ROBOTICS SURGERY

A PROJECT REPORT

S UBMITTED BY :
DEEPIKA SACHDEVA

In partial fulfillment for the award of the degree

Of

BACHELOR OF COMPUTERS APPLICATION

From

SIRIFORT COLLEGE OF COMPUTER TECHNOLOGY AND MANAGEMENT

ROHINI, DELHI

IP UNIVERSITY: DELHI
 ACKNOWLEDGEMENT

I owe a great many thanks to a great many people who helped and
supported me during the writing of this book.
My deepest thanks to Lecturer, Mr. ASHIWINI RATHOR the
Guide of the project for guiding and correcting various documents of
mine with attention and care. He has taken pain to go through the
project and make necessary correction as and when required.

I express my thanks to the Director of our college, [CPJCHS,

GGSIPU] for extending his support.

I would also thank my Institution and my faculty members without

whom this project would have been a distant reality. I also extend my
heartfelt thanks to my team workers.

DECLARATION
I hereby declare that the project work entitled “ROBOTICS SURGERY”

Submitted to IP UNIVERSITY, is a record of an original work done by me

(DEEPIKA SACHDEVA) under the guidance of Mr. RAJESH JAIN, Head

Dept of Computer Science, SIRIFORT COLLEGE OF COMPUTER

TECHNOLOGY AND MANAGEMENT, and this project work is submitted in

The partial fulfillment of the requirements for the award of the degree of

Bachelor of Computers Applications. The results embodied in this thesis have

Not been submitted to any other University or Institute for the award of any

Degree or diploma.

EXECUTIVE SUMMARY:-
OBJECTIVES:
To review the history, development and current application on robotic surgery.

The purpose of this report is to analyze surgical robotics which is a new

revolution and most talked about subjects. There is no doubt that they have
become an important tool in surgical armamentarium, but the extent of their use
in still evolving. According to L. Wiley Nifong, director of robotic surgery at
East Carolina University's Brody School of Medicine, "Nationally, only one-
fourth of the 15 million surgeries performed each year are done with small
incisions or what doctors call 'minimally invasive surgery'." Robots could raise
that number substantially (Stark 2002).

Currently Healthcare Organizations use robot technology for thoracic,

abdominal, pelvic, and neurological surgical procedures. Minimally invasive
surgery reduces the amount of inpatient hospital days, and the computer in the
system filters any hand tremors a physician may have during the surgery. The
use of robot-assisted surgery improves quality of care because the patient
experiences less pain after the surgery. Robot-assisted surgery demonstrates
definite advantages for the patient, physician, and hospital; however, healthcare
organizations in the United States have yet to acquire the technology because of
implementation costs and the lack of FDA (Food and Drug Administration)
approval for using the technology for certain types of heart procedures.
This article focuses on robot-assisted surgery advantages to patients, physicians,
and hospitals as well as on the disadvantages to physicians. In addition, the
article addresses implementation costs, which creates financial hurdles for most
healthcare organizations; offers recommendations for administrators to embrace
this technology for strategic positioning; and enumerates possible roles for
robots in medicine.

The Robot Institute of Carnegie Mellon University defines a robot as "a

reprogrammable multifunctional manipulator designed to move materials, parts,
tools, or specialized devices through various programmed motions for the
performance of a variety of tasks" (Govindarajan 2001). The term "robot" is
derived from the Czechoslovakian word "robata" meaning "forced labor"
(Horgan and Vanuno 2001).

The types of robots used in surgery can be divided into two broad categories:
passive and active. A physician controls a passive robot, while a computer
controls an active robot. An active robot has a degree of autonomy and the
capability to perform unsafe acts during surgery. Surgeons use passive robots in
cardiac surgery, which renders the surgery safe. However, with more advanced
systems a robot may switch from passive to active mode (Buckingham and
Buckingham 1995).

Surgical robots entered the medical field in the 1980s, assisting orthopedic
surgery and neurosurgery. Successes of robot use in these fields encouraged
other specialties, such as urology and otolaryngology, to adopt surgical robots.
The military began its first attempts with the technology through telesurgery.
Telesurgery allows the physician to control the robot and operate on a soldier
from behind "battle lines"--while the soldier was on the battlefield
(Govindarajan 2001). In 1992, the civilian medical sector implemented the
concept of telesurgery.

These robots evolved, since their inception into medicine, into two
sophisticated, competing kinds that surgeons can operate from about six feet
away: the Da Vinci robot and the Zeus robot. Surgeons in the United States,
Canada, and Europe use both the Zeus and the Da Vinci. The Da Vinci has FDA
approval to cut, dissect, and suture, while the Zeus can grasp, hold, and move
tissue.

HISTORY:
In 1985 a robot, the PUMA560 was used to place a needle for the brain biopsy.
The ROBODOC from Integrated Surgical Systems was introduced in 1992 to
mill out precise fittings. Further development of robotic systems was carried out
by intuitive surgical with the introduction of Da Vinci Surgical System and
computer motion. The use of robotics has been emerging for about 75 years;
however it is only during the past 5 years that the potential of robotics has been
recognized by the surgical community as a whole. This personal perspective is
intended to chronicle the development of robotics for the general surgical
community, the role of the military medical research effort and to document
many of the major programs that contributed to the current success.

INTRODUCTION:
It is designed as the use of robot in performing surgery. 3 major advances aided by surgical
robots have been remote surgery, minimally invasive surgery and unmanned surgery. The
scientific name for robotic surgery is Laparoscopic cholecystectomy. It is a new and exciting
emerging technology i.e. taking surgical profession by storm.

The robotic surgical system includes three components: a surgeon’s viewing and control
console, including a three-dimensional viewing system; a patient side cart with robotic arms
to position endoscopic instruments; and a vision cart with all the audiovisual controls and an
extra monitor for the rest of the surgical team.

Heart disease is the leading cause of death in the United States and one of Kentucky’s most
serious health concerns; a CABG is the most commonly performed heart operation. The
robotic surgical system soon will be used for urological, vascular, neurological, pediatric, and
complete cardiothoracic surgical procedures.

ADVANTAGES OF ROBOTIC SURGERY:

 1. LESS PERSONNEL REQUIRMENT: Because surgical robots can take over the
job of people inside the operating room and perform a more effective and safer
surgery.

2. SURGERY ATADISTANCE: With the improvement in telecommunication and

speed of data transfer, it can be done from distance.

3. REDUCE TRAUMA AND FASTER PATIENT RECOVERY:

Since robotic surgery allows small incisions for operations on patient’s body, the rate
of patient’s recovery accelerates. This translates less pain during and after operation,
less complications and risks.

4. DECREASE FATIGUE: Robotic assistance can be decrease the fatigue that doctors
experience during surgeries lasting for several hours. Surgeons can become exhausted
and can have hand tremors.

