Robotic Surgery

The Cutting Edge Surgery has been a method used to help fix people’s problems for generations. Whether it is a broken bone, dislocation, cancer, or ruptured appendix, surgery has provided the option of fixing these problems for the afflicted patients. The history of surgery is vast, and over the ages it has developed into a much more refined practice. According to Tim Lambert in A History of Surgery, it started in the Stone Age, with incisions and holes in people’s skulls for unknown reason.

Egyptians then furthered the realm of surgery by removing the organs of mummies to prevent rotting (Lambert). A big problem during this time was cleanliness; it was difficult to prevent infections in addition to controlling bleeding problems and pain. As generations passed, surgeons became more skilled in operating procedures, using alcohol and honey to prevent infections. In addition, surgeons gained more knowledge about the human body through dissections that became allowed by the church around the mid-14th century (Lambert).

The revolution of anesthetics wasn’t introduced until the 19th century; however it became a critical advancement in the field by allowing patients to receive pain relief by inhaling ether. This became especially important at this time, because new procedures such as the tracheotomy became a less intense procedure with the use of anesthetics. Options other than ether soon became available, such as chloroform, cocaine, and Novocain (Lambert). The surgical revolution didn’t end here, many technologies allowed for surgery to become a much more technical process.

The 20th century led to the first eye surgery due to the invention of the laser, as well as improvements in heart surgery that led to the pacemaker, heart transplants, and artificial hearts (Lambert). In spite of all the groundbreaking steps that were made in this field, new steps are still being taken today. There is a new outlook that could prove to advance the field of surgery even further, and it is known as robotic surgery. Due to improvements in technology and programming, robotic surgery is now a better option than conventional surgery. Robotic Nurses

Robotics can be used to aid in surgery in many different ways. Two main ways are using a robotic surgeon and using a robotic nurse. People may not realize that nurses can in fact have a negative impact in surgery. Research published by George Akingba shows that 31% of all communications in the Operating Room result in some sort of failure, and a third of those failed communications impact the patient (Akingba). Some of these errors are caused by team instability, which includes a lack of familiarity between nurses and surgeons, minimal staffing, and other random distractions.

The use of a robotic nurse can possibly reduce the number of failed communications between surgeons and nurses (Akingba). In order for robotics to be a successful replacement, these robots must achieve a certain level of accuracy and speed. In order to determine how well a robot could achieve this, George Akingba and his team performed and recorded multiple experiments using a robotic nurse called Gestonurse. Their goal was to show that a robotic nurse could be used in an actual surgery (Akingba).

In order to serve as a viable replacement, Gestonurse needed to be able to understand both verbal and non-verbal cues given by the surgeon, predict the instruments that the surgeon will require next, and doctors need knowledge of the boundaries and limitations of this fairly recent technology (Akingba). In order for Gestonurse to replace a nurse in an operating room it has to be able to replicate the same steps a regular nurse could perform. That means the robot must identify the hand gesture it is being given, match that gesture with a tool, find the tool, and transport it from the table to the surgeon.

This is a difficult process for a robot to perform in a small period of time. George Akingba and his team decided to start by determining how well the robotic nurse could get instruments for the surgeon based on the distance between each instrument. They feared that the robot would not be able to distinguish between objects that were too close together (Akingba). For this experiment to be performed, non-verbal cues were assigned to surgical instruments using fingers. One finger is a scalpel, two fingers are scissors, three is a retractor, four is forceps, and five is a hemostat (Akingba).

What the study found is that a robot can reliably identify and select the correct instrument for the surgeon when the instruments are separated by at least 25mm (Akingba). Next, the researchers tested different hand placements for these fingers in order to see if the robot would recognize the fingers being held up in different positions. The study showed that as long as they kept their hands parallel to the image plane, even by moving their hands in this plane, about 94% of the gestures were detected (Akingba).

About 4% of the remaining error is explained by out-of-plane rotations (Akingba). For example, if three fingers are held up, but they are rotated in such a way that the robot needs depth perception to accurately view them, the robot will not always recognize each finger, and will underestimate the actual number of fingers being presented (Akingba). George Akingba and his team had one last component to test before making a conclusion. His team wanted to test how fast the robot could get the instrument to the surgeon compared to a human.

They found that on average it took a human 3. 23 seconds to get an instrument for the surgeon, compared to the 4. 06 seconds it took the robot (Akingba). This results in a very minimal difference of only 0. 83 seconds longer for the robot to accomplish the task. Altogether, the experiments conducted showed the capabilities of robotic nurses in the Operating Room. During these trials, Gestonurse provided many advantageous features to surgery. Gestonurse was easy to use, and allowed the surgeons to use their hands.

