🤖Medical Robotics Unit 9 – Robotic Platforms for Minimally Invasive Surgery

Introduction to Robotic Platforms in Surgery

• Robotic platforms revolutionized minimally invasive surgery by enhancing precision, dexterity, and visualization
• Consist of a master console, patient-side cart, and specialized instruments
• Enable surgeons to perform complex procedures through small incisions (laparoscopic surgery)
• Provide 3D high-definition vision, tremor filtration, and scaled motion
• Offer ergonomic benefits for surgeons, reducing fatigue and discomfort
• Facilitate remote surgery, allowing surgeons to operate from a distance
• Require specialized training and certification for surgeons and surgical teams

Evolution of Minimally Invasive Surgery

• Traditional open surgery involved large incisions, leading to increased pain, longer recovery times, and higher risk of complications
• Laparoscopic surgery introduced the use of small incisions, a camera, and long instruments, reducing invasiveness
• Robotic-assisted surgery built upon laparoscopic techniques, adding advanced features and capabilities
• First robotic surgical system, the AESOP (Automated Endoscopic System for Optimal Positioning), was introduced in 1994
  • AESOP used voice recognition to control the endoscope during laparoscopic procedures
• da Vinci Surgical System, introduced in 2000, became the most widely used robotic platform
  • Offers 3D vision, wristed instruments, and intuitive control
• Continued advancements in robotic technology, including smaller platforms, single-port systems, and autonomous functions

Key Components of Surgical Robotic Systems

• Master console: The surgeon's control center, featuring a 3D viewer, hand controllers, and foot pedals
  • Provides an immersive view of the surgical field and allows intuitive control of instruments
• Patient-side cart: Houses the robotic arms, instruments, and endoscope
  • Typically includes three or four robotic arms for instrument manipulation and one arm for the endoscope
• Endoscope: A high-definition camera that provides a magnified view of the surgical site
  • Offers 3D vision and can be controlled by the surgeon or an assistant
• Instruments: Specialized tools designed for robotic manipulation, featuring wristed joints and multiple degrees of freedom
  • Examples include needle drivers, forceps, scissors, and energy devices
• Visualization system: Displays the surgical field on the master console and can include features like digital zoom and image enhancement
• Communication and control systems: Enable seamless communication between the master console and patient-side cart
  • Ensure precise and real-time control of the robotic instruments

Popular Robotic Platforms and Their Features

• da Vinci Surgical System (Intuitive Surgical): The most widely used platform, offering 3D vision, wristed instruments, and intuitive control
  • Available in multiple configurations (Xi, X, Si) for different surgical specialties
• Senhance Surgical System (TransEnterix): Features haptic feedback, eye-tracking camera control, and reusable instruments
• Versius Surgical Robotic System (CMR Surgical): A modular, portable system with wristed instruments and open console design
• Hugo RAS System (Medtronic): A modular platform with wristed instruments, 3D vision, and a cloud-based data management system
• SPORT Surgical System (Titan Medical): A single-port robotic platform with multi-articulating instruments and 3D vision
• Flex Robotic System (Medrobotics): A flexible, snake-like robot for accessing hard-to-reach anatomical locations
  • Particularly useful for transoral and colorectal procedures

Advantages and Limitations of Robotic Surgery

Advantages:

• Enhanced precision and dexterity, enabling surgeons to perform complex tasks in confined spaces
• Improved visualization with 3D high-definition imaging and magnification
• Reduced surgeon fatigue and discomfort due to ergonomic design and tremor filtration
• Shorter hospital stays, faster recovery times, and reduced pain for patients compared to open surgery
• Potential for remote surgery and telesurgery, expanding access to specialized care Limitations:
• High initial costs for acquiring and maintaining robotic systems
• Longer operating times compared to traditional laparoscopic surgery, particularly during the learning curve
• Lack of haptic feedback in most systems, requiring surgeons to rely on visual cues
• Potential for mechanical failures or malfunctions, requiring backup plans and trained personnel
• Limited applicability in certain surgical specialties or procedures
• Steep learning curve for surgeons and surgical teams, necessitating specialized training and certification

Surgical Applications and Procedures

• Urology: Prostatectomy, partial nephrectomy, cystectomy, pyeloplasty
• Gynecology: Hysterectomy, myomectomy, endometriosis resection, sacrocolpopexy
• General surgery: Cholecystectomy, hernia repair, colorectal procedures, bariatric surgery
• Cardiothoracic surgery: Mitral valve repair, coronary artery bypass grafting, lobectomy
• Head and neck surgery: Transoral robotic surgery (TORS) for oropharyngeal and laryngeal cancers
• Orthopedic surgery: Total knee arthroplasty, hip replacement, spinal fusion
• Pediatric surgery: Pyeloplasty, fundoplication, congenital diaphragmatic hernia repair
• Single-port and natural orifice transluminal endoscopic surgery (NOTES) procedures

Training and Certification for Robotic Surgery

• Surgeons must complete specialized training to operate robotic systems safely and effectively
• Training typically involves a combination of didactic learning, simulation, and proctored cases
  • Didactic learning covers the principles of robotic surgery, system components, and troubleshooting
  • Simulation training uses virtual reality or dry lab models to practice basic skills and procedures
• Proctored cases involve performing surgeries under the guidance of an experienced robotic surgeon
• Certification requirements vary by institution and robotic platform
  • da Vinci Surgical System requires completion of the da Vinci Technology Training Pathway
• Ongoing skill maintenance and assessment through case volume, simulation, and continuing education
• Importance of team training, including nurses, anesthesiologists, and surgical technicians
• Integration of robotic surgery training into residency and fellowship programs

Future Trends and Innovations

• Miniaturization of robotic systems for improved access and reduced invasiveness
• Integration of artificial intelligence and machine learning for surgical planning, guidance, and automation
  • Examples include autonomous suturing, tissue identification, and optimal instrument positioning
• Haptic feedback systems to enhance surgeons' sense of touch and tissue interaction
• Augmented reality and virtual reality for surgical navigation, training, and patient education
• Telesurgery and remote collaboration, enabling surgeons to operate on patients from distant locations
• Robotic systems for microsurgery, allowing for precise manipulation of delicate structures
• Expansion of robotic applications to new surgical specialties and procedures
• Cost reduction and increased accessibility of robotic platforms through technological advancements and competition