Biomedical Engineering Reference
In-Depth Information
tissue anastomosis techniques, improving laparoscopic instruments, and digital integration
of already existing technologies.
As previously mentioned, applications of robotic surgery are expanding rapidly into
many different surgical disciplines. Although the costs of these systems are high, their
contribution to the enhancement of medical practices is undoubted and their presence
in any medical institution is likely to become more inevitable with the advent of time,
although this still remains to be seen.
9.5 The Future of Robotic Surgery
There will be many questions regarding the use of robotics surgery, including malpractice
suits, liability, credentialing, training requirements, and interstate licensing for telesur-
geons. However, these obstacles will undoubtedly be resolved with over time and the
hitherto proven advantageous factors of robot-assisted surgery will ensure its continued
development and expansion. For example, the sophisticated controls and the multiple
degrees of freedom afforded by the ZEUS™ and da Vinci™ systems allow increased
mobility and no tremor without comprising the visual field, to make micro-anastomosis
possible. Many have made the observation that robotic systems are information systems
and, as such, they have the ability to interface and integrate many of the technologies
being developed for and currently used in the operating room [30]. One exciting possibil-
ity is expanding the use of preoperative (computed tomography or magnetic resonance)
and intraoperative video image fusion to better guide the surgeon in dissection and identi-
fying pathology. These data may also be used to rehearse complex procedures before they
are undertaken. The nature of robotic systems also makes the possibility of long-distance
intraoperative consultation or guidance possible and it may provide new opportunities for
teaching and assessment of new surgeons through mentoring and simulation. Computer
Motion, the manufacturers of the ZEUS
™
robotic surgical system, is already marketing
a device called SOCRATES
that allows surgeons at remote sites to connect to an oper-
ating room and share video and audio, to use a 'telestrator' to highlight anatomy, and to
control the AESOP endoscopic camera.
Technically, much remains to be done before the full potential of robotic surgery can
be realized. Although these systems have greatly improved in dexterity, they have yet to
develop the full potential in instrumentation or to incorporate the full range of sensory
input, and it is evident that more standard mechanical and energy-directed tools need to
be developed. Some authors also believe that robotic surgery can be extended into the
realm of advanced diagnostic testing, with the development and use of ultrasonography,
near infrared, and confocal microscopy equipment [44].
As much as robots are conjured in popular culture and literature, the future of robotics
in surgery is limited only by the imagination. Many future 'advancements' are already
the subject of ongoing research. Some laboratories, including the authors' laboratory, are
currently working on systems to relay touch sensation from robotic instruments back to the
surgeon [21, 45 - 49]. Other laboratories are working on improving current methods and
developing new devices for anastomoses that require no sutures [41, 50, 51]. When most
people think about robotics, they think about automation. The possibility of automating
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