Trip through the Decades: Robotic Surgery
What is Robotic Surgery?
Robotic surgery is not to replace surgeons but to assist them with precision, better flexibility, and control than humans could possibly perform. Hence, robotic surgery is also referred to as robot-assisted surgery and is typically used for complex procedures through tiny incisions and sometimes in open surgeries. The system usually consists of a camera arm and two mechanical arms that are attached with surgical instruments. At a control center called a console, a surgeon will control the arms while seated near the operating table and will give out instructions to assisting team members throughout the operation. Through the console, the surgeon will also be able to see a high definition 3D view of the operating site.
The benefits of robotic surgery are quicker recovery time, less blood loss and pain, decreased risks of an infected surgical site, and a much shorter stay at the hospital. However, all options should be discussed with a medical professional before being operated.
Origins and Progression of Robotic Surgery
Ideas sparking around robotic surgery occurred decades before its initial birth in the 1980s. Hypothesized since 1967, the Department of Defense needed a way to decrease battlefield casualties since too many soldiers were dying due to hemorrhagic shock and polytrauma which required immediate medical attention, however, surgical care was too far from the battlefield. Furthermore, even when soldiers received the care they needed, it would amplify the bleeding and trauma in injured areas, urging the medical field to develop solutions which inevitably resolved to robotic surgery.
The first instance of robotic surgery was first recorded in 1985 for a neurological biopsy, this machine was named the Programmable Universal Machine for Assembly 200, otherwise known as PUMA 560. Created to prevent hand tremors from causing unwanted accidents, it was later adapted for urological and prostate procedures by The Robotics Centre at Imperial College. In 1989, just before the beginning of the 1990s, discussion revolving around voice-controlled robotic surgery began at the SAGES annual conference which wouldn’t be funded until 1990 by Yulun Wang. The first prototype was developed by a company called Computer Motion which equipped the system with an endoscope called AESOP (Automated Endoscopic System for Optimal Positioning).
In 1992, RoboDoc was used to perform the first ever robot-assisted human hip replacement and is the only current robotic system permitted by the Food and Drug Administration (FDA) for orthopedic surgery.
The voice-controlled robotic surgery continued to be experimented until it was approved in 1994. Known as AESOP 1000, it was controlled by pedals until AESOP 2000 in 1996, finally accomplishing the goal of voice control which gave surgeons what is known as a “third arm”. It continued to evolve into AESOP 3000 and AESOP HR (HERMES Ready) which came with additional functions to the voice integration such as operating room lighting, operating table movement, and improved image stability that replaced surgical assistants from camera holding during longer operations. The demand for further improvements increased for telemanipulation of the video camera and surgeons’ movements fueling for more research and experimentation for robotic surgery to reach higher feats.
Simultaneously, in 1995 the Intuitive Surgical was founded by Frederick H. Moll and Robert Younge which focused on reworking the surgical telepresence that was originally developed by Phil Green of SRI which became Lenny (abbreviation of Leonard), their first prototype. Consisting of 3 arms, two were instrument arms while the third held the scope camera. In 1997, their second generation, Mona, was finally being tested on humans with its first operation as a cholecystectomy.
In 1998, Computer Motion came out with the Zeus system that featured three arms, surgical instruments, a two-dimensional display for the controlling surgeon, and introduction of telepresence in which the robot would execute the commands of the surgeon. Its first usage was in that same year in Cleveland Clinic for uterine tube anastomosis surgery. That same year Intuitive introduced what is now the most successful robotic surgery platform known as da Vinci which is capable of numerous procedures ranging from cardiac, urologic, pediatric, general, and gynecologic. It was approved by the FDA in 2000.
A pivotal feat was later accomplished in 2001 when a cholecystectomy was performed by Jacques Marescaux in New York for a patient in Strasbourg, France which lasted 54 minutes with no technical incidents.
In 2003, Computer Motion and Intuitive Surgical merged after a 3 year legal battle.
Currently, da Vinci is the most dominant robotic surgery system and continues to evolve with newer and better technology as time prolongs.
Robotic Surgery Today
Over 12 million robotic surgery procedures have been performed with 60,000 surgeons trained using the da Vinci systems. From 2012 to 2018 in Michigan, the use drastically increased from 1.8% to 15.1% with specific procedures having higher usages such as inguinal hernia repair which grew from 0.7% to 28.8%.
The rapid growth of robotic surgery can be accounted for by the known benefits thereof for all parties associated. Generally for patients, recovery time is faster, decreased discomfort due to minimal incisions, and less blood loss. For physicians or surgeons, they are able to sit during long procedures at the console which will decrease fatigue and they are able to have accurate precision throughout the procedure without worrying about hand tremors or accidentally injuring the patient.
Although currently, da Vinci is the most used system, more and more robotic systems are in development to hopefully increase the market and overall encourage for improving surgery for those receiving and operating parties.
Written By: Sunny Han
Sources
George, E. I., Brand, T. C., LaPorta, A., Marescaux, J., & Satava, R. M. (2018). Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 22(4), e2018.00039. https://doi.org/10.4293/jsls.2018.00039
Mayo Clinic. (2022, May 6). Robotic surgery - Mayo Clinic. Mayoclinic.org; Mayo Clinic. https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974
McCartney, J. (2023, May 10). Robotic Surgery Is Here to Stay—and so Are Surgeons. American College of Surgeons. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/may-2023-volume-108-issue-5/robotic-surgery-is-here-to-stay-and-so-are-surgeons/
MORRELL, A. L. G., MORRELL-JUNIOR, A. C., MORRELL, A. G., MENDES, J. M. F., TUSTUMI, F., DE-OLIVEIRA-E-SILVA, L. G., & MORRELL, A. (2021). The history of robotic surgery and its evolution: when illusion becomes reality. Revista Do Colégio Brasileiro de Cirurgiões, 48. https://doi.org/10.1590/0100-6991e-20202798
UC Health. (2018). About the daVinci Surgical System | UC Health. Uchealth.com. https://www.uchealth.com/services/robotic-surgery/patient-information/davinci-surgical-system/
