Surgical Robot: Computer-Controlled Manipulator - A Definition in Literature

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A surgical robot has been defined across literature as, a computer-controlled manipulator with artificial sensing that can be reprogrammed to move and position tools to carry out a range of surgical tasks (Dasgupta et al., 2005).Davies and his colleagues in 1991 documented the use of robotics in urological surgery. They modified the range of movement of an industrial Unimate PUMA robot to perform transurethral resection of the prostate (TURP) gland (Davies et al., 1991). The same Frame TURP modified by Davies and his colleagues was used on over 30 patients in the same year at St.

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Peters' group of Hospitals in London who presented with symptoms of outflow obstruction caused by prostatic enlargement. Postoperative assessment revealed almost parallel outcomes between patients who underwent the frame TURP and those who had the traditional TURP(Davies et al., 1991) (Timoney et al., 1991). Earlier in 1988, Kwoh et al documented the use of a modified light-duty industrial robotic arm to guide a laser for a stereotatic brain surgery which was recorded as the first robotic-assisted surgery in literature.

(F. et al., 2006)ARTEMISIn the earlier years of surgical robotic development; Buess and Schurr, using the Advanced Robotics and TeleManipulator System for Minimally Invasive Surgery (ARTEMIS) robotic system carried out a laparoscopic porcine cholecystectomy which was successful in 1996. However, this system was never used on any clinical trial or cases, despite promising outcomes on abdominal and cardiac cases. (Rassweiler et al., 2017)AUTOMATED ENDOSCOPIC SYSTEM FOR OPTIMAL POSITIONING (AESOP)In 1995, Kavoussi and his colleagues published their results comparing robotic and laparoscopic camera control.

They reported that the images with AESOP system was of greater benefit with few camera changes and minimal unintended instrument collision. (Kavoussi et al., 1995) Designed in the 1990s, the AESOP system was built to eliminate the need for an assistant holding the scope and to give the surgeon a greater visual control during laparoscopic procedures. The device holds the laparoscope, providing it with six degrees of freedom while the surgeon commands the laparoscope by using voice-activated commands via a directional microphone (F. et al., 2006). This proved superior over the traditional method of laparoscopic procedure, in which the assistant holds the laparoscope during the procedure, moving the laparoscope at different angle depending on the surgeon needs " with any slight alteration in movement leading to visual distortion on the camera field and possible complication to the patient. Following the AESOP system, many surgeons considered it standard for laparoscopic surgeries, especially for laparoscopic radical prostatectomies (F. et al., 2006)ZEUSAfter the AESOP, Computer Motion Incorporated in the US developed the Zeus Surgical System (ZSS) for a wider range of manipulation even at long distances. Designed with a control unit and three single arms plus the voice controlled camera arm within a workstation console(F. et al., 2006)(Rassweiler et al., 2017). More like an advanced version of the AESOP, the voice controlled camera is held by the AESOP, while the other two arms of the system holds the surgical instruments and are attached separately to the operating table. The Zeus system provides a 3D- imaging system during the procedure, and the instruments are reusable and attached via appropriate trocars.The surgeon sits at the workstation and controls the entire system via the handles, somewhat similar to chopsticks, which provides a four degree range of freedom (Satava et al., 2002) (Rassweiler et al., 2017). The production of the ZEUS and AESOP systems was terminated in 2004 when Intuitive Surgical bought over Computer Motion Incorporated, however, Intuitive Surgical still provides support to the remaining systems still in use.(F. et al., 2006)Marescaux et al demonstrated a remarkable use of the system in 2001, performing a transatlantic robotic-assisted cholecystectomy (Marescaux et al.,) (Rassweiler et al., 2017). In the field of urological surgery, there has only been very few application of the ZEUS System like pyeloplasty and pelvic lymph node biopsy (Guillonneau et al., 2001) (Luke et al., 2004)NEWER ROBOTIC SYSTEMSIn his preliminary experiments on a six-degree-of-freedom passive arm with dynamic constraints for application in cardiac surgery in 2001, Schneider et al classified robotic systems in surgery into three based on their mechanism of action: (a) Active, (b) Semi-active, (c) Master-Slave systems. (Schneider et al., 2001)Looking at the active systems, these group of surgical robotics under the command of the surgeon, perform surgical procedures freely. The prostatectomy Probot, ROBODOC and the Percutaneous Access to the Kidney (PAKY) system are examples of robotics that operate with the active mechanism.(F. et al., 2006)Semi-active systems have both surgeon-driven and automatic components (F. et al., 2006)