sutherland (left) and Paige Nickason at the press conference. Nickason is recovering after having a tumor removed from her brain with the assistance of neuroArm, a surgical robot system developed by a team led by Sutherland / photo by Ken Bendiktsen

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.

Sofie Surgical Robot.


Better surgery with new surgical robot with force feedback
Published on: 27 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

"Sofie"

"Surgeon's Operating Force-feedback Interface Eindhoven".

Design

Like several of the previous generations of surgical robots, 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:

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

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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