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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