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Robotic surgery are types of
surgical procedures Many surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectomy'' refers to the surgical remo ...
that are done using
robot A robot is a machine—especially one programmable by a computer—capable of carrying out a complex series of actions automatically. A robot can be guided by an external control device, or the control may be embedded within. Robots may be c ...
ic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery. In the case of robotically assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to administer the instruments. These include using a direct
telemanipulator A remote manipulator, also known as a telefactor, telemanipulator, or waldo (after the 1942 short story "Waldo" by Robert A. Heinlein which features a man who invents and uses such devices), is a device which, through electronic, hydraulic, or m ...
or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery. The
robotic arm A robotic arm is a type of mechanical arm, usually programmable, with similar functions to a human arm; the arm may be the sum total of the mechanism or may be part of a more complex robot. The links of such a manipulator are connected by joints ...
s carry out those movements using
end-effector In robotics, an end effector is the device at the end of a robotic arm, designed to interact with the environment. The exact nature of this device depends on the application of the robot. In the strict definition, which originates from serial ro ...
s and manipulators to perform the actual surgery. In computer-controlled systems, the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerized method is that the surgeon does not have to be present, leading to the possibility for
remote surgery Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or mo ...
. Memory devices play an essential role in preventing any inconveniences in the robot-assisted surgery. The memory storage solutions can perform multiple functions based on the patient's physical record. They can also indicate specific information to measure calibration offsets indicating misalignment of the storage drive system, life of the data, and so on. Robotic surgery has been criticized for its expense, with the average costs in 2007 ranging from $5,607 to $45,914 per patient. This technique has not been approved for cancer surgery as of 2019 as the safety and usefulness is unclear.


