The Future of Robotic Surgery
The future of robotic surgery is hard to believe but ....it is now. If you haven't noticed, robotic surgery has come long ways and it was only a dream for doctors and engineers to have something that you no longer had to make big, hideous scars that would mess up somebody's body for the rest of their lives. Doctors, before robotic surgery, worked on making minimally invasive surgery that would take hours of surgery time. Now, surgery is still made in hours, but shorter hours are now in check with the robotic surgery. So you can't really say there is a future of robotic surgery, but you can say that this has been the future for doctors long ago so all you can say is...the future is now!!
Robotic
Surgery: The Future Is Now
The field of surgery is entering a
time of great change, spurred on by remarkable recent advances in surgical and
computer technology. Computer-controlled diagnostic instruments have been used
in the operating room for years to help provide vital information through
ultrasound, computer-aided tomography (CAT), and other imaging technologies.
Only recently have robotic systems made their way into the operating room as
dexterity-enhancing surgical assistants and surgical planners, in answer to
surgeons' demands for ways to overcome the surgical limitations of minimally
invasive laparoscopic surgery, a technique developed in the 1980s.
On
July 11, 2000, FDA approved the first completely robotic surgery device, the
daVinci surgical system from Intuitive Surgical (Mountain View, CA). The system
enables surgeons to remove gallbladders and perform other general surgical
procedures while seated at a computer console and 3-D video imaging system
across the room from the patient. The surgeons operate controls with their hands
and fingers to direct a robotically controlled laparoscope. At the end of the
laparoscope are advanced, articulating surgical instruments and miniature
cameras that allow surgeons to peer into the body and perform the procedures.
This
system and other robotic devices developed or under development by companies
such as Computer Motion (Santa Barbara, CA) and Integrated Surgical Systems
(Davis, CA) have the potential to revolutionize surgery and the operating room.
They provide surgeons with the precision and dexterity necessary to perform
complex, minimally invasive surgical (MIS) procedures, such as beating-heart
single- or double-vessel bypass and neurological, orthopedic, and plastic
surgery, among many other future applications.
Manufacturers
believe that their products will broaden the scope and increase the
effectiveness of MIS; improve patient outcomes; and create a safer, more
efficient, and more cost-effective operating room. It is the vision of these
companies that robotic systems will one day be applicable to all surgical
specialties, although it is too early to tell the full extent to which they'll
be used.
Surgical
robotics manufacturers working toward FDA approval of their devices are
encouraged by Intuitive Surgical's recent FDA approval. "The future looks
bright," says Yulun Wang, MD, founder and chief technical officer of
Computer Motion. "This approval sends a positive signal to industry, and
there are tremendous opportunities."
According
to Wang, "The goal of robotic surgery is to offer superior quality and
reduced trauma to the patient. Today, the skeptical surgeon would say that's not
proven yet, but the progressive surgeon would say that these goals are
achievable. Thus far, the results have been phenomenal."
And
many researchers and industry participants in the field say that the
capabilities of first-generation systems are just the beginning. According to
Richard E. Wood, MD, chief of cardiothoracic surgery at Baylor University
Medical Center (Dallas), robotic surgery systems "will certainly make it
easier to perform major surgeries, but these systems still need to evolve.
They're not for every patient, but with time we will gain more experience and do
more procedures, and the instruments will evolve from this first
generation."
Currently,
the three principal device manufacturers in this area are Intuitive Surgical,
Computer Motion, and Integrated Surgical Systems. Their systems are described
below.
Future
Outlook
Surgeons
and device executives agree that first-generation robotics systems have already
displayed many advantages over traditional laparoscopic surgery and open
surgery, especially in terms of speedier patient recovery and reduced pain. But
they also insist that the technology is still evolving and will become more
capable with time.
"We're
on the cusp of redirecting and improving surgical capability, but we are in the
first generation of this process," says San Ramon's Gardiner. "The
technology will be applied selectively early on, but as patients begin to insist
on the new technology, it will become state-of-the-art and the standard of care
for selected procedures." In Gardiner's opinion, as a general surgeon,
"basically, the most promising applications for these systems will be in
any surgery in which suturing is an important feature."
Continued
evolution of robotic surgical systems is inevitable, says Gardiner. "Down
the road, as with PCs, the systems will become smaller, lighter, faster, and
easier to set up, and this will increase their applications. As with CT scans,
you will find uses and needs for the technology in excess of what the
projections were, and surgeons will want and need these devices. The surgeon
actually does a better, more precise, elegant, dexterous, controlled procedure
with robotics, with less tissue damage, which leads to a better outcome."
"In
the next five to seven years, almost all ORs worldwide will have robotic
assistance of some kind for major surgeries," says ISS's Trivedi. "We
will never, ever, replace the surgeon, but robotics will take over a lot of the
things they do by hand, with more precision and accuracy."
UCLA's
Schulam, who has been using robotic surgical systems since 1995, when the first
products were being developed, says that the elaboration of such systems may
change the relationships between surgeons and industry. "Robotics are here
to stay. However, it will take time for these devices to revolutionize the way
surgery is done, and educational programs are the key to their success.
"We
need to change how industry and surgeons interact," he continues. "In
the past, surgeons have had a consumerlike relationship with the device
industry, where the consumer buys the product and is off. But now, what will be
required is a much more collaborative relationship, in order to get surgeons to
change the way they're used to doing things."
Baylor's
Wood is even interested in forming a robotic surgery institute, perhaps within
the next year, where surgeons from many specialties can meet and discuss how to
bring robotics technology to the next level.
According
to surgeons, patients have been asking about robotic surgery, and their feedback
has been very positive. This demand is another key to the success of the
robotics industry. "People are very informed today, because of the
Internet," says Wood. "About 8% of my patients have asked about
robotic surgery."
"Frankly,
I was very surprised," says Gardiner. "I thought patients would feel
robotics is too impersonal, but I have found that not one patient has not wanted
it."
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