30 Years of Robotic Surgery 2016

Résumé de : 30 Years of Robotic Surgery 2016

Humanity has expressed the desire of being helped in medical interventions with the assistance of a mechanical robot for 3 000 years. The concretisation of this dream has only started since the 80's with the PUMA 200, the first robot surgeon ever created in 1985. The design of such a machine met two needs within the surgery field: telepresence and the exigency of accuracy with the accomplishment of repetitive tasks.

In the 90’s, robots conceived to be controlled by surgeons in a special workstation using remote manipulators appeared. This technology lacked tactile feedback but had advantages such as 3D vision, a better image, Endowrist instruments (recreation of a human wrist’s joints to perform precise movements) which were key to overcome limitations in the surgery field. Surgeons from every continent have used since then the Da Vinci ® robot which has proved itself to be very reliable, safe and practical for different types of procedures.

However, the current state of the technologies has its own boundaries with the lack of haptic feedback and the high costs, preventing the robot surgery to be the standard technique used worldwide. Thus, the spread and further development of robot surgery involves cost reduction, more tests to determine when these techniques should be used and more resources to finance the improvement of both the robot and the user’s interface.

Résumé de : A short story of robotic surgery 2018

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The whole medical field witnessed a huge and rapid development of robotic surgery. The excitement originates from the promising results of robots assisted operations in laparoscopic procedures. They are rapidly starting to become a standard of care. However, these improvements rarely come from randomised studies which is causing concern in the medical community.

Before trying to write any review of the history of robotic surgery, it is impossible to ignore the very definition of a robot. The definition accepted by everyone today is rather new and results from the term used by the Czech author Karel Capek in his book R.U.R, published in 1920. The word robot comes from the Czech one robota which means work and servitude. The term quickly became corrupted to reflect machines that performs repetitive tasks with little intelligence. In the plot, robots that once were enslaved by humans try to overthrow their masters in attempt to take control of their own fates. This echoes the recent progresses of artificial intelligence and the preoccupations from the scientific community that grow with the capacities of A,I robots. The ultra-precise robots exist for a long time now, but they are very recent in the medical field.

There are three types of surgery robot systems: active, semi-active and master-slave. Active systems work autonomously while being supervised by humans and execute pre-programmed task. PROBOT and ROBODOC are considered active systems. Semi-active systems assist surgeons with pre-programmed tasks and master-slave systems such as da Vinci ® and ZEUS are only highly precise surgeon-controlled tools that repeat their gestures. The first ever robotic procedure is attributed to Dr. Kwoh who used the PUMA 560 system to perform a neurosurgical biopsy. The PUMA series of systems ultimately evolved into the more renowned PROBOT. Although, it failed to breakthrough as real clinical option. Though the concept did not die and was reclaimed with a parallel project named ROBODOC which became the first active system recognised by the FDA. It was originally used for hip surgery and quickly became adopted in Europe and started to undertake procedures in 1992.

Active robotic systems showed potential to enhance the quality of operations but the reason of the development on the technology, the goal to enhance laparoscopic procedures was not yet achieved. US Army wanted surgeons to be able to perform operations from distance reduce mortality from non-combating forces and improve the quality of a task performed by a surgeon not worried about dying on the battlefield. These newly created systems were soon to be commercialised in the public sphere. The trend led to the development of the Automated Endoscopic System for Optimal Positionning (AESOP) robotic platform, the ancestor of the ZEUS operating system. Simultaneously was designed the slightly bulkier but way cheaper EndoAssist system, a headset worn by the surgeon communicating by infrared signals with the robot. Meanwhile, the SRI Green telepresence system was created to be later morphed into an early prototype of the current da Vinci ® system. The short frame within both ZEUS and Da Vinci ® were conceived resulted in a decade-lasting rivalry, trading world-firsts in the race of which robot finds the more uses in the surgery field. This duel pushed back the frontiers of surgery.

The da Vinci ® gradually became dominant thanks to its better articulated wrist despite not erasing the ZEUS from the race. In 2003, the ZEUS and da Vinci ® systems had their devices unified when Computer Motion and Intuitive Surgical merged. The further improvements were then centred on the da Vinci ® platform still using the remains of the ZEUS era. This new version and the subsequent went to dominate the robotic surgery field for a decade. It has only recently started to be challenged by various newer technology companies, thus introducing a new competition which will undoubtedly again erase some of the boundaries of robotic surgery.

Résumé de : The future of robotic surgery (2018)

Intuitive Surgical, the company that owns da Vinci ® deposed a lot of patents concerning the minimally invasive surgery. However, these patents will come to expiration in the future years and companies are already initiating programs of robotic surgery to try to challenge them. Among these companies, the American and former Italian Senhance Surgical Robotic System is the most advanced one as it's the only project to be commercially authorised by both E.U. and FDA. The main differences between the challenger and the current leader is that the later uses 3D-HD glasses with an eye-tracking system included and the robotic arms have their own cart in opposite to the da Vinci ® sytem. Most impressively, the haptic feedback, long desired by surgeons who use robotic surgery is finally implemented on the system. It is currently used in abdominal, pelvic and thoracic procedures excluding cardiac surgery. Gynaecology and colorectal procedures are currently in trial and further tests on animals are taking place in broader topics.

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