History

The concept of using standard hand grips to control manipulators and cameras of various sizes down to sub-miniature was described in the Robert Heinlein story '
Waldo Waldo may refer to: People * Waldo (given name), a list of people and fictional characters * Waldo (surname), a list of people * Waldo (footballer) (1934-2019), full name Waldo Machado da Silva, Brazilian footballer Places Canada * Waldo, ...
', which also mentioned brain surgery. The first robot to assist in surgery was the ''Arthrobot'', which was developed and used for the first time in
Vancouver Vancouver ( ) is a major city in western Canada, located in the Lower Mainland region of British Columbia. As the List of cities in British Columbia, most populous city in the province, the 2021 Canadian census recorded 662,248 people in the ...
in 1985. This robot assisted in being able to manipulate and position the patient's leg on voice command. Intimately involved were
biomedical engineer Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine)
James McEwen, Geof Auchinleck, a UBC
engineering physics Engineering physics, or engineering science, refers to the study of the combined disciplines of physics, mathematics, chemistry, biology, and engineering, particularly computer, nuclear, electrical, electronic, aerospace, materials or mechanical en ...
grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an
orthopaedic Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
surgical procedure on 12 March 1984, at the
UBC Hospital UBC Hospital is a health care facility located on the University Endowment Lands in Vancouver, British Columbia, Canada. It opened in 1968, and is now operated by Vancouver Coastal Health. Overview UBC Hospital is made up of three different build ...
in Vancouver. Over 60
arthroscopic Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the jo ...
surgical procedures were performed in the first 12 months, and a 1985
National Geographic ''National Geographic'' (formerly the ''National Geographic Magazine'', sometimes branded as NAT GEO) is a popular American monthly magazine published by National Geographic Partners. Known for its photojournalism, it is one of the most widely ...
video on industrial robots, ''The Robotics Revolution'', featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled ''Arthrobot – the world's first surgical robot'' illustrates some of these in operation. In 1985 a robot, the Unimation Puma 200, was used to orient a needle for a brain biopsy while under CT guidance during a neurological procedure. In the late 1980s, Imperial College in London developed PROBOT, which was then used to perform prostatic surgery. The advantages to this robot was its small size, accuracy and lack of fatigue for the surgeon. In 1992, the ROBODOC was introduced and revolutionized orthopedic surgery by being able to assist with hip replacement surgeries. The latter was the first surgical robot that was approved by the FDA in 2008. The ROBODOC from Integrated Surgical Systems (working closely with IBM) could mill out precise fittings in the
femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...
for hip replacement. The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp. Further development of robotic systems was carried out by
SRI International SRI International (SRI) is an American nonprofit scientific research institute and organization headquartered in Menlo Park, California. The trustees of Stanford University established SRI in 1946 as a center of innovation to support economic d ...
and
Intuitive Surgical Intuitive Surgical, Inc. is an American corporation that develops, manufactures, and markets robotic products designed to improve clinical outcomes of patients through minimally invasive surgery, most notably with the ''da Vinci'' Surgical System ...
with the introduction of the
da Vinci Surgical System The Da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, and increasingly for cardiac ...
and
Computer Motion Intuitive Surgical, Inc. is an American corporation that develops, manufactures, and markets robotic products designed to improve clinical outcomes of patients through minimally invasive surgery, most notably with the ''da Vinci'' Surgical System ...
with the ''AESOP'' and the
ZEUS robotic surgical system The ZEUS Robotic Surgical System (ZRSS) was a medical robot designed to assist in surgery, originally produced by the American robotics company Computer Motion. Its predecessor, AESOP, was cleared by the Food and Drug Administration in 1994 to ...
. The first robotic surgery took place at
The Ohio State University Medical Center The Ohio State University Wexner Medical Center is a multidisciplinary academic medical center located in Columbus, Ohio, United States, on the main campus of The Ohio State University. For 29 consecutive years, '' U.S. News & World Report'' has ...
in
Columbus Columbus is a Latinized version of the Italian surname "''Colombo''". It most commonly refers to: * Christopher Columbus (1451-1506), the Italian explorer * Columbus, Ohio, capital of the U.S. state of Ohio Columbus may also refer to: Places ...
, Ohio under the direction of Robert E. Michler. AESOP was a breakthrough in robotic surgery when introduced in 1994, as it was the first laparoscopic camera holder to be approved by the FDA. NASA initially funded the company that produces AESOP, Computer Motion, due to its goal to create a robotic arm that can be used in space, but this project ended up becoming a camera used in laparoscopic procedures. Voice control was then added in 1996 with the AESOP 2000 and seven degrees of freedom to mimic a human hand was added in 1998 with the AESOP 3000. ZEUS was introduced commercially in 1998, and was started the idea of telerobotics or telepresence surgery where the surgeon is at a distance from the robot on a console and operates on the patient. Examples of using ZEUS include a fallopian tube reconnection in July 1998, a ''beating heart'' coronary artery bypass graft in October 1999, and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001. In 2003, ZEUS made its most prominent mark in cardiac surgery after successfully harvesting the left internal mammary arteries in 19 patients, all of which had very successful clinical outcomes. The original telesurgery robotic system that the da Vinci was based on was developed at Stanford Research Institute International in Menlo Park with grant support from DARPA and NASA. A demonstration of an open bowel anastomosis was given to the Association of Military Surgeons of the US. Although the telesurgical robot was originally intended to facilitate remotely performed surgery in the battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Compared to the ZEUS, the da Vinci robot is attached to trocars to the surgical table, and can imitate the human wrist. In 2000, the da Vinci obtained FDA approval for general laparoscopic procedures and became the first operative surgical robot in the US. Examples of using the da Vinci system include the first robotically assisted
heart bypass Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pai ...
(performed in Germany) in May 1998, and the first performed in the United States in September 1999; and the first all-robotic-assisted
kidney transplant Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantati ...
, performed in January 2009. The da Vinci Si was released in April 2009 and initially sold for $1.75 million. In 2005, a surgical technique was documented in canine and cadaveric models called the transoral robotic surgery (TORS) for the da Vinci robot surgical system as it was the only FDA-approved robot to perform head and neck surgery. In 2006, three patients underwent resection of the tongue using this technique. The results were more clear visualization of the cranial nerves, lingual nerves, and lingual artery, and the patients had a faster recovery to normally swallowing. In May 2006 the first
artificial intelligence Artificial intelligence (AI) is intelligence—perceiving, synthesizing, and inferring information—demonstrated by machines, as opposed to intelligence displayed by animals and humans. Example tasks in which this is done include speech re ...
doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct
heart arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adult ...
. The results were rated as better than an above-average human surgeon. The machine had a
database In computing, a database is an organized collection of data stored and accessed electronically. Small databases can be stored on a file system, while large databases are hosted on computer clusters or cloud storage. The design of databases sp ...
of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient". In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic-assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain. In February 2008, Dr. Mohan S. Gundeti of the
University of Chicago Comer Children's Hospital The University of Chicago Comer Children's Hospital (UC CCH) formerly University of Chicago Children's Hospital is a nationally ranked, freestanding, 172-bed, pediatric acute care children's hospital adjacent to University of Chicago Medical Cent ...
performed the first robotic pediatric neurogenic bladder reconstruction. On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at
University of Calgary The University of Calgary (U of C or UCalgary) is a public research university located in Calgary, Alberta, Canada. The University of Calgary started in 1944 as the Calgary branch of the University of Alberta, founded in 1908, prior to being ins ...
by Dr. Garnette Sutherland using the NeuroArm. In June 2008, the
German Aerospace Centre The German Aerospace Center (german: Deutsches Zentrum für Luft- und Raumfahrt e.V., abbreviated DLR, literally ''German Center for Air- and Space-flight'') is the national center for aerospace, energy and transportation research of Germany ...
(DLR) presented a robotic system for minimally invasive surgery, the MiroSurge. In September 2010, the
Eindhoven University of Technology The Eindhoven University of Technology ( nl, Technische Universiteit Eindhoven), abbr. TU/e, is a public technical university in the Netherlands, located in the city of Eindhoven. In 2020–21, around 14,000 students were enrolled in its BSc a ...
announced the development of the
Sofie Sophia means "wisdom" in Greek. It may refer to: *Sophia (wisdom) *Sophia (Gnosticism) * Sophia (given name) Places *Niulakita or Sophia, an island of Tuvalu * Sophia, Georgetown, a ward of Georgetown, Guyana * Sophia, North Carolina, an unincor ...
surgical system, the first surgical robot to employ
force feedback Haptic technology (also kinaesthetic communication or 3D touch) is technology that can create an experience of touch by applying forces, vibrations, or motions to the user. These technologies can be used to create virtual objects in a computer ...
. In September 2010, the first robotic operation at the
femoral vasculature The femoral vessels are those blood vessels passing through the femoral ring into the femoral canal thereby passing down the length of the thigh until behind the knee. These large vessel are the: * Femoral artery (also known in this location a ...
was performed at the
University Medical Centre Ljubljana The Ljubljana University Medical Centre ( sl, Univerzitetni klinični center Ljubljana, abb. ''UKC Ljubljana'') or Ljubljana UMC is the largest hospital centre in Slovenia based in Ljubljana. It was officially opened on 29 November 1975 and has ...
by a team led by Borut Geršak.


