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ABSTRACT
Robotic surgery make use of Robots to perform surgery. Major potential advantages of robotic surgery are precision and miniaturization. With our skilled surgeons and the robotic system, we can now use minimally invasive techniques in even the most complicated procedures like Cardiac surgery, Gastrointestinal surgery, Gynecology, Neurosurgery, Orthopedics, Pediatrics, Urology etc.
The software is "command central" for the device's operation, da Vinci, Aesop, Hermes etc. are different kinds of the Robotic systems. The combination of increased view and tireless dexterity is helping us to overcome some of the limitations of other types of less invasive surgery.
1. INTRODUCTION
Robotic surgery is the use of robots in performing surgery. Major potential advantages of robotic surgery are precision and miniaturization. Further advantages are articulation beyond normal manipulation and three-dimensional magnification. At present, surgical robots are not autonomous, but are always under the control of a surgeon. They are used as tools to extend the surgical skills of a trained surgeon.
Robotic surgery is different from minimally invasive surgery. Minimally invasive surgery (sometimes called laparoscopic surgery) is a general term for procedures that reduce trauma by performing operations through small ports rather than large incisions. Minimally invasive surgery is now commonplace for certain procedures. But until now, we haven't been able to use minimally invasive techniques for more complex operations. With our skilled surgeons and the robotic system, we can now use minimally invasive techniques in even the most complicated procedures like Cardiac surgery, Gastrointestinal surgery, Gynecology, Neurosurgery, Orthopedics, Pediatrics, Urology etc.
2. HISTORY
In 1985 a robot, the PUMA 560, was used to place a needle for a hip replacement Intuitive Surgical System introduce the da Vinci Robot in 1995 and Computer Motion, AESOP and the ZEUS robotic surgical system.. In 1988, the PROBOT was used to perform prostatic surgery in England. The ROBODOC from Integrated Surgical Systems was introduced in 1992, and is a robot to mill out precise fittings in the surgery. In 2001, Marescaux used the Zeus robot to perform a surgery.

3. DIFFERENT TYPES OF ROBOTIC SYSTEMS
Computer Motion of Santa Barbara California has become the leading producer of medical robotics. Different types of robots are da Vinci, Aesop, Hermes, and Zeus.
The da Vinci Surgical System was the first operative surgical robot. Products like Aesop, Hermes, and Zeus are the next generation of surgical equipment and are used together to create a highly networked and efficient operating room.
3.1. da Vinci Surgical System
Incorporating the latest advancements in robotics and computer technology, the da Vinci Surgical System was the first operative surgical robot deemed safe and effective by the United States Food and Drug Administration for actually performing surgery.
The da Vinci system was developed by Intuitive Surgical system, which was established in 1995. Its founders used robotic surgery technology that had been developed at SRI International, previously known as Stanford Research Institute. The FDA approved da Vinci in May 2001
The da Vinci is a surgical robot enabling surgeons to perform complex surgeries in a minimally invasive way, in a manner never before experienced to enhance healing and promote well-being. It is used in over 300 hospitals in the America and Europe. The da Vinci was used in at least 16,000 procedures in 2004 and sells for about 1.2 million dollars.
Until very recently surgeons options included traditional surgery with a large open incision or laparoscopy, which uses small incisions but is typically limited to very simple procedures. The da Vinci Surgical System provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting a
surgeon's hands at the controls ofa 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. It is important to know that surgery with da Vinci does not place a robot at the controls; surgeon is controlling every aspect of the surgery with the assistance of the da Vinci robotic platform. Thus da Vinci is changing the experience of surgery for the surgeon, the hospital and most importantly for the patient.
3.2. Aesop
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.
3.3. Zeus
Zeus is the youngest and most technically advanced robotic aid. Zeus contains robotic arms that mimic conventional surgical equipment and a viewing monitor that gives the surgeon a view of his operative field. More importantly, Zeus enables a surgeon to operate on a patient using joystick like handles which translate the surgeon's hand movements into precise micro-movements inside the patient. For example a 1-cm movement by a surgeon's hand is translated into a .1 cm movement of the surgical tip held by a robotic arm. Zeus also has the unique capability of reducing human hand tremor and greatly increasing the dexterity of the surgeon. Zeus allows surgeons to go beyond the limits of MIS enabling a new class of delicate procedures currently impossible to perform. The main disadvantage is high machine cost. It is around 1 million dollars. Its FDA approval is pending.
3.4. Hermes
Unlike Aesop and Zeus, Hermes does not use robot arms to make the Operating Room more efficient. Rather Hermes is 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
4. WORKING OF ROBOTIC SYSTEM
Today's robotics devices typically have a computer software component that controls the movement of mechanical parts of the device as it acts on something in its environment The software is "command central" for the device's operation.
Surgeon sits in the console of the surgical system several feet from the patient. He looks through the vision system - like a pair of binoculars - and gets a huge, 3-D view of inside the patient's body and area of the operation.
The surgeon, while watching through the vision system, moves the handles on the console in the directions he wants to move the surgical instruments. The handles make it easier for the surgeon to make precise movements and operate for long periods of time without getting tired.
The robotic system translates and transmits these precise hand and wrist movements to tiny instruments that have been inserted into the patient through small access incisions.
This combination of increased view and tireless dexterity is helping us overcome some of the limitations of other types of less invasive surgery. It's also allowing us to finally use minimally invasive surgery for more complex operations.


