Innovation In Healthcare Using Robotic Assisted Surgery

Group One: Krystal Bowden, Elsa Collins,

Courtney Kallemeres,

Andre Tribble, Willie Nelson

LIS 4368-01: HealthInformatics


Usefulness of Robotic Assisted Surgery In Surgical Procedures

In 1921 (Figure 1), the term “robot” was coined by Karel Capek. Since, then robots have become increasingly important in reality (Ann Surg, 2004). Robots are used to perform many tasks, mostly tasks that humans are incapable of performing such as exploring the sea and manufacturing microprocessors used in computers (Ann Surg, 2004). Robotic Assisted Surgery has improved and evolved since 1985 and has become increasingly more important in the new millennium through the initiative for improving healthcare using technology. Robotics surgery has proven to be very effective, however, limitations remain. The purpose of this report is to provide insight on the use of robotic surgery in the past, present, and future and the effectiveness of robotic assisted surgery in traditional surgical procedures.

History of Robot Assisted Surgery

The term "robotic surgery" surely sounds like an ahead of its time surgical method for refining surgical results. Robotic surgery has truly been a modern development which has been spanning over medical surgeries for more than two decades. The year 1987 (Figure 1)s, first saw the usage of robotics in medical surgeries. Robotic surgery was used for a cholecystectomy, the first laparoscopic surgery ever. Since then, a few robotic surgeries have happened successfully by the use of laparoscopy. This has been possible because of the developed technology and the improved expertise of the surgeons.

This surgery is popular for being minimally invasive. It is so because the incisions are much smaller, risk of an infection is also reduced, restoration duration extremely less, and so, hospital stays are shorter. Robotic surgery equipment requires the surgeon to shift the robotic instruments and arms while looking at a video monitor. The surgeon is ought to move arms and instruments in the contrary direction from the target shown on the monitor, in order to have contact with the correct area on the patient. This demands the surgeons to have force and tactile feedback, superb hand-eye coordination, and dexterity. The use of robotic surgeries involves the restriction in degrees of motion, reduced sense of touch, and higher irritability to actions of the hand.

The da Vinci robotic surgery system, which is utilized by a few current and adequately equipped hospitals and health centers, has broken new grounds. The da Vinci robotic surgery therapy has been approved by the FDA in 2000 (Figure 1), for normal laparoscopic surgeries. The da Vinci robotic surgery fully uses camera or scope based surgical instruments and utensils. The da Vinci method works with a definitely nice three dimensional enlargement view screen, which allows the surgeon to inquire the incision spot superior because of the clarity of lofty resolution. The consequential advancements in laparoscopic surgery are represented by a one centimeter diameter surgical arm, which is a total contrast from the earlier systems. With such tiny sized operating arms, the da Vinci system has eradicated the usage of patient's tissue of the incision walls, for leverage. This enhancement has also allowed for less contact between the surgical device and the exposed internal tissue. This has truly been effective in reducing the chances of an infection. The exact replication of the surgeon's skilled movements has happened due to the usage of the "Endo-wrist" characteristic. These operating arms on the da Vinci system permit the surgeons superior controls. It also allows them to make truly accurate movements, even in a little operating space.

As of October 21, 2010 (Figure 1) the first all robot surgery has been performed. The team of surgeons at McGill University used a da Vinchi robot surgeon and a robotic anesthesiologist to complete the procedure. The robots transmit high definition three dimensional images to the doctor’s computer where it is remotely controlled by Dr. Thomas Hemmerling. The McGill University urologist-in-chief Dr. A. Aprikian points out that that the robots are controlled by surgeons “with a precision that cannot be provided by humans alone”.

The end outcome of this special advancement allows surgeons, across the globe, to execute minimally invasive robotic surgeries. This technology is also being continually researched upon and developed to provide patients a significantly well-advised effect which will embody even lesser ache and uneasiness , lesser recuperation time, practically no scarring, and a faster return to a well and dynamic life. These robotic surgeries have increased the dexterity in numerous ways. These new and improved instruments have improved the surgeon's controls over the instruments for superior command on the patient's tissues. These systems are designed such that the surgeon's moves are compensated through an appropriate hardware and software.

