Biomedical Engineering Reference
In-Depth Information
argue that AESOP gives a better image than real life. This is particularly true with surgeons
that have less than perfect vision or for those who are performing microscopic surgery
that deals with nerves. Also, by using hand controls, the surgeons can reach places in the
body that are normally unreachable by the human hand. Finally, one of the more evident
advantages of robotic surgery, is in long operations, particularly those that deal with
nerve or tissue reconstruction. Surgeons often become tired after performing microscopic
surgical procedures that last many hours. However, by having the ability to be seated and
have less strain on the eyes, doctors can control their natural flinching or nerves more
efficiently. So far, robots have been used to position an endoscope, perform gallbladder
surgery and correct gastroesophageal reflux and heartburn. A current ambitious goal within
the robotic surgery field is to design a robot that can be used to perform closed-chest,
beating-heart surgery. The current growth rate of this technology is an indication that the
use of robotics in surgery will increase significantly over the next decades.
In heart surgery the introduction of endoscopic techniques was promising, but not as
satisfying as the application of robots in other surgical disciplines [1-3]. Thus far, the
results of complex cardiac surgery are less than satisfactory due to tremor in the long
instruments and inadequate freedom of movement. Heart surgery, using pure endoscopic
techniques, has still not yet been fully established, since high-precision specialty instru-
ments are lacking in this field. The purpose of telemanipulated endoscopic assistance is to
eliminate many of these impediments and, in this regard, enhancements have been made
gradually with regard to motion scaling, tremor filtration, three-dimensional vision sys-
tems, and improving the fulcrum effect. Implementation of these advances would enable
the surgeon to operate using such a surgical mechatronic system in a more comfortable,
dextrous, and intuitive manner. Part of the solution is to implement telemanipulators that
would provide more than six degrees of freedom in movement (rather than the four that
is found in conventional endoscopic instruments). By virtue of this, the surgeon will have
as many degrees of freedom in movement, as in conventional open surgery. Furthermore,
this telemanipulator system would be remotely controlled by the surgeon, provide 3D-
optic viewing capabilities and be tremor-free [4]. The culmination of all this, 10 years
later, was the implementation of totally endoscopic heart surgery using the telemanipulator
da Vinciā„¢ system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) which was originally
introduced for endoscopic abdominal surgery.
However, for patients who require valve surgery, congenital heart surgery, and bypass
surgery, only a minority are able to avail themselves of telemanipulated technology due
to certain inequities in the system. One significant limitation is the necessity of acquiring
haptic feedback, a matter which is still a matter of controversy for both robotically working
surgeons and haptic engineers [5-7] and is the focus of different chapters in this topic.
For both the virtual and artificial scenarios, tactile sensing and haptic feedback is an
essential parameter [8, 9] and is still the subject of much discussion, due its importance
in the field of surgical telepresence of remote objects. Although micro-surgical telerobotic
systems have been addressed by many research groups [10-12], many important questions
and problems remain unanswered, or at least have not been answered or solved sufficiently,
in the area of haptic feedback. Another basic and unsolved problem with telemanipulated
surgery, and for which further exploratory work is required, is the sudden breaking of
surgical suture material with resulting tissue damage. It is certainly evident that the ability
to provide haptic feedback during robotic surgery would greatly alleviate the fatigue that
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