04 November 2022
3 minutes to read
Source / Disclosures
Sutherland GR, et al. Surg Neurol Int. 2015; doi: 10.4103/2152-7806.151321.
Petrelli has not made any relevant financial disclosures.
It is not uncommon to see a robot in today’s hospital environment.
Overall, robotics help medicine by relieving some medical personnel from their daily routine tasks that in essence take their time away from more important responsibilities and by making medical procedures safer and at lower cost to patients.
Nicholas J. Petrelli
You can classify robots into three main categories. There are medical devices, including robotic surgery devices, diagnostic and drug delivery devices; Assistive robotics, including wearable robots and rehabilitation devices; and robots that mimic the human body, including prosthetics.
Interestingly, the first surgical robot, PUMA 560, was used in 1985 in stereotaxic placement, in which tomography was used to guide the robot while a needle was inserted into the brain for biopsy. This avoided a procedure that was previously at risk of error due to hand tremors during needle placement.
Taking it even further, ZEUS was the first commercially available surgical robot to complete transatlantic surgery (“Lindbergh” surgery) with Jacques Marescaux, MD, on September 7, 2001. Professor Marescaux performed the first transcontinental laparoscopic surgery on a patient in Strasbourg, France, while It was in New York.
Any surgery chair knows we have been and will be in the era of robotic surgery. How can you argue that a patient who has had a robotic prostatectomy for cancer can be discharged on the first day after surgery? On the other side of the coin, robotic surgery is often criticized for the lack of tactile feedback for the surgeon. The best way to describe tactile reflexes is a combination of force/motor feedback and tactile/cutaneous reflexes. You guessed it, I looked up the definitions.
Force feedback is the assessment of tension or pressure across tissues. On the other hand, haptic feedback provides information on local tissue properties, such as viscosity and/or compliance. Interestingly, in minimally invasive surgery, tactile feedback is attenuated due to the long shaft of the laparoscope instrument. On the other hand, in robotic surgery the tactile feedback is lost due to the disintegration of the surgeon into the final effector by the robotic system.
Studies have shown that the absence of tactile feedback can lead to insufficient forces being applied to tissues during robotic surgery. This can lead to further tissue injury and improper handling of the sutures.
You might think that increased sensory feedback would be an advantage for the surgeon. Experienced robotic surgeons are making up for the lack of tactile feedback by becoming too attuned to visual cues, such as tissue deformation, to act as a substitute for both force and tension. There have been reports showing that haptic feedback significantly reduces errors in a remote autopsy task.
To avoid the difficulties encountered in associating applicable tactile information directly with the surgeon’s hands, studies have focused on sensory substitution that provides tactile information through auditory or graphic cues. Utilizing the power of visual feedback on robotic surgical knot ligation results in fewer suture fractures.
Nanotechnology continues to evolve in surgery. Nanorobotics are related to synthetic devices whose size ranges from 1 nm to 100 nm, and microbiotics are those less than 1 mm in size. By comparison, DNA strands are 2 nm wide and erythrocytes 7000 nm wide.
Consider the possibility that nanorobots could enter the body by intravascular injection, targeting a specific anatomical site and providing feedback to the surgeon prior to biodegradation without a trace. Surgical instruments with a nanometer size have already been produced. No one can deny that these nano-tools will lead to exciting advances in surgery.
Colleagues who know me realize I haven’t trained in the age of robotics. However, this comment makes it clear that no matter your age, you can continue to educate yourself. I had a teacher once tell me that you stop educating yourself when you’re in a pine box.
I remember the naysayers of robotic surgery because initially there was no standardization or guidelines. This resulted in surgical complications, some of them serious and life-threatening. Until recently, there was an automated nazir manager in my organization. However, he realized that if you want to stay on the cutting edge of surgical treatment and hire quality surgeons, you need to break down. I did it.
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- Clinicaltrials.gov. Experiment with a robotic retinal dissection device. Available at: Clintrials.gov/ct2/show/NCT03052881. Accessed October 5, 2022.
- Kitagawa M, et al. y Thorak Cardiovasc Surg. 2005; doi: 10.1016/j.jtcvs.2004.05.029.
- Comer MB and others. IEEE Transactional Robots. 2010; doi: 10.1109/TRO.2010.2073030.
- Mahvash M, et al. Force-feedback surgical remote control: controller design and palpation experiments. Presented at: 2008 Symposium on Haptic Interfaces for Virtual Environments and Teleoperator Systems; 13-14 March 2008; Reno, Nevada.
- Okamura AM. currency Opinion Urol. 2009; doi: 10.1097/MOU.0b013e32831a478c.
- Orlmaier T, et al. Robot-assisted force reaction surgery. In: Ferro M, et al., eds. Advances in Telerobotics, Springer Tracts in Advanced Robotics (STAR). Volume 31, New York, Springer; 2007: 341-358.
- Sutherland GR, et al. Surg Neurol Int. 2015; doi: 10.4103/2152-7806.151321.
for more information:
Nicholas J. Petrelli, MD, FACS, He is the Medical Director Awarded by the Bank of America for the Helen F. He also serves as Associate Editor of Surgical Oncology for HemOnc Today. He can be reached at email@example.com.
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