A Seminar report onRobotic SurgerySubmitted in partial fulfillment of the requirement for the award of degreeof Computer Science

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Preface

I have made this report file on the topic Robotic Surgery, I have tried my best to elucidate all the relevant detail to the topic to be included in the report. While in the beginning I have tried to give a general view about this topic.My efforts and wholehearted co-corporation of each and everyone has ended on a successful note. I express my sincere gratitude to ..who assisting me throughout the prepration of this topic. I thank him for providing me the reinforcement, confidence and most importantly the track for the topic whenever I needed it.

IntroductionA robot is a virtual or mechanical artificial agent. In practice, it is usually an electro-mechanical system which, by its appearance or movements, conveys a sense that it has intent or agency of its own. There is no consensus on which machines qualify as robots, but there is general agreement among experts and the public that robots tend to do some or all of the following: move around, operate a mechanical limb, sense and manipulate their environment, and exhibit intelligent behavior, especially behavior which mimics humans or other animals. Today, commercial and industrial robots are in widespread use performing jobs more cheaply or with greater accuracy and reliability than humans. They are also employed for jobs which are too dirty, dangerous or dull to be suitable for humans. Robots are widely used in manufacturing, assembly and packing, transport, earth and space exploration, surgery, weaponry, laboratory research, and mass production of consumer and industrial goods.[2]In 2006, there were an estimated 3,540,000 service robots in use, and an estimated 950,000 industrial robots. [35] A different estimate counted more than one million robots in operation worldwide in the first half of 2008, with roughly half in Asia, 32% in Europe, 16% in North America, 1% in Australasia and 1% in Africa.Robotic surgeryRobotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. There are three different kinds of robotic surgery systems: supervisory-controlled systems, telesurgical systems and shared-control systems. The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. The military is responsible for many of the advances in robotic surgery. That's because military officials hoped that robotic surgery would provide a way for doctors to help patients on the front lines of combat zones without putting themselves in danger. So far, latency issues make long-distance telesurgery difficult, but civilian doctors have put the technology to good use.In today's operating rooms, you'll find two or three surgeons, an anesthesiologist and several nurses, all needed for even the simplest of surgeries. Most surgeries require nearly a dozen people in the room. As with all automation, surgical robots will eventually eliminate the need for some personnel. Taking a glimpse into the future, surgery may require only one surgeon, an anesthesiologist and one or two nurses. In this nearly empty operating room, the doctor sits at a computer console, either in or outside the operating room, using the surgical robot to accomplish what it once took a crowd of people to perform

SUPERVISED CONTROLLED SYSTEMSOf the three kinds of robotic surgery, supervisory-controlled systems are the most automated. But that doesn't mean these robots can perform surgery without any human guidance. In fact, surgeons must do extensive prep work with surgery patients before the robot can operate.

Spencer Platt/Getty ImagesDr. Scott J. Boley demonstrates a robotic surgery system at the Montefiore Institute for Minimally Invasive Surgery in New York City.

That's because supervisory-controlled systems follow a specific set of instructions when performing a surgery. The human surgeon must input data into the robot, which then initiates a series of controlled motions and completes the surgery. There's no room for error -- these robots can't make adjustments in real time if something goes wrong. Surgeons must watch over the robot's actions and be ready to intervene if something doesn't go as planned.

What's Up, RoboDoc?The RoboDoc system from Integrated Surgical Systems is an example of a supervisory-controlled system used in orthopedic surgeries. Once a human surgeon positions the RoboDoc's bone-milling tool at the correct location inside the patient, the robot takes over. It automatically cuts the bone to just the right size for the orthopedic implant.The reason surgeons might want to use such a system is that they can be very precise, which in turn can mean reduced trauma for the patient and a shorter recovery period. One common use for these robots is in hip and knee replacement procedures. The robot's job is to drill existing bone so that an implant fits snugly into the new joint. Because no two people have the exact same body structure, it's impossible to have a standard program for the robot to follow. That means surgeons must map the patient's body thoroughly so that the robot moves in the right way. They do this in a three-step process called planning, registration and navigation [source: Brown University].In the planning stage, surgeons take images of the patient's body to determine the right surgical approach. Common imaging methods include computer tomography (CT) scans, magnetic resonance imaging (MRI) scans, ultrasonography, fluoroscopy and X-ray scans. For some procedures, surgeons may have to place pins into the bones of the patient to act as markers or navigation points for the computer. Once the surgeon has imaged the patient, he or she must determine the surgical pathway the robot will take.The surgeon must tell the robot what the proper surgical pathway is. The robot can't make these decisions on its own. Once the surgeon programs the robot, it can follow instructions exactly.The next step is registration. In this phase, the surgeon finds the points on the patient's body that correspond to the images created during the planning phase. The surgeon must match the points exactly in order for the robot to complete the surgery without error.The final phase is navigation. This involves the actual surgery. The surgeon must first position the robot and the patient so that every movement the robot makes corresponds with the information in its programmed path. Once everyone is ready, the surgeon activates the robot, which carries out its instructions.

