Saturday, December 15, 2007
Introduction
In what is often called the age of biotechnology, robotic devices play their role by being increasingly chosen over traditional surgical techniques. Robotic surgery is showing the potential to be the bedrock of a new era in surgery. As disturbing as it may seem, it is no longer absurd to imagine an operating room of only --no misprint—robots, which are controlled by a single human surgeon (or technician should we say?) from outside the OR. Soon, we may live in a world where Dr. A arrives at his downtown LA clinic, goes over protocol, and performs cardiothoracic surgery on patient B in Bangladesh.
For those who cannot swallow our predictions, we should clarify a few things about robotic surgery. Robots should not be confused with androids. A robot is defined as a computerized system with a motorized construction (usually an arm) capable of interacting with the environment. C3PO and R2-D2 are androids. The Da Vinci surgical system is a robot. You will also learn from our blog that robots do not actually replace human surgeons but merely improve operations through small incisions. Minimally invasive surgery existed long before the first robot. Laparoscopic cholecystectomy and gall bladder excisions are two procedures guided by a viewing device, typically an endoscope, through a small incision. Robots merely take these, as well as other minimally invasive surgeries to the next level. What they bring to the table (no pun intended) are accurate sensors, improved sterility, faster post-surgical recovery, highly intelligent user interfaces, and high resolution live video of the site of operation.
Though some surgeons claim to have already mastered certain cardiothoracic procedures with robotic devices, we will see that certain disadvantages of robotic surgery are preventing them from replacing human surgeries at this point. The consensus from various doctors and sources seem to indicate that current robotic surgery is on par with, not better, not worse, than human surgery.
Read our blog and join our exploration of the last decade of robotic surgery. We will discuss areas of surgery that robots have already impacted and future outlooks for this rapidly increasing field in medicine.
For those who cannot swallow our predictions, we should clarify a few things about robotic surgery. Robots should not be confused with androids. A robot is defined as a computerized system with a motorized construction (usually an arm) capable of interacting with the environment. C3PO and R2-D2 are androids. The Da Vinci surgical system is a robot. You will also learn from our blog that robots do not actually replace human surgeons but merely improve operations through small incisions. Minimally invasive surgery existed long before the first robot. Laparoscopic cholecystectomy and gall bladder excisions are two procedures guided by a viewing device, typically an endoscope, through a small incision. Robots merely take these, as well as other minimally invasive surgeries to the next level. What they bring to the table (no pun intended) are accurate sensors, improved sterility, faster post-surgical recovery, highly intelligent user interfaces, and high resolution live video of the site of operation.
Though some surgeons claim to have already mastered certain cardiothoracic procedures with robotic devices, we will see that certain disadvantages of robotic surgery are preventing them from replacing human surgeries at this point. The consensus from various doctors and sources seem to indicate that current robotic surgery is on par with, not better, not worse, than human surgery.
Read our blog and join our exploration of the last decade of robotic surgery. We will discuss areas of surgery that robots have already impacted and future outlooks for this rapidly increasing field in medicine.
Friday, December 14, 2007
Final Thoughts
In 1989 a medical robotic company called Computer Motion Inc. was born and so was surgical robotic technology. Computer Motion had the vision to revolutionize surgery by developing intelligent computerized and robotic systems to make surgeries easier for surgeons, safer for patients, and more efficient and cost effective for operating rooms (“Computer Motions”). Aesop™ was their first robot. It offered a third arm to surgeons and showed off a stable, voice-controlled high resolution endoscope. After several upgrades to the system, in 1998, the Aesop 3000 became the world’s first robot to be cleared by the FDA for surgery. This was just the beginning. Computer Motion went on to release the Hermes Control Center, the highly intelligent operating room as well as Zeus™. Zeus was the first robot used in CABG (1998) and micro-wrist and micro-joint (2001) procedures. In 1995, Intuitive Surgical, Computer Motion’s nemesis was founded. They were “the other” leader in surgical robotics based on technology from Stanford Research Institute (SRI), MIT, and IBM Corporation. They came up with the da Vinci® System, whose success we have documented in various posts. June 2001, BBC released a report that 17 patients at Rome’s Policlinico Casilino University were operated on by US surgeons thousands of miles away via robots. This “telesurgery,” involving 14 laparoscopies and 3 kidney operations was deemed a “success” despite minor complications (“Intercontinental Robotic Surgery”).