Uses


Ophthalmology

Ophthalmology Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medic ...
is still part of the frontier for robotic-assisted surgeries. However, there are a couple of robotic systems that are capable of successfully performing surgeries. * PRECEYES Surgical System is being used for vitreoretinal surgeries. This is a single arm robot, that is tele manipulated by a surgeon. This system attaches to the head of the operating room table and provides surgeons with increased precision with the help of the intuitive motion controller. Preceyes is the only robotic instrument to be CE certified. Some other companies like Forsight Robotics, Acusurgical that raised 5.75 M€ (France), and Horizon (US) are working in this field. * The
da Vinci Surgical System The Da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, and increasingly for cardiac ...
, though not specifically designed for ophthalmic procedures, uses telemanipulation to perform
pterygium Pterygium (plural ''pterygia'' or ''pterygiums'') refers to any wing-like triangular membrane occurring in the neck, eyes, knees, elbows, ankles or digits. The term comes from the Greek word ''pterygion'' meaning "wing". Types * Popliteal pter ...
repairs and ex-vivo corneal surgeries.


Heart

Some examples of heart surgery being assisted by robotic surgery systems include: *
Atrial septal defect Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria (upper chambers) of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale; however, when this d ...
repair – the repair of a hole between the two upper chambers of the heart, *
Mitral valve repair Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows f ...
– the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart, *
Coronary artery bypass Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest p ...
– rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.