Telesurgical systems A viewing and control console A surgical arm unit that includes three or four arms, depending on the model a human surgeon makes three or four incisions (depending on the number of arms the model has) -- no larger than the diameter of a pencil -- in the patient's abdomen, which allows the surgeons to insert three or four stainless-steel rods. The robotic arms hold the rods in place. The surgeon sits at the console and looks through two eye holes at a 3-D image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers. The da Vinci System scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments, which operate through small incisions in the body.According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci invented the first robot. The artist Leonardo also used anatomical accuracy and three-dimensional details to bring his works to life.[4] The instruments jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeons hand movements. At no time is the surgical robot in control or autonomous; it operates on a "Master:Slave" relationship, the surgeon being the "Master" and the robot being the "Slave." designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci Systems ergonomic design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.

Shared controlShared-control robotic systems aid surgeons during surgery, but the human does most of the work. Unlike the other robotic systems, the surgeons must operate the surgical instruments themselves. The robotic system monitors the surgeon's performance and provides stability and support through active constraint.Active constraint is a concept that relies on defining regions on a patient as one of four possibilities: safe, close, boundary or forbidden. Surgeons define safe regions as the main focus of a surgery. For example, in orthopedic surgery, the safe region might be a specific site on the patient's hip. Safe regions don't border soft tissues.In orthopedic surgery, a close region is one that borders soft tissue. Since orthopedic surgical tools can do a lot of damage to soft tissue, the robot constrains the area the surgeon can operate within. It does this by providing haptic responses, also known as force feedback. As the surgeon approaches the soft tissue, the robot pushes back against the surgeon's hand.As the surgeon gets closer to soft tissue, the instrument enters the boundary region. At this point, the robot will offer more resistance, indicating the surgeon should move away from that area. If the surgeon continues cutting toward the soft tissue, the robot locks into place. Anything from that point on is the forbidden region. Like the other robots we've looked at, shared-control system robots don't automatically know the difference between a safe region versus a forbidden region. The surgeons must first go through the planning, registration and navigation phases with a patient. Only after inputting that information into the robot's system can the robot offer guidance.Abby SomebodyOne potential future application of shared-control systems is neurosurgery. In a 2005 volume of Neurosurgery, doctors suggest a robotic system for brain surgery. The robot would have a single arm with multiple pivot points. The surgeon could rest his or her elbow on the robot's arm. The robot arm would also steady the surgical instrument. While the surgeon controls the motion of the instrument, the robot arm provides tremor control, stabilizing each movement .

DIFFERENT TYPES OF ROBOTIC SYSTEMS

Computer Motion of Santa Barbara California has become the leading producer of medical robotics. Different types of robots are da Vinci, Aesop, Hermes, and Zeus.The da Vinci Surgical System was the first operative surgical robot. Products like Aesop, Hermes, and Zeus are the next generation of surgical equipment and are used together to create a highly networked and efficient operating room.da Vinci Surgical SystemIncorporating the latest advancements in robotics and computer technology, the da Vinci Surgical System was the first operative surgical robot deemed safe and effective by the United States Food and Drug Administration for actually performing surgery.The da Vinci system was developed by Intuitive Surgical system, which was established in 1995. Its founders used robotic surgery technology that had been developed at SRI International, previously known as Stanford Research Institute. The FDA approved da Vinci in May 2001The da Vinci is a surgical robot enabling surgeons to perform complex surgeries in a minimally invasive way, in a manner never before experienced to enhance healing and promote well-being. It is used in over 300 hospitals in the America and Europe. The da Vinci was used in at least 16,000 procedures in 2004 and sells for about 1.2 million dollars.Until very recently surgeons options included traditional surgery with a large open incision or laparoscopy, which uses small incisions but is typically limited to very simple procedures. The da Vinci Surgical System provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting asurgeon's hands at the controls ofa state-of-the-art robotic platform. The da Vinci System enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision. It is important to know that surgery with da Vinci does not place a robot at the controls; surgeon is controlling every aspect of the surgery with the assistance of the da Vinci robotic platform. Thus da Vinci is changing the experience of surgery for the surgeon, the hospital and most importantly for the patient.. AesopAesop's function is quite simple merely to maneuver a tiny video camera inside the patient according to voice controls provided by the surgeon. By doing so, Aesop has eliminated the need for a member of the surgical team to hold the endoscope in order for a surgeon to view his operative field in a closed chest procedure. This advance marked a major development in closed chest or port-access bypass techniques, as surgeons could now directly and precisely control their operative field of view. Today about 1/3 of all minimally invasive procedures use Aesop to control an endoscope. Considering each Aesop machine can handle 240 cases a year, only 17,000 machines are needed to handle all minimally invasive procedures a relatively small number considering the benefits of this technology.