In total, Robotic Surgery increase dexterity, restore proper hand- eye coordination and
ergonomic positions and improve visualization and make surgeries that were technically
difficult or unfeasible previously.

DISADVANTAGES OF ROBOTIC SURGERY:

There are, however, prominent disadvantages to robotics, including time, cost, efficiency, and
compatibility with current systems.

1) Time:

Robotic assisted heart surgery can take nearly twice the amount of time that a typical heart
surgery takes, but this is variable depending on the surgeon's expertise and practice with the
equipment.
In a longer surgery, the patient is under anesthesia for longer and it costs more to staff the
procedure.

2) Cost:

At this early stage in the technology, the robotic systems are very expensive. It is possible
that with improvements in technology and more experience gained by surgeons the cost will
fall. Others believe that with these improvements in technology the systems will become
more complicated and the costs will rise. Another issue with costs is the problem with
upgrading the systems as they improve.

3) Efficiency and Compatibility:

Another disadvantage is the large size of the system in an overcrowded-operating room. The
robotic arms are awkward and bulky and there are many instruments needed in the small
space. For robotic-assisted beating heart surgery, the space is even smaller because stabilizers
are needed. For surgeons, this cramped area can interfere with their dexterity.

There are two possible suggestions for improving this problem, however both are costly.
Some suggest miniaturizing the robotic arms and instruments while others believe that larger
operating rooms are needed. With either solution, robotics is an especially expensive new
technology. Another disadvantage is that current operating room instruments and equipment
are not necessarily compatible with the new robotic systems. Without the correct equipment,
tableside assistance is needed to perform part of the surgery.

There are also concerns about using a static model for beating heart surgery and concerns
about technical glitches that might occur during the surgery. In comparison to robots used in
the industrial sector, medical robots present designers with much more complicated safety
problems.

4) Human absence:

In an industrial situation, there are no humans present in the application environment. Should
that be necessary, safety regulations specify that the robot be de-activated while humans are
in the vicinity. This greatly simplifies the safety requirements and their satisfaction. In the
medical sector, however, robots are required to assist rather than to replace humans. In that
respect, they must be able to work in close proximity to humans and perform well in a
chaotic, time-varying environment. This requires medical robots to have rich sensory and
reasoning capabilities concerning their environment, something that both pushes the current
technology to the limits and presents robot designers.

5) Fault consequences:

This is closely related not only to the presence of humans near the robot, but also to the
nature of the task of the robot, which typically involves a human patient.

In the industrial sector, a fault can mean at most some loss of physical equipment. In the
medical sector, where lives are at stake, the implications are of profound importance.

6) Non-generic task:

In the industrial sector, the robot is required to perform a series of movements in some pre-
defined order. The object it is operating on, be it as simple as a metal pipe or as complex as a
car, is not distinguished in any way, that is, the robot is not required to take account of
differences on an object-by-object basis, but treats them all as being equal. When dealing
with patients, however, this is not possible. Each patient has their own distinguishing
characteristics, making a uniform approach inappropriate. In safety terms, this requires
testing, or at least reasoning about infinitely many scenarios.

REMARK:
Possible reasons that can lead to unsafe operation of a medical unit include flawed design,
malfunction of hardware and software components, misinterpretation and incorrect or
inadequate specification. As in many other applications, improving some of these parameters
results in a degraded performance in other areas, while an overall increased level of safety is
accompanied by an increase in cost, complexity, or both.

APPLICATIONS OF ROBOTIC SURGERY:

 1) GENERAL SURGERY:-

General surgery, despite its name, is a surgical specialty that focuses on abdominal organs,
e.g., intestines including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder
and bile ducts, and often the thyroid gland (depending on the availability of head and neck
surgery specialists). They also deal with diseases involving the skin, breast, and hernias.
These surgeons deal mainly in the Torso. It is jokingly referred to by other specialists as the
"butts and guts" specialty, because it primarily deals with the digestive tract.

Many general surgical procedures can now be performed using the state of the art robotic
surgical system. In 2007, the. University of Illinois at Chicago medical team, lead by Prof.
Pier Cristoforo Giulianotti, performed the world's first ever robotic pancreatectomy and also
the Midwest’s fully robotic Whipple surgery, which is the most complicated and demanding
procedure of the abdomen. In April 2008, the same team of surgeons performed the world's
first fully minimally invasive liver resection for living donor transplantation, removing 60%
of the patient's liver, yet allowing him to leave the hospital just a couple of days after the
procedure, in very good condition. Furthermore the patient can also leave with less pain than
a usual surgery due to the four puncture holes and not a scar by a surgeon.
 2) CARDIOTHORACIC SURGERY:-

Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases

affecting organs inside the thorax (the chest). Generally treatment of conditions of the heart
(heart disease) and lungs (lung disease). Cardiac surgery (involving the heart and great
vessels) and thoracic surgery (involving the lungs and any other thoracic organ) are separate
surgical specialties, except in the USA and Australia, where they are frequently grouped
together, so that a surgeon training in the cardiothoracic specialty will receive a broader but
less specialized experience in both fields.

Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) surgeries are
being performed with the da Vinci system. Mitral valve repairs and replacements have been
performed. East Carolina University, Greenville (Dr W. Randolph Chitwood), Saint Joseph's
Hospital, Atlanta (Dr Douglas A. Murphy), and Good Samaritan Hospital, Cincinnati (Dr J.
Michael Smith) have popularized this procedure and proved its durability with multiple
publications. Since the first robotic cardiac procedure performed in the USA in 1999, The
Ohio State University, Columbus (Dr. Robert E. Michler, Dr. Juan Crestanello, Dr. Paul
Vesco) has performed CABG, mitral valve[[, esophagectomy, lung resection, tumor
resections, among other robotic assisted procedures and serves as a training site for other
surgeons. In 2002, surgeons at the Cleveland Clinic in Florida (Dr. Douglas Boyd and
Kenneth Stahl) reported and published their preliminary experience with minimally invasive
"hybrid" procedures. These procedures combined robotic revascularization and coronary
stenting and further expanded the role of robots in coronary bypass to patients with disease in
multiple vessels.
 3) CARDIOLOGY And ELECTROPHYSIOLOGY

Cardiology (from Greek καρδίᾱ, kardiā, "heart"; and -λογία, -logia) is a medical specialty
dealing with disorders of the heart. The field includes diagnosis and treatment of congenital
heart defects, coronary artery disease, heart failure, valvular heart disease and
electrophysiology. Physicians specializing in this field of medicine are called cardiologists.
Cardiologists should not be confused with cardiac surgeons, cardiothoracic and
cardiovascular, who are surgeons who perform cardiac surgery via sternotomy - open
operative procedures on the heart and great vessels.

