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A Seminar report on

Robotic Surgery
Submitted in partial fulfillment of the requirement for the award of degree
of Computer Science

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Preface
I have made this report file on the topic Robotic Surgery, I have tried
my best to elucidate all the relevant detail to the topic to be included in
the report. While in the beginning I have tried to give a general view about
this topic.
My efforts and wholehearted co-corporation of each and everyone has
ended on a successful note. I express my sincere gratitude to
..who assisting me throughout the prepration of this topic. I thank
him for providing me the reinforcement, confidence and most importantly
the track for the topic whenever I needed it.

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Introduction
A robot is a virtual or mechanical artificial agent. In practice, it is usually
an electro-mechanical system which, by its appearance or movements,
conveys a sense that it has intent or agency of its own. There is no
consensus on which machines qualify as robots, but there is general
agreement among experts and the public that robots tend to do some or
all of the following: move around, operate a mechanical limb, sense and
manipulate their environment, and exhibit intelligent behavior, especially
behavior which mimics humans or other animals. Today, commercial and
industrial robots are in widespread use performing jobs more cheaply or
with greater accuracy and reliability than humans. They are also
employed for jobs which are too dirty, dangerous or dull to be suitable for
humans. Robots are widely used in manufacturing, assembly and packing,
transport, earth and space exploration, surgery, weaponry, laboratory
research, and mass production of consumer and industrial goods. [2]
In 2006, there were an estimated 3,540,000 service robots in use, and an
estimated 950,000 industrial robots. [35] A different estimate counted more
than one million robots in operation worldwide in the first half of 2008,
with roughly half in Asia, 32% in Europe, 16% in North America, 1% in
Australasia and 1% in Africa.
Robotic surgery
Robotic surgery is the use of robots in performing surgery. Three major
advances aided by surgical robots have been remote surgery, minimally
invasive surgery and unmanned surgery. 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. 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

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danger. So far, latency issues make long-distance telesurgery difficult,


but civilian doctors have put the technology to good use.
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

SUPERVISED CONTROLLED SYSTEMS


Of the three kinds of robotic surgery, supervisory-controlled systems are
the most automated. But that doesn't mean these robots can perform
surgery without any human guidance. In fact, surgeons must do extensive
prep work with surgery patients before the robot can operate.

Spencer Platt/Getty Images


Dr. Scott J. Boley demonstrates a robotic surgery system
at the Montefiore Institute for Minimally Invasive Surgery
in New York City.
That's because supervisory-controlled systems follow a specific set of
instructions when performing a surgery. The human surgeon must input
data into the robot, which then initiates a series of controlled motions and
completes the surgery. There's no room for error -- these robots can't
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make adjustments in real time if something goes wrong. Surgeons must


watch over the robot's actions and be ready to intervene if something
doesn't go as planned.

What's Up, RoboDoc?


The RoboDoc system from Integrated Surgical Systems is an example of a
supervisory-controlled system used in orthopedic surgeries. Once a
human surgeon positions the RoboDoc's bone-milling tool at the correct
location inside the patient, the robot takes over. It automatically cuts the
bone to just the right size for the orthopedic implant.
The reason surgeons might want to use such a system is that they can be
very precise, which in turn can mean reduced trauma for the patient and a
shorter recovery period. One common use for these robots is in hip and
knee replacement procedures. The robot's job is to drill existing bone so
that an implant fits snugly into the new joint.
Because no two people have the exact same body structure, it's
impossible to have a standard program for the robot to follow. That means
surgeons must map the patient's body thoroughly so that the robot
moves in the right way. They do this in a three-step process called
planning, registration and navigation [source: Brown University].
In the planning stage, surgeons take images of the patient's body to
determine the right surgical approach. Common imaging methods include
computer tomography (CT) scans, magnetic resonance imaging
(MRI) scans, ultrasonography, fluoroscopy and X-ray scans. For some
procedures, surgeons may have to place pins into the bones of the patient
to act as markers or navigation points for the computer. Once the surgeon
has imaged the patient, he or she must determine the surgical pathway
the robot will take.
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The surgeon must tell the robot what the proper surgical pathway is. The
robot can't make these decisions on its own. Once the surgeon programs
the robot, it can follow instructions exactly.
The next step is registration. In this phase, the surgeon finds the points on
the patient's body that correspond to the images created during the
planning phase. The surgeon must match the points exactly in order for
the robot to complete the surgery without error.
The final phase is navigation. This involves the actual surgery. The
surgeon must first position the robot and the patient so that every
movement the robot makes corresponds with the information in its
programmed path. Once everyone is ready, the surgeon activates the
robot, which carries out its instructions.

