Surgical Systems and Robotics

As indicated above, robotics provides a unique opportunity to integrate all the functions of a surgical procedure (surgeon, assistant, nurse, etc.) into a single system. The next generation of robotics will also include entirely new capabilities: smart instruments, automatic functions, energy-directed therapy and MEMS, nano-, and biosurgery. Smart instruments are those that include sensors or diagnostic capabilities within the surgical instrument. Instruments, such as graspers, will have sensors that provide the sense of touch, at normal sensory levels as well as scaled to even microforce levels—beyond the level a normal human hand can feel. Other instruments, such as scalpels, will include various diagnostic sensors (Raman spectroscopy, hy-perspectral analysis) that will be able to distinguish between healthy and malignant tissue [10]. In addition, instruments are becoming multifunctional and capable of performing entire tasks. The most typical example is the end-to-end anastomosis (EEA) stapler. Rather than dividing the intestines and hand sewing the two ends together, current practice is to divide the bowel, attach the stapler, and with one squeeze of the hand, perform a complete anastomoses, usually with a higher level of precision than hand sewing. There are other new tools becoming available, such as a number of methods for automatically creating a vascular anastomosis [11]. Analysis of a surgical procedure can be done by breaking down the entire procedure into a series of sequential smaller tasks; it is reasonable to expect that it would be possible to automate each of the individual steps, eventually integrating all the steps into a single autonomous procedure. Once the integration of a sequence of steps is achieved, it would only be logical to simulate or rehearse the entire procedure (on patient specific three-dimensional CT scan); this procedure can also be edited (delete all the errors, like editing a document on a word processor), and then export the perfected procedure, step by step, to the robotic system to perform the entire procedure auto-matically—under the close supervision of the surgeon, who could intervene at any time. This is the methodology used every day in the engineering community: automating a process and supervisory control. Since robotic systems currently available can perform tasks at 12 to 15 times the speed, with 10 to 20 times the precision of humans, it could be speculated that once the surgeon has rehearsed and edited the procedure on the virtual person, the robotic system could perform the procedure in minutes instead of hours, with greater precision. More speculative is the coupling of the human thought process to controlling robotic systems. The brain-machine interface systems that are in today's laboratories permits monkeys to control a robotic arm simply by thinking, albeit it at a very rudimentary level [12, 13]. As this technology rapidly progresses, there has been speculation that it will be possible to simply think through a complex task such as surgery and have the robotic systems perform to precision. While clearly beyond any technology that will be implemented by the current generation of surgeons, some lesser variation of direct intellectual control of robotic systems may emerge. This speculation is supported through analogy to the implementation of clinical trials in quadriplegic patients using an implanted brain chip to control robotic manipulator motion.

To the practicing surgeon, this means that surgery may place more and more emphasis on intellectual and cognitive skills and less on manual skills. Crafting a surgical procedure may become more important than performing the procedure. As advanced technology provides more precise automatic instruments (and robotics) and better surgical planning tools, surgeons must learn to master these new systems (rather than ignore them) and learn how to best integrate them into a busy clinical practice.

0 0

Post a comment