ZeusZeus is the youngest and most technically advanced robotic aid. Zeus contains robotic arms that mimic conventional surgical equipment and a viewing monitor that gives the surgeon a view of his operative field. More importantly, Zeus enables a surgeon to operate on a patient using joystick like handles which translate the surgeon's hand movements into precise micro-movements inside the patient. For example a 1-cm movement by a surgeon's hand is translated into a .1 cm movement of the surgical tip held by a robotic arm. Zeus also has the unique capability of reducing human hand tremor and greatly increasing the dexterity of the surgeon. Zeus allows surgeons to go beyond the limits of MIS enabling a new class of delicate procedures currently impossible to perform. The main disadvantage is high machine cost. It is around 1 million dollars. Its FDA approval is pending.HermesUnlike Aesop and Zeus, Hermes does not use robot arms to make the Operating Room more efficient. Rather Hermes is platform designed to network the OR, integrating surgical devices, which can be controlled by simple voice commands. Many pieces of surgical equipment are outside the range of sterility for the surgeon and must be manipulated by a surgical staff while Hermes enables all needed equipment to be directly under the surgeon's control. Hermes can integrate tables, lights, video cameras and surgical equipment decreasing the time and cost of surgery. Ultimately Hermes decreases the need for a large surgical staff and facilitates the establishment of a networked, highly organized OR. Ultimately Computer Motion is working to bring Hermes into 84,000 operating rooms worldwide

FUTURE DEVELOPMENTSThe use of a computer console to perform operations from a distance opens up the idea of telesurgery, which would involve a doctor performing delicate surgery miles away from the patient. If the doctor doesn't have to stand over the patient to perform the surgery, and can control the robotic arms from a computer station just a few feet away from the patient, the next step would be performing surgery from locations that are even farther away. If it were possible to use the computer console to move the robotic arms in real-time, then it would be possible for a doctor in California to operate on a patient in New York. A major obstacle in telesurgery has been latency -- the time delay between the doctor moving his or her hands to the robotic arms responding to those movements. Currently, the doctor must be in the room with the patient for robotic systems to react instantly to the doctor's hand movements.

ADVANTAGES Major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification .Having fewer personnel in the operating room and allowing doctors the ability to operate on a patient long-distance could lower the cost of health care in the long term. In addition to cost efficiency, robotic surgery has several other advantages over conventional surgery, including enhanced precision and reduced trauma to the patient. For instance, traditional heart bypass surgery requires that the patient's chest be "cracked" open by way of a 1-foot (30.48-cm) long incision. However, with the da Vinci system, it's possible to operate on the heart by making three or four small incisions in the chest, each only about 1 centimeter in length. Because the surgeon would make these smaller incisions instead of one long one down the length of the chest, the patient would experience less pain, trauma and bleeding, which means a faster recovery. Robotic assistants can also decrease the fatigue that doctors experience during surgeries that can last several hours. Surgeons can become exhausted during those long surgeries, and can experience hand tremors as a result. Even the steadiest of human hands cannot match those of a surgical robot. Engineers program robotic surgery systems to compensate for tremors, so if the doctor's hand shakes the computer ignores it and keeps the mechanical arm steady.

DISADVANTAGESSome robotic surgery systems cost more than $1 million to purchase and more than $100,000 a year to maintain. While hospitals can save on costs by decreasing the length of a patient's stay due to a shorter recovery period, they might not save enough to justify the expense of the system.Critics have pointed out that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.[3]

LIMITATIONS

Current equipment is expensive to obtain, maintain, and operate. Surgeons and staff need special training. Data collection of procedures and their outcomes remains limited.

CONCLUSIONRobotic surgery is an emerging technology in the medical field. It gives us even greater vision, dexterity and precision than possible with standard minimally invasive surgery, so we can now use minimally invasive techniques for a wider range of procedures. But it's main drawback is high cost. Besides the cost, Robotic System still has many obstacles that it must overcome before it can be fully integrated into the existing healthcare system. More improvements in size, tactile sensation, cost, and are expected for the future.

REFERENCE http://www.stronghealth.com http://www.computermotion.coin http://www.intuitivesurgical.com - http://www.ctsuse.edu com http://www.cn.wikipedia.org

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