SURGICAL ROBOTICS

Abstract

Surgical robotics is a vary vast topic to put in a few pages.in this topic so I divided the seminar in two parts. The part one gives general guideline about surgical robotics.this actually covers the basic block schematic, their actual working, why they are needed.since when they are in use.and why for?

In the second part I selected on application that is robotics used in antireflux disease. In this the 3 robots used are discussed from engineering point of view. And also how they help to the doctor while surgery. Also their advantages, disadvantages, are discussed. Finally the cost and future developments are discussed

DEFINATION OF ROBOT:

 Re-programmable, multi-functional Manipulator designed to move material, parts, tools, or specialized devices through various programmable motions for the performance of a variety of tasks.

Webster says “An automatic device that performs functions normally ascribed to humans or a machine in the form of a human”.

In short any machine that do’s human work efficiently, economically, faster, consistanntly, with good flexibility can be called as a robot.

ROBOTS IMPORTANCE

Honestly speaking   today world is vary difficult to imagine without a robot. Every human being uses a robot in his day-to-day life. Work has become much simpler because of a robot. Various transactions done in banks vary fast because of a robotics.

However their main application is related to the field of engineering. They are widely in plant automation, in intrinsic safety. There are number of applications

HISTORY OF ROBOTICS

The first industrial modem Robots were the Unimates developed by George Devol and Joe Engelberger in the late 50’s and early 60’s. The first patents were by Devol for parts transfer machines. Engelberger formed Unimation and was the first to market Robots. As a result, Engelberger has been called  FATHER OF ROBOTICS.

With their computational and agile skills Robots perform tasks that are difficult or hazardous to humans. Advances in -microchips, microprocessors, sensors, control systems, mechanical engineering, transducers and telecommunications have resulted in widespread growth of Robotic processes and applications.

Today’s Robots are mechanical arms controlled by computers that are programmed to perform a range of handling activities. They are establishing themselves in manufacturing automation systems to produce a range of goods with great precision

CHAPTER 2

MEDICAL ROBOTICS:

MEDICAL ROBOTICS THE CHALLENGE

The very first Robots in medical history were applied to introduce a stereo tactic’frame on the patient’s skull, thus enabling the clinical team to place electrodes and to localise the exact position in the brain, which needed surgical intervention.

But the question from engineering point is what are these machines?. As amazingly interdisciplinary systems, Robots are comprised ol mechanies, electronics, hardware and software and issues germane to all these categories. The term ‘Robotics’ refers to was coined and first used by the Russian-born American scientist and writer lsaac Asimov the study and use of  medical Robots.

For the field of Medical Robotics, the definitions are to be broadened and modified. They can be classified in two ways.

  1. 1. Functional classification.

Dexterity enhancement

1 These Robots are directly controlled by some input device used by the surgeon – e.g., to reduce tremor during microsurgery, etc. The patient may be geographically remote from the surgeon.

Precision localization.

These allow precise location of predetermined surgical locations (e.g., based on a pre-operative image study.)

Precision manipulation:

These Robots operate on the patient in some fashion based on a presurgical plan, rather than directly by the surgeon’s control.

  1. Technological Classification..

Autonomous.

The control of the manipulator is based purely on a pre-operative or intra-operative plan.

Supervisory.

The system provides a means of guiding the surgeon to accurately perform the operation.

Teleoperated.

The Robot is controlled directly by input devices used by the surgeon at a different location during the operation.

 

OBJECTIVES

The field of Medical Robotics offers a number of attractive features. It has potential to provide better quality patient care by improving current procedures, allowing additional capabilities that are currently unavailable, & improving the means of evaluating the success of surgeries.

THE SPECIFIC OBJECTIVES OF THIS TECHNOLOGY INCLUDE

  1. Allow finer control.
  2. Increase reproducibility (consistency).
  3. Incorporate Improve accuracy of the procedure
  4. Complicated, detailed and voluminous image data in surgical execution.
  5. Allow remote activation, which could expand accessed to operator expertise for patients.
  6. Allow longer endurance than humans in the same task.
  7. Improve safety – a Robot can safely intervene ir situations where risk to a human operator may be high.
  8. Minimize invasion of procedure.
  9. Provide new possibilities for miniaturization of the surgical task.

