Robotic and Telerobotic Surgical System of Abdominal Surgery

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ABSTRACT

The United States Federal Drug Administration (FDA) has approved four robotic surgical systems for use in clinical laparoscopic operations. In laparoscopic robotic surgery, AESOP and Endoassist replace the cameraman and provide a stable platform for the video telescope. AESOP is controlled by voice commands by the surgeon, while the Endoassist responds to the movements of an infrared light attached to the surgeon’s head. During telerobotic laparoscopic operations, the surgeon sits in front of a computer console that is distant from the patient. The surgeon observes a virtual operating field in three dimensions and performs the operation by controlling two telerobotic arms, which hold the surgical instruments. These instruments simulate the movements of the surgeon’s hands, presenting six degrees of freedom and two degrees of axial rotation. The combination of three-dimensional images and manual-like movements for surgical instruments facilitates complex laparoscopic procedures. The FDA authorized the Da Vinci telerobotic surgery system to act as an operating surgeon in June 2000, while in the case of Zeus, it only authorized him to act as a surgical assistant during laparoscopic operations only in October 2001. As a result, surgeons have reported great clinical experience with da Vinci. Laparoscopic abdominal telerobotic surgery is feasible, and its initial results are similar to those of traditional laparoscopic surgery. Robotic and telerobotic surgical systems overcome some of the inherent limitations of traditional laparoscopic surgery and could increase the number of surgeons performing complex laparoscopic operations in the future.

INTRODUCTION

The United States Federal Drug Administration (FDA) has approved four robotic surgical systems for clinical use during abdominal operations within the United States. During surgery, the robotic surgical system performs the functions of one of the surgical assistants. The surgeon stands beside the surgical table and operates directly on the patient using traditional laparoscopic instruments. AESOP and Endoassist are robotic surgical systems that replace the cameraman and hold the video telescope during laparoscopic surgeries. In contrast, during telerobotic surgery, the telerobotic holds the camera and also performs the operation using two or more robotic arms. The surgeon controls the movements of the arms and telerobotic surgical instruments through a computer interface.

In this article, we will present the historical development of robotic and telerobotic general surgery instruments. Likewise, we will review the current state of these surgical systems during their use in abdominal operations. In addition, we will describe each of the FDA-approved robotic and telerobotic surgical systems highlighting their particular characteristics, differences, and limitations.

ROBOTIC SURGERY

The first clinically successful robot, called?? Robotic, was introduced in a total hip replacement.1 2 General surgeons initially turned their attention to replacing the cameraman with a robot controlled by a surgeon. In 1993, at the University of California at Davis, Moran described a pneumatically controlled and passively electronically regulated camera clip Buses and colleagues in Tubingen, Germany, developed a prototype robotic cameraman considered the? FIPS Endoarm? 4 This robotic arm was remotely controlled by a?? Ring?? For the finger that was attached to one of the surgeon’s instruments. This mobilized presenting four degrees of freedom while retaining a fixed point of forced motion.

AESOP

The first robot to be approved by the FDA for clinical use in the abdomen is AESOP, which is manufactured by Computer Motion Incorporated of Santa Barbara, CA. FDA approval was granted in 1994. Computer Motion was initially founded with a NASA research grant to develop a robotic arm for the United States space program. This arm was later modified to hold a laparoscope and replace the laparoscopic cameraman. A computer tracks the position of the telescope’s tip. When AESOP is first introduced, the surgeon controls the robotic arm either manually or remotely via a foot pedal or manual control. 5 6 Newer generations of AESOP respond to voice commands 7 8 the robot is held to the side of the OR table. This is lightweight and can be easily lifted. However, a car is provided that facilitates the transportation of the robot. It has a series of adapters that can hold any rigid laparoscope. This allows the surgeon to vary between 3mm, 5mm, and 10mm telescopes, as well as between various angled telescopes.

ENDOASSIST

A British company, Armstrong Healthcare Ltd, has introduced a robotic cameraman called “Endoassist.” 13 14 The FDA has recently licensed Endoassist for use within the United States. Unfortunately, very little has been published about him to date. The surgeon controls the movement with his head ( FIGURE 2 ), using a device that emits infrared rays on his forehead. The surgeon aims the beam at the point on the video monitor that he wishes to observe. The robot moves the camera view to that position. This system offers some advantages to those surgeons who may find the constant talk required to monitor AESOP distracting. It is attached to a separate base that is rolled to the side of the patient.

SUMMARY In robotic laparoscopy surgery, AESOP and Endoassist replace the cameraman and provide a stable platform for the video telescope. AESOP is controlled by the surgeon?? Voice commands, whereas Endoassist responds to the movements of an infrared light adhered to the surgeon.