ROBOTIC SURGERY

MODERATOR - DR POONAM
PRESENTER - DR SHIVAJI

 DEFINATION
It is a method to perform surgery using
very small tools attached to robotic arm
and surgeon controls robotic arm using
computer.

 History of Robotic surgery Kwoh et al(1980) first used a modified

industrial robot called PUMA
(Programmable universal machine for
Assembly 560) for stereotactic brain
biopsies.
These similar system is still used
extensively by neuromate system for
image guided instrument placement in
neurosurgical procedures.

 In 1992 , integrated surgical systems

introduced ROBODOC designed to
perform precise bone milling during hip
arthroplasty.
1993 USA FDA approved
AESOP(automated endoscopic system for
optimal positioning) used for abdominal
surgeries.
Later AESOP robotic arm was modified
into teleoperated system called ZEUS,
which has only two dimensional image
effect and traditional laproscopic range of
movements.

 In 1999 intuitive surgical introduced the

other teleoperated robot called da Vince.
Which has 3 dimensional image effect and
range of movement is as surgeons hands
in open surgery.
In 2001 first teleassited cardiac bypass
surgery was done in germany.

 Brief description of all available robotic

system in surgery.
1) AESOP- Initial AESOP was designed
with foot and hand controls but recent
ones are voice activated.
Surgeon is able to control position and
view of laproscope directly and avoid
potential tremors and fatigue.
In some cases it also helps skilled
laproscopic surgeon to work
independently.

 2) ZEUS- specifically designed system for

minimally invasive surgery.
It consist of three table mounted robotic
arms, two of which translated the hand
and arm movement of surgeon into robotic
movements and one for voice operated
laproscope.
It did not gave three dimensional image
effect to surgeon at console and could
perform only traditional laproscopic
movements. So third robotic system called
da Vince came in force.

 3)Da Vince system Consists of three main parts: a) patient

side cart, b) vision system, c) surgical
console.
Surgical console- contains computer
system as well as master controls which
manipulate robotic arms.
Patient site cart- consist 3-4 robotic arms
that effectively carry out procedure.
Vision system provides three
dimensional endoscopic view.

 Each instrument is designed for particular

purpose such as cutting, grasping,
suturing and can be accomodated with
monopolar and bipolar current for
hemostasis.
Robotic arms can apply variable levels of
force allowing surgeon to perform tasks
ranging from delicate tissue dissection to
mass tissue retraction.
Best feature of da Vinci system is 3
dimensional image effect. The laproscope
consist of 2 optic channels that connects
to camera head that house 2 camera.

 When surgeon looks

into surgical console
a fused 3-dimensional
image of operative
field is presented.

 ADVANTAGES OF ROBOTIC SURGERY

TO LAPROSCOPIC SURGERY Surgeon is able to manipulate the
instruments in a manner that closely
resembles open surgery.
There is no mirror image or fulcrum effect
with robotic instruments which also
provide 7 degree freedom that an open
surgery gives.
It abolishes any tremors in the surgeons
movement that may be present in
laproscopy

 Surgeons motions are scaled at 5:1 ratio

which allows precise dissection in places
such as pelvis and thorax.
Instrument positioning and stereoscopic
three dimensional view of surgical field
maintain depth perception and normal
hand eye co-ordination.
Manual dexterity in minimally invasive
surgery is enhanced with robotic surgery.
Another potenial advantage for robot may
be more rapid learning curve.

DISADVANTAGES:
Cost
Absent haptic feedback
Complicated set-up and position change.
Limited instrumentation.
Need of skilled assistants.

Uses of robotic surgeryGall bladder removal

Hip removal
Hysterectomy, tubal ligation
Nephrectomy, pyeloplasty.
kidney transplant
Cardiac bypass surgery, mitral valve
repair.
Oncosurgery- such as lung cancer
(pulmonary embolectomy)
breast cancer (lymphadenectomy),

 Gastric cancers (wedge resection,

intragastric resection, distal gastrectomy)
Kidney ( partial and total nephrectomy)
Colon (total and hemicolectomy)
Rectal ( lower anterior resection and APR)
Prostate ( radical prostatectomy)
Testies ( RPLND)
Tongue transoral resection

 Risk with Robotic surgery Anesthetic breathing problems and

reaction to medications.
Surgical risk are similar to open or
laproscopic surgeries.

 Pre op preparation are similar as open or

laproscopic surgery.
To stop blood thinner 10 days before
surgery.
Pulmonary and cardiac issues to be
setteled pre-op.

Benefits of Robotic surgery

Faster recovery
Less pain
Less risk of infection.
Shorter hospital stay.
Smaller scar.

 Sterotactic biopsy