Robotic surgery is one of the most exciting areas of medical technology because it promises more accurate, minimally invasive methods of treating injuries. With the robotic system, tiny tools can make their way through hard-to-reach parts of the body, performing their work with less pain and less blood loss. As a result, hospital stays, recovery times and physical scarring are all decreased. Is robotic technology the future of medical science?

Currently there are three types of robotic surgery systems: Supervisory-Controlled systems, Telesurgical systems and Shared-Control systems. Supervisory-Controlled systems (a.k.a. Computer Assisted Surgery) are the most automated of the three. The surgeon undertakes considerable prep work, inputs data into the robotic system, plans the course of action, takes x-rays, tests the robot’s motions, places the robot in the appropriate start position and oversees the robotic action to ensure everything goes as planned. The most famous prototype is the RoboDoc system developed by Integrated Surgical Systems, which is commonly used in orthopedic surgeries.

The Telesurgical type of robotic surgery system involves having a human direct the motions of the robotic system. The Da Vinci Surgical System, developed by Intuitive Surgical, is the most popular type of robotic telesurgical devices. The $1.5 million system is comprised of a viewing and control console, as well as three or four robotic arms. After the surgeon makes three or four incisions as small as a pencil, three or four stainless steel rods are inserted, with robotic arms holding them in place. One of the rods contains two endoscopic cameras, which provide the internal images to the human surgeon, and the other rods have surgical tools that may dissect, suture or perform other actions. Sitting at the viewfinder, the surgeon never touches the instruments directly, but instead directs the actions using a joystick to complete the surgery.

The Shared-Control System is the final category of robotic surgery devices. In this system, the human does the bulk of the work, but the robot assists when needed. In many cases, the robotic system monitors the surgeon, providing stability and support during the procedure. Before getting started, the surgeons program the robots to recognize safe, close, boundary and forbidden territories within the human body. Safe regions are the main focus of the surgery. Close regions border easily damaged soft tissue and the boundary is where soft tissue begins. As the surgeon nears these dangerous areas, the robot pushes back against the surgeon, or in some cases, when the forbidden zone is reached, the robotic system actually locks up to prevent any further injury. Shared-Control systems might work best for brain surgeries, where the surgeon provides the action but the robot arm steadies the hand.

Despite costing $1.5 million per unit, the Da Vinci robotic system is turning heads in hospitals across America. The addition of robotic systems in operating rooms promises more precise surgeries, less damage to the surrounding tissues, smaller incisions, less blood loss, less risk of surgeon fatigue and quicker recovery times. While intelligent robots are far from executing their own surgeries, using autonomous robots and robotic arms as assistants is revolutionizing medical science.

The Da Vinci Surgical System is a groundbreaking innovation that’s garnered much attention by media and surgeons alike over the past decade. Ideally, these new robots will be used in delicate surgeries like heart valve/artery surgery, brain surgery and cancer removal. Telesurgical robotic systems consist of two components; one is a computerized tele-micromanipulator, the other a surgical unit containing three robotic arms. At the start of the surgery, four keyhole-sized incisions are made as entry-points. Down one incision will be the endoscopic camera, which is attached to a fiber-optic cable. The remaining ports will carry tiny surgical tools, which rotate and maneuver using flexible robot wrists. The surgeon sits at a console, watching the 3-D images from the camera and making the necessary motions to perform the surgery, which the robotic system then mimics with much more precision and accuracy.

Robotic systems can benefit surgeons for a number of reasons. First, machines can be extremely precise and nearly infallible, which means less trauma for the patient. Even the most dexterous hand can suffer from fatigue, muscle cramps, shakiness or a slip-up from time to time. Also, the range of motion is limited for human beings, whereas the robotic hand can move in a 360 degree circle, bending every which way it is needed. Secondly, robots allow for minimally invasive procedures, which equates to quicker recovery times. In the past, doctors had to open up a person’s chest to reach difficult areas like the heart ventricle. Now, a mobile robot arm can reach inside with flexible tubes to bend around obstacles and reach the precise location it needs, all within a keyhole-sized insertion.

“I haven’t felt this great in years. I was at a Christmas party last night talking to a woman about my procedure and how it was the best thing I had ever done,” said one woman who recently had a surgery that involved robotic systems. The 49-year-old public accountant’s uterus had become laden with tumors that were too large to be removed by conventional methods, which prevented her from canoeing, biking and playing volleyball. AAMC Surgeon Dr. Paula Radon used a morcellator to cut down the benign tumor tissue until it was removable by trocar. The woman said the surgery changed her life, which shows that robots have their place in medicine.

Cybernetics professor Kevin Warwick professes to be the “first Cyborg.” Project Cyborg began in August of 1998, when Warwick implanted a computer chip into his left arm, which later allowed him to open doors, move a robotic hand and operate an electronic wheelchair. The implant also allowed him to tap into the Internet at Columbia University in New York and control a robotic arm at the University of Reading in the UK. Another one of the experiments tested telepathic communication between two individuals by way of implants. In the 70s, researchers felt that robotic arms would be a vital asset to the workplace. Little did they know, humans would consider fusing themselves with this technology to become super-human cyborgs!

Starting in 1975, robotic arms have been used for industrial purposes. In some cases, they do the work more quickly, more accurately and more efficiently than human workers ever could. Yet in other instances, they simply perform work that is too monotonous, dangerous or undesirable for men and women. In the US auto industry, for example, there is one robotic arm for every ten workers. Industrial robots lift heavy objects, handle chemicals, and paint and assemble parts. Rather than replace jobs, the robotic system is intended to free up more creative, fulfilling work for people instead. After all, the Czech word “robota” translates to “drudgery work.”

Using a modified robotic arm, Dr. Alon Wolf and Dr. Howie Choset have developed a machine that can perform minimally-invasive surgery with great accuracy. The invention is called the “CardioARM” and has been designed for abdominal surgery, heart bypass surgery and mouth surgery, but can also be used to perform a laparoscopy, colonoscopy, and arthroscopy. The CardioARM is operated by a joystick and can navigate through the body to the problem areas. The flexible tele-operated probe is programmed to remember pathways and it can take tools into regions that surgeons would otherwise have to slice into. “Tools in operation rooms are not flexible. The CardioARM is flexible enough for remote and hard to reach anatomies,” explains Dr. Wolf. “The heart is a good example… now we don’t have to cut the person open.”

The first robotic arm was a crude device, similar to arcade games. However, the latest robotics automation technology has arms functioning more like the human anatomy, able to perform a wide range of motions, with fingers waving and wrists rotating. Perhaps the greatest challenge will be to devise a way to make these devices affordable to more people so it becomes a practical solution for hospitals, small businesses and homes.