Thoracic

Robotic surgery has become more widespread in thoracic surgery for mediastinal pathologies, pulmonary pathologies and more recently complex esophageal surgery. The da Vinci Xi system is used for
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
and mediastinal mass resection. This minimally invasive approach as a comparable alternative to
video-assisted thoracoscopic surgery Video-assisted thoracoscopic surgery (VATS) is a type of minimally invasive thoracic surgery performed using a small video camera mounted to a fiberoptic thoracoscope (either 5 mm or 10 mm caliber), with or without angulated visuali ...
(VATS) and the standard open thoracic surgery. Although VATS is the less expensive option, the robotic-assisted approach offers benefits such as 3D visualizations with seven degrees of freedom and improved dexterity while having equivalent perioperative outcomes.


ENT

The first successful robot-assisted
cochlear implant A cochlear implant (CI) is a surgically implanted neuroprosthesis that provides a person who has moderate-to-profound sensorineural hearing loss with sound perception. With the help of therapy, cochlear implants may allow for improved speech und ...
ation in a person took place in
Bern german: Berner(in)french: Bernois(e) it, bernese , neighboring_municipalities = Bremgarten bei Bern, Frauenkappelen, Ittigen, Kirchlindach, Köniz, Mühleberg, Muri bei Bern, Neuenegg, Ostermundigen, Wohlen bei Bern, Zollikofen , website ...
,
Switzerland ). Swiss law does not designate a ''capital'' as such, but the federal parliament and government are installed in Bern, while other federal institutions, such as the federal courts, are in other cities (Bellinzona, Lausanne, Luzern, Neuchâtel ...
in 2017. Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the
mastoid bone The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has openings for blood vessels. From its borders, ...
, accessing the
inner ear The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...
and inserting the electrode into the
cochlea The cochlea is the part of the inner ear involved in hearing. It is a spiral-shaped cavity in the bony labyrinth, in humans making 2.75 turns around its axis, the modiolus. A core component of the cochlea is the Organ of Corti, the sensory org ...
. Advantages of robot-assisted cochlear implantation include improved accuracy, resulting in fewer mistakes during electrode insertion and better hearing outcomes for patients. The surgeon uses image-guided surgical planning to program the robot based on the patient's individual anatomy. This helps the implant team to predict where the contacts of the electrode array will be located within the cochlea, which can assist with audio processor fitting post-surgery. The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way. Challenges that still need to be addressed include safety, time, efficiency and cost. Surgical robots have also been shown to be useful for electrode insertion with pediatric patients.


Gastrointestinal

Multiple types of procedures have been performed with either the 'Zeus' or
da Vinci Leonardo di ser Piero da Vinci (15 April 14522 May 1519) was an Italian polymath of the High Renaissance who was active as a painter, Drawing, draughtsman, engineer, scientist, theorist, sculptor, and architect. While his fame initially res ...
robot systems, including bariatric surgery and
gastrectomy A gastrectomy is a partial or total surgical removal of the stomach. Indications Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall. In severe duodenal ulcers it may be necessary to remove the lower port ...
for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices. Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of
gastroesophageal reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...
and
Heller myotomy Heller myotomy is a surgical procedure in which the muscles of the cardia ( lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach. It is used to treat achalasia, a disorder in which the lower esophageal sphi ...
for the treatment of
achalasia Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esoph ...
. Robot-assisted pancreatectomies have been found to be associated with "longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay than laparoscopic pancreatectomies; there was "no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups."