An electrophysiology study (EPS) of the heart is a test performed to analyze the electrical
activity of the heart. The test uses cardiac catheters and sophisticated computers to generate
electrocardiogram (EKG) tracings and electrical measurements with exquisite precision from
within the heart chambers.

The Stereo taxis Magnetic Navigation System (MNS) has been developed to increase
precision and safety in ablation procedures for arrhythmias and atrial fibrillation while
reducing radiation exposure for the patient and physician, and the system utilizes two
magnets to remotely steerable catheters. The system allows for automated 3-D mapping of
the heart and vasculature, and MNS has also been used in interventional cardiology for
guiding stents and leads in PCI and CTO procedures, proven to reduce contrast usage and
access tortuous anatomy unreachable by manual navigation. Dr. Andrea Natale has referred
to the new Stereo taxis procedures with the magnetic irrigated catheters as "revolutionary."

The Hansen Medical Sensei robotic catheter system uses a remotely operated system of
pulleys to navigate a steerable sheath for catheter guidance. It allows precise and more
forceful positioning of catheters used for 3-D mapping of the heart and vasculature.
 4) GASTROINTESTINAL SURGERY:-

Multiple types of procedures have been performed with either the Zeus or da Vinci robot

systems, including bariatric surgery.

Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone.
Gastrointestinal surgery is a good option for people who are severely obese and cannot lose
weight by traditional means or who suffer from serious obesity-related health problems. The
surgery promotes weight loss by restricting food intake and, in some operations, interrupting
the digestive process. As in other treatments for obesity, the best results are achieved with
healthy eating behaviors and regular physical activity.

People who may consider gastrointestinal surgery include those with a body mass index
(BMI) above 40 -- about 100 pounds overweight for men and 80 pounds for women (see our
BMI chart). People with a BMI between 35 and 40 who suffer from type 2 diabetes or life-
threatening cardiopulmonary problems, such as severe sleep apnea or obesity-related heart
disease, may also be candidates for surgery.

The concept of gastrointestinal surgery to control obesity grew out of results of operations for
cancer or severe ulcers that removed large portions of the stomach or small intestine. Because
patients undergoing these procedures tended to lose weight after surgery, some physicians
began to use such operations to treat severe obesity.
 5) GYNECOLOGY:-

Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. This
includes the use of the da Vinci surgical system in benign gynecology and gynecologic
oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis,
ovarian tumors, pelvic prolapse, and female cancers. Using the robotic system, gynecologists
can perform hysterectomies, myomectomies, and lymph node biopsies. The need for large
abdominal incisions is virtually eliminated.

When medication and non-invasive procedures are unable to relieve symptoms, surgery
remains the accepted and most effective treatment for a range of gynecologic conditions.
These include, but are not limited to, cervical and uterine cancer, uterine fibroids,
endometriosis, uterine prolapse and menorrhagia or excessive bleeding.

Robot assisted hysterectomies and cancer staging are being performed using da Vinci robotic
system. The University of Tennessee, Memphis (Dr. Todd Tillmanns, Dr. Saurabh Kumar),
Northwestern University (Dr. Patrick Lowe), Aurora Health Center (Dr. Scott Kamelle),
West Virginia University (Dr. Jay Bringman) and The University of Tennessee, Chattanooga
(Dr. Donald Chamberlain) have extensively studied the use of robotic surgery and found it to
improve morbidity and mortality of patients with gynecologic cancers. They have also for the
first time reported robotic surgery learning curves for current and new users as a method to
assess acquisition of their skills using the device.
 6) NEUROSURGERY:-

Several systems for stereotactic intervention are currently on the market. MD Robotics’
NeuroArm is the world’s first MRI-compatible surgical robot. Neurosurgery (or
Neurological Surgery) is the medical specialty concerned with the prevention, diagnosis,
treatment and rehabilitation of disorders that affect the entire nervous system including the
brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerebrovascular
system.

NEUROSURGICAL METHODS

Neuroradiogy methods are used in modern neurosurgical diagnosis and treatment. computer
assisted imaging computed tomography (CT), magnetic resonance imaging (MRI), positron
emission tomography (PET), magnetoencephalography (MEG) and the development of
stereotactic surgery. Some neurosurgical procedures involve the use of MRI and functional
MRI intraoperative. Microsurgery is utilized in many aspects of neurological surgery.
Microvascular anastomosis are required when EC-IC surgery is performed. The clipping of
aneurysms is performed using a microscope. Minimally invasive spine surgery utilizes relies
on these techniques. Procedures such as microdiscectomy, laminectomy, and artificial discs
rely on microsurgery. Minimally invasive endoscopic surgery is utilized by neurosurgeons.
Techniques such as endoscopic endonasal surgery is used for pituitary tumors,
craniopharyngiomas, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular
endoscopy is used for colloid cysts and neurocysticercosis. Endoscopic techniques can be
used to assist in the evaculation of hematomas and trigeminal neuralgia.
 7) ORTHOPEDICS:-

The ROBODOC system was released in 1992 by Integrated Surgical Systems, Inc. which
merged into. Also, The Acrobot Company Ltd. sells the "Acrobot Sculptor", a robot that
constrains a bone cutting tool to a pre-defined volume. Another example is the CASPAR
robot produced by U.R.S.-Ortho GmbH & Co. KG, which is used for total hip replacement,
total knee replacement and anterior cruciate ligament reconstruction

Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery

concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use
both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries,
degenerative diseases, infections, tumors, and congenital disorder.

Nicholas Andry coined the word "orthopaedics", derived from Greek words for orthos
("correct", "straight") and paideion ("child"), when he published Orthopaedia: or the Art of
Correcting and Preventing Deformities in Children in 1741.

In the United States orthopedics is standard, although the majority of university and
residency programs, and even the American Academy of Orthopaedic Surgeons, still use
Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable;
orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.
 8) PEDIATRICS

Surgical robotics has been used in many types of pediatric surgical procedures including:
tracheoesophageal fistula repair, cholecystectomy, nissen fundoplication, morgagni's hernia
repair, kasai portoenterostomy, congenital diaphragmatic hernia repair, and others. On
January 17, 2002, surgeons at Children's Hospital of Michigan in Detroit performed the
nation's first advanced computer-assisted robot-enhanced surgical procedure at a children's
hospital.

The Center for Robotic Surgery at Children's Hospital Boston provides a high level of
expertise in pediatric robotic surgery. Specially-trained surgeons use a high-tech robot to
perform complex and delicate operations through very small surgical openings. The results
are less pain, faster recoveries, shorter hospital stays, smaller scars, and happier patients and
families. In 2001, Children's Hospital Boston was the first pediatric hospital to acquire a
surgical robot. Today, surgeons use the technology for many procedures and perform more
pediatric robotic surgeries than any other hospital in the world. Children's Hospital physicians
have developed a number of new applications to expand the use of the robot, and train
surgeons.