 

CHAPTER 3

ROBOTICS IN SURGERY

 THEORY

Surgery traditionally involves making large incision to access the part of the patient that requires attention. This method is referred to as the open surgery approach. The incision and the significant dissection needed to allow the surgeon to visualize the filed are the parts of the operation that contribute to delayed patient recovery and cause most of associated pain.

For many surgical procedures, the method of choice has shifted from traditional open surgery to the use of less invasive means. Minimally Invasive Surgery (MIS) is a effective cost effective alternative to open surgery, whereby essentially the same operations are performed using specialized instruments designed to enter into the body through several tiny punctures, rather than one large incision. These Minimally Invasive alternatives usually result in less pain, scarring and recovery time for the patient, as well as reduced health-care costs. Instead of looking directly at the part of the body being  treated, the physician monitors the procedure via a special video camera inserted through one of the small punctures. By eliminating the large incision and extensive dissection much of the pain of recovery and the length of hospital stay are reduced.

However, compared to open surgery, MIS is affected by additional physical, visual, motor, spatial, and force constrains.the miss tools are constrained by the incision point. The surgeon must coordinate the hand motion that controls the tool, with the remote visual display of the operation being performed by the end-tool. The limited workspace and coordination of a pair of tools further compounds the challenge.

As a direct result of these constraints there is an extended learning curve for the surgeon to gain the required skill and dexterity. Furthermore, there is a great deal of operating variability even among trained surgeons. Time motion studies of endoscopic surgeries have indicated that for activities such as suturing, knot tying, suture cutting, and tissue dissection, the operation time variation among surgeons can be as large as 50%. For suturing, in particular, it was noted that the major difference lies in the proficiency at grasping the needle and moving it to a desired position and orientation, without slipping or dropping it. The continuing growth of MiS operations depends in large part on the reduction of variability and increase of efficiency of the MIS procedures. Toward this goal, many Robotic devices have been proposed in the literature and many have been patented.

One class of surgical Robotic devices that has been proposed to assist in endescopic surgeries is based on the concept of tele-operation. Here a surgeon performs the operation remotely, with a Robot completely under the surgeon’s command, operating on the patient. The Robot motion is slaved, via mechanical linkages or computer control, to the movements of the surgeon. The surgeon’s view of the operation may be further enhanced by the remote vision, magnification and synthesis of 3 dimensional space to create a virtual presence

Various Robotic positioners and stabilizers have also been proposed where, similar to tele-operation, a Robot- holding surgical tool is controlled so as to follow the surgeon’s command. The role of the Robot is to filter out tremors and disturbances of the surgeon’s hands so as to enhance the precision and mechanical stability of the operation.

It is important to note that most Robotic surgical procedures are still completely performed and controlled by the human surgeon. The human commands are mimicked by the Robotic device. The surgeon’s virtual presence, through visual feedback, is operating the tool, thus reducing one of the challenges of MIS. However procedures that require a high level of skill, such as suturing, ligation, and precise tissue dissection, continue to depend on the skill of the surgeon. Some works have also been reported on a Robotic system that can collaboratively perform endoscopic procedures with the surgeon: performing certain tasks autonomously to reduce the strain on the surgeon, removing variability of surgeons training levels, and enhancing system efficiency by decreasing the operation time.

Robotic assisted coronary artery bypass grafting is a rapidly growing phenomenon in minimally invasive heart surgery. Coronary surgery can now be performed by Robot arms with the aid of a tiny video camera. In this operation, three pencil-sized ports are created. Through one port a tiny high-powered, voice- operated camera or endoscope is inserted and held by a Robotic arm. Robotic arms that control the surgical equipment are inserted in the other two ports. The physician’s role is to maneuver the camera through voice-operated controls and to manipulate the surgical equipment using a hand held joystick. Thus the only surgical cut that a physician directly performs is the initial puncture of the chest.

Besides the obvious advantages of keyhole punctures and the absence of a heart-lung machine, Robotic assisted bypass eliminates errors involving human hand tremor and enables precise micro- movements beyond the scope of human vision. Robotics has enabled surgeons to perform cuts and operations beyond the scale of human ability. By eliminating the often intangible inaccuracies of human error, robotics have ushered in a technological, rather then physican dominated era of heart surgury.