Figure. 1: Operating Room
The working of da Vinci is explained as follows.
There are four main components to da Vinci: the surgeon console, patient-side cart, Endo Wrist Instruments, and Insite Vision System with high resolution 3D Endoscope and Image Processing Equipment

Figure.2: da Vinci Surgical System

4.1. Surgeon Console
The surgeon is situated at this console several feet away from the patient operating table. The surgeon has his head tilted forward and his hands inside the system's master interface. The surgeon sits viewing a magnified three- dimensional image of the surgical field with a real-time progression of the instruments as he operates. The instrument controls enable the surgeon to move within a one cubic foot area of workspace.


Figure.3: Surgeon Console
4.2. Patient-side Cart
This component of the system contains the robotic arms that directly contact the patient. It consists of two or three instrument arms and one endoscope arm. As of 2003, Intuitive launched a fourth arm, costing $175,000, as a part of a new system installation or as an upgrade to an existing unit. It provides the advantages of being able to manipulate another instrument for complex procedures and removes the need for one operating room nurse.


4.3. Detachable Instruments
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.

Figure.5: Robotic Arm
4.4. 3-D Vision System
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.
5. ADVANTAGES
Robotic surgery offers many benefits over traditional surgery. The Robotic Surgical System is great for patients and for surgeons. Robotic surgery gives us even greater vision, dexterity and precision than possible with standard minimally invasive surgery, so we can now use minimally invasive techniques for a wider range of procedures. The patient side benefits include,
¢ Reduced pain and trauma
¢ Fewer complications
¢ Less blood loss and need for transfusions
¢ Less post-operative pain and discomfort
¢ Less risk of infection
¢ Shorter hospital stay
¢ Faster recovery and return to work
¢ Less scarring and improved appearance

6. LIMITATIONS
¢ Current equipment is expensive to obtain, maintain, and operate.
¢ Surgeons and staff need special training.
¢ Data collection of procedures and their outcomes remains limited.

