SpaceMed Newsletter
Spring 2009
Volume 2, Number 2
The Future of Surgery is Here Now
OVERVIEW
The past two decades have witnessed a revolutionary transition in surgical technique and technology. Traditionally, surgeries had been performed in the open manner, in which large incisions were required for the surgeon to plainly observe and manipulate the surgical field. These incisions inevitably created significant patient trauma ― substantial pain and suffering, extended recovery time, prolonged pain management, and elevated costs.
Approximately 20 years ago, surgeons began practicing a new approach to performing surgery, an approach that came to be known as minimally invasive surgery, or MIS. During this era, tiny cameras in instruments called endoscopes or laparoscopes were introduced. These visual and surgical aids could be inserted in the patient's body through small ports. Although revolutionary in its positive effect on patient trauma and recovery times, MIS encountered significant technical drawbacks. The surgeon operated using a standard 2-D monitor instead of looking at his or her hands. The resulting image flattened the natural depth of field, and the fixed-wrist instruments limited his/her dexterity. The lack of 3-D visualization of the operative field, the poor ergonomic design and reduced control were major roadblocks to further progress. As a result, this type of MIS turned out to be suitable for a narrow range of surgical procedures.
In the late 1990s, another evolutionary stage in the development of surgical technique was achieved with the application of robotics to surgical technology. At the forefront of this new era, Intuitive Surgical introduced the da Vinci Surgical System® which is now used at medical centers throughout the U.S. to perform complex surgical procedures including general, cardiac, thoracic, gynecologic, and urologic procedures. It is the only commercially available technology that can provide the surgeon with the intuitive control, range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through tiny incisions typical of minimally invasive surgery.
HOW IT WORKS
With the Da Vinci Surgical System, the surgeon performs surgery with a surgical arm unit that positions and maneuvers detachable surgical EndoWrist instruments. These pencil-sized instruments (with tiny, computer-enhanced mechanical wrists) are designed to provide the dexterity of the surgeon's forearm and wrist at the operative site through entry ports less than one centimeter. This enables the surgeon to enter the body through keyhole incisions to perform surgery. One port allows access for the endoscope, a tiny camera that is attached to a fiber-optic cable. The other ports provide access for surgical tools. Instead of the surgeon holding the tools, the robots wrists do ― bending back and forth, side to side, and rotating in a full circle ― thereby providing greater range of motion than humanly possible. The wrists of the robot mimic the motions made by the surgeon, who sits at a console remote from the patient. The surgeon peers through an eyepiece that provides high-definition, full-color, magnified, 3-D images of the surgical site provided by the endoscope. The physician moves his or her hands, which are attached to manipulation controls and the robot follows along. An important element of this technology is that the built in computer enhances the surgeon's hand movement and renders it more precise with less tremors ― an important element in delicate surgery.
KEY OPERATING ROOM COMPONENTS
The da Vinci Surgical System consists of an ergonomically designed surgeon’s console, a patient-side cart with four interactive robotic arms, the high-performance InSite Vision System and proprietary EndoWrist instruments. The four components can be accommodated in a standard operating room that is designed for major surgical procedures (e.g., 600 net square feet).
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Surgeon Console. The surgeon operates while seated at a console viewing a 3-D image of the surgical field. The surgeon's fingers grasp the master controls below the display, with hands and wrists naturally positioned relative to his or her eyes. The system seamlessly translates the surgeon's hand, wrist and finger movements into precise, real-time movements of surgical instruments inside the patient.
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Patient Side Cart. The patient side cart provides either three or four robotic arms — two or three instrument arms and one endoscope arm — that execute the surgeon's commands. Supporting surgical team members assist in installing the proper instruments, prepare the ports in the patient’ body and supervise the laparoscopic arms and tools being utilized.
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EndoWrist Instruments. A full range of proprietary EndoWrist instruments is available to support the surgeon while operating. The instruments are designed with seven degrees of motion that mimic the dexterity of the human hand and wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation. Quick-release levers speed instrument changes during surgical procedures.
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Vision System. The Vision System, with high-resolution 3-D endoscope and image processing equipment, provides the true-to-life 3-D images of the operative field. Operating images are enhanced, refined and optimized using image synchronizers, high-intensity illuminators and camera control units.
TELEMEDICINE WILL BE NEXT
The da Vinci Surgical System ― with patient on the operating room table and the surgeon console physically separated ― can theoretically be used to operate over long distances. Although this capability is not currently the primary focus of Intuit Surgical it will certainly be the next evolution of this exciting technology.
Additional information can be found at www.davincisurgery.com.
Tech 1309.6.1