Pediatrics is the branch of medicine that deals with the medical care of infants, children, and
adolescents. The age limit of such patients ranges from birth to 18. In countries where the age
of majority is 18, this age limit may be from birth to age 17 (such as in Canada). A medical
practitioner who specializes in this area is known as a pediatrician. The word pediatrics and
its cognates mean healer of children. In Commonwealth countries, the respective spellings
paediatrics and paediatrician are usually preferred. There may be a slight semantic
difference: in the USA, a pediatrician is often a primary care physician who specializes in
children, whereas in the Commonwealth a paediatrician is a medical specialist not in
primary general practice.
 9) RADIO SURGERY:-

Radiosurgery is a medical procedure that allows non-invasive treatment of benign and

malignant tumors. It is also known as stereotactic radiotherapy, (SRT) when used to target
lesions in the brain, and stereotactic body radiotherapy (SBRT) when used to target lesions in
the body. In addition to cancer, it has also been shown to be beneficial for the treatment of
some non-cancerous conditions, including functional disorders such as arteriovenous
malformations (AVM's) and trigeminal neuralgia. It operates by directing highly focused
beams of ionizing radiation with high precision. It is a relatively recent technique (1951),
which is used to ablate, by means of a precise dosage of radiation, intracranial and
extracranial tumors and other lesions that could be otherwise inaccessible or inadequate for
open surgery. There are many nervous diseases for which conventional surgical treatment is
difficult or inadvisable due to deleterious consequences for the patient, such as damage to
nearby arteries, nerves, and other vital structures.

The Cyber Knife Robotic Radio surgery System uses image-guidance and computer
controlled robotics to treat tumors throughout the body by delivering multiple beams of high-
energy radiation to the tumor from virtually any direction.
 10) UROLOGY:-

The da Vinci robot is commonly used to remove the prostate gland for cancer, repair
obstructed kidneys, repair bladder abnormalities and remove diseased kidneys. New
minimally invasive robotic devices using steerable flexible needles are currently being
develope for use in prostate brachytherapy. A few leading urologists in the field of robotic
urological surgery are Drs. David Samadi, Ashutosh Tewari, Mani Menon, Peter Schlegel,
Douglas Scherr, Darracott Vaughan, and Vipul Patel.
 TYPES OF ROBOTICS SURGERY:-

 DA VINCI ROBOTIC SURGERY

 REMOTE SURGERY
 MINIMALLY INVASIVE SURGERY OR LAPAROSCOPIC
CHOECTECTOMY
 ZEUS ROBOTIC SURGERY

DA VINCI ROBOTIC SURGERY:-

St. John’s Hospital offers patients the latest robotic-assisted surgery system, the da Vinci Si.
The da Vinci Si gives surgeons an enhanced three-dimensional viewing area, greater
flexibility and the depth perception necessary to manipulate tissue. Robotic-assisted surgery
is an alternative to traditional open surgical procedures and conventional laparoscopic
surgery. The da Vinci Si Surgeon Console is set away from the actual operating table and
contains the master controls the surgeon uses to operate. The handles mimic the surgeon’s
natural hand and wrist movements into corresponding, precise and scaled movements. The
"EndoWrist" Instruments are only able to move when commanded by the surgeon.

The new dual-control da Vinci Si surgery system allows for greater collaboration for surgeons
who perform robotic surgical procedures and enhance teaching opportunities at St. John's
Hospital.
Surgeons at St. John’s Hospital are using the da Vinci Si for a variety of procedures
including:

 Hysterectomy (removing the uterus)

 Partial Nephrectomy (removing section of kidney)
 Prostatectomy (removing the prostate)
 Sacrocolpopexy (repairing uterine or vaginal vault prolapse)
 Pyeloplasty (correcting a blockage at the kidney/ureteral junction)
  Myomectomy (removal of fibroids from the uterus)
 Tubal re-anastomosis (reversal of tubal ligation)
 Endometriosis
 Gynecologic cancer
 Reproductive surgery
 Fertility preservation surgery

Components:-

The da Vinci Surgical System comprises three components: a surgeon console, a patient-side
robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to
manipulate instruments), and a high-definition 3D vision system. Articulating surgical
instruments are mounted on the robotic arms which are introduced into the body through
cannulas. The surgeon hand movements are scaled and filtered to eliminate hand tremor then
translated into micro-movements of the proprietary instruments. The camera used in the
system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci
System is FDA cleared for a variety of surgical procedures including surgery for prostate
cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the
Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells
for about $1.2 million

Limitations:-

 Current equipment is expensive to obtain, maintain and operate.

 If one of the older model non-autonomous robots is being used, surgeons

and staff need special training.

 Data collection of procedures and their outcomes remains limited.

 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. Remote surgery combines elements of robotics, cutting edge communication
technology such as high-speed data connections and elements of management information
systems. While the field of robotic surgery is fairly well established, most of these robots are
controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced
telecommuting for surgeons, where the physical distance between the surgeon and the patient
is immaterial. It promises to allow the expertise of specialized surgeons to be available to
patients worldwide, without the need for patients to travel beyond their local hospital.

Application of Remote surgery:-

The Lindbergh Operation

''Main article: Lindbergh Operation''

One of the earliest remote surgeries was conducted on 7 September 2001 across the Atlantic
Ocean, with a surgeon in New York performing a gallbladder operation on a patient 6,230 km
away in Strasbourg, France [1]. That operation, called Project Lindbergh for Charles
Lindbergh’s pioneering transatlantic flight from New York to Paris, was conducted over a
dedicated fiberoptic link to ensure guaranteed connectivity and minimal lag.

Since then, remote surgery has been conducted many times in numerous locations. To date
Dr. Anvari, a laparoscopic surgeon in Hamilton, Canada, has conducted numerous remote
surgeries on patients in North Bay, a city 400 kilometres from Hamilton. Even though he uses
a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular
telecommunications data, Dr. Anvari's has not had any connection problems during his
procedures.
Rapid development of technology has allowed remote surgery rooms to become highly
specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital in Toronto,
Canada, the surgical room responds to the surgeon’s voice commands in order to control a
variety of equipment at the surgical site, including the lighting in the operating room, the
position of the operating table and the surgical tools themselves. With continuing advances in
communication technologies, the availability of greater bandwidth and more powerful
computers, the ease and cost effectiveness of deploying remote surgery units is likely to
increase rapidly.
The possibility of being able to project the knowledge and the physical skill of a surgeon over
long distances has many attractions. There is considerable research underway in the subject.
The armed forces have an obvious interest since the combination of telepresence,
teleoperation, and telerobotics can potentially save the lives of battle casualties by providing
them with prompt attention in mobile operating theatres.
Another potential advantage of having robots perform surgeries is accuracy. A study
conducted at Guy’s Hospital in London, England compared the success of kidney surgeries in
304 dummy patients conducted traditionally as well as remotely and found that those
conducted using robots were more successful in accurately targeting kidney stones