7. CONCLUSION
Robotic surgery is an emerging technology in the medical field. It gives us even greater vision, dexterity and precision than possible with standard minimally invasive surgery, so we can now use minimally invasive techniques for a wider range of procedures. But it's main drawback is high cost. Besides the cost, Robotic System still has many obstacles that it must overcome before it can be fully integrated into the existing healthcare system. More improvements in size, tactile sensation, cost, and are expected for the future

8. REFERENCE
¢ stronghealth.com
¢ computermotion.coin
¢ intuitivesurgical.com -
¢ ctsuse.edu com
¢ cn.wikipedia.org
CONTENTS
1. INTRODUCTION 1
2. HISTORY 2
3. DIFFERENT TYPES OF ROBOTIC SYSTEMS 3
3.1. DA VINCI SURGICAL SYSTEM 3
3.2. AESOP 4
3.3. ZEUS 4
3.4. HERMES 5
4. WORKING OF ROBOTIC SYSTEM 6
4.1. SURGEON CONSOLE 9
4.2. PATIENT-SIDE CART 9
4.3. DETACHABLE INSTRUMENTS 10
4.4. 3-D VISION SYSTEM 11
5. ADVANTAGES 12
6. LIMITATIONS 13
7. CONCLUSION 14
8. REFERENCE 15

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ROBOTIC SURGERY AND ITS APPLICATION

ABSRACT
Surgery is a field of study that deals mainly with lives especially that of the human life. A lot of activities take place in the theatre, as surgeons and other medical personnel are usually faced with problem of saving human live via surgical operations. Sometimes, errors occur in course of operating on delicate parts of the body, which might result to severe injury and sometimes death due to inaccuracy on the side of surgeons. This is the reason why it is imperative that the issue of error should be corrected using a well developed machine called ROBOT to perform delicate surgical operations as they can only do that which they have been programmed for.

INTRODUCTION
Robot is a computer-controlled machine that is programmed to move, manipulate objects, and accomplish work while interacting with its environment. Robots are able to perform repetitive tasks more quickly, cheaply, and accurately than humans. The term robot originates from the Czech word robota, meaning “compulsory labor.

Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics.
HISTORY
In 1985 a robot, the PUMA 560 was used to place a needle for a brain biopsy using CT guidance. 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 Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. (Intuitive Surgical bought Computer Motion in 2003; ZEUS is no longer being actively marketed.
The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The device senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the Americas and Europe. The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of Dr. Robert E. Michler, Professor and Chief, Cardiothoracic Surgery.<McConnell PI, Schneeberger EW, Michler RE. History and development of robotic cardiac surgery. Problems in General Surgery 2003;20:62-72.>
• In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.[2]
• In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.

Prepared by:
Aarthi.AKV

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INTRODUCTION:
Robotic Surgery is basically a surgery aided by robots an unmanned and minimal invasive surgery. Here I had taken the application of robotics in performing a brain surgery (COMPUTER-AIDED BRAIN SURGERY). Every Robot has an IQ (Intelligent Quotient) by which it works.


THE WORKING:
The principles and devices used here in implementing come under Image Processing, Analog Digital conversion, Mechanical Interfacing and Integrating and Feedback Signal Processing and Loop Back to Interface. The basic idea behind is primarily to perform a detail mapping of sites of malfunctioned tissue or neurons by assigning a threshold of contrast as well as color differentiation of the sites of brain which are responsible for poor performing perception of outside stimuli, Next is amplification and converting from analog to digital, encoding into machine language i.e. compatible with all the aspects of robot, Next is segmenting the areas of less active neurons for the benefit of easy, accurate accessibility and reach of the robot and for the six degrees freedom of the robot and to perform the surgery sequentially by different mapped areas or phases of direction. The various blood and bio-compatible forceps, screws, knives, needles, tonsils are incorporated for the main purpose. Most important component used is the cryogenic agents are used for preventing bleeding and for clear vision and sharp images for the camera. Suitable anaesthetics find their major role in the process. The whole surgery is performed in a sterilized and environment under immediate attention. To improve the accuracy of the operation GPS is interlaced with the robot. The six degrees of freedom are controlled by six brushless DC servo motors, each coupled with a 500-1000 count multi-channel encoder. The robot can determine its global position from the given feedback information based on segmental pattern. The whole surgery is conducted by a active web camera by a high resolution feed back is fed into the loop for incremental values till the operation is completed to the pre-determined values based on pre-mapping. The risk of error occurance for the robot is minimized by the loop back system incorporated.