While medical robots may make some surgical procedures easier or help the surgeon perfrom an operation more precisely the food and drug administration which regulates these new devices, has several concerns. One concern is software.

Today’s Robotic devices typically have a computer software component that controls the moving, mechanical parts of the device as it acts on something in its environment. FDA reviewers evaluate the software components of such devices because the software is “command central” for the device’s operation. When evaluating the devices, FDA looks to see if the company is following good software engineering practices in writing and designing the software. These practices often include establishing device requirements, writing good specifications, evaluating the software and device, analysing the device’s potential hazards, and implementing controls that specifically address those hazards. Other concerns include the safety and effectiveness of the hardware component of the device.
CRITICAL ROLE OF ROBOTICS IN SURGURY

IN ORTHOPEDIC CASES

In orthopaedic where the accurate positioning of the rod in any parts of the body is required now when the human has to do that work the consiststancy,accuracy (most important ),flexibility is not obtained as the robot can do. Now a days a robots used in orthopedics are of mathematical type robots. This robots does the mathematical calculations and tells the surgeon the accurate positioning of the rod. Of cource the decision making has to be done by the doctor.

Besides this they are used in

  • total hip replacement
  • total knee replacement
  • spine replacement
  • ligament reconstruction
  • hand and other microsurgury
  • total shoulder replacement

below figure shows the orthopedic microwrist operation where we can see no. of robots.this is a surgury using telemanupulator.i.e. the surgeon does this surgury in the same room but not in front of patients in this case all the operation done with the help of joystick .no. of robots are invovled in actual surgury

ROBODOC  is a surgical robot that performs the following procedures:

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Primary  total  hip  replacement:

The robot mills a cavity in the femur for the placement of a prosthetic implant. The system is designed to accurately shape the cavity for a precise fit and precise positioning of the implants in the cavity for optimum biomechanics. 

Revision hip replacement:

The robot automatically removes bone  cement and creates a new, accurately shaped cavity for a revision prosthesis

Total knee replacement:
The robot planes knee surfaces on the femur and tibia to achieve a precise fit of the implant

Robodoc is a  company in u.s.a. and majority of ortopedic operations are done with the ROBODOC robots. The robodoc is a global name in the world and you will find the word robodoc when there is orthopedic surgury. These are also called as Critical Care Robots

(CCR). Because they are used  only in critical care  orthopedic surgury.

CHAPTER4

NEEDS OF SURGICAL ROBOTICS
TECHNICAL NEEDS OF MEDICAL ROBOTICS
  • Accuracy, fidelity of image data
  • Efficient, accurate registration of multi-modality image data, pre- or intra operatively with the eventual ability to track internal tissue in real time. Fail-safe features of mechanical design.
  • Compatibility between different elements of the surgical system: imaging/ computing/manipulating
  • Computing power availability Vs cost
  • Component sterilisation
  • Tracking of tools etc optical systems require line of sight. Magnetic systems have more accuracy problems
  • Improvement of robotic control theories
  • Expansion of feedback modalities – e.g. sound, touches
  • Other end effected options – lasor, ultasound,& emerging technologies
  • Error detection sensitivity/ specificity. Error detection should be sensitive while allowing quick localization & resolution

NON TECHNICAL NEEDS IN MEDICAL ROBOTICS

  • Funding problems exist in all phases needed to bring a product into clinical practice & become financially viable:
  • Development
  • Refinment
  • Technology transfer
  • Outcome study – experimental procedures are not reimbursed by health insurance.
  • Waiting for regulatory(FDA,etc) approval
  • Launching a commercial product – production, documentation, packaging, & support
  • Liability issues. Any sub-optimal patient outcome may be argued to be due to the technique, whether or not the claim is valid
  • Patient & surgeon acceptance. Some skepticism & resistence on the part of both the patients & surgeons have been encountered with the trail system
  • Licensure & intellectual property issues. Patenting of certain components of technology can impade development of system.
  • Standardization & compatibility issues
  • Lack of development of valid practical term

Outcome measures. Since differences in outcome may not be seen for decades, it is desirable to identify short-term pridictors of eventful outcome. Without these, it can be vary hard to make a case of innovative techniques superiority compared with conventional methods.

