Robotic Surgery is the use of robots in performing surgery. “Surgery is performed by manipulating straight instruments while viewing the instruments on a monitor. Robotic surgery is the evolution of laparoscopy that addresses the drawbacks of laparoscopy”(NJ urology). Considering the never ending improvement of technology, this type of surgery is being used more by a day worldwide and has a potential to totally take over the field of surgery. However, as robotic surgery has its advantages, it also has its disadvantages. 1. History and Evolution of Robotic Surgery.
History of robots industry can be linked to ancient Greeks, which had some kind of concept that we call today robots, many years before Christ. However, first recorded designs were in late 15th century. “One of the first recorded designs of a humanoid robot was made by Leonardo da Vinci in around 1495″( Wikipedia ). Da Vinci’s notebooks were discovered later in the middle of 20th century. Term Robot came from Czech writer Karel Capek in 1921. Robots in medicine didn’t start to be used until late 20th century and there were several events that helped the integration of robotics into the medicine.
“The first event was the creation and mainstreaming of computer technology. The second event was installation of robots in an American automobile manufacturing plant in 1961″( The Evolution). These events also helped because they introduced robotics to people in the United States. However, first robotic procedure in medicine came more than 20 years later. “Although laparoscopic procedures were performed in gynecology for many years, completion of the first laparoscopic cholecystectomy in 1985 was a contributing event in the development of medical robotic technology” (The Evolution).
Following that, robot was used to execute prostate surgery in 1988. 1992 was the first time that robot was used in the process of hip replacement. Robotic surgery continued to getting developed as people were able to do a surgery from a long distance. With these robots surgeons can be located in Europe, for example, and do the surgery in the United States. “Investigators such as Alberto Rovetta, PhD of Milan, Italy, have tried to work around the problem by having identical software programs at the two remote places, so the only thing transmitted is the hand signals.
In 1993, Alberto Rovetta(15) was able to successfully perform a liver biopsy on a pig liver with the surgeon’s station being at the NASA Jet Propulsion Lab (JPL) in Pasadena, CA and the manipulators and pig liver in his laboratory in Milan”(WEBSURG). In previously mentioned procedures robotic surgeries were run by human hand and it surgeons were not ready to try a procedure that will be totally done by robot, essentially unmanned. However, in 2006 robotic surgery came to that level that it was ready for surgery that didn’t needed any assistance by human hand.
“The first unmanned robotic surgery took place in May 2006 in Italy” (Wikipedia). Use of robotics is largely expanding not just in surgery, but in medicine as whole, by a day. Today, robots are used in cardiac surgery, gastrointestinal surgery, gynecology, neurosurgery, orthopedics, pediatrics and urology. 2. Pros and Cons of Robotic Surgery There are many advantages of the robotic surgery that have significantly improved medicine. Firstly, one of the main pros of robotic surgery is precision and miniaturization, meaning that incision is drastically smaller comparing to ones made with human hand.
“The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Due to the small and precise cuttings, the patents hospital stay is greatly reduced” (Thinkquest). Since cuttings are so precise, patience needs drastically less time to recover and risk of post surgery infections decreases as well. Besides these reasons that greatly help patients, there are many advantages from the doctors’ side of view, too. Some of those are: enhanced 3D visualization, improved dexterity, improved access, and increased range of motion.
“Enhanced 3D visualization provides the surgeon with a true 3-dimensional view of the operating field. Improved dexterity provides the surgeon with instinctive operative controls that make complex MIS procedures feel more like open surgery than laparoscopic surgery. Improved access: surgeons perform complex surgical maneuvers through 1-cm ports, eliminating the need for large traumatic incisions” (NJ urology). Another obvious advantage of robotic surgery is seen during the long surgeries, where surgeons as human beings can get tired in middle of procedure.
However, with the help of robots even the longest surgery is achievable much easier. Finally, some would argue that robotic procedure is significantly more expensive and not worth it, however when everything is set and done, with the shorter recovery, the cost for the patient comes out pretty much even. “Dr. Michael Argenziano at New York Presbyterian Hospital said that on average, the robotic-assisted heart surgeries costs $2,000 more per operation, but in the end, the costs come out even because the patients recover sooner with the robotic procedure” ( Brown ). There are several disadvantages of robotic surgery.
To begin with, robotic surgery is a very new technology and is not totally proven. “Robotic surgery is a new technology and its uses and efficacy have not yet been well established. To date, mostly studies of feasibility have been conducted, and almost no long-term follow up studies have been performed” (Medscape). Furthermore, robotic equipment that is being used today is extremely expensive not just to buy, but also to keep and operate. Like any other technology, these machines go out of date rather quickly which creates more problems to hospital that are willing to purchase them.
” At this early stage in the technology, the robotic systems are very expensive. Another issue with the cost is the problem with upgrading the systems as they improve. Only when these systems gain more widespread multidisciplinary use the costs will become more justified” (Brown). Along with price, another con of these systems is their size, which is gigantic and creates the problem in operating room because when you put that machine along with surgeons and other staff it overcrowds the room. In conclusion, pros of robotic surgery outweigh the cons, which with the time will reduce. 3. Robotic Surgical System Types.
Since robotic surgery systems started to be available for commercial use in 1985, there were several different models. First robot that was non-laparoscopic was PUMA 560 and it was used to complete neurosurgical biopsies. After the previously mentioned pioneer in this industry of robotic surgery, there were two robots that cam out in 1988 and 1992, respectively: PROBOC and ROBOTOC. “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 femur for hip replacement surgery” (Wikipedia).