Additionally, Gestonurse responded to nonverbal commands that were fast and intuitive, without the need of a surgeon to wear a microphone or marker in order to use the system. And lastly, the hand gestures used by the surgeons were very accurately identified. Robotic Surgery On a more sophisticated level, robots can be used to perform an actual surgery. According to an article written by Anthony Lanfranco, Robot-assisted surgery can be done using three different types of robots; ARTEMIS, da Vinci, and Zeus.

Artemis (advanced robotic telemanipulator for minimally invasive surgery) is a robotic mechanism that consists of two robotic arms that are controlled by a surgeon on a control console (Lanfranco). The da Vinci system uses a slightly more complex 3-part system, comprised of a vision cart with a dual light source, dual 3 chip cameras, a console for the surgeon, and 2 instrument arms on a movable cart and a camera arm mounted onto a cart. The Zeus machine is very similar to the da Vinci, however the console is in an ergonomically designed arrangement for the surgeon.

In addition, Zeus has a third robotic arm that is voice controlled, allowing the surgeon to give audible instructions on where the camera should be placed for the best picture (Lanfranco). What this is essentially offering is surgery that can be performed by a robot that is being guided by a surgeon, which provides numerous advantages to doctors and patients. According to the article Robotic Surgery by Anthony Lanfranco, these systems enhance dexterity and allow the surgeon to better manipulate the instruments and the body tissues.

Additionally, the systems produce greater control of hand tremors and sudden movements that doctors would normally have. Lanfranco adds that these robots help by allowing the surgeon to “sit in an ergonomically designed workstation” as well as “eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor. ” The advantage to this is that the system restores proper hand-eye coordination to the surgeon, and reduces the risk of slipping during a procedure as well as not being able to see clearly (Lanfranco).

A video titled Minimally Invasive Robotic Surgery with the da Vinci Surgical System records a patient who prefers robotic surgery because “a surgeon can focus in 10 to 12 times magnification” and that was very important to him. This same man, named Doug Mclean, ran in a marathon within about a month after his prostatectomy (da Vinci Surgery). This leads to another critical advantage of robotic surgery. These robots have been mainly used in laparoscopic surgeries, which are also known as Minimally Invasive Surgeries (Lanfranco).

These laparoscopic surgeries provide the ability for surgery to be done without the need of a lengthy recovery period or a sizeable scar. Patients who would normally need to stay in a hospital to recover are now able to leave the hospital on the same day as their surgery (Lanfranco). After his prostatectomy, Marlow Gilmore said, “I had no idea that it would be this quick to get back to my normal, functioning self” (da Vinci Surgery). Despite its amazing advantages, some disadvantages are still present in Robot-assisted surgery.

Anthony Lanfranco recognizes in his article that the limitations of these robots are still not well known. Additionally, he states that the cost of installing one of these systems is close to a million dollars. As new upgrades become available for these new systems, the cost might climb even higher. This makes them difficult for some hospitals to purchase. Lastly, these robotic systems are very large. They take up a huge amount of the operating room, and can sometimes result in overcrowding between the robot and the surgical team (Lanfranco). Haptic Feedback

Researchers, however, are currently working on improving the technology associated with robotic surgery. One way of doing this is using haptic feedback in robotic systems. Haptic feedback is the process of giving surgeons the same “sense of touch” that they would receive if they were performing the surgery without a robot (Robotic Surgery). Associate professor Allison Okamura is conducting experiments to provide a touch sensation during these procedures, instead of feeling what she calls, “chopsticks that have grippers on the end” (Robotic Surgery). This process is a very difficult and complex problem to solve.

In order to allow for doctors to feel these sensations, physics must be combined with technology and incorporated in the machines. The machine will need to use an advanced force sensor, which will measure the force applied by the robot, and exert the same force on the surgeon’s hand (Robotic Surgery). This will create a similar feeling to performing the actual surgery. Another option is to create a computer model that tracks the movements of the robotic tools. This will allow the data collected by the computer to be converted into haptic feedback for the operator (Robotic Surgery). There is much debate to which approach would be better.

Force sensors are highly accurate; however they would need to be made of sterile materials in order to be used. On the other hand, a computer model would work well but it may not respond fast enough to be beneficial to the surgeon. Until a system has been developed and is proved to be beneficial, Allison Okamura is using a light operated system that uses red, yellow, and green lights to display if the right amount of force is being used (Robotic Surgery). A new era is approaching and Robotic Surgery is at the front of it. It may be a recent and developing field, but has proved to be beneficial thus far.

While human nurses are still the most common, and most surgeons are not using robotic technology, these practices may become outdated in the future with minimally invasive procedures now becoming more available. Robotics has the ability to advance surgery and perform surgical methods that are not achievable by humans. While still incredibly expensive, robotics is now beneficial to the field of surgery, and as time passes this cost will hopefully become more reasonable. While people may be using conventional surgery more often, Robotic Surgery has become a superior alternative.

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