We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
2. We live in an age of
a new unpreceded
wonders
The wonders of the world are not
seven any more
The inanimate talk to us
We are flying in the air
More than 65,000-Ton can float
over the water in an iron vessel
The Robotic Doctor is already a
reality
6. When we talk about robots doing
the tasks of humans, we often talk
about the future.
But robotic surgery is already a
reality.
The surgeon views the patient via
a terminal and manipulates
robotic surgical instruments via a
control panel.
7. The surgeon views the patient via a terminal and manipulates
robotic surgical instruments via a control panel.
8. The difference between Endoscopic
surgery (as laparoscopic surgery)
and Robotic surgery is that
The instruments are controlled by
the Robotic system in stead of the
direct hold by the human (surgeon)
hands
9. Robotics does not replace
Human intelligence
Skill
Experience
RobotSurgeon
12. Pedicle screw instrumentation :
1- Free hand (FH) conventional pedicle screw
instrumentation
15.3% error rate for 544 screws from T5 to S1
7 patients necessitated reoperation
4 patients sustained long-term neurological sequelae
2- Computer assisted navigation (CAN) and surgical
robotics
5.4% error rate for the 294 screws
No patients required reoperation in the CAN group
None experienced postoperative neurological deficits.
Navigation and Robotics in Spinal Surgery: Where Are We Now?
Neurosurgery 80:S86–S99, 2017
VOLUME 80 | NUMBER 3 | MARCH 2017 Supplement www.
Samuel C. Overley, MD∗, Samuel K. Cho, MD∗, Ankit I. Mehta, MD‡, Paul M. Arnold, MD§
∗The Mount Sinai Hospital, Icahn School of Medicine, New York, New York; ‡University of Illinois, Hospital
and Health Sciences Center, Chicago, Illinois; §The University of Kansas Hospital, Kansas City, Kansas
13. These systems have the potential to
improve the safety and effectiveness
of surgeries.
Three major advances aided by
surgical robots:
Remote surgery,
Minimally invasive surgery, and
Unmanned surgery.
32. The surgeon instead of directly moving the instruments, He uses one of two
methods to control the instruments;
1- Direct telemanipulator
. A remote manipulator that allows the surgeon to perform the normal movements
associated with the surgery (on simulator) whilst the robotic arms carry out those
movements using end-effectors and manipulators to perform the actual surgery on the
patient.
2- Computer control systems
The surgeon uses a computer to control the robotic arms and its end-effectors, (these
systems can also still use telemanipulators for their input).
One advantage of using the computerized method is that the surgeon does not
have to be present, but can be anywhere in the world, leading to the possibility
for remote surgery.
Robotically-assisted minimally-invasive surgery
and Remote surgery (Telesurgery)
33.
34. Robotic surgery
Robotic surgery is a type of
minimally invasive surgery.
“Minimally invasive” instead
of operating on patients
through large incisions,
we use miniaturized surgical
instruments that fit through a
series of quarter-inch
incisions.
35. Robotic surgery
The main object of such smart
instruments is to reduce or
eliminate the tissue trauma
traditionally associated with
open surgery without
requiring more than a few
minutes' training on the part
of surgeons.
36. Why Robotic Surgery
A robot is not just a machine
It is an information system with
arms
The robots are actually more
accurate than Human beings
(Robotic Pedicular screws error 5% vs. 11% human experts vs.
40% human learning curve)
37. Total Integration of Surgical Care
Courtesy of Joel Jensen,
SRI International, Menlo Park, CA
Minimally Invasive
& Open Surgery
Pre-operative planning
Surgical Rehearsal
Intra-operative navigation
Remote Surgery
Simulation & Training
Pre-operative Warm-up
38. APPLICATIONS
• Cardiac surgery
• Gastrointestinal
surgery
• Gynecology
• Neurosurgery
• Orthopedics
• Pediatrics
• Radio surgery
• Urology
Different procedures, including:
Coronary artery bypass
Cutting away cancer tissue from sensitive
parts of the body such as blood vessels,
nerves, or important body organs
Gallbladder removal
Hip replacement
Hysterectomy
Kidney removal
Kidney transplant
Mitral valve repair
Pyeloplasty (surgery to correct ureteropelvic
junction obstruction)
Pyloroplasty
Radical prostatectomy
Radical cystectomy
Tubal ligation
39. Da Vinci Surgical System
ZEUS Robotic Surgical
System
AESOP Robotic System
There are three surgical robots that have
been recently developed
40. Surgical Robot - “Da vinci”
4 arms
• Da vinci’s miniaturized instruments are mounted on
three separate robotic arms, allowing the surgeon
maximum range of motion and precision. The da Vinci’s
fourth arm contains a magnified high-definition 3-D
camera that guides the surgeon during the procedure.
Da vinci is the one of the most
advanced Surgical bot in the
world.
43. Da Vinci robot consists
• A surgical console
• Patient- side cart
• Instruments and imaging processing equipment
44. The surgeon views the patient via a terminal and manipulates robotic surgical
instruments via a control panel.
