The universal robot surgeon that was able to perform operations on different nosology was developed in the late 90s. This robot was called Da Vinci in honor of the great inventor Leonardo da Vinci, who, in his time, built the first anthropomorphic robot that could move his legs and arms, carrying out other actions. This leading technology, located on the edge of technical progress in medicine, allows doctors to treat cancers without surgical implantation into patient fiducial markers. This unique technology provides physicians with greater flexibility and precision in the implementation of radiosurgical treatment without a single cut.
This system also provides improved quality of radiation treatment of tumors because it gives robotic surgeons to see the tumor in remote locations and to provide detailed access to it. The relevance of this research is to determine that robotic surgery is a breakthrough in surgical technology.
The Origin of Robotic Surgery
The development of robot-assisted surgery started 25 years ago. When the United States began to develop its ambitious space program, the program managers asked themselves what would happen if astronauts need emergency surgical care during their stay in orbit. Indeed, this was not feasible to create a separate space station or module in which traditional operating room and a surgical team would be placed. To solve this problem, NASA has developed a special surgical robot which can be controlled based on the analysis of individual state astronaut, implemented on the ground by experienced medical professionals. The presentation of the results exceeded all expectations. Although the robot could not perform automatic actions, it had significantly expanded opportunities, and it increased the efficiency of medical care. The previous tests in military technology led to the development of medical robots that allowed making a large number of specific surgical procedures (Sood and Leichtle 14).
The first fact of using the robot during surgery was recorded in 1985, when with the help of the manipulator PUMA, 560 neurosurgical biopsy was performed (Kroh and Chalikonda 21). After the successfully performed operation, robotic surgery was a real breakthrough in the field of minimally invasive procedures. Watanabe reported that in 1987, laparoscopic surgery was made, using the robot - cholecystectomy (removal of the gallbladder) (58). In the following year, PUMA was used for transurethral resection (Kroh and Chalikonda 22). AESOP Productions Company Computer Motion System is the first system that was approved in 1990 by the sanitary supervision over the quality of the US Food and Drug Administration for use in the field of endoscopic surgery (Sood and Leichtle 16).
In 2001, the robotic system da Vinci took a new milestone in the development of surgical techniques, and it was the first system that was approved by FDA for food quality and Drug Administration for use in general laparoscopic surgery (Kroh and Chalikonda 31). Its predecessors had significant technical drawbacks and relied on endoscopic method, impossible without the help of numerous assistants. Three-dimensional color display allowed a surgeon to see a clear picture of his field. Hand robotic manipulator was one centimeter in diameter that had a great advantage compared to a bulky size of previous systems, such as PUMA 560 (Kroh and Chalikonda 32). This feature allows a surgeon to limit the contact of surgical equipment with internal tissue incision, which greatly reduces the risk of wound infection. Manipulators were equipped with Da Vinci tools, reminiscent of the human wrist that is many times greater than the capacity of the human hand. The above advantages provide access and accuracy of movement when operating in confined spaces. Da Vinci Surgical System is officially approved for use in the following areas: urology, total laparoscopic surgery, and others (Sood and Leichtle 18).
The Current Trends
At present, the only universal robotic system with remote control in the world is da Vinci system. Today, many experts in the developed world operate using this technology. For example, currently, the world held more than 52,000 prostate cancer treatments using surgical robot da Vinci (Kroh and Chalikonda 33). The first such operation lasted for about 420 minutes but today, in the most advanced clinics in the world, it takes between 120 and 180 minutes (Watanabe 60). The Da Vinci Surgical System allows surgeons to perform surgery to patients, even without touching them. Being in a couple of meters away from a patient, a physician receives a detailed understanding of what is happening on the operating table.
The system is controlled exclusively by a surgeon who uses a special console. A significant increase in the image, the ability to launch a three-dimensional display and a conventional two-dimensional image allow a surgeon to get the most accurate picture of the operable location. The Da Vinci Surgical System is equipped with special mechanical devices, recurring features of human hands, and they have a diameter of just one centimeter. It is an indisputable advantage over all previous systems and devices of this type. Due to such features, the risk of getting an infection in the wound and a restriction of contact with the tissues of operating equipment notch has been significantly reduced.
In leading clinics around the world, 70% of urological procedures are performed by robots, mainly for prostatectomies and renal ablation or correcting abnormalities of the urinary system (Sood and Leichtle 20). In the United States, approximately 80% of prostatectomy for prostate cancer is performed using a surgical robot Da Vinci (more than 73,000 transactions per year) (Kroh and Chalikonda 35). The spread of technology associated with significant advantages of this unique robotic system during minimally invasive surgery such as the reduction of post-operative pain, reducing bleeding, and scarring. Ultimately, the robotic surgery maintains a shorter hospital stay and a faster return to a familiar life of patients. The main disadvantage of surgical robot Da Vinci is its high cost as well as high maintenance costs.
Advantages of Robotic Surgery
In the United States, Da Vinci Prostatectomy is the key choice in the cure of localized prostate cancer. The radical surgery carried out through a small incision with considerably less pain, faster return to daily activities, a shorter time in hospital, and with probably the best outcome of the disease. According to Watanabe, in the treatment of prostate cancer, every millimeter counts, and nerve fibers and blood vessels adjacent to the prostate gland should be clearly separated from the prostate before its removal (69). Surgeons use the precision and control of the robotic system Da Vinci to assist in removing malignant prostate while blood vessels and nerves are preserved intact. Regarding cancer control in several large published scientific papers, da Vinci prostatectomy showed the same low level of positive surgical margins (indicates the number of cancer cells left inside) than other forms of surgery (Kroh and Chalikonda 40).
Robot Da Vinci is a high-tech system that helps surgeons to perform complex laparoscopic procedures. This system can be applied only in cases where prostate cancer metastases have not appeared. A surgeon-urologist can cure a patient completely by means of this technique. However, in addition to such operation, a doctor can make a choice in favor of radiation therapy that depends on several factors such as the age and general health of a patient. This technique is used for the complete removal of the prostate in several places in the world. During this surgery, a surgeon sits at a working console and controls the instruments using fine finger movements. It takes a lot of training to perform this procedure in a relatively short period. Nowadays, surgeons widely used Da Vinci when the operation is carried out not through the incision but through small punctures.
The Future Trends
Robotic surgery is rapidly developing with the invention of more sophisticated and miniaturized medical instruments. There is every reason to believe that technical capabilities of the system will be improved as much as possible in the next generation of medical robots. Such feature as the absence of physical contact between a patient and a surgeon during surgery reduces the risk of infection, and it can be used to carry out operations at a much greater distance between a surgeon’s console and the operating table. This advantage allows a surgeon to carry out an operation on a patient located in a separate operating room that will eliminate the risk of infection. More improved robots will probably be a remote preparation for the operation, eliminating unnecessary human factors.
Other possible improvements can be made in the development of a sense of “feeling” in robots that is criticized for its lack. If the management console learns how to reproduce the feeling inherent in the commission of a traditional open surgery, a surgeon will be able to use both methods of operating advantages: overview and feeling.
Robotic surgery is a breakthrough in surgical technology. Medical robots allow surgeons to provide a large number of specific surgical procedures in-patient with different types of cancer such as the lung, prostate, and some others. The importance of robotic surgery is in the absence of physical contact between a patient and a surgeon during surgery. It reduces the risk of infection and can be used to carry out operations at a much greater distance between a surgeon’s console and the operating table. Robot Da Vinci is a high-tech system that helps surgeons to perform complex laparoscopic procedures. Nowadays, robotic surgery is used all over the world when the operation is carried out not through the incision but through small punctures.
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