Gynecology

The first report of robotic surgery in
gynecology Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
was published in 1999 from the Cleveland Clinic. The adoption of robotic surgery has contributed to the increase in minimally invasive surgery for gynecologic disease. Gynecologic procedures may take longer with robot-assisted surgery and the rate of complications may be higher, but there are not enough high-quality studies to know at the present time. In the United States, robotic-assisted hysterectomy for benign conditions was shown to be more expensive than conventional laparoscopic hysterectomy in 2015, with no difference in overall rates of complications. This includes the use of the da Vinci surgical system in benign gynecology and gynecologic
oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''ó ...
. Robotic surgery can be used to treat fibroids, abnormal periods,
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...
,
ovarian tumor Ovarian tumors, or ovarian neoplasms, are tumors arising from the ovary. They can be benign or malignant (ovarian cancer). They consist of mainly solid tissue, while ovarian cysts contain fluid. Histopathologic classification Ovarian tumors are ...
s,
uterine prolapse Uterine prolapse is when the uterus descends towards or through the opening of the vagina. Symptoms may include vaginal fullness, pain with sex, trouble urinating, urinary incontinence, and constipation. Often it gets worse over time. Low back ...
, and female cancers. Using the robotic system, gynecologists can perform
hysterectomies Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may be ...
, myomectomies, and
lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...
biopsies. The ''Hominis robotic system'' developed by
Momentis Surgical™ Just Energy Group Inc. (formerly Just Energy Income Fund and before that Energy Savings Income Fund) is a Canadian-based natural gas and electricity retailer operating in Canadian and American markets across North America. Operations Just Energy ...
is aimed to provide a robotic platform for
natural orifice transluminal endoscopic surgery Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique whereby "scarless" abdominal operations can be performed with an endoscope passed through a natural orifice (mouth, urethra, anus, vagina, etc.) then through an inte ...
(Notes) for
myomectomy Myomectomy, sometimes also called fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential. Indica ...
through the vagina. A 2017 review of surgical removal of the uterus and cervix for early
cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.


Bone

Robots are used in orthopedic surgery. ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip
arthroplasty Arthroplasty (literally " e-orming of joint") is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that i ...
(THA). It is programmed preoperatively using data from computer tomography (CT) scans. This allows for the surgeon to choose the optimal size and design for the replacement hip. Acrobot and Rio are semi-active robotic systems that are used in THA. It consists of a drill bit that is controlled by the surgeon however the robotic system does not allow any movement outside the predetermined boundaries.
Mazor Mazor ( he, מָזוֹר, ''lit.'' Cure) is a moshav in central Israel. Located in the Sharon plain around three kilometres south-east of Petah Tikva and covering 2,300 dunams, it falls under the jurisdiction of Hevel Modi'in Regional Council ...
X is used in spinal surgeries to assist surgeons with placing
pedicle Pedicle or pedicel may refer to: Human anatomy *Pedicle of vertebral arch, the segment between the transverse process and the vertebral body, and is often used as a radiographic marker and entry point in vertebroplasty and kyphoplasty procedures ...
screw instrumentation. Inaccuracy when placing a pedicle screw can result in neurovascular injury or construct failure. Mazor X functions by using templating imaging to locate itself to the target location of where the pedicle screw is needed.


Spine

Robotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s. As of 2014, there were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches. As of 2019, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation. In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only. Studies on use of robotics for placing screws in the cervical and thoracic vertebrae are limited.


Transplant surgery

The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure. Weight loss however is the preferred initial effort.


General surgery

With regards to robotic surgery, this type of procedure is currently best suited for single- quadrant procedures, in which the operations can be performed on any one of the four quadrants of the abdomen. Cost disadvantages are applied with procedures such as a cholecystectomy and
fundoplication A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical ther ...
, but are suitable opportunities for surgeons to advance their robotic surgery skills.


Urology

Robotic surgery in the field of urology has become common, especially in the United States. There is inconsistent evidence of benefits compared to standard surgery to justify the increased costs. Some have found tentative evidence of more complete removal of cancer and fewer side effects from surgery for
prostatectomy Prostatectomy (from the Greek , "prostate" and , "excision") as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for pros ...
. In 2000, the first robot-assisted laparoscopic
radical prostatectomy Prostatectomy (from the Greek , "prostate" and , "excision") as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prosta ...
was performed. Robotic surgery has also been utilized in radical cystectomies. A 2013 review found less complications and better short term outcomes when compared to open technique.