Limitations

For now, remote surgery is not a widespread technology. Before its acceptance on a broader
scale, many issues will need to be resolved. For example, established protocols and global
compatibility of equipment must be developed in order for such procedures to occur in spite
of communication problems such as linguistic differences. Also, there is still the need for an
anesthetist and a backup surgeon to be present in case there is a disruption of communication.
LAPAROSCOPIC SURGERY: (most important surgery)

Laparoscopic surgery, also called minimally invasive surgery (MIS), band aid surgery,
keyhole surgery is a modern surgical technique in which operations in the abdomen are
performed through small incisions (usually 0.5–1.5 cm) as compared to larger incisions
needed in traditional surgical procedures.
Keyhole surgery uses images displayed on TV monitors for magnification of the surgical
elements.
Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas
keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery.
Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
There are a number of advantages to the patient with laparoscopic surgery versus an open
procedure. These include reduced pain due to smaller incisions and hemorrhaging, and
shorter recovery time.
The key element in laparoscopic surgery is the use of a laparoscope. There are two types: a
telescopic rod lens system, that is usually connected to a video camera (single chip or three
chip), or a digital laparoscope where the charge-coupled device is placed at the end of the
laparoscope, eliminating the rod lens system..Also attached is a fiber optic cable system
connected to a 'cold' light source (halogen or xenon), to illuminate the operative field,
inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The
abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide
gas. This elevates the abdominal wall above the internal organs like a dome to create a
working and viewing space. CO2 is used because it is common to the human body and can be
absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is
important because electrosurgical devices are commonly used in laparoscopic procedures
Procedures

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In

this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be
introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to
keep the CO2 from leaking). Dr. Eddie Joe Reddick of Nashville, TN was the pioneer of
laparoscopic cholecystectomies in the U.S., and was instrumental in teaching other surgeons
the procedure and establishing the technique as the standard of care for gall bladder removal.
[citation needed] Over one million cholecystectomies are performed in the U.S. annually,
with over 96% of those being performed laparoscopically.
There are two different formats for laparoscopic surgery. Multiple incisions are required for
technology such as the "Da Vinci" system, which uses a console located away from the
patient, with the surgeon controlling a camera, vacuum pump, saline cleansing solution,
cutting tools, etc. each located within its own incision site, but oriented toward the surgical
objective. The surgeon uses two Play Station type controls to manipulate the devices.
In contrast, requiring only a single small incision, the "Bonati system" (invented by Dr.
Albert Bonati), uses a single 5-function control, so that a saline solution and the vacuum
pump operate together when the laser cutter is activated. A camera and light provide
feedback to the surgeon, who sees the enlarged surgical elements on a TV monitor. The
Bonati system was designed for spinal surgery and has been promoted only for that purpose.
Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four
incisions of 0.5–1.0 cm will be sufficient to perform a laparoscopic removal of a gallbladder.
Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually
be removed from the abdomen by suctioning out the bile and then removing the deflated
gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay
in the hospital is minimal, and same-day discharges are possible in cases of early morning
procedures.
In certain advanced laparoscopic procedures where the size of the specimen being removed
would be too large to pull out through a trocar site, as would be done with a gallbladder, an
incision larger than 10mm must be made. The most common of these procedures are removal
of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some
surgeons perform these procedures completely laparoscopically, making the larger incision
toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also
prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other
surgeons feel that since they will have to make a larger incision for specimen removal
anyway, they might as well use this incision to have their hand in the operative field during
the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities
(palpate), as they would in open surgery. This technique is called hand-assist laparoscopy.
Since they will still be working with scopes and other laparoscopic instruments, CO2 will
have to be maintained in the patient's abdomen, so a device known as a hand access port (a
sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this
hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic
approach, as well as providing them more options in dealing with unexpected adverse events
(i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and
converting to a fully open surgical procedure.
Conceptually, the laparoscopic approach is intended to minimize post-operative pain and
speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to
improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted
by various surgical sub-specialties including gastrointestinal surgery (including bariatric
procedures for morbid obesity), gynecologic surgery and urology. Based on numerous
prospective randomized controlled trials, the approach has proven to be beneficial in reducing
post-operative morbidities such as wound infections and incision hernias (especially in
morbidly obese patients), and is now deemed safe when applied to surgery for cancers such
as cancer of colon.
The restricted vision, the difficulty in handling of the instruments (new hand-eye
coordination skills are needed), the lack of tactile perception and the limited working area are
factors which add to the technical complexity of this surgical approach. For these reasons,
minimally invasive surgery has emerged as a highly competitive new sub-specialty within
various fields of surgery. Surgical residents who wish to focus on this area of surgery gain
additional training during one or two years of fellowship after completing their basic surgical
residency. In OBGYN residency programs, the average laparoscopy-to-laparotomy quotient
(LPQ) is 0.55.
The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic
gallbladder removal.
Laparoscopic techniques have also been developed in the field of veterinary medicine. Due to
the relative high cost of the equipment required, however, it has not become commonplace in
most traditional practices today but rather limited to specialty-type practices. Many of the
same surgeries performed in humans can be applied to animal cases - everything from an
egg-bound tortoise to a German shepherd can benefit from MIS. A paper published in
JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs
spayed laparoscopically experienced significantly less pain (65%) than those that were
spayed with traditional 'open' methods. Arthroscopy, thoracoscopy, cystoscopy are all
performed in veterinary medicine today. The University Of Georgia School Of Veterinary
Medicine and Colorado State University's School of Veterinary Medicine are two of the main
centers where veterinary laparoscopy got started and have excellent training programs for
veterinarians interested in getting started in MIS.
 Advantages:

