Japanese Journal of Clinical Oncology 30:371-372 (2000)
© 2000 Foundation for Promotion of Cancer Research
Letters to the Editor |
Robotic Surgery
1Division of Colorectal Surgery and 2Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
To the Editor:
We have witnessed and participated in the era of endoscopic (laparoscopic and thoracoscopic) surgery. Features of these new procedures are minimal invasiveness. They can be performed without large laparotomy or thoracotomy so that they make patients less painful, are more cosmetic and possibly accelerate postoperative recovery. For some diseases such as gallstones, they have been accepted as standard procedures because they are as effective as and less invasive than conventional surgery. Thus new technology has contributed to certain progress in the art and science of surgery. However, there are some drawbacks in endoscopic surgery as compared with conventional techniques. Endoscopic procedures are limited by two-dimensional vision and awkwardness due to the use of long instruments fixed at port sites and misalignment of hands and instruments. Therefore, endoscopic surgery is really applicable only in simple procedures. To overcome these problems, more advanced technology is awaited.
Now we are standing at the entrance to the era of robotic surgery. It utilizes more advanced technologies including endoscopic surgery, robotics, teleoperation, computer-assisted manipulation and three-dimensional visualization. We had an opportunity to inspect a frontier of robotic surgery in Silicon Valley with support from the Foundation for Promotion of Cancer Research in Japan. We visited Intuitive Surgical Inc. (Mountain View, CA, USA), a typical high-tech venture company founded by Frederic Moll (surgeon) and Robert Younge (engineer) in 1995. In the company building all necessary sections are located, namely the management section, development section, design section, meeting rooms, assembly factory, packing and loading section and even a museum of the history of surgical instruments and robots. Except for the executives, the employees here look like students at Stanford University wearing jeans and we were surprised to see a man riding a bicycle and wearing racing gear in a passage inside this building! After a welcome and briefing from the vice-president, we were able to see and touch a surgery robot, da Vinci, in a show room mimicking an operating room.
There are two main components, surgeon’s viewing and control console with master manipulator and surgical arm unit and the slave manipulator. The surgeon sits comfortably by the control console, looks into a three-dimensional monitor in front of his face, fixes his bilateral thumbs and index fingers to bilateral manipulators with ‘magic tapes’ and can control manipulators (Fig. 1). In the surgeon’s view, there is magnified operative field and the robotic arms. The surgeon can operate ‘intuitively’ by using the robotic arms because the robotic arms move faithfully as if they were the operator’s real arms and hands. The surgeon can also move the operative field ‘intuitively’ by grasping it as he would grasp it with his own hands and moving it as he likes after using a foot pedal which switches between robotic arms and operative field. We tried to handle a small disc and pass a thread through a small hole on it and tie it. All of us could succeed in performing these procedures with ease.
|
The surgical arm unit is set by the operating table. It has three arms, a central arm for a three-dimensional endoscope and two other arms for instruments such as a grasper, scissors, electrocautery and so on (Fig. 2). These instruments are changeable and in each case the diameter is about 1 cm. Their movement is made by a precise servo-motor mechanism, force-feedback sensors and motion-scaling software which is controlled by a computer. The computer resolves motions of the surgeon’s arm, from shoulder to hand, into seven parameters and immediately calculates and reconstructs movements of the robotic arm and attached instruments from these parameters. The attached instruments can make far more complicated motions than ordinary laparoscopic or thoracoscopic instruments, because they have a wrist mechanism, which gives them more degrees of freedom than ordinary instruments. Therefore, the robotic arm and attached instrument, which has seven degrees of freedom, can simulate the natural movement of a human arm.
|
The technologies associated with da Vinci originated from Stanford Research Institute with respect to telesurgery, Massachusetts Institute of Technology for haptics and International Business Machines for computer algorithms. It is literally an aggregate of high technologies. This experience was exciting. Undoubtedly, da Vinci is a surprising surgical robot. According to the company’s data, 11 sets have already been installed in Europe and the USA. A total of 350 cardiac surgeries and 220 general surgeries have been performed with them. Cardiac procedures include coronary artery bypass graft, atrial septal defect repair, valve replacement and so on. General procedures include Nissen fundoplication, cholecystectomy, colorectal procedures, tubal reanastomosis and so forth. Here da Vinci is most excellent at cardicac procedures, which could not be done by ordinary thoracoscopic techniques, because it is aimed particularly at this aspect. It has magnifying view, motion scaling and tremor elimination, so that it is most suitable for precise operations.
How about our major concerns, abdominal and thoracic oncological surgeries? The operative fields in most oncological surgeries are far wider than in cardiac procedures. Also, operative procedures in the majority of oncological surgeries are more dynamic and complicated than in cardiac procedures. Whether such procedures are feasible or not under da Vinci’s eyes and arms is yet to be clarified. If they are feasible, then survival and quality of life should be compared among conventional surgery, endoscopic surgey and robotic surgery. In addition, issues of cost effectiveness should be also addressed because we do not drive a Formula 1 racing car to buy chocolate at a nearby convenience store. Finally, we hope that the Japanese industrial society will develop and improve its own surgical robots and medical robotics because Japan is one of the leaders in the field of industrial robotics and medical robotics will be one of the most important fields in future industries.
Takayuki Akasu and Hisao Asamura
.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||