Factors of Robotic Assisted Surgery

Using robotic systems to facilitate surgical procedures requires several important factors that affect the success of robotic assisted surgery. Factors are equipment, surgeons, manufacture engineers, methodology, mechanics, technology, and expense.

Equipment, Manufacture Engineers, and Technology

Before, robotic systems are completed and ready to enter the surgery room, they must be FDA approved. Reducing the limitations of robotic systems, engineers must understand the anatomy of the human body as well as the surgeons’ interaction during surgery. This is important when building the different pieces and components that make-up a robotic system because the systems are made as a replica of the surgeon with greater features which allow the system to perform surgeries that are technically difficult or unfeasible without the assistance of RAS systems (Ann Surg, 2004). Engineers must program each system properly because there are hundreds of robotic systems and the application of each robotic system varies depending on the type of surgical procedure.

Surgeons, Methodology, and Mechanicals

Surgeons are probably one of the most important factors in RAS. All robotic systems used in surgical procedures require human control in order to conduct surgery. Most systems are voice activated by the surgeon in order to perform certain tasks during surgeries, while other systems require surgeons to control the movements of the robot. Using Telehealth services surgeons are able to conduct robotic surgeries remotely. The main issue of robotic and human interaction is surgeon training. Incorporating robotic systems during surgery drastically changes the methodology of traditional surgical procedures. Before, a robot can used in surgery, surgeons are required to attend training courses. The training courses train surgeons how to operate the new system, place surgeons in an environment with the robots in order to become comfortable, perform surgery on dummy patients using the new robotic system, and teach surgeons the new methods and surgical procedures implemented using a robotic system. Training courses are crucial for both, the surgeon and the new robotic system because both have to become familiar with one another and the new surgical procedure in order to perform accurate, successful, and effective surgery.

Expense

Money is always an issue and the use of robots in surgery is no different. Robotic surgical systems range in price from $1 million to $2.5 million for each unit (Glied and Barbash, 2010). The cost for robotic surgical systems are fixed and require costly maintenance and need the of additional consumables (Glied and Barbash, 2010). The total cost of using a robot assisted procedure is approximately $3,200.00 (Glied and Barbash, 2010). Cost for purchasing and implementing robotic surgical systems are extremely expensive and this factor determines the success or downfall of robotic surgical systems.

Surgical Robots

Da Vinci Surgical System

History of The Da Vinci Surgical System

Years of research went into the da Vinci Surgical System, which was a huge leap in the field of medicine, specifically robotic assisted surgery. Intuitive Surgical, a corporation that manufactures robotic surgical systems, is responsible for its creation. It all started back in the late 1980s with a non-profit research institute named SRI International. The research conduectd then, led to funding from the National Institutes of Health, which allowed them to create the prototype of the da Vinci. The Defense Advanced Research Projects Administration received information about it and thought of how it could impact medical care dealing with soldiers were injured on the frontline. It opened up the opportunity for surgeons to operate on the soldiers that were injured through the robotic surgical system. This idea was ingenious and innovative.

From there, more development took place. The year was 1994. A doctor by the name of Frederic Moll was interested in the SRI System, 1995 he found a way to confer with John Freund to gain possession of SRI. During this period the hardware was prototyped. You might wonder how this device was named. Well the da Vinci Surgical System is actually named after Leonardo da Vinci. The first prototype was originally referred to as “Lenny” and as others came about, they were named “Leonardo” and “Mona”, with the final version being named “da Vinci Surgical System.” The reason it was given the name “da Vinci” is because “Leonardo da Vinci invented the first robot”. He also used anatomical accuracy & 3D to display the realness in his works.

The first prototype, “Lenny”, was ready for testing in 1997. Extensive testing was done and Intuitive Surgical started marketing campaigns with this system over in Europe (1999) while waiting for the FDA to give its’ approval in the United States. In 2000, the FDA approved the usage of the da Vinci Surgical System for laparoscopic surgery and later in 2001, it was approved for prostate surgery. Soon after, the FDA also approved da Vinci Surgical System for gynecologic procedures, thoracoscopic surgery and cardiac procedures that included adjunctive incisions.