Three months later, the Zeus robotic system stunned the entire world by being used to perform a landmark overseas surgery (“Surgeons in US Perform Operation in France via Robot”). The surgeon was in New York City while the gallbladder being removed was in Strausbourg, France. After 54 minutes of surgery without complications, Zeus made a very compelling case for surgical robots.
In 2003, the two giants, Intuitive Surgical and Computer Motion, merged. This move to combine the unprecedented technology of the two companies was promised by both CEO’s to produce the best products for patients and surgeons (“March 7, 2003 – Intuitive Surgical and Computer Motion Merge”).
Surely, they have kept to their word. Since the merge, there have been many success stories. In 2005, the da Vinci system was used to remove 60% of the patient’s liver, who only needed 2 days to be cleared to go home (“First Robotic Complex Liver Surgery”). December that same year, 20% of all prostatectomy procedures in the US was performed with robots, which proved to be induce less blood loss in patients (“Cutting Edge”).
By this year, 2007, robotic surgery is used for an increasing number of different surgeries. We have documented success stories ranging from complex heart procedures (“Total Endoscopic Repair of A Pediatric Atrial Septic Defect Using the da Vinci Robot and Hypothermic Fibrillation”) to Urological microsurgery (“Robotic Assistance in Urological microsurgery”). In all cases, robotic surgery brags minimal invasiveness via operating with high resolution cameras. Patients enjoy reduced recovery time ( http://www.brightcove.tv/title.jsp?title=1213874957&channel=1184612073) and most notably with cardiothoracic surgeries where the need for a sternumectomy is hurdled by using robots to make extremely precise incisions.
While robotic surgery boasts a variety of accomplishments, there are drawbacks to this technique. The main complaint among surgeons and critics of robotic surgery is the loss of tactile sensation since the surgery isn’t being performed with the surgeons own hands. An extension of this complaint is the lack of haptics in most surgical robotic systems. Haptics is a system that recreates the feel of tissues through force feedback through robotic controls. Another major issue with robotic surgery is cost effectiveness. A typical robotic system costs $1.2-$1.5 million to purchase and a yearly maintenance cost of $100,000.
Regardless of the drawbacks to robotic surgery, it still stands that robotic surgery is the technology of the future. Nothing illustrates the amazing evolution of surgery from its messy inception to the highly sophisticated technological systems of today like robotic surgery does. Robotic surgery has expanded to include neurological, urological, cardiac, orthopedic, and gynecological functions. The benefits of robotic surgery, including but not limited to: less pain, better wound cosmesis, fewer wound complications, shorter hospital stays, and shorter recovery time, are revolutionary. In the near future, "I, Robot" will signify more than a mere movie title for many surgeons around the world.
Three months later, the Zeus robotic system stunned the entire world by being used to perform a landmark overseas surgery (“Surgeons in US Perform Operation in France via Robot”). The surgeon was in New York City while the gallbladder being removed was in Strausbourg, France. After 54 minutes of surgery without complications, Zeus made a very compelling case for surgical robots.
In 2003, the two giants, Intuitive Surgical and Computer Motion, merged. This move to combine the unprecedented technology of the two companies was promised by both CEO’s to produce the best products for patients and surgeons (“March 7, 2003 – Intuitive Surgical and Computer Motion Merge”).
Surely, they have kept to their word. Since the merge, there have been many success stories. In 2005, the da Vinci system was used to remove 60% of the patient’s liver, who only needed 2 days to be cleared to go home (“First Robotic Complex Liver Surgery”). December that same year, 20% of all prostatectomy procedures in the US was performed with robots, which proved to be induce less blood loss in patients (“Cutting Edge”).
