Robotics in surgery.

Abstract

The drive to introduce operating robots into theaters is for a number of reasons related to their intrinsic properties: these include three-dimensional spatial accuracy, reliability, and precision, and in minimal-access surgery they aid the surgeon, who must contend with deficits in sensation and dexterity. There are a number of robots already in clinical use, in neurosurgery and orthopaedics, that possess these traits and can be used once the area to be removed or biopsied has been highlighted. In one particular area there has been a rapid expansion in the commissioning and use of surgical robots: that of the telemanipulators. The introduction of the telemanipulators in minimal-access surgery has restored the loss of dexterity and visual quality that is inherent in minimalaccess surgery, allowing for more complex procedures to be undertaken with a high degree of quality. This article will consider the history of robots in surgery and their current use with particular reference to these systems. The robot has been defined as “a reprogrammable multifunctional manipulator designed to move material, parts, tools, or specialized devices through variable programmed motions for the performance of a variety of tasks” by the Robot Institute of America. Webster defines them as “an automated device that performs functions normally ascribed to humans or a machine in the form of a human.” The term robotics refers to the study and use of robots. The word robot was first introduced in Karel Capek’s play “Rossum’s Universal Robots,” which opened in Prague in 1921. This play concerned the dehumanization of man in a technological civilization, and the robots were created by chemical rather than mechanical means. The word robotics refers to the study and use of robots and was first used by Isaac Asimov in his short story “Runaround”, later proposing the Laws of Robotics (Table 1). His laws refer to the protection of humanity above humans, that robots must obey humans unless it conflicts with a higher law. These principles of safety, initially raised by Asimov, will be considered later, especially with reference to public education. The first industrial robots were the Unimates developed by George Devol and Joe Engelberger in the late 1950s and early 1960s. The robotics industry expanded rapidly in the 1980s with their use in production lines of the automotive industry, followed by a relative collapse and recent regrowth of the industry. The move of robots into surgery has occurred in the last twenty years with a recent rapid expansion related to cost and computing power. There is an important distinction to be made between computer aided surgery (CAS) and robotic surgery. In CAS, the surgeon generally holds the tools and computers might help in planning and positioning, but in robotic surgery, robots will hold tools, providing greater accuracy and precision. The majority of these computer-based systems are tracking systems, tracking a tool or a part of the anatomy. The tracking system can be sensor-based—eg, light-emitting diodes or optical reflectors mounted on the tool—or if anatomy is being tracked, then three-dimensional modelling by radiographic means will be required. These anatomic reference maps require either obvious anatomical markers or artificial markers known as fiducials. The power for the tools comes from the surgeon. Obviously, there must be careful preoperative planning and the preoperative images of the patient must accurately match the intraoperative position of the patient. The use of robots in medicine can be broadly divided into rehabilitation, service, and surgery (including ancillary devices such as microscopes). Their use in rehabilitation and for assisting disNo competing interests declared.