There are a number of advantages to the patient with laparoscopic surgery versus an open
procedure. These include:
 Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
 Smaller incision, which reduces pain and shortens recovery time, as well as resulting
in less post-operative scarring.
 Less pain, leading to less pain medication needed.
 Although procedure times are usually slightly longer, hospital stay is less, and often
with a same day discharge which leads to a faster return to everyday living.
 Reduced exposure of internal organs to possible external contaminants thereby
reduced risk of acquiring infections
.
Risks:
Some of the risks are briefly described below:
 The most significant risks are from trocar injuries to either blood vessels or small or
large bowel. The risk of such injuries is increased in patients who have below average
or have a history of prior abdominal surgery. The initial trocar is typically inserted
blindly. While these injuries are rare, significant complications can occur. Vascular
injuries can result in hemorrhage that may be life threatening. Injuries to the bowel
can cause a delayed peritonitis. It is very important that these injuries be recognized
as early as possible.
 Some patients have sustained electrical burns unseen by surgeons who are working
with electrodes that leak current into surrounding tissue. The resulting injuries can
result in perforated organs and can also lead to peritonitis. This risk is eliminated by
utilizing active electrode monitoring.
 There may be an increased risk of hypothermia and peritoneal trauma due to increased
exposure to cold, dry gases during insufflation. The use of heated and humidified CO2
may reduce this risk.
 Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum
(gas in the abdominal cavity), resulting in a need for conversion to open surgery after
the initial attempt at laparoscopic approach.
 Not all of the CO2 introduced into the abdominal cavity is removed through the
 incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the
abdomen, it pushes against the diaphragm (the muscle that separates the abdominal
from the thoracic cavities and facilitates breathing), and can exert pressure on the
phrenic nerve. This produces a sensation of pain that may extend to the patient's
shoulders. For an appendectomy, the right shoulder can be particularly painful. In
some cases this can also cause considerable pain when breathing. In all cases,
however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it
through respiration.
 Coagulation disorders and dense adhesions (scar tissue) from previous abdominal
surgery may pose added risk for laparoscopic surgery and are considered relative
contra-indications for this approach.
 ZEUS® SURGICAL SYSTEM:-

The ZEUS® Surgical System is made up of an ergonomic surgeon control console and three
table-mounted robotic arms, which perform surgical tasks and provide visualization during
endoscopic surgery. Seated at an ergonomic console with an unobstructed view of the OR,
the surgeon controls the right and left arms of ZEUS, which translate to real-time articulation
of the surgical instruments. A third arm incorporates the AESOP® Endoscope Positioner
technology, which provides the surgeon with magnified, rock-steady visualization of the
internal operative field.

Peerless voice control capabilities allow the surgeon to precisely guide the movements of the
endoscope with simple spoken commands, freeing the surgeon's hands to manipulate the
robotic surgical instrument handles. ZEUS custom scales the movement of these handles and
filters out hand tremor, enabling surgeons with greater capability to perform complex micro-
surgical tasks.

In 1999, ZEUS made history in the world's first robotic-assisted beating-heart bypass surgery,
by Douglas Boyd, MD.
The event ushered in a new era in Minimally Invasive Surgery, as promising and inspiring for
patients as it is for surgeons and hospitals. Today ZEUS is being integrated into a broad range
of procedures encompassing cardiac, bariatric, general surgery, urology, and neurology.**
ZEUS® Surgical System—Features

 The ZEUS® Surgical System features the

following components:
o Video Console
o Primary Video Monitor up to 23"W x
23"D
o Flat Panel Monitor: with support for an
additional flat panel monitor
 Surgeon Control Console
o Touch Screen Monitor
o Support Arms and Surgeon Handles
o Mounting Areas: for speakers; access to controller front panels; access to PC
and HERMES™ Control Center; mounting shelves for housing Control Units

Industry Standard Mechanism - Easy Sterilization

 Incorporates mechanism design based on standard flushing port and push-pull rod
technology, the same makeup as industry-standard endoscopic equipment. Provides
easy sterilization.

Instrument Reusability

 Uses robust, reusable instruments, built to withstand the rigorous OR environment.

Instrument and Port Size

 Offers unparalleled precision through 3.5 to 5-mm instrument and endoscope

accommodation.

Wide Array of Instruments

 Offers a suite of more than 40 ZEUS®-compatible instruments, available in a variety

of shaft diameters, from industry leaders Scanlan, Storz and US Surgical.

Quick Instrument Changes

 Incorporates a quick-change mechanism to seamlessly swap instruments and safely

guide the placement of the instrument tips.

Console Placement
  Provides total flexibility in overall console placement, easily converting from setup
directly at the operating table to setup as a physically removed console.

Rapid Setup

 Takes less than 15 minutes to set up.

Visualization

 Designed to adapt to individual surgeon preferences in viewing modes, permits both

2D and 3D visualization and accommodates a wide variety of endoscopes and monitor
setups.

Secondary Monitors

 Secondary flat screen video monitors mount parallel to the main monitor to provide
additional patient data including vitals, image guidance reference display and a
redundant view of the operative field for use with SOCRATES™.

Profile

 Built lightweight for easy installation and flexible adjustment, ZEUS® maintains a
low profile. Its twin instrument positioning arms adhere equally to this design
imperative, allowing assistant to retract, suction and irrigate during surgery.

Operation

 A user-friendly, single foot pedal provides device engagement and disengagement.

When engaged, specific controls are easily accessed using voice control and touch
screen interfaces.

Micro wrist Hand Controls

 Micro Wrist form-fitting hand controls translate the surgeon's movements with
precise scaling and hand tremor filtering.

Six Degrees of Freedom

 4 Motorized
o Up and Down
o In and Out
o Shoulder: Back and Forth
o Elbow: back and forth
  2 Floating
o Forearm: back and forth - safety function: float away to avoid ramming
something
o Wrist

 1 Fixed change in angle

o Elbow Tilt (+/- 3 degrees)

Scaling

 Offers infinite motion scaling, without limitation to arbitrarily defined increments.

Scaling adjustment can be accomplished using either touchscreen or voice command.

Seating Accommodation

 Ergonomic console and seat provides optimal surgeon comfort for long procedures

Repositioning

 During surgery, endoscopic and instrument positioning arms tilt with the operating
table; this flexible design eliminates the need to readjust or recalibrate the arms.

Re-Indexing

 At any time, the foot pedal releases the clutch, allowing surgeons to relax and
reposition (center and re-index) their hands and arms.

Endoscopic Position Saving

 Provides the powerful capability to save 3 different endoscopic positions, retaining x-

y-x axis coordinates that can be quickly and easily returned to at any time.

Voice Control

 Voice control components leverage the advantages of a sophisticated overall

communications paradigm: individual surgeon voice modeling; context sensitive tree
command structure; limited vocabulary for error avoidance; voice and visual feedback
on command success; compensation for ambient OR noise.

Pendant Control

 Device control and communications options are embedded also in ZEUS®' portable
pendant device, allowing flexible, duplicate control options that transcend the OR's
sterile boundary.

