Information Technology Reference
In-Depth Information
Robotic subsystem
Master
Manipulator
Slave
Manipulator
Surgical
Surgeon
Patient
Other sensor input
Integration
Workstation
Visual feedback
Pre/Intra-operative
Imagery
Fig. 1
The role of robots in surgery: a robotic device is an accurate, intelligent intermediary
between the surgeon
s intent and action of the surgical instruments on the patient. Both telesurgical
(master-slave) and directly manipulated (a surgeon
'
is assistant, where the slave subsystem is
omitted) robotic paradigms have been used in augmented surgical procedures. For example, the
former paradigm is used in widely used robotic surgery systems such as the da Vinci surgical
system (Intuitive Surgical Inc.), and the latter in the MAKOplasty RIO orthopedic devices (MAKO
Surgical Corporation, now part of Stryker). While visual feedback is always available to the
surgeon in these procedures, neurosurgical and orthopedic robotic procedures typically include
target guidance and navigation assistance integrated using a powerful computer workstation that
uses intra-operative sensory feedback for registration of pre-operative and real-time imagery to
provide augmented target visualization
'
cacy evidence has
hampered adoption in precision dependent specialties such as cardiology [
2
].
Similarly, neurosurgery has yet not widely used robotics [
3
].
By contrast, spine surgery provides a much closer approximation to other
orthopedic surgery procedures (for example, the hip, knee, or the shoulder surgery)
and the surgical goals and tolerances are relatively easily de
In soft-tissue surgery, the lack of appropriate safety and ef
ned in geometric terms
and robotic parameters. Recent wider acceptance of robotics among orthopedic
surgeons has made some procedures both more commonly available as well as
made robotics an invaluable tool. In their reviews of orthopedic robots, Mavrogenis
et al. [
4
] present a clinical perspective on the adoption of orthopedic robots. Many
reviews from engineering perspectives have also been published; for example,
Sistona et al. [
5
] review the surgical navigation aspects for knee applications.
Orthopedic surgery performs fusing, shaping, or cutting of bones for either
providing access or creating cavities for placement of implants. Many spinal sur-
gery tasks, such as pedicle screws, spinal fusion, or disk implant placement are
closely similar tasks from a robotics perspective to robotic orthopedic tasks.
However, spinal surgery introduces unique challenges for the surgeon due to the
complex three-dimensional anatomy, and placement of critical and delicate neural
and vascular structure in close proximity to the bony anatomy being operated.
Conventional navigationmainly relies on identi
cation of bone surface anatomy in
2D
fl
fluoroscopy images, providing robotic guidance and operation a great opportunity