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ABSTRACT

The field of surgery is entering a time of great change, spurred onby remarkable recent advances in surgical and computer technology. Only recently have robotic systems made their way into the operating room as dexterity-enhancing surgical assistants and surgical planners, in answer to surgeons' demands for ways to overcome the surgical limitations of minimally invasive laparoscopic surgery.The first generation of surgical robots is already being installed in a number of operating rooms around the world. These aren't true autonomous robots, but they are lending a mechanical helping hand to surgeons. Remote control and voice activation are the methods by which these surgical robots are controlled. Robotics is being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. Robots in the field of surgery have dramatically changed the procedures for the better. The most significant advantage to Robotic Surgery to the patient is the decrease in pain and scaring. The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Besides the obvious rewards to the patient, Robotic Surgery is also very advantageous to the surgeon and hospital.

INTRODUCTION
Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other consumer goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean. In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMO robot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients.

While robotic surgery systems are still relatively uncommon, several hospitals around the world have bought robotic surgical systems. These systems have the potential to improve the safety and effectiveness of surgeries. But the systems also have some drawbacks. It's still a relatively young science and it's very expensive. Some hospitals may be holding back on adopting the technology.
Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery.

History

In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. 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 Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.

• In 1997 a reconnection of the fallopian tubes operation was performed
successfully in Cleveland using ZEUS.

• In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot
performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.

• In October 1999 the world's first surgical robotics beating heart coronary artery
bypass graft (CABG) was performed in Canada using the ZEUS surgical robot.[2]

• In 2001, Prof. Marescaux used the Zeus robot to perform a cholecystectomy on a pig in Strasbourg, France while in New York.[3]

• The first unmanned robotic surgery took place in May 2006 in Italy

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I WANTED EVEN THE PPT OF THE ROBOTIC SUGERY

PRESENTED BY
PHANEESWAR V.

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ABSTRACT
The field of surgery is entering a time of great change, spurred on by remarkable recent advances in surgical and computer technology. Only recently have robotic systems made their way into the operating room as dexterity-enhancing surgical assistants and surgical planners, in answer to surgeons' demands for ways to overcome the surgical limitations of minimally invasive laparoscopic surgery. The first generation of surgical robots is already being installed in a number of operating rooms around the world. These aren't true autonomous robots, but they are lending a mechanical helping hand to surgeons. Remote control and voice activation are the methods by which these surgical robots are controlled. Robotics is being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. Robots in the field of surgery have dramatically changed the procedures for the better. The most significant advantage to Robotic Surgery to the patient is the decrease in pain and scaring. The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Besides the obvious rewards to the patient, Robotic Surgery is also very advantageous to the surgeon and hospital.
INTRODUCTION:
Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other consumer goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean. In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMO robot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients. While robotic surgery systems are still relatively uncommon, several hospitals around the world have bought robotic surgical systems. These systems have the potential to improve the safety and effectiveness of surgeries. But the systems also have some drawbacks. It's still a relatively young science and it's very expensive. Some hospitals may be holding back on adopting the technology. Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery.
HISTORY:
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. 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 Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.
• In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.
• In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.
• In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada using the ZEUS surgical robot.
• In 2001, Prof. Marescaux used the Zeus robot to perform a cholecystectomy on a pig in Strasbourg, France while in New York.
• The first unmanned robotic surgery took place in May 2006 in Italy.
ROBOTIC SURGEONS:
The first generation of surgical robots are already being installed in a number of operating rooms around the world. These aren't true autonomous robots that can perform surgical tasks on their own, but they are lending a mechanical helping hand to surgeons. These machines still require a human surgeon to operate them and input instructions. Remote control and voice activation are the methods by which these surgical robots are controlled. Robotics is being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, these machines have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. According to one manufacturer, robotic devices could be used in more than 3.5 million medical procedures per year in the United States alone. Here are three surgical robots that have been recently developed:
• da Vinci Surgical System
• ZEUS Robotic Surgical System
• AESOP Robotic System
CLASSIFICATION :
Not all surgical robots are equal. There are three different kinds of robotic surgery systems:
• Supervisory-controlled systems
• Telesurgical systems
• Shared-control systems.
The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. On one end of the spectrum, robots perform surgical techniques without the direct intervention of a surgeon. On the other end, doctors perform surgery with the assistance of a robot, but the doctor is doing most of the work.
There are mainly three telesurgical robotic systems namely da Vinci Surgical System, ZEUS Robotic Surgical System and AESOP Robotic System.
SUPERVISORY-CONTROLLED ROBOTIC SURGERY SYSTEMS :
Of the three kinds of robotic surgery, supervisory-controlled systems are the most automated. But that doesn't mean these robots can perform surgery without any human guidance. In fact, surgeons must do extensive prep work with surgery patients before the robot can operate. Dr. Scott J. Boley demonstrates a robotic surgery system at the Montefiore Institute for Minimally Invasive Surgery in New York City.