FUTURE SCOPE

It is unlikely that robots will ever completely take over take over the surgeon’s role. Although in the best situation the surgeon may only appear to provide access to the robot, & the robot may even perform certain portions of the operations autonomously, it is the surgeon’s expiriance & the guidance that assures the safe & accurate performance of each operation.But there are many areas in which robots may expand their ‘EXPERTISE’ & become & become & even more valuable member of operating team.Robots will certainly continue to play a more important role in medicine & in surgury in perticular. They permit an extension of the human providing more pricise manipulation in smaller spaces & with fewer traumas to the patient. Within a few weeks, if a patient were at the beach he be barely recognised for having undergo heart surgury. It can become a reality over the next decadeThe mobile phone nobody imagine in the 70’s .but in year 2000 they are used almost by everybody. The primary stage was the evalution of phone. Then the cost reduction happened & now everybody is using itSo the meaning is the world is changing vary fast in technology. And no doudt that the robots will be widely used in the next decade as the more approch now a days is cost reduction.

 

SURGICAL ROBOTIC

PART I I          APPLICATION OF ROBOTICS IN ANTIREFLUX  SURGERY

 

                        INDEX

BRIEF GUIDELINE ABOUT GASTROESPHAGITAL DISEASE·          TRADITIONAL TREATMENT TO REDUCE REFLEX·          ANTIREFLUX SURGERY (LAPAROSCOPIC APPROACH)

·          ADVANTAGES BY USING ROBOTICS IN REFLUX  DISEASE

·          ROBOTIC INSTRUMENTATION

·          ROBOTIC ANTIREFLUX SURGERY

·          ROBOTS ROLE IN SURGERY

·          CONCLUSION

·          FUTURE SCOPE

·          REFRANCES

GASTROESOPHAGEAL REFLEX DISEASE

Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return

of the contents back of the stomach up into the esophagus

Normal digestion, the LES opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately allowing the stomach’s contents to flow up into the esophagus. Figure 1 shows the

location of the LES between the esophagus and the stomach.The severity of GERD depends on LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.

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More than 60 million American adults experience Gerd and heartburn at least once a month, and about 25 million adults suffer daily from heartburn. Twenty-five percent of pregnant women experience daily heartburn, and more than 50 percent have occasional distress. Recent studies show that GERD in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing and other respiratory problems, or failure to thrive.

 

TREATMENT TO REDUCE REFLUX

Tips to Control Heartburn

Avoid foods and beverages that affect LES pressure or irritate the esophagus lining, including fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products.
Lose weight if overweight.
Stop smoking.
Elevate the head of the bed 6 inches.
Avoid lying down 2 to 3 hours after eating.
Take an antacid.

 

The medicines like omeprazole capsules and in severe condition lansprazole drugs are used. However, there is no such a drug after eating that disease will be cured. Doctor’s basic aim in giving the medicine is to reduce the acid contents in the stomach and patient must feel comfort. But in case of severe reflux then doctors has to consider a different approach and the approach is surgury. NISSAN FUNDOPLICATION is the name of the surgery.

 

LAPROSCOPIC NISSAN FUNDOPLICATION

The laproscopic nissan fundoplication is a open surgery developed in early 1950. The surgery is vary successful and now a days widely used. In the surgery the LES pressure is increased to allow the contents of esophagus to enter in a stomach vary rapidly.by using this surgery about 95% of REFLUX is eliminated.

 

DISADVANTAGES OF THE SURGURY

The recovery of the patient after the surgery
Damage to other parts of body while the surgery
Huge time required for the surgery
Medicine period after the surgery
Complications in the surgery
Precise monitoring not possible
Huge Bleeding while surgery
avg. follow up time

 

Taking into considerations all this disadvantages the new approach to surgery called ROBOTIC ANTIREFLUX SURGURY came to existence.