Telesurgical systems

A viewing and control console


A surgical arm unit that includes three or four arms, depending on
the model a human surgeon makes three or four incisions (depending on
the number of arms the model has) -- no larger than the diameter of a
pencil -- in the patient's abdomen, which allows the surgeons to insert
three or four stainless-steel rods. The robotic arms hold the rods in place.
The surgeon sits at the console and looks through two eye holes at a 3-D
image of the procedure, meanwhile maneuvering the arms with two foot
pedals and two hand controllers. The da Vinci System scales, filters and
translates the surgeon's hand movements into more precise micromovements of the instruments, which operate through small incisions in
the body.
According to the manufacturer, the da Vinci System is called "da Vinci" in
part because Leonardo da Vinci invented the first robot. The artist
Leonardo also used anatomical accuracy and three-dimensional details to
bring his works to life.[4] The instruments jointed-wrist design exceeds the
natural range of motion of the human hand; motion scaling and tremor
reduction further interpret and refine the surgeons hand movements. At
no time is the surgical robot in control or autonomous; it operates on a
"Master:Slave" relationship, the surgeon being the "Master" and the robot
being the "Slave." designed to improve upon conventional laparoscopy, in
which the surgeon operates while standing, using hand-held, long-shafted
instruments, which have no wrists. With conventional laparoscopy, the

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surgeon must look up and away from the instruments, to a nearby 2D


video monitor to see an image of the target anatomy. The surgeon must
also rely on his/her patient-side assistant to position the camera correctly.
In contrast, the da Vinci Systems ergonomic design allows the surgeon to
operate from a seated position at the console, with eyes and hands
positioned in line with the instruments. To move the instruments or to
reposition the camera, the surgeon simply moves his/her hands.
By providing surgeons with superior visualization, enhanced dexterity,
greater precision and ergonomic comfort, the da Vinci Surgical System
makes it possible for more surgeons to perform minimally invasive
procedures involving complex dissection or reconstruction. For the patient,
a da Vinci procedure can offer all the potential benefits of a minimally
invasive procedure, including less pain, less blood loss and less need for
blood transfusions. Moreover, the da Vinci System can enable a shorter
hospital stay, a quicker recovery and faster return to normal daily
activities.

Shared control
Shared-control robotic systems aid surgeons during surgery, but the
human does most of the work. Unlike the other robotic systems, the
surgeons must operate the surgical instruments themselves. The robotic
system monitors the surgeon's performance and provides stability and
support through active constraint.
Active constraint is a concept that relies on defining regions on a patient
as one of four possibilities: safe, close, boundary or forbidden.
Surgeons define safe regions as the main focus of a surgery. For example,
in orthopedic surgery, the safe region might be a specific site on the
patient's hip. Safe regions don't border soft tissues.
In orthopedic surgery, a close region is one that borders soft tissue. Since
orthopedic surgical tools can do a lot of damage to soft tissue, the robot
constrains the area the surgeon can operate within. It does this by
providing haptic responses, also known as force feedback. As the surgeon

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approaches the soft tissue, the robot pushes back against the surgeon's
hand.
As the surgeon gets closer to soft tissue, the instrument enters the
boundary region. At this point, the robot will offer more resistance,
indicating the surgeon should move away from that area. If the surgeon
continues cutting toward the soft tissue, the robot locks into place.
Anything from that point on is the forbidden region.
Like the other robots we've looked at, shared-control system robots don't
automatically know the difference between a safe region versus a
forbidden region. The surgeons must first go through the planning,
registration and navigation phases with a patient. Only after inputting that
information into the robot's system can the robot offer guidance.
Abby Somebody
One potential future application of shared-control systems is
neurosurgery. In a 2005 volume of Neurosurgery, doctors suggest a
robotic system for brain surgery. The robot would have a single arm with
multiple pivot points. The surgeon could rest his or her elbow on the
robot's arm. The robot arm would also steady the surgical instrument.
While the surgeon controls the motion of the instrument, the robot arm
provides tremor control, stabilizing each movement .

DIFFERENT TYPES OF ROBOTIC SYSTEMS


Computer Motion of Santa Barbara California has become the leading
producer of medical robotics. Different types of robots are da Vinci, Aesop,
Hermes, and Zeus.
The da Vinci Surgical System was the first operative surgical robot.
Products like Aesop, Hermes, and Zeus are the next generation of surgical
equipment and are used together to create a highly networked and
efficient operating room.
da Vinci Surgical System
Incorporating the latest advancements in robotics and computer
technology, the da Vinci Surgical System was the first operative surgical
robot deemed safe and effective by the United States Food and Drug
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Administration for actually performing surgery.