45. Da Vinci Components
Surgeon’s Console
• Optimal hand-eye
alignment
• Immersive 3D stereo
viewer
• Comfortable seat
posture – ergonomic
• Motion scaling &
tremor reduction
Master controller controls the motion of the end effector wrist
46. Da vinci Cart
•Endowrist instruments
•3-4 robotic arms
•Interchangeable end
effectors
Da Vinci Components
47. Da Vinci System
• Multiple robotic arms
– For camera control and end
effector control
Stereo endoscope
Tools at arms of bot
48. The Endoscope
• Fiber optic instrument
• Inserted through a small
incision
• Has a very tiny video camera
• Shows the surgeon a 3-
dimensional, magnified view
• Projects to a television screen
49. Speciality of Da vinci
The surgeon controls these instruments and the camera from
a console located in the operating room. Placing his fingers
into the master controls, he is able to operate all four arms of
the da Vinci simultaneously while looking through a
stereoscopic high-definition monitor that literally places him
inside the patient, giving him a better, more detailed 3-D view
of the operating site than the human eye can provide
50.
51. Robotic and Remote surgery (Telesurgery)
Robotic surgery is a type of rapidly
advancing minimally invasive
surgery.
A robot is not just a machine
It is an information system with
arms
The robots are actually more
accurate than Human beings
52. • Surgeons have enhanced view
• Easier to attach nerve endings
• Surgeons tire less easily
• Fewer doctors required in operating
rooms
• In turn, cheaper for hospitals.
• Smaller risk of infection
• Less anesthesia required
• Less loss of blood
Benefits of Robotic Surgery (Operative)
53. Benefits of Robotic Surgery (Post operative)
• Operations through small tiny
incisions less scarring
• Faster recovery time
• Reduce loss of healthy tissue
• Less pain, shorter hospital stay
• Reduced cost
• Patient returns to work sooner
• Greater surgical precision
• Less blood loss and transfusion.
54. • Time lag between surgeons commands and
action of robot could harm the patient
(fiber optic)
• Loss of power in an electrical failure
• Robotics does not replace human
intelligence, skill and experience
• Surgericals Robots are much
costlier - Da vinci's cost is 2.5 million euro.
Legal/Ethical issue in Robotic surgery
55. • The rate of discovery of new technology is
outpacing the ability of business, society,
and healthcare to integrate and apply
• Robotic surgery is but one example of such
technology that may reduce operative
morbidity, hospital stay, and recovery, while
potentially improving clinical outcomes
• But at what point do the benefits justify the
increased expense?
Legal/Ethical issue in Robotic surgery
56. Figure 1. Annual Numbers of Adverse Event Reports and Rates of Events per Procedure
The left Y-axis corresponds to the bars showing the absolute numbers of adverse events (based on the year that
reports were received by the FDA). The right Y-axis corresponds to the trend lines showing (in logarithmic scale)
the annual number of adverse events per 100,000 procedures (based on the year the events occurred). Numbers on
the bars indicate number of deaths reported per year. Error bars represent 95% confidence intervals for the
proportion estimates. Because of the small number of injury and death events reported for 2004 and 2005, a
combined rate was calculated for 2004–2006. Note that of all the events, 40 were reported as part of the articles or
the legal disputes received by the manufacturing company.
DISADVANTAG
ES
The Question
of
Safety & Cost
57. During the study period
1- 144 deaths (1.4% of the 10,624
reports)
2- 1,391 patient injuries (13.1%)
3- 8,061 device malfunctions
(75.9%) were reported
14 year period of 2000–2013
Adverse Events in Robotic Surgery:
A Retrospective Study of 14 Years of FDA Data
specialties, for which robots
are extensively used, such as
gynecology and urology, had
lower number of injuries,
deaths, and conversions per
procedure
than more complex surgeries,
such as cardiothoracic and
head and neck
58. Device and instrument malfunctions, such as
falling of burnt/broken pieces of instruments into the patient (14.7%),
electrical arcing of instruments (10.5%),
unintended operation of instruments (8.6%),
system errors (5%), and video/imaging problems (2.6%), constituted a major
part of the reports.
Device malfunctions impacted patients
in terms of injuries or procedure interruptions. In 1,104 (10.4%) of the events,
the procedure was interrupted to restart the system (3.1%), to convert the
procedure to non-robotic techniques (7.3%), or to reschedule it to a later time
(2.5%)
8,061 device malfunctions (75.9%) were reported
59. Figure 2. Cumulative rates of malfunctions per
procedure
The rates of malfunctions per procedure were obtained
for each week (see Figure 2 in Appendix for more
details).
Limitations
The results of our study come with
the caveats that inherent risks
exist in all surgical procedures
(more so in complex procedures)
and that the MAUDE database
suffers from underreporting and
inconsistencies.
Thus, the estimated number of
adverse events per procedure are
likely to be lower than the actual
numbers in robotic surgery.
Further, the lack of detailed
information in the reports makes
it difficult to determine the exact
causes and circumstances
underlying the events.
Therefore, the sensitivity of
adverse event trends to changes
in reporting mechanisms, surgical
team expertise, and inherent risks
of surgery could not be assessed
here.
61. ِّهِّب واُرِّكُذ اَم واُسَن اَّمَلَفَْوبَأ ْمِّْهيَلَع اَنْحَتَفٍءْيَش ُِّلك َابِّب واُح ِّرَف اَذِّإ ٰىَّتَحمُهاَنْذَخَأ واُتوُأ اَم
َونُسِّلْبُّم مُه اَذِّإَف ًةَتْغَب(44)
األنعام سورة
So when they forgot that by which they had been reminded,
We opened to them the doors of every [good] thing until, when
they rejoiced in that which they were given, We seized
them suddenly, and they were [then] in despair.
Reviewing the history of mankind's cumulative
experience starting with the ancient very
primitive trials and ending with the presence
of Robotic and Telesurgery
Clearly show that the major and rapid
advances in the whole mankind's life occur
only in the last few decades especially the last
10 years ?