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Objective:
To review the history, development, and current applications of robotics in surgery.
Background:
Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving.
Methods:
A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications.
Results:
Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques.
Conclusions:
Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedure
Robotic surgery is a new and exciting emerging technology that is taking the surgical profession by storm. Up to this point, however, the race to acquire and incorporate this emerging technology has primarily been driven by the market. In addition, surgical robots have become the entry fee for centers wanting to be known for excellence in minimally invasive surgery despite the current lack of practical applications. Therefore, robotic devices seem to have more of a marketing role than a practical role. Whether or not robotic devices will grow into a more practical role remains to be seen.
Our goal in writing this review is to provide an objective evaluation of this technology and to touch on some of the subjects that manufacturers of robots do not readily disclose. In this article we discuss the development and evolution of robotic surgery, review current robotic systems, review the current data, discuss the current role of robotics in surgery, and finally we discuss the possible roles of robotic surgery in the future. It is our hope that by the end of this article the reader will be able to make a more informed decision about robotic surgery before “chasing the market.”
BACKGROUND AND HISTORY OF SURGICAL ROBOTS
Since 1921 when Czech playwright Karel Capek introduced the notion and coined the term robot in his play Rossom’s Universal Robots, robots have taken on increasingly more importance both in imagination and reality.1,2 Robot, taken from the Czechrobota, meaning forced labor, has evolved in meaning from dumb machines that perform menial, repetitive tasks to the highly intelligent anthropomorphic robots of popular culture. Although today’s robots are still unintelligent machines, great strides have been made in expanding their utility. Today robots are used to perform highly specific, highly precise, and dangerous tasks in industry and research previously not possible with a human work force. Robots are routinely used to manufacture microprocessors used in computers, explore the deep sea, and work in hazardous environment to name a few. Robotics, however, has been slow to enter the field of medicine.
The lack of crossover between industrial robotics and medicine, particularly surgery, is at an end. Surgical robots have entered the field in force. Robotic telesurgical machines have already been used to perform transcontinental cholecystectomy.3,4Voice-activated robotic arms routinely maneuver endoscopic cameras, and complex master slave robotic systems are currently FDA approved, marketed, and used for a variety of procedures. It remains to be seen, however, if history will look on the development of robotic surgery as a profound paradigm shift or as a bump in the road on the way to something even more important.
Paradigm shift or not, the origin of surgical robotics is rooted in the strengths and weaknesses of its predecessors. Minimally invasive surgery began in 1987 with the first laparoscopic cholecystectomy. Since then, the list of procedures performed laparoscopically has grown at a pace consistent with improvements in technology and the technical skill of surgeons.5 The advantages of minimally invasive surgery are very popular among surgeons, patients, and insurance companies. Incisions are smaller, the risk of infection is less, hospital stays are shorter, if necessary at all, and convalescence is significantly reduced. Many studies have shown that laparoscopic procedures result in decreased hospital stays, a quicker return to the workforce, decreased pain, better cosmesis, and better postoperative immune function.6–8 As attractive as minimally invasive surgery is, there are several limitations. Some of the more prominent limitations involve the technical and mechanical nature of the equipment. Inherent in current laparoscopic equipment is a loss of haptic feedback (force and tactile), natural hand-eye coordination, and dexterity. Moving the laparoscopic instruments while watching a 2-dimensional video monitor is somewhat counterintuitive. One must move the instrument in the opposite direction from the desired target on the monitor to interact with the site of interest. Hand-eye coordination is therefore compromised. Some refer to this as the fulcrum effect.9Current instruments have restricted degrees of motion; most have 4 degrees of motion, whereas the human wrist and hand have 7 degrees of motion. There is also a decreased sense of touch that makes tissue manipulation more heavily dependent on visualization. Finally, physiologic tremors in the surgeon are readily transmitted through the length of rigid instruments. These limitations make more delicate dissections and anastomoses difficult if not impossible.10 The motivation to develop surgical robots is rooted in the desire to overcome the limitations of current laparoscopic technologies and to expand the benefits of minimally invasive surgery.
From their inception, surgical robots have been envisioned to extend the capabilities of human surgeons beyond the limits of conventional laparoscopy. The history of robotics in surgery begins with the Puma 560, a robot used in 1985 by Kwoh et al to perform neurosurgical biopsies with greater precision.6,11 Three years later, Davies et al performed a transurethral resection of the prostate using the Puma 560.12 This system eventually led to the development of PROBOT, a robot designed specifically for transurethral resection of the prostate. While PROBOT was being developed, Integrated Surgical Supplies Ltd. of Sacramento, CA, was developing ROBODOC, a robotic system designed to machine the femur with greater precision in hip replacement surgeries.1 ROBODOC was the first surgical robot approved by the FDA.