ROBODOC was the first robot to be approved by FDA. Following these first few machines, company names Intuitive Surgical created two surgical systems, Da Vinci Surgical System and ZEUS Surgical system, which showed huge progress from PROBOC and ROBOTOC. 4. Da Vinci Surgical System As previously mentioned, Da Vinci Surgical System is system created by Intuitive Surgical Corporation with headquarters in Sunnyvale, California. It is designed for variety of surgeries, such as Myomectomy, Hysterectomy, and urologic surgery.
It was named after famous Italian polymath, Leonardo Da Vinci, who has drawn plans for mechanical man back in 1495, which was basically first saved document that mentioned something that we would later on call robots. The original model of the Da Vinci Surgical System was made in late 1980s at Stanford University. However, world had to wait over the decade to see the first Da Vince model being launched. “In January 1999, Intuitive launched the da Vinci Surgical System, and in 2000, it became the first robotic surgical system cleared by the FDA for general laparoscopic surgery (Wikipedia).
Today, “the average base cost of a system is around $1,5 million dollars” and “there are more than 300 Da Vinci systems in use worldwide” (Intuitive Surgical FAQ). The Da Vinci Surgical System is consisted of four main parts, “ergonomically designed surgeon’s console, a patient-side cart with four interactive robotic arms, the high-performance InSite® Vision System and proprietary EndoWrist® Instruments” (Intuitive Surgical). Surgeon console is the part of system where surgeon operates the procedure from while seated. He has a 3D view image of the field that he is operating.
Patient side Cart is basically a part with “three or four robotic arms? two or three instrument arms and one endoscope arm” (Intuitive Surgical), that execute surgeons commands from the console in real-time movement. Vision system, as name itself explains, provides high resolution 3D images of operating field. Lastly, surgical instruments main use is to support the surgeon while operating. “The da Vinci Surgical System’s surgical instruments are the same diameter of a pencil and the ends of the instruments are the size of a dime.
The ends of the instruments are modeled after the human wrist and give the surgeon a wide range of motion to work with” (St. Vincent’s Hospital). In conclusion, in the words of many surgeons, Da Vinci surgical system has allowed them to improve clinical results with fewer complications. Santiago Horman, Director of Minimally Invasive Surgery at the University of California, San Diego said: “I can achieve superb clinical results in technically demanding operations such as Heller myotomy and Esophagectomy with fewer complications” (Intuitive Surgical). 5. Future of Robotic Surgery.
Considering the advantages of the robotic surgery, the future of this industry is very bright. Current systems can be considered as just the beginning of the robotic revolution in medicine. It is a matter of time before we see extremely small machines rather than gigantic that we have today. “The systems will become smaller, more robust and less expensive. They will adapt for the requirements of the other surgical subspecialties. In the evolution of the robotics, the systems will become more intelligent, eventually performing most, if not all, of an operative procedure” (WEBSURG).
Technically, new generation should have less and more improved instruments and sense of touch. Last but not least, the evolution of the robots will bring more intelligent systems. Eventually, those systems will be able to perform entire operating procedure without the help of the surgeon. Financial business of Intuitive Surgical, who is global technology leader in robotic surgery, its sales and revenues, and stock price are dramatically growing, which proves the great future not just for Da Vinci Surgical system, but for all system that will be created in time to come. For example, Intuitive Surgical’s sales went from $138.
3 million in 2004, to $227. 3 millions in 2005. That is an unbelievable growth of 64% in only year. Company’s revenue from 2004 to 2005 has experienced even bigger growth. Total revenues went up from $60 to $102, which is a growth of 71% (Intuitive Surgical ? Company Profile). According to the same, official web-site of Intuitive Surgical, stock price as of March 16, 2007 is $116. 67, comparing to same date in 2006, when the price was $98. 37. Going back to March 16, 2007, stock price was only $17. 46. University of Southern California is working on further developing robotic surgery industry by developing a Robotic Surgery Institute.
“Dr. Starnes notes that the USC Department of Cardiothoracic Surgery is developing a Robotic Surgery Institute and Laboratory that will encompass all surgical specialties that could benefit from robotic surgery such as general surgery, urology and orthopedics” ( Robotic Surgery Institute). 6. Conclusion Robotic surgery has established its name in the field of medicine. Robotic surgery systems have been available for everybody now for several years. Even though, the future of these systems is so bright, it will need several more years to pass in order for those systems to prove their efficiency, mainly its cost efficiency.
With the weight of around 1400lbs and the average price of around $1. 5 million, Da Vinci Surgical system will need to get smaller and cheaper before starting to be used in most hospitals, rather than only 500 systems that are installed worldwide. However, the pros of the robotic assisted surgeries, such as precision, miniaturization, 3D view, and with that smaller cuts and reduced recovery time, easily overweigh its cons. Finally, medicine that has already been significantly improved, will keep improving because of these robotic systems.
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Robotic Surgery. http://biomed. brown.edu/Courses/BI108/BI108_2004_Groups/Group02/Group%2002%20Website/robodisadvan. htm 8. Intuitive Surgical. Official Web Site. http://www. intuitivesurgical. com/products/davinci_surgicalsystem/index. aspx 9. Intuitive Surgical FAQ.
Official Web Site-Frequently Asked Questions. http://www. intuitivesurgical. com/corporate/newsroom/mediakit/da_Vinci_Surgical_System_FAQ. pdf 10. St. Vincent’s Hospital. About Da Vinci Surgical System. http://www. stv. org/advertising/technology/davinci/ 11. Robotic Surgery Institute. University of Southern California. http://www. cts. usc. edu/rsi-future. html.