By this year, 2007, robotic surgery is used for an increasing number of different surgeries. We have documented success stories ranging from complex heart procedures (“Total Endoscopic Repair of A Pediatric Atrial Septic Defect Using the da Vinci Robot and Hypothermic Fibrillation”) to Urological microsurgery (“Robotic Assistance in Urological microsurgery”). In all cases, robotic surgery brags minimal invasiveness via operating with high resolution cameras. Patients enjoy reduced recovery time ( http://www.brightcove.tv/title.jsp?title=1213874957&channel=1184612073) and most notably with cardiothoracic surgeries where the need for a sternumectomy is hurdled by using robots to make extremely precise incisions.
While robotic surgery boasts a variety of accomplishments, there are drawbacks to this technique. The main complaint among surgeons and critics of robotic surgery is the loss of tactile sensation since the surgery isn’t being performed with the surgeons own hands. An extension of this complaint is the lack of haptics in most surgical robotic systems. Haptics is a system that recreates the feel of tissues through force feedback through robotic controls. Another major issue with robotic surgery is cost effectiveness. A typical robotic system costs $1.2-$1.5 million to purchase and a yearly maintenance cost of $100,000.
Regardless of the drawbacks to robotic surgery, it still stands that robotic surgery is the technology of the future. Nothing illustrates the amazing evolution of surgery from its messy inception to the highly sophisticated technological systems of today like robotic surgery does. Robotic surgery has expanded to include neurological, urological, cardiac, orthopedic, and gynecological functions. The benefits of robotic surgery, including but not limited to: less pain, better wound cosmesis, fewer wound complications, shorter hospital stays, and shorter recovery time, are revolutionary. In the near future, "I, Robot" will signify more than a mere movie title for many surgeons around the world.
Total endoscopic repair of a pediatric atrial septal defect using the da Vinci robot and hypothermic fibrillation
http://icvts.ctsnetjournals.org/cgi/rapidpdf/icvts.2007.158626v1
Article in Interactive Cardiovascular and Thoracic
September 10th, 2007
It is known that heart disease is the leading cause of death in the U.S. today. While there are several major risk factors that most people know, such as high blood pressure, high cholesterol, and diabetes, one that is not talked about as much is atrial septal defect [ASD], which affects about 4 in 100,000 people. It is a congenital defect that is essentially an opening in the wall between the right and left atria, leading to inefficient distribution of oxygenated blood.
In this article, we found that the da Vinci surgical robot, mentioned in another article as well, was used to complete the entire operation for ASD repair. While ASD repair is done relatively free of any complications via median sternotomy and cardoplegic arrest, there have still been deaths that have resulted. Additionally, a particularly important goal in many surgeries today is to prevent big, unsightly scars. Lastly, This is where the da Vinci surgical robot comes in with its accurate precision and visualization, as well as a less painful procedure that looks much better afterwards. The article reports that the robotic closure of an ASD in a child was carried out without a sternotomy, thoracotomy, or cardioplegic arrest.
Of course, the robot has faced difficulties with limited space shorter ischemic times, and such for performing surgery on small children, but the article states that alterations were made to the machine and procedure to accommodate these challenges. Using the da Vinci robot for ASD repair is just one of many examples of how robotic surgery has improved a procedure in the medical world.
Article in Interactive Cardiovascular and Thoracic
September 10th, 2007
It is known that heart disease is the leading cause of death in the U.S. today. While there are several major risk factors that most people know, such as high blood pressure, high cholesterol, and diabetes, one that is not talked about as much is atrial septal defect [ASD], which affects about 4 in 100,000 people. It is a congenital defect that is essentially an opening in the wall between the right and left atria, leading to inefficient distribution of oxygenated blood.
In this article, we found that the da Vinci surgical robot, mentioned in another article as well, was used to complete the entire operation for ASD repair. While ASD repair is done relatively free of any complications via median sternotomy and cardoplegic arrest, there have still been deaths that have resulted. Additionally, a particularly important goal in many surgeries today is to prevent big, unsightly scars. Lastly, This is where the da Vinci surgical robot comes in with its accurate precision and visualization, as well as a less painful procedure that looks much better afterwards. The article reports that the robotic closure of an ASD in a child was carried out without a sternotomy, thoracotomy, or cardioplegic arrest.
Of course, the robot has faced difficulties with limited space shorter ischemic times, and such for performing surgery on small children, but the article states that alterations were made to the machine and procedure to accommodate these challenges. Using the da Vinci robot for ASD repair is just one of many examples of how robotic surgery has improved a procedure in the medical world.
