Saturday, April 08, 2006

Da Vinci - Robotic Assisted, Minimally Invasive Cardiac Surgery

Minimally Invasive Surgical (MIS) procedures have been brought to a new level of advancement with the existence of Da Vinci Surgical system, in which the system combines robotics and computer technology to allow surgeons to perform delicate surgical procedures. By making use of these surgical robots, human surgeons can fully manipulate small instruments, which are inserted through small chest incisions, in tight spaces, thus achieving most of those technical maneuvers that are only made possible with open exposure. Nowadays, hospital have begun to utilize this technology, and are currently involved in several exciting clinical protocols testing this surgical system, manufactured by Intuitive Surgical, Inc. (Mountainview, CA) for a variety of cardiac surgical operations.
Technology behind Da Vinci Surgical System
The system consists of three main components: the surgeon’s viewing and control console, the surgical cart, which consists of the robotic arm that can position and maneuver detachable surgical EndoWrist instruments, and the video tower that consists of the video camera and processing units.
The pencil sized instruments which are attached to the robotics arms, together with computer enhanced mechanical wrists are being designed for the purpose of providing dexterity movements of the human surgeon’s forearm and wrist during operation site through entry ports which are less than 1 cm. Thus, with the precision and accuracy of surgical movements, it allows surgeon to enter the chest through keyhole incisions and performed closed chest, heart and lung surgery. The robot’s mechanical wrists can bend forth and backward, side to side, and rotate in a full circular motion, while holding the surgical tools, thus it provides a greater range of motion than which is not made possible with human beings. The wrists imitate the motions which are made by the surgeon who sits at the console outside the operation room. He will monitor the whole surgical operation through an eyepiece that provides high resolution, multi color, magnified and three dimension images of the surgical site which is provided by the endoscope. The surgeon will move along his hands which are attached to the controls of the robotic system, and the robotic hands will follow. The built in computer for this system will enhance the surgeon's hand movement with more precision and less tremors which is considered an important factor in performing successful delicate bypass and valve surgery.
Potential Impact of Da Vinci Surgical Technology
This robotic surgery technology has the potential to impact the practice of cardiac surgery in many ways. It allows the existing MIS operations to be made more easily and routine. These surgical procedures which are performed by using MIS techniques can be performed more quickly and easily with the increased dexterity and control provided by robotic assistance. On the other hand, those surgical procedures that today are performed only rarely using MIS techniques can be achieved routinely with robotic assistance. Some of the surgical procedures have been adapted for port-based techniques but the problem is that it is extremely difficult to perform and only currently is being done by a limited number of highly skilled surgeons. Now, with this availability of robotic assistance, more surgeons at more institutions will be able to perform these procedures. It also makes new surgical procedures possible as a certain number of procedures that are currently not feasible by MIS techniques may eventually be performed through small incisions with the help of robotic technology. Thus, only small incisions are needed for the small dedicated robotic arms to perform the operation, reducing the invasive nature of the operations and the risk of other complications arising from it.
Future of Da Vinci Surgical Technology
The future will be even brighter with the existence of this technology. If operations can be made by a surgeon from across a room, one would suppose that the operation could be made from another room or even from another country. It means that a doctor could even perform surgery from his own home with the existence of this technology. The implications for this technology include the possibility of operating on residents of a remote village who do not have the access to a specialized surgeon, or during war when a wounded soldier could be taken into an army vehicle equipped with the robotic system while the surgeon may operate from one safe location in an efficient manner on many wounded soldiers. Even astronauts can be operated on by these robots in the outer space!!! Hope this blog can give you all guys a clearer picture of the existing robotic surgery technology. References [1] [2] [3]


Exploration said...

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Indeed, with this robotic assisted technology, the cardiac operations on patients will be at a higher success rate with more precisions and lesser implications with smaller incisions.

But I personally feel that the only main concern with this technology is the lag time between the surgeon and the robotic mechanical arms. For eg, when the surgeon sees the scalpel move to during the operation and the lag time when it actually makes the cut. The lag time must not be slow or else the surgeon is at the danger of making a cut in the wrong place.

There is also a great deal of data being transmitted during the operation, most of which is created by the video,which takes some time to be processed.Thus, this issue of processing time has to be taken note of.

Domenico Savatta, M.D. said...

I am a urologist and head of the robotic adult urology division at a large hospital in New Jersey.

This was a good review of robotic surgery.

Id like to add that although this article focused on heart surgery, currently the main use is for the removal of prostates for prostate cancer by urologists.

I have more info about this at my website and also started a robotic surgery blog a few months ago at

Exploration said...

Hoo We Tak U037972H

Robot as such requires high precision vision system in order to operate. As such applications are closely related with human, I would think human is still needed in the decision making process.

Edutainment said...

U0308283 Wu Chengyu

Wow! I am quite impressed by this advancement. I think this would be quite useful in saving lives, especially in times when the surgeon cannot make its way there or its simply too troublesome.

What I am worried is that, will there be people who abuses the system? As in, there will be no way to verify the 'surgeon' behind the control screen and this might be used by some bogus surgeon with only some basic knowledge. Also, the communications must be very fast, secure and privatised. Imagine the consequences if there is a lag between actions and decisions! Also, interferences in transmission may result in the wrong command executed....causing dire outcomes. I think much has to be done first before this can be implemented.