Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other consumer goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean.
In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMO robot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients.
Not all surgical robots are equal. There are three different kinds of robotic surgery systems: supervisory-controlled systems, telesurgical systems and shared-control systems. The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. On one end of the spectrum, robots perform surgical techniques without the direct intervention of a surgeon. On the other end, doctors perform surgery with the assistance of a robot, but the doctor is doing most of the work [source: Brown University].
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The military is responsible for many of the advances in robotic surgery. That's because military officials hoped that robotic surgery would provide a way for doctors to help patients on the front lines of combat zones without putting themselves in danger. So far, latency issues make long-distance telesurgery difficult, but civilian doctors have put the technology to good use.
While robotic surgery systems are still relatively uncommon, several hospitals around the world have bought robotic surgical systems. These systems have the potential to improve the safety and effectiveness of surgeries. But the systems also have some drawbacks. It's still a relatively young science and it's very expensive. Some hospitals may be holding back on adopting the technology.
Why would a hospital consider a robotic surgery system in the first place? Find out in the next section.
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نوشته شده در چهارشنبه سی ام مرداد 1387ساعت 10:37 توسط علی
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Advantages of Robotic Surgery
In today's operating rooms, you'll find two or three surgeons, an anesthesiologist and several nurses, all needed for even the simplest of surgeries. Most surgeries require nearly a dozen people in the room. As with all automation, surgical robots will eventually eliminate the need for some personnel. Taking a glimpse into the future, surgery may require only one surgeon, an anesthesiologist and one or two nurses. In this nearly empty operating room, the doctor sits at a computer console, either in or outside the operating room, using the surgical robot to accomplish what it once took a crowd of people to perform.
The use of a computer console to perform operations from a distance opens up the idea of telesurgery, which would involve a doctor performing delicate surgery miles away from the patient. If the doctor doesn't have to stand over the patient to perform the surgery, and can control the robotic arms from a computer station just a few feet away from the patient, the next step would be performing surgery from locations that are even farther away. If it were possible to use the computer console to move the robotic arms in real-time, then it would be possible for a doctor in California to operate on a patient in New York. A major obstacle in telesurgery has been latency -- the time delay between the doctor moving his or her hands to the robotic arms responding to those movements. Currently, the doctor must be in the room with the patient for robotic systems to react instantly to the doctor's hand movements.
Having fewer personnel in the operating room and allowing doctors the ability to operate on a patient long-distance could lower the cost of health care in the long term. In addition to cost efficiency, robotic surgery has several other advantages over conventional surgery, including enhanced precision and reduced trauma to the patient. For instance, traditional heart bypass surgery requires that the patient's chest be "cracked" open by way of a 1-foot (30.48-cm) long incision. However, with the da Vinci system, it's possible to operate on the heart by making three or four small incisions in the chest, each only about 1 centimeter in length. Because the surgeon would make these smaller incisions instead of one long one down the length of the chest, the patient would experience less pain, trauma and bleeding, which means a faster recovery.
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Some robotic surgery systems cost more than $1 million to purchase and more than $100,000 a year to maintain. While hospitals can save on costs by decreasing the length of a patient's stay due to a shorter recovery period, they might not save enough to justify the expense of the system.
Robotic assistants can also decrease the fatigue that doctors experience during surgeries that can last several hours. Surgeons can become exhausted during those long surgeries, and can experience hand tremors as a result. Even the steadiest of human hands cannot match those of a surgical robot. Engineers program robotic surgery systems to compensate for tremors, so if the doctor's hand shakes the computer ignores it and keeps the mechanical arm steady.
Let's take a look at the different approaches to robot surgery, starting with supervisory-controlled systems in the next section.
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نوشته شده در چهارشنبه سی ام مرداد 1387ساعت 10:35 توسط علی
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In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. (Intuitive Surgical bought Computer Motion in 2003; ZEUS is no longer being actively marketed.[1])
The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells for about $1.2 million.[citation needed]
In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.[2]
In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada using the ZEUS surgical robot.[3]
Many general surgical procedures can now be performed using the state of the art robotic surgical system. In 2007, the University of Illinois at Chicago medical team, lead by Prof. Pier Cristoforo Giulianotti, performend the world's first ever robotic pancreatectomy and also the Midwests fully robotic Whipple surgery, which is the most complicated and demanding procedure of the abdomen. In April 2008, the same team of surgeons performed the world's first fully minimally invasive liver resection for living donor transplantation, removing 60% of the patients liver, yet allowing him to leave the hospital just a couple of days after the procedure, in a very good condition.
Endoscopic coronary artery bypass (TECAB) surgery and mitral valve replacement have been performed. Totally closed chest, endoscopic mitral valve surgeries are being performed now with the robot. Irfan mulic was the first person to have this done to him
Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, pelvic prolapse, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. The need for large abdominal incisions is virtually eliminated.
The CyberKnife Robotic Radiosurgery System uses image-guidance and computer controlled robotics to treat tumors throughout the body by delivering multiple beams of high-energy radiation to the tumor from virtually any direction.
The da Vinci robot is commonly used to remove the prostate gland for cancer, repair obstructed kidneys, repair bladder abnormalities and remove diseased kidneys. New minimally invasive robotic devices using steerable flexible needles are currently being developed[7][8] for use in prostate brachytherapy. A few leading urologists in the field of robotic urological surgery are Drs. Ashutosh Tewari, Mani Menon, Patrick Walsh, Peter Schlegel, and Darracott Vaughan [9][10][11][12].
Current equipment is expensive to obtain, maintain and operate. If one of the older model non-autonomous robots is being used, surgeons and staff need special training. Data collection of procedures and their outcomes remains limited.
As scientists seek to improve the versatility and utility of robotics in surgery, some are attempting to miniaturize the robots. For example, the University of Nebraska Medical Center has led a multi-campus effort to provide collaborative research on mini-robotics among surgeons, engineers and computer scientists.[13] Scientists at Hebrew University have also developed a miniature robot to navigate through the bloodstream.[citation needed]
The Center for Robotic Surgery at Children's Hospital Boston provides a high levelof expertise in pediatric robotic surgery. Specially-trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings. The results are less pain, faster recoveries, shorter hospital stays, smaller scars, and happier patients and families.
In 2001, Children's was the first pediatric hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic surgeries than any other hospital in the world. Children's physicians have developed a number of new applications to expand the use of the robot, and train surgeons from around the world on its use.