Robotic help at heart of hospital’s initiative; U. of C. hires expert in bypass procedure
http://proquest.umi.com/pqdweb?index=2&did=1325977841&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1195576194&clientId=7344&cfc=1
Article in Chicago Tribune
August 27th, 2007
From this article, the increasing popularity of robotic surgery not only in hospitals, but also in various medicinal fields, can be seen. While they cost about $1.5 million each, the robot systems are becoming more prevalent, and even though they have been available for only several years now, there are 504 systems in North America and 108 in Europe already. And the machines are being used to do increasingly differing procedures such as coronary bypass surgery.
On that note, an eye-catcher in this article is the segment on coronary angioplasty and the use of stents to keep arteries open, since we specifically learned about these in class. As it was mentioned in class, the article talks about how the use of drug-eluting stents is beginning to raise more and more concerns regarding their safety. Now, more and more people are opting to take the less invasive, robotics approach to bypass procedures. It’s too soon to say that robots are taking over this world, but it’s pretty amazing to see how two separate areas of biotechnology interact in something as specific as clearing up major blocked arteries.
A doctor who has just been hired by University of Chicago’s Medical Center is Dr. Sudhir Srivastava, one of the few experts on robotics surgery when it comes to the heart. While many other doctors were (understandably) too confident and “competent” to learn the skill set required for robotic bypass surgery, Srivastava has performed hundreds of heart valve repairs using the machine. This is coming from a guy who has been 20 years into practice, while the technology for robotics became available five years ago. One of the biggest cited drawbacks of robotics surgery is that it is still a new, emerging field with much research and technological improvement to undergo. But Srivastava has proven that despite that, with practice it’s possible to master something so seemingly difficult and impersonal (doctors don’t get to physically touch feel the arteries, vessels, etc. that they are working on), and it’s sure to make a lot of patients happy.
Article in Chicago Tribune
August 27th, 2007
From this article, the increasing popularity of robotic surgery not only in hospitals, but also in various medicinal fields, can be seen. While they cost about $1.5 million each, the robot systems are becoming more prevalent, and even though they have been available for only several years now, there are 504 systems in North America and 108 in Europe already. And the machines are being used to do increasingly differing procedures such as coronary bypass surgery.
On that note, an eye-catcher in this article is the segment on coronary angioplasty and the use of stents to keep arteries open, since we specifically learned about these in class. As it was mentioned in class, the article talks about how the use of drug-eluting stents is beginning to raise more and more concerns regarding their safety. Now, more and more people are opting to take the less invasive, robotics approach to bypass procedures. It’s too soon to say that robots are taking over this world, but it’s pretty amazing to see how two separate areas of biotechnology interact in something as specific as clearing up major blocked arteries.
A doctor who has just been hired by University of Chicago’s Medical Center is Dr. Sudhir Srivastava, one of the few experts on robotics surgery when it comes to the heart. While many other doctors were (understandably) too confident and “competent” to learn the skill set required for robotic bypass surgery, Srivastava has performed hundreds of heart valve repairs using the machine. This is coming from a guy who has been 20 years into practice, while the technology for robotics became available five years ago. One of the biggest cited drawbacks of robotics surgery is that it is still a new, emerging field with much research and technological improvement to undergo. But Srivastava has proven that despite that, with practice it’s possible to master something so seemingly difficult and impersonal (doctors don’t get to physically touch feel the arteries, vessels, etc. that they are working on), and it’s sure to make a lot of patients happy.