Also in the mid-to-late 1980s a group of researchers at the National Air and Space Administration (NASA) Ames Research Center working on virtual reality became interested in using this information to develop telepresence surgery.1 This concept of telesurgery became one of the main driving forces behind the development of surgical robots. In the early 1990s, several of the scientists from the NASA-Ames team joined the Stanford Research Institute (SRI). Working with SRI’s other robotocists and virtual reality experts, these scientists developed a dexterous telemanipulator for hand surgery. One of their main design goals was to give the surgeon the sense of operating directly on the patient rather than from across the room. While these robots were being developed, general surgeons and endoscopists joined the development team and realized the potential these systems had in ameliorating the limitations of conventional laparoscopic surgery.
The US Army noticed the work of SRI, and it became interested in the possibility of decreasing wartime mortality by “bringing the surgeon to the wounded soldier—through telepresence.”1 With funding from the US Army, a system was devised whereby a wounded soldier could be loaded into a vehicle with robotic surgical equipment and be operated on remotely by a surgeon at a nearby Mobile Advanced Surgical Hospital (MASH). This system, it was hoped, would decrease wartime mortality by preventing wounded soldiers from exsanguinating before they reached the hospital. This system has been successfully demonstrated on animal models but has not yet been tested or implemented for actual battlefield casualty care.
Several of the surgeons and engineers working on surgical robotic systems for the Army eventually formed commercial ventures that lead to the introduction of robotics to the civilian surgical community.1 Notably, Computer Motion, Inc. of Santa Barbara, CA, used seed money provided by the Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled by the surgeon voice commands to manipulate an endoscopic camera. Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery system. This system underwent extensive redesign and was reintroduced as the Da Vinci surgical system. Within a year, Computer Motion put the Zeus system into production.
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CURRENT ROBOTIC SURGICAL SYSTEMS
Today, many robots and robot enhancements are being researched and developed. Schurr et al at Eberhard Karls University’s section for minimally invasive surgery have developed a master-slave manipulator system that they call ARTEMIS.13 This system consists of 2 robotic arms that are controlled by a surgeon at a control console. Dario et al at the MiTech laboratory of Scuola Superiore Sant’Anna in Italy have developed a prototype miniature robotic system for computer-enhanced colonoscopy.14 This system provides the same functions as conventional colonoscopy systems but it does so with an inchworm-like locomotion using vacuum suction. By allowing the endoscopist to teleoperate or directly supervise this endoscope and with the functional integration of endoscopic tools, they believe this system is not only feasible but may expand the applications of endoluminal diagnosis and surgery. Several other laboratories, including the authors’, are designing and developing systems and models for reality-based haptic feedback in minimally invasive surgery and also combining visual servoing with haptic feedback for robot-assisted surgery.15–19
In addition to Prodoc, ROBODOC and the systems mentioned above several other robotic systems have been commercially developed and approved by the FDA for general surgical use. These include the AESOP system (Computer Motion Inc., Santa Barbara, CA), a voice-activated robotic endoscope, and the comprehensive master-slave surgical robotic systems, Da Vinci (Intuitive Surgical Inc., Mountain View, CA) and Zeus (Computer Motion Inc., Santa Barbara, CA).
The da Vinci and Zeus systems are similar in their capabilities but different in their approaches to robotic surgery. Both systems are comprehensive master-slave surgical robots with multiple arms operated remotely from a console with video assisted visualization and computer enhancement. In the da Vinci system (Fig. 1), which evolved from the telepresence machines developed for NASA and the US Army, there are essentially 3 components: a vision cart that holds a dual light source and dual 3-chip cameras, a master console where the operating surgeon sits, and a moveable cart, where 2 instrument arms and the camera arm are mounted.1 The camera arm contains dual cameras and the image generated is 3-dimensional. The master console consists of an image processing computer that generates a true 3-dimensional image with depth of field; the view port where the surgeon views the image; foot pedals to control electrocautery, camera focus, instrument/camera arm clutches, and master control grips that drive the servant robotic arms at the patient’s side.6 The instruments are cable driven and provide 7 degrees of freedom. This system displays its 3-dimensional image above the hands of the surgeon so that it gives the surgeon the illusion that the tips of the instruments are an extension of the control grips, thus giving the impression of being at the surgical site.