Intuitive Surgical wasn’t the only corporation who was in the business of creating robotic surgical systems. Computer Motion, Inc. was also a fierce competitor. They placed a lawsuit on Intuitive Surgical for “patent infringement” because of their earlier endeavor known as the ZEUS Robotic Surgical System. The reason being was because ZEUS was approved in Europe before da Vinci, but had not been approved for any procedure before da Vinci was. Later, in 2003, both Computer Motion, Inc. and Intuitive Surgical decided to merge. Shortly thereafter, the ZEUS Surgical System was put to rest to focus more on the da Vinci Surgical System and it has been a success because there are currently over one thousand units worldwide.

Application and Operation of The Da Vinci Surgical System

The da Vinci Surgical System consists of a surgeon’s console that’s usually in the same room as the patient, a patient-side cart and four robotic arms that are controlled from the surgeon’s console. One of the arms are use an endoscopic camera that has two lenses that give the surgeon full stereoscopic vision from the console. The other three hands are used as hands to perform surgery on the patients. They hold items such as scalpel, scissors, electrocautery instruments, etc. The surgery is conducted by the surgeon through the console as he or she looks through the eye holes to see a 3D image rendered of what’s going on. The surgeon moves da Vinci’s arms by using foot pedals and hand controllers. The movements are translated into very precise movements taken out by da Vinci, causing for a very accurate surgery. The da Vinci Surgical System brings a new dimension to laparoscopy where the human can only go so far. Normally, the surgeon would have to operate standing over the patient while holding the instruments in his or her hand, while also looking at a monitor to get a closer view of what they are actually operating on. The da Vinci takes away a lot of the strain by allowing the surgeon to operate while sitting down, using the foot pedals, hand controllers and 3D image monitor. With everything being enhanced, surgeries become less dangerous.

The da Vinci Surgical System is also being used quite frequently in gynecology, both benign and oncology. It opens up the umbrella for all kinds of medical advancements. This system is used to help treat abnormal periods, endometriosis, female cancers, fibroids, ovarian tumors and pelvic prolapse. The procedures that can be done or have been done are hysterectomies, lymph node biopsies and myomectomies. By the performance of da Vinci and how it reduces the need for many incisions, nothing done to the abdominal is necessary.

Orthopilot

History of Orthopilot Navigation System

Orthopilot is a surgical robot primarily used for knee arthroplastys. First developed in 1999, the Orthopilot received a CE marking, meeting European Standards. Recently, in 2001, the Orthopilot received FDA approval and became the first CT-free navigation system in the United States . Since receiving FDA approval the Orthopilot has undergone much development and advancements improve several procedures. Eighty-thousand surgeries have been performed using the Orthopilot Navigation System.

Applications of Orthopilot

Orthopilot is noted for its many applications of joint replacement and repair. The most common applications are Total Knee Arthoplasty, Unicondylar Knee Arthoplasty, Total Hip Arthoplasty, Cartilage Defect Management, Anterior Cruciate Ligament (ACL) Reconstruction, and High Tibal Osteotomy. Among these applications, Total Knee Arthoplasty (TKA) is the primary surgery performed by the Orthopilot.

Operation of Orthopilot

The Orthopilot Navigation System is used to provide physicians with accurate solutions in order to successfully replace large joints during surgery. There are two phases of Total Knee Repair. The preoperative and intraoperative phases. Procedures vary depending on the type of surgery. An overview of the Total Knee Repair surgery and the general methodology of the surgery is described below:

The preoperative phase uses three-dimensional computer modeling, facilitating surgeons assess the patient’s joint and choose the surgical strategy of the patient’s limb. Then, a special CT examination is performed, taking a couple scout views of the leg in extension and accurate scanning of the knee. Step one of planning is identify the limb’s mechanical axis. The surgeon chooses different joints in scout view. Second step, choose the positions for the prosthetic components which is based on more detailed views of the knee. The medio-lateral (ML) and anterior-posterior (AR) orientations are automatically computed by the system which sets the prosthesis axis aligned parallel to the line joining anatomical centers. This procedure provides restoration of the correct mechanical axis of the leg for the two components in frontal and lateral views. Once the ML and AP positions have been recorded the anatomical knee center coincides with the prosthesis center, in order to maintain the anatomical features of the joint. The proximodistal (PD) is also recorded automatically reducing bone loss and to preserve the articular line.