Advances in robotics technology are completely transforming today’s hospital operating rooms. With robot control and assistance, surgery for any kind of injury or ailment is faster, more accurate, and less invasive than ever before. Because robots help accelerate procedures, operations become safer. With conventional surgery, a surgeon performing an operation lasting several hours can become exhausted. As a result, the surgeon’s hand can be subject to harmful errors, particularly for complicated and delicate tasks like neurosurgeries. But a robot hand never tires, and it won’t waver out of position.
Improvements in sensing (particularly haptic sensing), imaging, better robotic control and articulation, and the development of robots that are more dexterous have spurred the dramatic rise in robotic surgery. The medical community is now developing a greater understanding of its benefits as well as the processes involved in ensuring seamless interfacing between a surgeon and a robotic system.
Medical robots aren’t completely autonomous, and they don’t perform the surgery by themselves. Instead, they assist the surgeon, who commands and controls them. As a result, surgery is fast becoming a partnership between man and machine. According to BCC Research, the market for surgical robots in the U.S. alone will total $2.5 billion by 2011. This market is projected to grow between 2006 and 2011 by an expected annual growth rate of 43%.
Medical robots are assisting in urological, neurological, gynecological, cardiac, orthopedic, gastrointestinal, pediatric, and radio-surgical procedures. Depending on the degree of the surgeon’s interaction during an operation, these systems can be broadly divided into three categories: supervisory-controlled, telesurgical, and shared-control systems.
During supervisor-controlled surgeries, the robot executes the procedure in response to programmed computer inputs from the surgeon. In telesurgery (or remote surgery), the surgeon manipulates the robot’s hand from a distance using real-time imaging and haptic feedback. Surgeons are most involved in shared-control procedures, where they use the robot to obtain “steady hand” manipulation of the surgical instruments in use.
The U.S. government also is pursuing robotic surgery. The Trauma Pod program from the Defense Advanced Research Projects Agency (DARPA) envisions the operating room of the future. Led by SRI, this multiphased program seeks to use robotics to project the skills of surgeons to precisely where they’re needed on the battlefield (Fig. 1). It includes contributions from the universities of Washington, Texas, and Maryland; Oak Ridge National Laboratory; General Dynamics; Intuitive Surgical; General Electric; Integrated Medical Systems; and Robotic Surgical Tech.
The most notable product on the market, the da Vinci Surgical System from Intuitive Surgical Co., consists of a viewing and control console and a surgical arm unit (Fig. 2). Used worldwide, it’s the only robotic-assisted device being used for laproscopic as well as a variety of minimally invasive keyhole surgeries. It’s also been used successfully in a number of gynecological, urological, and cardiac procedures.
PRE-PLANNING WITH VIRTUAL SURGERIES
For all its advantages, robotic surgery still needs better computer modeling, image processing, and haptic sensing for a more seamless integration of man and machine in surgical operations. Such improvements will enable better pre-surgical planning, too, allowing doctors to perform virtual surgeries before the actual operation.
The University of Washington is developing a “holomer” system that serves as a total body scan to guide intra-operative navigation during surgery. A surgeon can then use this information to perform a virtual operation on a patient prior to performing the real operation.
That’s also the goal at the Johns Hopkins University Engineering Research Center for Computer Integrated Systems and Technology. Its surgical CAD-CAM system offers “one-stop shopping” to integrate re-planning through post-operation evaluation and to create modular systems for “plug-and-play” surgery (Fig. 3).
The researchers also are investigating the sense of touch, which is very important in delicate surgeries. “Surgeons have asked for this kind of feedback. So we’re using our understanding of haptic technology to try to give surgeons back the sense of touch they lose when they use robotic medical tools,” says Allison Okamura, a leading researcher in man-machine interaction at Johns Hopkins.
Sensors could be attached to the robotic tools to convey how much force is being applied to, say, a surgical suture. Also, mathematical models would represent the moves made by the robotic tools, and this data would be converted to haptic feedback sent to the surgeon.
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