Robotic Assistance and Intervention in Spine Surgery - Spinal Imaging and Image Analysis - page 488

scales down the hand-motion depicting surgeon ' s intent between the master

manipulators and their con gurable associated slaves. Laparoscopic robotic surgery

with the da Vinci surgical systems is now widely used beyond prostate surgery.
Active specialties include complex gynecological procedures [ 20 ], partial nephr-
ectomies and other urological procedures [ 21 ]. Development and adoption for other
procedures continues in cardiac surgery, head/neck surgery [ 22 ], and many other
applications.
Now in the fourth generation (the da Vinci Xi), the da Vinci consists of several
parts. A surgeon

s console contains the control handles (master manipulators) that
are driven by the surgeon using laparoscopic instrument like grips, while viewing
an auto-stereoscopic endoscopic view of the surgical site. A set of patient side
manipulators hold the camera and the surgical instruments, and associated com-
puting and stereo-endoscopic vision equipment completes the setup. With the
instrument degrees of freedom included, the slave robots can be con

'

gured to have

up to seven degrees of freedom in total.
A da Vinci system may mount up to four instruments, with one restricted to
being the stereo endoscopic camera. The third-generation systems (the da Vinci Si)

'

consoles [ 23 ] to be used simultaneously.
A large catalog of 8 mm wristed rigid and 5 mm articulated (snake-like) removable
fl

first allowed for up to two surgeon

flexible surgical instruments can be interactively mounted during surgery for spe-
cific surgical tasks (e.g. cutting, suturing, or cautery) as needed.
As noted by Shuford et al. [ 18 ], a majority of the approximately 75,000 radical
prostatectomies performed in the United States annually were performed robotically
by 2007, rising from only 18,000 procedures in 2005. Multiple large population and
long-term studies show comparable or favorable performance of robotic methods
[ 19 ] in urology.

1.2 Limitations of Current Systems

Current robotic systems suffer many limitations in addition to the substantial initial
system cost, annual maintenance expenses, and the higher cost of the disposable
surgical instruments compared to laparoscopy. Signi cantly long learning curves

for clinical pro ciency have also been reported.

These existing systems can

t be used in image-guided surgery as currently
designed due to their size, limited accuracy, and interference with the conventional
clinical work

'

ow. Currently reported spine applications using the da Vinci systems
are mostly forward-looking procedure development similar to other specialties such
as head/neck surgery [ 22 ].
In such procedure development, intra-operative devices for registration have
included instruments held by the robot,

fl

fiducials combined with C-Arm or other

fl fluoroscopy, or optical and electromagnetic trackers such as the Axiem EM tracking

(Medtronic Inc), or the Optotrak or Polaris systems (Northern Digital, Canada)
systems. Intra-operative registration is performed similar to the spine navigation