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History:-
1.In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.
2.In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.
3.On 2 September 1999, Dr. Randall Wolf and Dr. Robert Michler performed the first robotically assisted heart bypass in the USA at The Ohio State University.
4.In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada by Dr. Douglas Boyd and Dr. Reiza Rayman using the ZEUS surgical robot.
THE DA VINCI SURGICAL SYSTEM:-
A product of the company Intuitive Surgical, the da Vinci Surgical System is perhaps the most famous robotic surgery apparatus in the world. It falls under the category of telesurgical devices, meaning a human directs the motions of the robot. The da Vinci uses technology¬ that allows the human surgeon to get closer to the surgical site than human vision will allow, and work at a smaller scale than conventional surgery permits. The $1.5 million da Vinci system consists of two primary components
DIFFERENT KINDS OF ROBOTIC SURGERY:-
Type-1 supervisory-controlled systems:-
supervisory-controlled systems follow a specific set of instructions when performing a surgery. The human surgeon must input data into the robot, which then initiates a series of controlled motions and completes the surgery. There's no room for error -- these robots can't make adjustments in real time if something goes wrong. Surgeons must watch over the robot's actions and be ready to intervene if something doesn't go as planned
Type-2 Shared-control Robotic Surgery Systems:-
Shared-control robotic systems aid surgeons during surgery, but the human does most of the work. Unlike the other robotic systems, the surgeons must operate the surgical instruments themselves. The robotic system monitors the surgeon's performance and provides stability and support through active constraint.
Type-3 Telesurgerical system:-
The use of a computer console to perform operations from a distance opens up the idea of telesurgery, which would involve a doctor performing delicate surgery miles away from the patient. If the doctor doesn't have to stand over the patient to perform the surgery, and can control the robotic arms from a computer station just a few feet away from the patient.
ADVANTAGES:-
1. Telesurgery:- The use of a computer console to perform operations from a distance
. Having fewer personnel:- Having fewer personnel in the operating room and allowing doctors the ability to operate
3.Less pain:- the patient would experience less pain, trauma and bleeding, which means a faster recovery
4. Enhanced precision:- surgery with the help of robots may help to remove these errors. Robotics help to make the surgery with high precision and high accuracy
5. Decrease the fatigue:- It helps to decrease the fatigue that doctors experience during surgeries that can last several hours.
DISADVANTAGES:-
1. Time:-Robotic assisted heart surgery can take nearly twice the amount of time that a typical heart surgery takes.
2. Cost:-At this early stage in the technology, the robotic systems are very expensive.
3. Efficiency and Compatibility:-current operating room instruments and equipment are not necessarily compatible with the new robotic systems.thus there is less efficiancy and compatibility
Application:-
1.Cardiothoracic surgery:- Robot-assisted MIDCA Band endoscope coronary artery bypass (TECAB) surgeries are being performed with the da Vinci system
2. Gynecology:-Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery.
3. Orthopedics:-The Acrobot Company Ltd. sells the "Acrobot Sculptor", a robot that constrains a bone cutting tool to a pre-defined volume.
6. Pediatrics:-Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair
7. Radiosurgery:-The CyberKnife Robotic Radiosurgery System uses image-guidance and computer controlled robotics to treat tumors throughout the body
8. Urology;-Removing the prostate gland for cancer, repair obstructed kidneys, repair bladder abnormalities and remove diseased kidneys.
Conclusion:-
Although still in its infancy, robotic surgery is a cutting-edge development in surgery that will have far-reaching implications. While improving precision and dexterity, this emerging technology allows surgeons to perform operations that were traditionally not amenable to minimal access techniques. As a result, the benefits of minimal access surgery may be applicable to a wider range of procedures. Safety has been well established, and many series of cases have reported favorable outcomes. However, randomized, controlled trials comparing robotic-assisted procedures with laparoscopic or open techniques are generally lacking.

