Surgical Robots and Minimally Invasive Surgery (MIS)

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Surgical Robots and Minimally Invasive Surgery
(MIS)

• Dr Ryan Beasley

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Minimally Invasive Surgery

• Non-invasive
• E.g., Imaging, CyberKnife
• Minimally invasive
• E.g., gall bladder (cholecystectomy)
• Multiple keyhole incisions
• Often outpatient
• Open
• E.g., CABG
• Large incisions

Increasing damage to healthy tissue. Decreasing
difficulty/risk.
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MIS Terms/Visualization

• Thoracoscopy Thoracic cavity
• Laparoscopic MIS in abdomen
• Endoscopic uses endoscope
• Invented 1806
• MIS in 1912
• Evolves until 1960
• MIS common 80s

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MIS Tools

• Laparo-/Endo- scope
• Rigid or flexible or articulated
• Direct sight or camera
• Graspers/scissors/scalpels/
• electrocautery/needle graspers

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MIS Tools

• Spider Surgical System (Fall 2009)

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Laparoscopic Training

• http//www.pbs.org/kcet/wiredscience/video/94-lapa
  roscopic_training.html
• http//www.youtube.com/watch?vQpIMng1Zv5o

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MIS Tradeoffs

• Less trauma/morbidity
• Less pain
• Faster recovery
• Higher difficulty
• Poor dexterity, visual feedback, tactile feedback
• Higher risk of complications
• Harder to deal with complications
• Longer procedure
• More time on anesthesia

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Robots FTW!

• Precise and accurate
• Orthopedic surgery
• Increase dexterity
• Prostatectomy
• Increase safety (e.g., no-fly zones)
• ?
• Telesurgery?
• Lindbergh Operation
• Spaceship/battlefield/underdeveloped nation
  surgery?

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FDA approved robot

• Da Vinci by Intuitive Surgical (2000)
• Warning bloody
• http//www.pbs.org/kcet/wiredscience/video/90-robo
  doc_ep_101_.html
• Cost (Wall Street Journal, May 4th, 2010)
• 1 million to 2.25 million, depending on the
  model
• 140,000 a year for maintenance
• 1,500 to 2,000 per surgery for replacement
  parts
• Reported profits of 233 million on sales of
  1.05 billion. In use at 853 hospitals across the
  U.S.
• Takes a urologist anywhere from 250 to 700 cases
  to master it. 

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Orthopedics

• Hip and knee replacement
• Enormous reduction in pain, increase in life
  satisfaction
• Implant longevity issue
• Orientation/position/loading?
• Accuracy of cuts?
• Robots!
• http//www.robodoc.com/vidplayer_kneesurgery.swf
• http//www.acrobot.co.uk/Sculptor.html

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Robot problems

• Big
• Expensive
• Workspace blocked by tissue
• E.g., cannot do quadruple bypass
• Non-ideal
• Affects accuracy (my dissertation)
• Excepting prostatectomy, no proven benefit

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Future

• Snake robots
• Robot catheters
• http//www.hansenmedical.com/st.-david-b-roll

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Future

• Other Surgical robots
• RAVEN
• http//www.youtube.com/watch?vnPk90YCpqFg
• Catherine Mohr
• History and future of surgery
• http//www.ted.com/talks/catherine_mohr_surgery_s_
  past_present_and_robotic_future.html (start at 7
  min)

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Questions?