Robotic Surgery: Urologic Implications

Abstract

Current medical robots have nothing in common with the anthropomorphic robots in science fiction classics. They are in fact, manipulators, working on a master-slave principle. Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more spaces." The success of robots in surgery is based on their precision, lack of fatigue, and speed of action. This review describes the theory, advantages, disadvantages, and clinical utilization of mechanical and robotic arm systems to replace the second assistant and provide camera direction and stability during laparoscopic surgery. The Robotrac system (Aesculap, Burlingame, CA), the First Assistant (Leonard Medical Inc, Huntingdon Valley, PA), AESOP (Computer Motion, Goleta, CA), ZEUS (Computer Motion), and the da Vinci (Intuitive Surgical, Mountain View, CA) system are reviewed, as are simple mechanical-assist systems such as Omnitract (Minnesota Scientific, St. Paul, MN), Iron Intern (Automated Medical Products Corp., New York, NY), the Bookwalter retraction system (Codman , Somerville, NJ), the Surgassistant trade mark (Solos Endoscopy, Irvine, CA), the Trocar Sleeve Stabilizer (Richard Wolf Medical Instruments Corp., Rosemont, IL), and the Endoholder (Codman, Somerville, NJ).

Comparison of success rates, learning curves, and inter-subject performance variability of robot-assisted and manual ultrasound-guided nerve block needle guidance in simulation

“…Another important impact of using robot assistance for performing nerve blocks may be the reduction in fatigue: a study by Sites and colleagues 19 of anaesthesia residents learning regional anaesthesia skills identified fatigue as one of the five greatest problems faced while performing a nerve block. An important benefit of robotic systems is that they never fatigue 20 and their use has been shown to reduce operator fatigue: 21 22 as robot-assistance systems developed for anaesthesia are analogous to their surgical counterparts, they could logically afford this same benefit to anaesthesiologists.…”

Robotic Assisted Microsurgery (RAMS): Application in Plastic Surgery

“…Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more spaces." The success of robots in surgery is based on their precision, lack of fatigue, and speed of action (Moran, 2003).…”

Evolution of robotic arms

“… “If you will have the precision out of them, and make their fingers measure degrees like cog-wheels, and their arms strike curves like compasses, you must inhumanize them.” (J. Ruskin, The Stones of Venice [ 1 ]) Although surgical robotics is in its infancy, the rapid proliferation of surgical systems attests to the fact that this technology is here to stay and that we urologists should brace ourselves for the next wave of technology that will yet again change the way we work [ 2 ]. Many in practice are rather startled by the rapid insurgence of this sophisticated technology into the armamentarium of clinical practice.…”