The da Vinci system was developed by Intuitive Surgical system, which
was established in 1995. Its founders used robotic surgery technology that
had been developed at SRI International, previously known as Stanford
Research Institute. The FDA approved da Vinci in May 2001
The da Vinci is a surgical robot enabling surgeons to perform complex
surgeries in a minimally invasive way, in a manner never before
experienced to enhance healing and promote well-being. It is used in over
300 hospitals in the America and Europe. The da Vinci was used in at least
16,000 procedures in 2004 and sells for about 1.2 million dollars.
Until very recently surgeons options included traditional surgery with a
large open incision or laparoscopy, which uses small incisions but is
typically limited to very simple procedures. The da Vinci Surgical System
provides surgeons with an alternative to both traditional open surgery and
conventional laparoscopy, putting a
surgeon's hands at the controls ofa state-of-the-art robotic platform. The
da Vinci System enables surgeons to perform even the most complex and
delicate procedures through very small incisions with unmatched
precision. It is important to know that surgery with da Vinci does not place
a robot at the controls; surgeon is controlling every aspect of the surgery
with the assistance of the da Vinci robotic platform. Thus da Vinci is
changing the experience of surgery for the surgeon, the hospital and most
importantly for the patient.
. Aesop
Aesop's function is quite simple merely to maneuver a tiny video camera
inside the patient according to voice controls provided by the surgeon. By
doing so, Aesop has eliminated the need for a member of the surgical
team to hold the endoscope in order for a surgeon to view his operative
field in a closed chest procedure. This advance marked a major
development in closed chest or port-access bypass techniques, as
surgeons could now directly and precisely control their operative field of
view. Today about 1/3 of all minimally invasive procedures use Aesop to
control an endoscope. Considering each Aesop machine can handle 240
cases a year, only 17,000 machines are needed to handle all minimally
invasive procedures a relatively small number considering the benefits of
this technology.
Zeus
Zeus is the youngest and most technically advanced robotic aid. Zeus
contains robotic arms that mimic conventional surgical equipment and a
viewing monitor that gives the surgeon a view of his operative field. More
importantly, Zeus enables a surgeon to operate on a patient using joystick
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like handles which translate the surgeon's hand movements into precise
micro-movements inside the patient. For example a 1-cm movement by a
surgeon's hand is translated into a .1 cm movement of the surgical tip
held by a robotic arm. Zeus also has the unique capability of reducing
human hand tremor and greatly increasing the dexterity of the surgeon.
Zeus allows surgeons to go beyond the limits of MIS enabling a new class
of delicate procedures currently impossible to perform. The main
disadvantage is high machine cost. It is around 1 million dollars. Its FDA
approval is pending.
Hermes
Unlike Aesop and Zeus, Hermes does not use robot arms to make the
Operating Room more efficient. Rather Hermes is platform designed to
network the OR, integrating surgical devices, which can be controlled by
simple voice commands. Many pieces of surgical equipment are outside
the range of sterility for the surgeon and must be manipulated by a
surgical staff while Hermes enables all needed equipment to be directly
under the surgeon's control. Hermes can integrate tables, lights, video
cameras and surgical equipment decreasing the time and cost of surgery.
Ultimately Hermes decreases the need for a large surgical staff and
facilitates the establishment of a networked, highly organized OR.
Ultimately Computer Motion is working to bring Hermes into 84,000
operating rooms worldwide

FUTURE DEVELOPMENTS
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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.

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ADVANTAGES
Major advantages of robotic surgery are precision, miniaturization, smaller
incisions, decreased blood loss, less pain, and quicker healing time.
Further advantages are articulation beyond normal manipulation and
three-dimensional magnification .
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. 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.

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DISADVANTAGES
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.Critics have pointed out that hospitals have a hard time recovering
the cost and that most clinical data does not support the claim of
improved patient outcomes.[3]

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LIMITATIONS
Current equipment is expensive to obtain, maintain, and operate.
Surgeons and staff need special training.
Data collection of procedures and their outcomes remains limited.

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CONCLUSION
Robotic surgery is an emerging technology in the medical field. It gives us
even greater vision, dexterity and precision than possible with standard
minimally invasive surgery, so we can now use minimally invasive
techniques for a wider range of procedures. But it's main drawback is high
cost. Besides the cost, Robotic System still has many obstacles that it
must overcome before it can be fully integrated into the existing
healthcare system. More improvements in size, tactile sensation, cost, and
are expected for the future.

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REFERENCE

http://www.stronghealth.com
http://www.computermotion.coin
http://www.intuitivesurgical.com http://www.ctsuse.edu com
http://www.cn.wikipedia.org

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