Technologies Tackle Early Stage Prostate Cancer
http://health.usnews.com/articles/health/2007/08/23/technologies-tackle-early-stage-prostate-cancer.htm
Article in US News
August 23rd, 2007
As a group we are researching all facets of robotic surgery, both positive and negative aspects of the emerging technology. This article, dated August 23, 2007 on the Health Page of USNews.com, addresses new technologies in treating prostate cancer, one of which, is the da Vinci Surgical System. The da Vinci Surgical System is a $1.5 million robot with 4 arms and a high definition, 3D video camera. Its popularity has doubled in within the past 2 years and currently over 650 hospitals are using the robot to assist in urologic, cardiothoracic, and prostatectomy surgeries. The attitude from the article is that robotic surgery is currently just as good as conventional surgeries when it comes to prostate cancers, but has not yet boasted significant additional benefits to prostate cancer patients. The impotence rate and survival rates of prostate cancer patients are the same as standard surgeries. However, according to the author, the da Vinci system has less blood loss during surgery and reduced hospital stays. Maybe for prostate cancer patients this is not huge deal, but surely for cardiac disease patients, this matters a lot more! I then did a search to see the da Vinci Robot in action. Below I have attached links to a video from the University Of Southern California Keck School Of Medicine, where Vaughn Starnes, MD and Mark Cunningham, MD introduce their use of the da Vinci system in micro valve repair surgery. Sure enough, one of the main attractions to patients with cardiac disease is that robotic surgery circumvents the need for a sternumectomy! On the same website are several other videos with the da Vinci system in various other procedures. Caution, not for the weak stomach! The article agrees with what these USC surgeons have to say, which is basically at this point there is no benefit to robotic surgery other than recovery time. However, for cardiothoracic surgeries that could be enough of a reason to choose robotic surgery! However, more research needs to be done to find out what other negative side effects there are to robotic surgery but also, what the ultimate goal with using this technology is.
Other Links:
Cardiothoracic surgeons at USC introduce the da Vinci Robot for mitral valve repair
Robotic Assisted Surgical Treatment of Atrial Fibrillation at USC
A cardiothoracic surgeon speaks of the benefits
Article in US News
August 23rd, 2007
As a group we are researching all facets of robotic surgery, both positive and negative aspects of the emerging technology. This article, dated August 23, 2007 on the Health Page of USNews.com, addresses new technologies in treating prostate cancer, one of which, is the da Vinci Surgical System. The da Vinci Surgical System is a $1.5 million robot with 4 arms and a high definition, 3D video camera. Its popularity has doubled in within the past 2 years and currently over 650 hospitals are using the robot to assist in urologic, cardiothoracic, and prostatectomy surgeries. The attitude from the article is that robotic surgery is currently just as good as conventional surgeries when it comes to prostate cancers, but has not yet boasted significant additional benefits to prostate cancer patients. The impotence rate and survival rates of prostate cancer patients are the same as standard surgeries. However, according to the author, the da Vinci system has less blood loss during surgery and reduced hospital stays. Maybe for prostate cancer patients this is not huge deal, but surely for cardiac disease patients, this matters a lot more! I then did a search to see the da Vinci Robot in action. Below I have attached links to a video from the University Of Southern California Keck School Of Medicine, where Vaughn Starnes, MD and Mark Cunningham, MD introduce their use of the da Vinci system in micro valve repair surgery. Sure enough, one of the main attractions to patients with cardiac disease is that robotic surgery circumvents the need for a sternumectomy! On the same website are several other videos with the da Vinci system in various other procedures. Caution, not for the weak stomach! The article agrees with what these USC surgeons have to say, which is basically at this point there is no benefit to robotic surgery other than recovery time. However, for cardiothoracic surgeries that could be enough of a reason to choose robotic surgery! However, more research needs to be done to find out what other negative side effects there are to robotic surgery but also, what the ultimate goal with using this technology is.
Other Links:
Cardiothoracic surgeons at USC introduce the da Vinci Robot for mitral valve repair
Robotic Assisted Surgical Treatment of Atrial Fibrillation at USC
A cardiothoracic surgeon speaks of the benefits
Robotic Assistance in Urological Microsurgery
http://www.springerlink.com/content/yt36507371120461/fulltext.html
Article in Journal of Robotic Surgery
May 30th, 2007
“Robotic assistance in urological microsurgery: initial report of a successful in-vivo robot-assisted vasovasostomy” appears in the July 2007 volume of The Journal of Robotic Surgery. The article is a case study where robotic surgery was used for urological microsurgery. More specifically, it is a case study of a single microscope-assisted vasovasostomy, which is the restoration of fertility after a pervious vasectomy. The surgery was conducted in the Onze-Lieve-Vrouw Hospital, in Alsat, Belgium.