DEVICES USED FOR ROBOTIC SURGERY:

 1) Medtronic Stealth Station:-
The Stealth Station, a product of Medtronic Surgical Navigation Technologies, is a three-dimensional
imaging system that allows surgeons to navigate through the body.  It is a next generation product that
combines images from a variety of traditional sources.  Some of these include X-ray, computerized
tomography (CT), magnetic resonance imaging (MRI), and ultrasound.  By combining such a variety of
imaging techniques, the Stealth Station allows for more precise three-dimensional images so the surgeon
can focus on the exact location desired.(1)

Operation:-

The Stealth Station analyzes pre-operative diagnostic scans to create three-dimensional

images used by the surgeon to map out the safest and least invasive surgical path.  Real time
images are continually produced throughout the surgery.  By merging images from multiple
sources, the Stealth Station allows surgeons to view their targets from any angle.  Lastly,
images of instruments are incorporated into images of the patient’s anatomy allowing the
surgeon to see the exact location of the instrument in three-dimensions and in real time.(2)

Applications:

Cranial Neurosurgery – tumor biopsy, tumor resection, cerebrospinal fluid management

Spinal – screw placement throughout the spine

Orthopedic Joints/Trauma – total knee replacement, total hip replacement, trauma

Ear, Nose & Throat – functional endoscopic sinus surgery, laterl and anterior skull base
surgery
 2) Orthopilot:-

Operation

The Orthopilot system is used to provide doctors with a way to accurately execute large joint
replacement/corrective surgeries.  The procedures vary depending on the type of surgery,
however the general methodology of the surgery is as follows:  The surgeon fixes sensors to
the part of the patient being operated on, and then moves the patient in specific natural
motions so that the camera receives the data and uses it to form a model on the screen.  The
representations on the monitor allow the surgeon to perform the surgery with greater
accuracy, as the Orthopilot system will be able judge when the joint is properly aligned.

3) NeuroMate:-
NeuroMate was the first robotic system designed to perform stereotactic brain surgery.
The system is currently used to aid surgeons in the execution of stereotactic neurosurgical
procedures.  It was designed by Integrated Surgical Systems Inc. and was designed to
perform surgeries using the VoXim™, IVS Software Engineering software system.  The
image guided, computer controlled device manipulates a 6 jointed robotic arm, allowing for 5
degrees of freedom. The NeuroMate system

Operation

NeuroMate can be used with the patient’s head either placed in a frame or without a frame
during surgery; the difference between the two is the accuracy of the imaging displayed, with
the frameless method currently less accurate but improving. The robotic and software system
interact, providing a 3D view of anatomical structures of the brain using CT or MRI scans. 
Once a plan is formed the surgeon will control the arm, using the imaging displayed on a PC
as to guide the operation.

RESULTS OF RESEARCH DONE ON ROBOTICS SURGERY:

According to the study, which evaluates the outcomes of robotic surgery, some 41,000
women every year in the United States are diagnosed with endometrial cancer, a common
malignancy of the female genital tract. While most patients undergo surgery to treat the
disease - the fourth most common form of cancer for females – about 80 percent are
performed through the traditional open method.
But the study’s findings indicate that robotic surgery for endometrial cancer may prompt
more patients to seek less invasive options. The study, which appears in the August issue of
“Obstetrics & Gynecology,” evaluated a database of 405 patients who underwent robotic
surgery for endometrial cancer between April 2003 and January 2009.
The results support previous research, which found that women with endometrial cancer who
underwent robotic surgery experienced shorter operative times and decreased length of
hospital stays. In addition, patients also had minimal blood loss, a reduction in surgical
complications and reduced recovery times. One reason for the benefits is that robots offer
exceptional control and precision of surgical instruments.
The research reportedly is the largest and the first multi-institutional study to look at the
effectiveness of robotic surgery for endometrial cancer.
Dr. M. Patrick Lowe, the lead author of the study and a gynecologic oncologist at
Northwestern Memorial Hospital in Chicago, said the research has the potential to influence
surgical treatment of the disease.
“Many women are unaware that a robotic alternative to treat endometrial cancer exists, and
the advantages of this minimally invasive approach may provide them with their best surgical
option,” Lowe said in a statement.
The study also examined surgical outcomes and the learning curve of five participating
surgeons who incorporated robotic technology. The number of robotic surgeries performed
by each surgeon in the study ranged from 41 to 119, and results found that patient outcomes
for intraoperative complications, length of hospital stay, lymph node yield, and blood loss
were similar among the group of surgeons, regardless of experience.
Surgeons with extensive laparoscopic experience and those without also had similar
outcomes, which resulted in a more level playing field among surgeons when performing
robotic surgery, the study found.
“When compared to published literature on the surgical outcomes of the traditional open or
laparoscopic technique to treat endometrial cancer, robotics is at least equivalent, if not
superior to both modalities in several areas,” Lowe said. “Based on the promising results of
this study, the era of traditional open surgery to primarily treat women with endometrial
cancer has come to a close.”
The recent study builds off other industry research, which said robotics is increasingly being
used in diverse surgical procedures. And technological advances and patient awareness will
only fuel the field.
Earlier this year, a Portland, Ore. doctor made history by conducting the first documented
unaccompanied, laparoscopic hysterectomy using robotic Vision Control in endoscopy or
ViKY, a robotic creation from EndoControl.
DISCUSSIONS:-

 ROBOTIC SURGERY A BOON OR A BANE

Robotic surgery is in deed a BOON for all its patients. For decades, science fiction has been
promising a future filled with robots that will make the various annoyances and dangers of
life easier or more bearable. Robotics changed manufacturing in the '70s and '80s. Today, a
new generation of robots is making a significant difference in medicine and surgery and
could conceivably change the way that we deal with disease. Robots, which help create
minimal invasions for surgeries are extremely precise and are transforming the way heart
disease will be treated forever.

Dr. Gopichand and a few colleagues went to the United States last year to get trained in these
new techniques using robots and practiced on the daVinci equipment to equip and train &
equip themselves. The first patient, a 72 year old male, was successfully operated for Bypass
using the robotic equipment about one month ago and the second such patient, a 45 year old
labourer, was operated for Bypass Surgery on Saturday, 4th June, 2005. Dr. Gopichand
elaborated on the procedure and said, “The recovery time using robotic surgery is
phenomenal because of the small incisions. There is also no need to cut of any bones for the
surgery. It is fascinating to see the patients go home within 5 days. The robotic arms which
have been modeled after the human wrist allow a full range of motion, transposing the action
of the finger tips to the robotic instrument.”

The advanced robotic equipment and trained doctors on the equipment, firmly places
Hyderabad as among the most advanced medical hubs in the country.

Dr. Gopichand Mannam graduated from Guntur Medical College, Guntur, AP, in April 1981.
In May 1981 he went to Jamaica, West Indies, where he developed his initial skills in
surgery. In 1983 he went to the UK to pursue his career in general surgery. He passed FRCS
in General surgery from the Royal College of Surgeons, Edinburgh, in 1986 and The Royal
College of Surgeons, Glasgow in 1987. 

In November 1994, he came back to India and joined the Apollo Hospital, Hyderabad, as a
senior Consultant in Cardio-Thoracic surgery. Later, in June 1997, he has joined Medwin
Hospital, Hyderabad as Consultant Cardiothoracic Surgeon. Currently, for the past 5 years, he
is at CARE hospital, Banjara Hills as Chief of Cardiothoracic surgery. His main interests are
congenital cardiac surgery and Coronary artery bypass on a beating heart (OPCAB). So far he
has done more than 6000 heart operations. 