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ABSTRACT
The field of surgery is entering a time of great change, spurred on by remarkable recent advances in surgical and computer technology. Only recently have robotic systems made their way into the operating room as dexterity-enhancing surgical assistants and surgical planners, in answer to surgeons' demands for ways to overcome the surgical limitations of minimally invasive laparoscopic surgery.
The first generation of surgical robots is already being installed in a number of operating rooms around the world. These aren't true autonomous robots, but they are lending a mechanical helping hand to surgeons. Remote control and voice activation are the methods by which these surgical robots are controlled.
Robotics is being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery.
Robots in the field of surgery have dramatically changed the procedures for the better. The most significant advantage to Robotic Surgery the patient is the decrease in pain and scaring. The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Besides the obvious rewards to the patient, Robotic Surgery is also very advantageous to the surgeon and hospital.

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Origins of the da Vinci Robot


USA government funded a robotic program
at Stanford University in collaboration with NASA
in late 1980’s.

Original concept was to perform remote surgery
on the battlefield.

Robotic surgery started in 2000 with adult surgery mainly urology .

Basic Components Of da vinci Surgical System


Surgeons Console (Master)
Surgical Cart (Slave)
Endoscope & Instruments
IMAGE PROCESSING SYSTEM

What is midCAB?


Minimally invasive direct coronary artery bypass (MIDCAB) / off-pump CABG

The suturing is performed through keyhole-size opening while the heart is still beating.

No need of heart-lung machine.

Special octopus suction stabilizer is used .

TECAB and MIDCAB Advantages:
Faster recovery

Less risk of infection

Shorter hospital stay

Minimal scarring

Minimal blood loss and less need for transfusion

A good option for people of weakened bones due to osteoporosis.

The process of cutting achieves precision

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