The word 'robot' evokes many different thoughts and images, perhaps conflicting ones. Some may think of a metal humanoid, others of an industrial arm, and yet more may think, unfortunately, of a lost job. In the field of medical robotics, the word robot is just as fuzzily defined, with many different applications. These range from simplistic laboratory robots, to highly complex surgical robots that can either aid a human surgeon or execute operations by themselves.
The idea of robotics in surgery got its start in the military. The idea was to develop technology where a surgeon could perform an operation from a remote location on an injured soldier in the battlefield. This concept has evolved into robotics to enhance surgical performance. In this instance, a robotic arm called Endowrist performs the procedure with the surgeon guiding the robotic arm from a location in or adjacent to the operating room. The surgeon sits at a station peering at a monitor that shows a magnified view of the surgical field. A computer mimics and enhances his hand movements. The computer in this instance makes the movements more precise by dampening even a tiny tremor in the surgeon's hands, which might increase the difficulty in performing procedures under high power microscopic magnification. Examples of such procedures now being performed that were extremely difficult if not impossible before this technology are fallopian tube repair in women, microsurgery on the fetus, and minimally invasive coronary bypass surgery. The Zeus robot made by Computer Motion and a similar device, the Endowrist made by Intuitive Surgical are now in clinical trials for the above-mentioned procedures. Even with the robot to enhance the surgeon's ability, a great deal of practice is required to master the technique.
The reasons behind the interest in the adoption of medical robots are multitudinous. There is a great analogy to be found with the automation involved in the manufacturing industry. That is not to say that the issues of medical robotics are the same, but that the advantages to be gained are similar. Robots provide industry with something that is, to them, more valuable than even the most dedicated and hard-working employee - namely speed, accuracy, repeatability, reliability, and cost-efficiency. A robotic aid, for example, one that holds a viewing instrument for a surgeon, will not become fatigued, for however long it is used. It will position the instrument accurately with no tremor, and it will be able to perform just as well on the 100th occasion as it did on the first. The use of robotics and computers in minimally invasive spine surgery has resulted in more accurate surgical procedures, shortened operative time and fewer complications. It is expected that Computer Enhanced Image Guidance Systems will improve the precision of these procedures as a result of real time 3-D imaging at the time of the surgery. Diagnostic studies will be digitally transmitted to the operating room and projected to monitors to further aid the surgeon in performing the correct procedure with minimal trauma to the patient
SURGICAL NAVIGATION SYSTEM
A surgical navigation system has been built that is currently used regularly for neurosurgical cases such as tumor resection at Brigham and Women's Hospital. The system consists of a portable cart containing a Sun UltraSPARC workstation and the hardware to drive the laser scanner and Flashpoint tracking system (Image Guided Technologies, Boulder, CO). On top of the cart is mounted an articulated extendible arm to which a bar is attached to house the laser scanner and Flashpoint cameras. The three linear Flashpoint cameras are inside the bar. The laser is attached to one end of the bar, and a video camera to the other. The joint between the arm and scanning bar has three degrees-of-freedom to allow easy placement of the bar in desired configurations