Robotics in General Surgery: Update and Future Perspectives

Abstract

Medicine is going through a technological revolution that produces a paradigm shift and makes us think in new ways of treating and diagnosing our patients [1]. Minimally invasive surgery development and routine application in multiple procedures has been the main evolution in the last 50 years, bringing great benefits to patients, surgeons, hospitals and even insurance companies.In laparoscopic surgery the surgeon keeps control by handling patient's tissues inside an insufflated cavity with an external fulcrum point for instrumentation. It changes drastically in robotic surgery, with the surgeon taking place in a virtual environment outside the operative field, with a distant and indirect control. SAGES defines robotic surgery as a surgical procedure that adds a computer technology enhancement interface to the interaction between the surgeon and his patient during a surgical operation and assumes some degree of control heretofore completely reserved for the surgeon.Surgical robots have been envisioned to overcome the limitations and extend the capabilities of human surgeons, allowing them to perform precise and reproducible tasks [2]. Its performance is rooted in the strengths and weaknesses of laparoscopic surgery, being able to avoid the fulcrum effect, overcome the limited range of movements and depth perception, and dismiss the surgeon physiological tremor, while keeping its minimally invasive nature [3].Robotic surgery or computer-assisted surgery is an interactive system fast and intuitive that allows the computer to disappear from the surgeon's mind, who senses as real the environment generated by the system. Through virtual reality, the surgeon defines the manoeuvres that the robot performs in the patient. The consolemanipulator device can be placed in the same operating room, or in a different place, or eventually in another city or country [4,5].Robotic or remote tele-presence surgery is based in two fundamental concepts: virtual reality and cybernetics. Virtual reality achieves 3D immersion effects, navigation, interaction and simulation in real time, making real what the surgeon sees and touches. Cybernetics makes possible the movement digitalisation, promoting the development of mechanical articulated parts programmed with motion degrees, cameras, sensors, information saving and data processing.So far tele-presence surgery uses slave robots that are not programmed to do any movement without surgeon's command, and therefore are completely dependent on his judgement, knowledge and skills. It has a structure that resembles the anatomy of human arms and articulations, capable of imitating movements such as those from shoulders, elbows, wrists and fingers, but exceeding its natural range of motion and increasing the degree of freedom. Da Vinci System® by Intuitive Surgical Inc, the most commonly used device, consists of a surgeon's console, a slave robot with four interactive arms, instruments, a graphic interface and a camera. This design allows the surgeon to operate from a seated position with ergonom...

EnViSoRS: Enhanced Vision System for Robotic Surgery. A User-Defined Safety Volume Tracking to Minimize the Risk of Intraoperative Bleeding

“…The main advantages brought by robotic systems consist in the enhancement of surgeons' dexterity, restoration of hand-eye coordination, and improvement of surgeons' ergonomics (Lanfranco et al, 2004;Beyl et al, 2013;Garbin et al, 2015;Bravo et al, 2015). However, even though these benefits lead to improved surgical outcome, adverse events, such as intraoperative bleeding, can still occur during a robotic-assisted surgical procedure.…”