Dr. Gopichand also does hundreds of free cardiac surgeries on children every year. He is also
the Managing Trustee of “Hrudaya”, a charitable trust that helps finance free heart surgeries
for the children of the underprivileged.
 Robotic Surgery A Bane:-
The concept is often one that is ripped right out of a horror novel or late-night news special.
The idea that doctors can perform surgery on the wrong side of the body is a frightening one.
Most people would dismiss the idea of such a surgery mishap as being a remote occurrence,
believing things like medical training and advanced technology would help prevent such
things. However, there is some alarming information that has come to light because of a news
report from The Providence Journal, a newspaper in the state of Rhode Island. An article that
detailed how three different patients had doctors perform surgery on the wrong side of their
brains uncovered the disturbing statistic showing just how common such snafus actually are
in the medical world.

When taking the number of surgeries that occur on a yearly basis, the statistics show that a
doctor is more likely to leave a small item in the body after surgery than operate on the wrong
side or part of the body. The percentages are rather small when one first looks at them,
making it seem like a minor occurrence that isn't really a viable risk. However, once someone
considers just how many that those percentages actually represent, one comes to realize that
that small number could mean hundreds or thousands of people every year are experiencing
problems of that sort. The worst part is that there is a distinct possibility that the number is
inaccurate because most of the cases of this sort of thing happening during surgery are not
even reported by the patients or doctors.

A number of these incidents are of the hit-or-miss variety, where the doctor realizes that
they're not going after the target area before any real damage has been done. In most cases,
this would not count as medical malpractice since the surgery was halted and directed to the
appropriate area of the body before any real harm was caused. However, when one considers
how sensitive the brain and other areas of the body might be and the possibility of the doctor
not realizing his mistake in time, the sense of risk becomes even greater than normal. This
has been of particular concern with procedures that involve laser surgery equipment. The
nature of the machinery involved can potentially do more damage within a short amount of
time than less precise surgical tools within that same time frame.

Conclusion:-
There have been procedures and steps suggested to minimize the chances of these things
happening, such as openly marking the areas where the surgery is to take place. Other steps
being considered include making sure all records are accurate and updated, as well as taking
time prior to making the procedure to make sure all of the information can be corroborated
with the patient's medical history and the pertinent data about the procedure itself. These are
just some of the steps that medical boards and hospitals are starting to implement to prevent
this problem, but they can only help in prevention cannot fully eliminate the problem. This is
because situations of this sort are caused by that which is the bane of engineers and
investigators alike: human error.
 ETHICS OF ROBOTICS RESPONSIBILITY
This is a report of the discussion at a roundtable meeting held at The Royal
Academy of Engineering on the social, legal and ethical issues surrounding the
development and use of autonomous systems. The meeting involved
stakeholders from a range of areas, including medicine and healthcare,
transport, defence, systems engineering, computer science, financial systems,
public engagement and policy development. A full list of participants and
other contributors is given in 5.1.
Autonomous systems are likely to emerge in a number of areas over the
coming decades. From unmanned vehicles and robots on the battlefield, to
autonomous robotic surgery devices, applications for technologies that can
operate without human control, learn as they function and ostensively make
decisions, are growing. These technologies can promise great benefits,
replacing humans in tasks that are mundane, dangerous and dirty, or detailed
and precise. They also have potential in allowing the remote performance of
various functions, from defusing bombs to monitoring the ill or housebound
CONCLUSION:-
Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current
practical uses are mostly confined to smaller surgical procedures. Although still in its
infancy, robotic surgery is a cutting-edge development in surgery that will have far-reaching
implications. While improving precision and dexterity, this emerging technology allows
surgeons to perform operations that were traditionally not amenable to minimal access
techniques. As a result, the benefits of minimal access surgery may be applicable to a wider
range of procedures. Safety has been well established, and many series of cases have reported
favorable outcomes. However, randomized, controlled trials comparing robotic-assisted
procedures with laparoscopic or open techniques are generally lacking.

Telerobotics surgery stands out as a way of delivering surgical care to patients who have no
direct access to a surgeon; however, costs are prohibitive to the spread of such technology to
underserved areas that need it most. Even in the United States, surgical robots are mainly
available in large academic centers. The issues of cost, technical drawbacks, and clinical
effectiveness need to be resolved before robotic procedures can become mainstream,
everyday surgical procedures.

New technologies, such as virtual reality, haptics, and telementoring, can powerfully ally
with surgical robots to create a new medium for acquisition and assessment of surgical skills
through simulation of all operations that can be done via the robot. Performance of robotic
procedures requires specialized training. However, the majority of residency programs in the
United States do not provide formal training in robotic surgery skills. Students, residents, and
residency programs should strive to keep up with this new development in surgical
technology that is likely to reshape the way we practice surgery.
RECCOMENDATIONS:-
Scientific advances have made the viability of robotic prostate surgery a reality. Robotic
surgery to remove or reduce the prostate gland carries a number of advantages, including
enhanced precision in the procedure itself. As the procedure is less invasive than traditional
"open" prostate surgery, the average recovery time for patients is normally much less than
during other types of prostate surgery.

GENERAL RECOMMENDATIONS:

1. Prepare for surgery as you would for an athletic event, attempting to bring your
weight into your ideal range before the day of the operation. Generally speaking,
individuals who are in better physical condition have an easier time recovering from
any type of surgery, so keeping yourself in optimal shape is crucial to minimize
recovery time, no matter what time of prostate surgery you utilize.

PROCEDURE RECOMMENDATIONS:

2. Understand the elements of the procedure to understand the reduced recovery time
involved. During robotic prostate surgery, several smaller incision are made (as
opposed to one large incision during open surgery), providing the arms of the robot
access to the necessary area. Bleeding is minimized through the use of pressurized
gas, which is pumped into the abdominal cavity throughout the surgery. Due to the
less invasive nature of the process, recovery time is vastly diminished. According to
the Global Robotics Institute at Florida Hospital, both recovery time and the time
spent in-hospital for observation is reduced. On average, patients having robotic
prostate surgery depart the hospital within 24 hours after their operation and most
patients are back to work within one to two weeks. Recovery time can be further
optimized through the use of regular light walking as rehab, along with the consistent
practice of Kegel (pelvic floor) exercises.
SOURCES

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Nerlich - Reduction of femoral shaft fractures in vitro by a new developed reduction
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EXTERNAL LINKS

 SURGICAL ROBOTICS - BIONICS LAB - UNIVERSITY OF CALIFORNIA - SANTA

CRUZ
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Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;
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