Pediatrics

Pediatric Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
procedures are also benefiting from robotic surgical systems. The smaller
abdominal The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso ...
size in pediatric patients limits the viewing field in most urology procedures. The robotic surgical systems help surgeons overcome these limitations. Robotic technology provides assistance in performing *
Pyeloplasty Pyeloplasty is performed to treat an uretero-pelvic junction obstruction if residual renal function is adequate. This revision of the renal pelvis treats the obstruction by excising the stenotic area of the renal pelvis or uretero-pelvic juncti ...
- alternative to the conventional open dismembered pyeloplasty (Anderson-Hynes). Pyeloplasty is the most common robotic-assisted procedures in children. * Ureteral reimplantation - alternative to the open intravesical or extravesical surgery. * Ureteroureterostomy - alternative to the transperitoneal approach. *
Nephrectomy A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant pr ...
and heminephrectomy - Traditionally done with
laparoscopy Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medlin ...
, it is not likely that a robotic procedure offers significant advantage due to its high cost.


Comparison to traditional methods

Major advances aided by surgical robots have been
remote surgery Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or mo ...
,
minimally invasive surgery Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...
and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication. The existing open surgery technique has many flaws such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks. The robot's costs range from $1 million to $2.5 million for each unit, and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher. Additional surgical training is needed to operate the system. Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must perform 150 to 250 procedures to become adept in their use. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction and regret. Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance. There are some issues in regards to current robotic surgery usage in clinical applications. There is a lack of haptics in some robotic systems currently in clinical use, which means there is no
force feedback Haptic technology (also kinaesthetic communication or 3D touch) is technology that can create an experience of touch by applying forces, vibrations, or motions to the user. These technologies can be used to create virtual objects in a computer ...
, or touch feedback. No interaction between the instrument and the patient is felt. However, recently the Senhance robotic system by Asensus Surgical was developed with haptic feedback in order to improve the interaction between the surgeon and the tissue. The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application. Critics of the system, including the American Congress of Obstetricians and Gynecologists, say there is a steep learning curve for surgeons who adopt the use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional
laparoscopic surgery Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...
. Articles in the newly created '' Journal of Robotic Surgery'' tend to report on one surgeon's experience. Complications related to robotic surgeries range from converting the surgery to open, re-operation, permanent injury, damage to viscera and nerve damage. From 2000 to 2011, out of 75 hysterectomies done with robotic surgery, 34 had permanent injury, and 49 had damage to the viscera. Prostatectomies were more prone to permanent injury, nerve damage and visceral damage as well. Very minimal surgeries in a variety of specialties had to actually be converted to open or be re-operated on, but most did sustain some kind of damage or injury. For example, out of seven coronary artery bypass grafting, one patient had to go under re-operation. It is important that complications are captured, reported and evaluated to ensure the medical community is better educated on the safety of this new technology. If something was to go wrong in a robot-assisted surgery, it is difficult to identify culpability, and the safety of the practice will influence how quickly and widespread these practices are used. One drawback of the use of robotic surgery is the risk of mechanical failure of the system and instruments. A study from July 2005 to December 2008 was conducted to analyze the mechanical failures of the da Vinci Surgical System at a single institute. During this period, a total of 1797 robotic surgeries were performed used 4 da Vinci surgical systems. There were 43 cases (2.4%) of mechanical failure, including 24 (1.3%) cases of mechanical failure or malfunction and 19 (1.1%) cases of instrument malfunction. Additionally, one open and two laparoscopic conversions (0.17%) were performed. Therefore, the chance of mechanical failure or malfunction was found to be rare, with the rate of converting to an open or laparoscopic procedure very low. There are also current methods of robotic surgery being marketed and advertised online. Removal of a cancerous prostate has been a popular treatment through internet marketing. Internet marketing of medical devices are more loosely regulated than pharmaceutical promotions. Many sites that claim the benefits of this type of procedure had failed to mention risks and also provided unsupported evidence. There is an issue with government and medical societies promotion a production of balanced educational material. In the US alone, many websites promotion robotic surgery fail to mention any risks associated with these types of procedures, and hospitals providing materials largely ignore risks, overestimate benefits and are strongly influenced by the manufacturer.


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{{DEFAULTSORT:Robotic Surgery Computer-assisted surgery Telemedicine Health informatics