ADVANTAGES BY USING ROBOTICS

Minimally invasive surgery  (MIS)
Quick recovery
Fast operation
Minimum stay in hospital
Flexibility in surgery
Minimum bleeding
Medicine use after surgery is limited.
Improved 2-d 3-d visual reduced surgeon’s fatigue

ROBOTIC ANTIREFLUX SURGURY

First, let us consider the robotic instrumentation involved. Their principle, operation, their advantages & applications.

Robotic instrumentation

There are number of robots used in laproscopic Nissan fundoplication or in antireflux surgery.

The list of robots is as follows.

VOICE CONTROLLED ROBOTIC CAMERA HOLDER
DECISION MAKING ROBOTS
BUTTEN OPERATED ROBOTS
ENDOASSIST

Now let us discuss each robot one by one.

VOICE CONTROLLED ROBOTIC CAMERA HOLDER

The robotic camera holder is being widely used in all forms of surgery not only in reflux oesophagitis

OPERATION

The doctor just says ‘ MOVE LEFT’ and ‘ MOVE RIGHT’ and the robot moves in the direction as the doctor commands. The robot is actually programmed to the instructions of the doctor. These robots are called as VOICE CONTROLLED ROBOTS

 

CIRCUITARY OF ROBOT

Firstly when the doctor commands ‘MOVE LEFT’ then the English language is converted to machine language, further machine language is converted to analog signal .The A/D conversion takes place then processing of signal takes place. Then digital signal is converted to analog signal and then it is given to the mechanical arm of the robot where the robot actually moves to the left.

Firstly when the  doctor commands ‘MOVE LEFT’  then the English language is converted to machine language , further machine language is converted to analog signal .The A/D conversion takes place then processing of signal takes place . Then digital  signalis converted to analog signal and then it is given to the mechanical arm of the robot where the robot actually moves to the left

There is also a confirmation circuit inside the robot and comment circuitry is provided because if the doctor gives any wrong instruction by mistake then the robot asks for a confirmation twice before he moves and then moves. The robot also makes the decision making in some cases.

 

ADVANTAGESOF ROBOTIC CAMERA HOLDER

1.No need of human assistant

2.Quick & fast response then human assistant

3.Exact focusing of light where doctor wants

4.Multiprogramming  can be done

5.Requires less time for surgery

Disadvantages:

Cost is vary high

The cost is about $10000 per robot. This is not affordable to

everybody. no need of human assistant

conclusion:

The robotic camera holder only helps or assists the doctors & hence surgery is same but the time required for the surgery is reduced & human assistance not required.

DECISION MAKING ROBOT

These robots are preprogrammed &used in crucial decision making while complicated surgery. These robots actually assist the doctors while surgery.

For ex. During surgery the doctor is not finding a nerve then he has to consider some logic now, these permutation & combination are preprogrammed in decision making robot. He calculates the permutation & combination & gives the answer to the doctor. In short, it tells the doctor the better way.the risk factor reduces down & less bleeding. Of course, the final decision only the doctor takes.

Circuit in decision making robot

There are some standard digital signal processing (dsp) programs of permutation & combination for the medical decision making robots. They are widely used. They are all software controlled

Advantanges & disadvantages

Quick decision can be made

Risk is minimum
Fast operation

Disadvantages

Cost is the only disadvantage

ENDOASSIST

EndoAssist holds the laparoscopic camera and moves it in unison with the surgeon’s head, which it tracks using a headband sensor.

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The surgeon simply looks in the direction of the movement required … a glance to the right or left of the monitor causes the camera to pan in the same direction. Similar natural movements cause the camera to look up or down, and to zoom in or out.
The robot only moves when the surgeon is pressing a footswitch, allowing complete freedom of movement at all other times

Intuitive camera control

No camera assistant

A steady image at all times
Hand tremor and wandering off are eliminated
Ideal for solo surgery
Ideal for training junior surgeons
Ideal for lectures and telesurgery
Cost effective

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Easy to set up

Floor standing – can be wheeled to any point around the operating table
Registration by aligning two lights over the entry point

Easy to use

Responds to natural head movements

Fully mastered after just a few minutes practice

Easy to sterilise:

Camera holding arm is detachable for autoclaving

No draping required

Easy to work around:

Minimal intrusion into the operating field

Enables easy all-round access

Easy for training:

