Biomedical Engineering Reference
In-Depth Information
robotic arms and increase efficiency, although it is fully hoped and supposed that these
disadvantages will be remedied with the advent of time.
Secondly, the cost of robotic systems is prohibitive for many institutions [29]. The
extent to which these costs become less with the passage of time is dependant largely on
improvements in technology and the extent, therefore, to which this technology becomes
affordable and hence more widely accepted [27]. Others believe that the incumbent invest-
ments required to improve haptics technology, together with increased processor speeds
and more complex software, will increase the cost of these systems [30]. Also at issue is
the problem of upgrading systems which will pose the question to hospitals and healthcare
organizations as to how much they will need to spend on upgrades and how often. In
any case, many believe that to justify the purchase of these systems they must first gain
widespread and multi-disciplinary usage [30].
Thirdly, these systems are bulky and are equipped with cumbersome robotic arms
which, in today's already crowded operating rooms, could cause space issues with the
surgical team [30]. Given the fact that it is difficult for both the surgical team and the robot
to fit into the operating room, and that expanding the size of the surgical environment is
hardly practical and certainly not cost-effective, the only practical alternative is to further
miniaturize the robotic arms and instruments.
One of the potential disadvantages identified is a lack of compatible instruments and
equipment, which necessitates the inclusion of table-side assistants to perform part of the
surgery [27]. This, however, is a transient disadvantage because new technologies have,
and will, be developed to address these shortcomings. Most of these disadvantages will
be remedied with improvements in technology and, only with time will it be known if the
use of these systems justifies their cost. Certainly, if the cost of these systems continues
to remain high, and their inclusion in routine surgeries does not reduce the cost, it is
unlikely that there will be a robot in every operating room.
9.4 Applications
Several robotic systems are currently approved by the FDA for specific surgical proce-
dures. ROBODOC
is used to precisely core out the femur in hip replacement surgery.
Computer Motion Inc. of Goleta, CA, has two systems on the market. One, called AESOP,
is a voice-controlled endoscope with seven degrees of freedom. This system can be used in
any laparoscopic procedure to enhance the surgeon's ability to control a stable image. The
ZEUS™ and da Vinci™ systems have been used in a variety of disciplines for laparoscopic
surgeries, including cholecystectomies, mitral valve repairs, radical prostatectomies, rever-
sal of tubal ligations, in addition to many gastrointestinal surgeries, nephrectomies, and
kidney transplants. The number and types of surgeries being performed with robots is
increasing rapidly as more institutions acquire these systems, one of their more notable
uses being in totally endoscopic coronary artery grafting, a procedure formerly outside
the limitations of laparoscopic technology.
The amount of data being generated on robotic surgery is growing rapidly, and the
early data are promising. Many studies have evaluated the feasibility of robot-assisted
surgery. One study by Cadiere
et al
. [31] evaluated the feasibility of robotic laparo-
scopic surgery on 146 patients. Procedures performed with a da Vinci™ robot included
™
