10-12-2012, 12:35 PM
Robotic surgery: History and teaching impact
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Abstract
The purpose of this article is to review the history of robotic surgery, its impact on
teaching as well as a description of historical and current robots used in the medical arena.
Summary of evidence: Although the history of robots dates back to 2000 years or more, the
last two decades have seen an outstanding revolution in medicine, due to all the changes that
robotic surgery has made in the way of performing, teaching and practicing surgery.
Conclusions: Robotic surgery has evolved into a complete and self-contained field, with enormous
potential for future development. The results to date have shown that this technology is
capable of providing good outcomes and quality care for patients.
Introduction
Robotic surgery has been considered by some authors as the
future of surgery due to the dramatic changes and impact
that it has shown in the last two decades. It has had a
rapid development and has shown numerous advantages of
enhancing surgical techniques, which, in turn, is changing
the way we practice and teach surgery.
The da Vinci® Robotic Surgical System (Intuitive Surgical
Sunnyvale, CA) is the only one of its kind to be approved by
the Food and Drugs Administration (FDA). It offers several
advantages over conventional laparoscopic surgery, such
as 3D vision, dexterity, articulated instruments, increased
range of motion, elimination of fulcrum effect, tremor filtration
and an ergonomic position for the surgeon. These
advantages translate into a more delicate treatment of tissues,
precision surgery and improved results for patients.
The purpose of this article is to describe the history of
robotic surgery including its evolution and improvements in
teaching and practicing surgery.
Robotic history
Karel Capek in 1921 introduced the notion and the term
robot in his play Rossom’s Universal Robots.1,2 The word
robot comes from the Czech word ‘‘robota’’, meaning
‘‘labor’’. Later, in 1942, Isaac Asimov inspired by Capek’s
works defined the term ‘‘robotics’’ and wrote the three
rules of robotics in his books Runaround and I Robot.3---5
Though robotics is a relatively new term, autonomously
operated machines can be dated from 400 BC when Archytas
of Arentum developed a steam-driven, self-propelling
wooden bird capable of flying 200 m.6
However, the first robot that imitated human movements
of the jaw, arms and neck was designed by Leonardo da Vinci
in 1495 and was named the Metal-Plated Warrior (Fig. 1).
This invention served as an inspiration to Gianello Torriano,
who created a robotic mandolin-playing lady in 1540.
Current robots
The modern history of robotics in surgery begins with the
Puma 560®, a robot used to perform neurosurgical biopsies
by Kwoh et al. in 1985 in a very precise way.8---10 Later in
1988, Davies et al. performed a transurethral resection of
the prostate using the same system.10,11
Integrated Surgical Supplies Ltd. of Sacramento, created
two models with similar characteristics: PROBOT®, a
robot designed specifically for transurethral resection of
the prostate and ROBODOC®, a robotic system designed to
machine the femur with greater precision in hip replacement
surgeries.1 This last one was the first surgical robot
approved by the FDA.1,3
Today, many robots and robot enhancements are being
researched and developed. When we talk about robotics,
we must emphasize and focus on the major robotic surgical
systems that have contributed in the development of current
systems.
Robotic surgery and surgical education
Despite numerous technological advances, surgical training
has stayed more or less unchanged for more than a century.
Surgeons in training have always had to gain operative experience
through ‘‘supervised trial and error’’ on real patients.
This approach makes surgical training completely dependent
on the actual case load, prolongs surgical training,
and compromises patients’ safety.18,19 Robotic surgery will
create a new medium for acquiring surgical skills through
simulation of all operations that can be done via the robot.
Surgeons can use surgical robots to practice operations
on 3-dimensional, virtual-reality simulators and soft-tissue
models that recreate the texture of human tissue through
force feedback (haptics refers to the sense of touch, tactile
sensation).18,20,21 Image-guided simulations will allow
surgeons to practice procedures on 3-dimensional reconstructions
of a targeted anatomy scheduled for surgery the
next day.
Virtual training in robotic surgery
Another aspect to consider is that robotics is being used for
virtual training. There are a few simulators and software
that allow surgeons to practice surgical procedures as many
times as they need before actually performing it on a real
patient.
Mimic Technologies, Inc. is one of the companies that is
working on robotic virtual training and has developed systems
such as: Mimic’s dV-TrainerTM, a ‘‘flight simulator’’
for robotic surgery designed to allow efficient on-demand
training for surgeons learning to use the da Vinci® Surgical
System31 (Fig. 3). Mimic’s Mantis DuoTM is a truly unique twohanded
haptic system that can be used for a wide range of
simulation applications, including open surgery and robotics
with a high quality force feedback and little computational
overhead to your host PC.
Conclusions
The history of robotics has shown a rapid evolution in the
last decade. This technology has been responsible for establishing
new concepts such as telesurgery, imaging symbiosis,
and virtual training.
Robotic surgery has developed and enhanced several
surgical techniques in specialties such as urology, general
surgery, and gynecology, to mention a few. Moreover,
robotics has shown results that are changing the way of performing
and teaching surgery, establishing new standards
of treatment and demonstrating that it is here to stay and
evolve.
It has also been able to facilitate and increase the uses
of minimally invasive surgery allowing surgeons to use technology
like LESS in many procedures.
There is still much in the horizon to study and develop
in robotic surgery but the results obtained are encouraging
and it seems to be just a matter of time until robotic
surgery becomes the new standard of treatment in a significant
amount of surgical procedures.