The trainee controls the camera, leaving the supervisor with both hands free

Easy for Telementoring and Tele-links:

Ideal for tele-demonstrations, holding the camera completely still while the demonstrating surgeon addresses colleagues, who may be:

  1. In the O.R. watching a second monitor;
  2. In another location connected by closed circuit TV;
  3. Watching by remote tele-link

Easy for Telesurgery assistance:

Telesurgery version allows a remote surgeon to control EndoAssist by a special joystick connected via modem

A distant surgeon can assist operating colleagues through standard teleconferencing links

ADVANTAGES OF ENDOASSIST

Operating Time Saving:

EndoAssist has been shown* to produce a significant time saving. In a series of 100 laparoscopic cholecystectomies, cases using manually held cameras took an average of 74.39 minutes, as against 65.73 minutes when EndoAssist was used. (p=0.04 two tailed t-test).

This saving of almost 9 minutes per case equates to over 10% of the operation time. The cumulative saving from 2 or 3 cases on a typical list allows another short case to be added to the list without any extra resources being required.

Staff Saving:

Using EndoAssist releases a camera operator, who may be a surgeon or a nurse. The staff saving is particularly valuable when additional evening or weekend lists are planned.

The typical saving for a hospital carrying out 6 laparoscopic cases/week is 25% of a full time staff equivalent.

Risk Management:

> Reduced stress in surgeon

Studies have shown that the loss of control inherent in laparoscopic surgery leads to increased stress in surgeons. Conversely, restoring control to the surgeon reduces stress levels.

> Improved image quality and positioning

The camera is moved precisely to the site required by the operating surgeon, and the image is held completely steady without the problem of hand tremor. As a result the number of conversions and revisions is reduced.

From the experience of surgeons known to Armstrong, a typical hospital carrying out 6 laparoscopic cases/week could expect to save 2 conversions or revisions annually, giving a substantial cost saving.

Improved Resource Planning and Scheduling:

EndoAssist has been shown* to reduce the variability of case lengths.

In a series of 100 cases, the standard deviation was reduced from 22 minutes to 16 minutes when EndoAssist was used, allowing more accurate scheduling of cases and more efficient use of resources.

Improvement in Training:

EndoAssist allows both trainee and instructor to have both hands free, whilst keeping the camera fixed on the clinical target. Users have found that this leads to smoother and shorter training cycles, and a number of EndoAssist users specifically employ EndoAssist for this purpose.

Regulatory Approvals:

EndoAssist is available on sale worldwide. It has CE approval and FDA 510(k) clearance and has been tested to IEC601. It has been used in thousands of procedures in countries around the globe. Outside the European Union and United States local Regulatory Approvals may be required. Please contact Armstrong for details.

Control Method:

The standard control method for EndoAssist is an infrared sensor linked to a headband. An alternative option is the EndoAssist Telecontrol module which allows joystick control. Other methods of control are also possible and can be connected to EndoAssist via a serial RS232 port using a protocol built by Armstrong.

Power Supply:

EndoAssist requires a single phase electrical supply voltage 110-250V, 50-60Hz. The power consumption is 400W.

Electrical Safety:

EndoAssist is tested and manufactured to IEC601-1. The Electrical Insulation is Class 1 type BF.

Dimensions:

Trolley dimensions 520mm (W) x 812mm (D) x 1470mm (H) EndoAssist arm dimension from base 878mm

Butten operated robots

The butten operated robot is simply a assistant & reduces human preaance.

The robots are butten operated & doctor presses the buttens located on the robot machine & robot simply assist

On the robot no. of instruments actually located & according to buttens pressed that instrument he gives to the doctor

The butten operated robots are not used in telesurgury.

This robots are used in laproscopic nissan fundoplication & only in U.S.A.

ADVANTAGES

 No need of assistant

Fast work
In long surgury vary useful
No chance of giving false instrument
Cost is vary high

PATHFINDER SURGICAL ROBOTS

PathFinder™ is an image guided robot that provides a stable, accurate tool position platform for stereotactic neurosurgery. Using its unique automatic registrationprocess, PathFinder aligns tools with sub-millimetre accuracy for intracranial interventions.

