Understanding Robotic Surgery
The Recent advances in robotic surgery are incredible feats that have changed the game of medicine over the last three decades. Known for its revolutionary nature, this technology has fascinated the medical community with its undeniable benefits. Let’s dive into the world of robotic surgery and explore its rise.
The Shortcomings of Minimally Invasive Surgery
Before the emergence of robotic surgery, minimally invasive surgery (MIS) was the primary choice for many medical procedures. However, MIS had its limitations. It lacked the tactile and force-related sensations crucial for accurate surgical operations. Furthermore, the instruments used in MIS had only four degrees of motion, unlike the human wrist and hand, which offer seven degrees of motion. Additionally, physiological tremors often affected the precision of MIS procedures.
The Birth of Surgical Robots
The journey towards robotic surgery began in 1985 with the introduction of the Puma 560, a robot designed for neurosurgical biopsies. Soon after, the transurethral resection of the prostate was successfully performed using robotic assistance. These early developments laid the foundation for what would follow.
Telesurgery and Beyond
As telesurgery gained momentum, the National Air and Space Administration (NASA) Ames Research Center played a pivotal role in advancing surgical robotics. The Automated Endoscopic System for Optimal Positioning (AESOP), introduced in 1990, was a significant breakthrough. This voice-controlled camera holder paved the way for further innovations.
The Rise of the da Vinci System
One of the most prominent advancements in surgical robotics is the da Vinci system by Intuitive Surgical Inc. This advanced master-slave system boasts multiple robotic arms or manipulators controlled remotely by a surgeon from a console. Unlike its predecessors, the da Vinci system employs miniaturized operating arms, eliminating the need to retract incisions. Its Endo-Wrist technology provides seven degrees of freedom, offering unprecedented dexterity. Newer systems have adopted ergonomically superior open consoles.
Overcoming Size and Cost Barriers
Traditional robotic systems like the da Vinci pivot around the insertion trocar, limiting their dexterity and posing a risk to adjacent vital structures. Moreover, their large size and cost hinder their widespread adoption. Laparo-endoscopic single-site surgery (LESS) robots have made strides by allowing the insertion of cameras and instruments through a single incision, often resulting in no visible scarring. Smaller systems like the SurgiBot-SPIDER aim to make robotic surgery more cost-effective, but they are still awaiting FDA approval.
The Era of Flexible Robots
Recent developments have given rise to robots constructed from soft, flexible materials. Biocompatible materials and 3D-printed soft plastics enhance safety by allowing robots to change shape and mechanical properties in response to touch. These robots also offer greater instrument flexibility and elongation options, optimizing their precision.
Advancements in Haptic Feedback
Tissue property modeling has paved the way for haptic feedback in robotic surgery. Robots now sense the force applied by shape reconstruction, enabling active adjustment of the payload. Variable stiffness in different segments of an endoscope allows flexible movement within soft organs without complications.
Biomimetic Robots: Nature-Inspired Innovation
Everting pneumatic tubes have led to the development of biomimetic robots that can elongate, maneuver through tight spaces, and navigate corners with ease. Inspired by nature, these robots hold promise for remote manipulation.
Notable Robotic Surgical Systems
Innovations continue to flourish in the field of robotic surgery. Newer colonoscopic surgical robots focus on adjustable stiffness, detectability, bendability, and controllability. For instance, the “Endotics” system mimics inchworm-like mobility to enhance colonoscopic accuracy. Constrained tendon-driven serpentine mechanisms expand the workspace, improving control over bending.
The NeoGuide colonoscopy system introduces compliance, safe interaction with the body, actuation, sensing, dexterity, and an extended workspace. Its unique design allows for variable stiffness control, enhancing patient comfort during endoscopy.
Specialized Robotic Systems
Robotic technology has also found applications in neurosurgery. The Minimally Invasive Neurosurgical Intracranial Robot (MINIR) utilizes advanced mechanisms for brain tumor removal. Cable-driven systems like the Flex system offer increased flexibility while occupying less space than traditional alternatives.
Exploring Unconventional Designs
In the quest for innovation, robotic designers have drawn inspiration from nature. The Meshworm and Invendoscope mimic earthworm movement for colonoscopy procedures, while the STIFF-FLOP soft robot emulates the dexterity of an octopus arm, offering modular stiffening and bending capabilities.
Pushing Boundaries with the Aer-O-Scope
The Aer-O-Scope, an Israeli creation, is a self-propelling colonoscope. It relies on carbon dioxide propulsion, eliminating the need for external pushing. This innovation enhances patient comfort during colonoscopy.
Remote Guidance under MRI-Based Systems
Incorporating robotics into MRI-based guidance has improved the detectability of scopes. By eliminating electromagnetic interference, these systems offer precise control and enhanced safety.
Expanding Horizons: Imaged-Guided Therapy
Noninvasive robots have also found their place in imaged-guided therapy. The CyberKnife, an FDA-approved platform, combines robotics with image-guided radiosurgery. High-intensity focused ultrasound (HIFU) therapy, coupled with robotic manipulators, promises non-invasive thermotherapy.
The Future of Robotic Surgery: NOTES and Beyond
Advancements in robotic technology have brought natural orifice transluminal endoscopic surgery (NOTES) closer to reality. These innovations offer increased instrument stability, traction, proper positioning, dexterity, and imaging quality, making surgery truly non-invasive.
Miniature In Vivo Robots: A Leap Forward
Miniature in vivo robots, developed by Virtual Incision and the Center for Advanced Surgical Technology (CAST), introduce a novel approach. Entire MIS surgical platforms are inserted into the peritoneal cavity. These robots, equipped with two arms and multiple functionalities, offer scarless surgery and can be operated by inexperienced surgeons under the guidance of experts. Their mobility and versatility extend patient access to various settings, from outer space to remote medical emergencies.
Capsule Robots: Tiny Marvels
Capsule robots, miniature endoscopes, find utility in diagnostics, surgeries, and drug delivery. Manipulated via magnetic interactions, these untethered devices offer exceptional freedom of movement, causing minimal tissue damage and ensuring rapid accessibility.
A Glimpse into the Future: Microbots
Microbots, although a futuristic concept, hold immense potential. They require no incisions and can be introduced into the circulatory system, navigating to specific destinations.
Revolutionizing Surgery with Microrobots
Microrobots represent a departure from traditional master-slave systems, offering unparalleled access, telemanipulation accuracy, and miniaturized functionality. As technology evolves to address key challenges, microrobots stand poised to revolutionize the field of surgery.
Conclusion
The journey of robotic surgery, from its inception to its current state, is a testament to human innovation and the relentless pursuit of excellence in medical science. With each advancement, the horizon of possibilities expands, offering the promise of safer, more precise, and increasingly accessible surgical procedures.
References
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