The patient involved in the study is a 34-year old man who is interested in restoring fertility after having a vasectomy. The robotic device utilized for this surgery was the da Vinci robot. This robotic device was introduced to urological surgery seven years ago for more precise tissue dissection. However, now the use of this device is being expanded to include microsurgery in urology. Usually this device is used in corneal and plastic surgery. In this particular case, the main advantages of the da Vinci system were the 3D view, 30 times the magnification, detail suture placement but the main advantage is the elimination of tremor during surgery. The major disadvantage however is the loss of tactile sensation but this can be overcome by careful understanding of visual cues, such as suture stretching, to evaluate the surgical process. This particular surgery shows that robotic vasovasostomy is technically feasible and has a promising future in urological microsurgery.
This article is published in a very specialized journal, which focuses on only robotic surgery information and case studies. It doesn’t have much of an effect on the general public because of the scope of the publication but it does affect the surgeons, healthcare professionals, professors and students who subscribe to this publication. The information in this case study is very novel, hence, there are no contradictory studies on robotic urological microsurgery. However, since this is a singular case study there is a need for further research on the efficacy of robotic urological surgery. While this study contends that less experienced surgeons would have a better experience with robotics assisted surgery as opposed to microscope assisted surgery, this conclusion is based on the assumption that the surgeon has a general knowledge of robotic surgery, however since robotic surgery is a relatively novel concept in urological surgery , this knowledge isn’t very common. The main contribution of this case study is knowledge that the use of a common robotic surgical instrument can be used in a surgical field where robotic surgery is very rare. Since this article is a specific study, it only allows the reader a very isolated view of robotic surgery. However, this isolated view allows the reader to better understand the advantages and disadvantages of robotic surgery in the context of a single case. This understanding leads to a solid base of knowledge that the reader can subsequently expand on in future research.
Article in Journal of Robotic Surgery
May 30th, 2007
“Robotic assistance in urological microsurgery: initial report of a successful in-vivo robot-assisted vasovasostomy” appears in the July 2007 volume of The Journal of Robotic Surgery. The article is a case study where robotic surgery was used for urological microsurgery. More specifically, it is a case study of a single microscope-assisted vasovasostomy, which is the restoration of fertility after a pervious vasectomy. The surgery was conducted in the Onze-Lieve-Vrouw Hospital, in Alsat, Belgium.
The patient involved in the study is a 34-year old man who is interested in restoring fertility after having a vasectomy. The robotic device utilized for this surgery was the da Vinci robot. This robotic device was introduced to urological surgery seven years ago for more precise tissue dissection. However, now the use of this device is being expanded to include microsurgery in urology. Usually this device is used in corneal and plastic surgery. In this particular case, the main advantages of the da Vinci system were the 3D view, 30 times the magnification, detail suture placement but the main advantage is the elimination of tremor during surgery. The major disadvantage however is the loss of tactile sensation but this can be overcome by careful understanding of visual cues, such as suture stretching, to evaluate the surgical process. This particular surgery shows that robotic vasovasostomy is technically feasible and has a promising future in urological microsurgery.
This article is published in a very specialized journal, which focuses on only robotic surgery information and case studies. It doesn’t have much of an effect on the general public because of the scope of the publication but it does affect the surgeons, healthcare professionals, professors and students who subscribe to this publication. The information in this case study is very novel, hence, there are no contradictory studies on robotic urological microsurgery. However, since this is a singular case study there is a need for further research on the efficacy of robotic urological surgery. While this study contends that less experienced surgeons would have a better experience with robotics assisted surgery as opposed to microscope assisted surgery, this conclusion is based on the assumption that the surgeon has a general knowledge of robotic surgery, however since robotic surgery is a relatively novel concept in urological surgery , this knowledge isn’t very common. The main contribution of this case study is knowledge that the use of a common robotic surgical instrument can be used in a surgical field where robotic surgery is very rare. Since this article is a specific study, it only allows the reader a very isolated view of robotic surgery. However, this isolated view allows the reader to better understand the advantages and disadvantages of robotic surgery in the context of a single case. This understanding leads to a solid base of knowledge that the reader can subsequently expand on in future research.
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