PathFinder removes the need for a stereotactic frame and its associated calculations. It serves as a precision tool localiser that is safe, non intrusive, easy to set up and easy to use.

PathFinder can be fitted with a variety of tools from a simple guide cannula to a range of motorised drivers for standard neurosurgical instruments.

 

The PathFinder surgery planning workstation accepts standard dicom 3 images; the output format used by most CT and MR scanners. Alternatively it can be linked to an existing Image Guided Surgery planning system.

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ROBOTIC ANTIREFLUX SURGURY

In the laparoscopic procedure, the surgeon makes five small incisions in the abdomen. A laparoscope, a miniature telescope attached to a video camera, is inserted through one incision. This allows the surgeon to see the interior of the abdominal cavity. The surgical instruments are inserted through the other incisions. If the patient has a hiatal hernia, that is repaired first. The esophageal hiatus is tightened with a couple of stitches to prevent herniation of the fundoplication and then the surgeon performs the procedure. The fundoplication is performed in the same fashion as in open surgery.

Laparoscopic surgery allows for a faster recovery period, less postoperative pain, a shorter hospital stay, and a much smaller scar. Whether or not a patient is eligible for laparoscopy depends on several factors and is made on an individual basis. In some circumstances, open surgery is safer.

 Robots role in surgury

A small puncture to the two locations is done.one is from 12mm from the left abdomen & the other one is from 11 mm from liver. These punctures are done automatically. The doctor just sends a command DRILL A HOLE 6MM FROM ESOPHEGUS & the pathfinder robot drills the hole automatically. The pathfinders do exact tracing of tool also.

They are a voice controlled.the pathfinders are having seven axis of motion. They can rotate in any direction in any seven planes.

The seven axis of motion is called seven axis of freedom. There are various motions through the pathfinder rotate.

Nextly the robotic camera holder & the necessary instruments are send through the hole.

Endoassist is also  properly placed .the endoassist operates on eyeball tracting. As the doctor changes his vision the robot directly assist to that part

The button-operated robots are mainly used for the change of instruments.

The doctor presses the button on the robot machine & the robot simply replaces the tool.

With the help all robots the actual surgery is completed within two hours.where as the traditional laproscopic surgery takes about 4-5 hours.

In the surgery, the weakened LESis repaired. By means of inserting, one instrument called FUNDUS. That is why the name laproscopic Nissan fundoplication.

The fundus is inserted in the 12cm epigastric port to increase the LES pressure.

COST OF ROBOTIC ANTIREFLUX SURGURY
The cost is about 20000$. This surgery is done only in u.s.a. However, as you can see 20000$ is not affordable to everyone.that is way it is not commonly used.

CONCLUSION

Computer assisted antireflux surgery is a new technology available to surgeon that improve upon some short coming laproscopy.

Computer assisted surgery is safe & effective but currently offers little advantage over standard laproscopy.

The technology continues to improve & may have more of role in antireflux surgery.

Future scope

computer assisted Antireflux surgery now a days is used only in u.s.a.

The basic reason behind this is a cost .the endo assist cost is about 10000$ for one robot. Now this is not affordable to the patient.

However, no doubts that the future will change vary quickly & robotic antireflux surgery will be used almost any part of the world the only thing is that a matter is cost of robot.

The another thing that is going to change is the size of a robot.now a days the robots are having a vary large size. In the future, if you found doctors are working on microsize robot there will be no surprise.

refrances

A review of robotics in surgery by devies b

9the part of pathfinder & minimal invasive surgery is taken from that book)

laproscopy, endoscopy, precausous techniques (a magazine from Johnson & Johnson)

The most parts are taken from that book. Especially about voice controlled robotic camera holder

Hinder r.a. libbey

Antireflux surgery indications, preoperative evaluation & outcome

The study of gerd disease is taken from that book

The web site

www.computermotion.com

robotic antireflux surgery photogarhs are take

www.armstrong-healthcare.com

the information about endoassist is taken

www.robodoc.com

this website having various rOBObotics which helps in pricise location of tools

www.ncbi.nih.gov.

this is a government website. Vary useful in understanding current technology.

www.pubmed.com

www.mediline.com

this site are specially for surgical robotics & provides the information in brief.

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